U.S. Physicians' Training and Experience in Providing Trauma-Informed Care in Clinical Settings.

Trauma-informed care (TIC) is a comprehensive approach that focuses on the whole individual. It acknowledges the experiences and symptoms of trauma and their impact on health. TIC prioritizes physical and emotional safety through a relationship of trust that supports patient choice and empowerment. It provides a safe and respectful healing environment that considers specific needs while promoting a greater sense of well-being, patient engagement, and partnership in the treatment process. Given the prevalence of trauma, this descriptive cross-sectional study examined the attitudes and perspectives of U.S. physicians (N = 179; 67% males; 84% White; 43% aged 56-65) in providing trauma-informed care using an anonymous 29-item online survey administered by Reaction Data. Findings showed that 16% (n = 18) of physicians estimated that >50% of their patients have a history of trauma. Commonly perceived barriers to providing TIC were resource/time/administrative constraints, provider stress, limited awareness of the right provider to refer patients who experienced trauma, and inadequate TIC emphasis in medical education/training. Expanding physicians' knowledge base of trauma through training and organizational policy/support is crucial in enhancing their TIC competence, particularly in caring for patients with complex care needs whose social determinants increase their risk of exposure to adverse experiences that carry lasting physical and psychological effects.

Maternal executive function and stress and children's behavior problem treatment outcomes.

This prospective, observational study was designed to investigate the relationship of mothers' executive function capacities and parenting stress to early dropout, appointment attendance, and outcomes of in-clinic delivery of parent management training to address children's behavior problems. We hypothesized that mothers' executive functions (EFs) would be prospectively and positively associated with adherence to children's behavioral treatment appointments and reduction in children's behavior problems and that mothers' stress levels would be inversely related to these outcomes. Mothers (n = 288) completed the Behavior Rating Inventory of Executive Function for Adults (EF) and Parenting Stress Index at the beginning of treatment. Children were 2-12 years old. Regression models evaluated the extent to which deficits in maternal EF and clinical levels of parenting stress contributed to the three outcomes. The 11% of mothers with clinically significant deficits in executive functioning were significantly (3 times) more likely to drop out early compared to mothers in the normal range. Almost one third of mothers reported clinically significant parenting stress. Their children were half as likely to achieve a positive behavior outcome, although stress was not significantly associated with attendance. Remaining in treatment is fundamental to being able to learn and practice the parenting skills necessary to manage young children's age-inappropriate behavior in positive ways. Clinical consideration of mothers' EF challenges may help prevent early treatment attrition and clinical management of parenting stress may further help improve children's treatment outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Positive adult experiences as turning points for better adult mental health after childhood adversity.

Background: The purpose of this study was to examine whether positive adult experiences (PAEs) were associated with lower odds for anxiety and depression even in the presence of high adverse childhood experiences (ACEs) or low positive childhood experiences (PCEs). Methods: The sample was comprised of 435 adults (48% female), ages 18-56 years and who were living in the United States. Participants completed a survey about their childhood experiences, PAEs, and mental health. A series of multiple logistic regression models were estimated in Stata 17 to examine the aims. Results: Positive childhood experiences were associated with higher PAE scores, but ACEs did not significantly correlate with PAEs. Positive adult experiences were associated with lower odds of moderate-to-severe anxiety and depression, especially among those who had experienced high ACEs or low PCEs. Younger adults were more likely to experience a positive benefit from PAEs compared to adults 35 years and older. Conclusion: Even when ACEs were high or PCEs were low, adults with high PAEs had lower odds for moderate-to-severe anxiety and/depression. Positive adult experiences may be an opportunity to turn the tide for individuals who experienced childhood adversity and/or low levels of support or connection.

Understanding the relationship between domestic and intimate partner violence, adverse childhood experiences, and chronic opioid use disorder: The patient perspective.

INTRODUCTION: Opioid dependence and misuse are a plague of epidemic proportions in our communities and globally. Prior trauma in childhood may contribute to opioid dependence, while one consequence of opioid misuse is increased risk for involvement as both perpetrators and victims in domestic and intimate partner violence (DV and IPV). The aims of this study were to understand the proportion of patients who identified as having an opioid use disorder (OUD), if OUD was associated with higher rates of DV and IPV as both perpetrators and victims, and whether adverse childhood experiences (ACEs) as well as demographic factors related to instability in their social life were higher among those with OUD compared to those without. METHODS: The sample consisted of 124 patients who were identified as having an OUD in their medical records based on ICD-10 codes. Each participant completed an anonymous survey about basic demographics, their alcohol, drug, and opioid intake, and their history of domestic and IPV. Descriptive statistics, univariate, and multivariate regression analyses were conducted in STATA 17.1 software. RESULTS: A sample of patients with an OUD diagnosis in their medical record found that 64 percent of patients acknowledged having a history of opioid addiction. Patients acknowledging OUD were more likely to not be married (divorced or single) (p < 0.01), younger than 50 years of age (p < 0.01), non-White (p < 0.01), and had higher average ACEs scores (p < 0.0X). Patients who reported OUD were also more likely to be both victims and perpetrators of DV/IPV compared to patients who denied OUD. DISCUSSION: OUD needs to be treated holistically to ensure that the adverse consequences of DV and IPV do not become a silent disease perpetuated on this population, their families, and society.

A Modified Menstrual Attitudes Scale: Heteronormative Attitudes, Sexism, and Attitudes Toward Menstruation in Male and Female Adults.

Social shame and stigma surround menstruation, which may compromise women's health and rights in various contexts. Men's attitudes are particularly important because men often hold positions of power that influence women's experience. This study examined factors associated with menstrual attitudes, including heteronormative attitudes, sexism, and family influences. A cross-sectional Qualtrics panel survey (n = 802; aged 18-44; 50.8% female) was performed. We tested a revised menstrual attitudes scale based on items drawn from previously validated measures. Data were analyzed using a structural equation modeling framework. Factor analysis identified and confirmed a 5-factor model for menstrual attitudes. Men endorsed more negative attitudes toward menstruation than women; however, this difference was largely explained by factors other than gender in the structural equation model. After controlling for family and demographic characteristics, attitudes toward openness and secrecy surrounding menstruation were most strongly associated with gender role expectations and hostile sexism. Benevolent sexism was associated with finding menstruation debilitating, denying menstrual symptoms, and endorsing avoidance of activities during menstruation. Heteronormative and sexist attitudes were associated with more negative menstrual attitudes, while increased menstrual knowledge was associated with more positive menstrual attitudes. The difference in menstrual attitudes between males and females was explained largely by heteronormative attitudes and sexism. This suggests that attitudes toward menstruation are closely linked to social ideals about men and women.

Influence of Social Media Uses and Gratifications on Family Health among U.S. Parents: A Cross-Sectional Study.

Some research suggests that parents on social media have access to greater social support and health information. However, evidence also connects parental social media use to negative outcomes including increased parental stress, depression, and distraction. Using the uses and gratification theory, this study goes beyond measures of parents' individual mental health and explores social media use and its association with family well-being. Family health outcomes were predicted to vary with parents' use and gratifications of social media, with parents who use social media primarily for information and connection scoring higher on family health and parents who used social media for entertainment scoring worse on family health. The sample included 482 heterosexual married or cohabiting partners recruited through a Qualtrics panel. All participants were parents of children ages of 3-13, with mothers and fathers each completing the survey. Findings indicated that fathers' use of social media for entertainment and connecting with family and friends was associated with better family well-being and health resources (p < 0.01). However, mothers' use of social media did not have a statistically meaningful relationship with family health variables. There was no evidence that parental social media use was associated with negative family health outcomes. Longitudinal data is needed to determine the temporal relationship between social media use and family health. Public health professionals interested in improving family health may consider how to better reach fathers on social media to increase health resources.

The effects of COVID-19 stressors and family life on anxiety and depression one-year into the COVID-19 pandemic.

The purpose of this study was to examine the effects of Coronavirus (COVID-19)-related stressors and family health on adult anxiety and depressive symptoms 1 year into the pandemic. The sample consisted of 442 adults living in the United States who were recruited via Amazon Mechanical Turk. Data were analyzed using multiple logistic regression. Results indicated that compared to a sample 1 month into the pandemic, participants in the current sample reported worse family health and increases in both positive and negative perceptions of the pandemic on family life and routines. COVID-19 stressors and perceived negative effects of the pandemic on family life increased the odds for moderate-to-severe depression and anxiety while having more family health resources decreased the odds for depression and anxiety symptoms. Participants reported lower odds for worse depression and anxiety since the beginning of the pandemic when they reported more positive family meaning due to the pandemic. The results suggest a need to consider the impact of family life on mental health in pandemics and other disasters.

Examining relationships between positive and adverse childhood experiences with physical and mental health indicators in a low-income adult sample.

BACKGROUND: Emerging research on positive and adverse childhood experiences (PCEs and ACEs) indicates that both may be important to adult health, but little is understood about the pathways through which childhood experiences affect adult health. OBJECTIVE: The aims of this study were to 1) examine how shame may mediate the relationship between childhood experiences and health, and 2) whether PCEs moderated the relationship between ACEs, shame, and adult health. PARTICIPANTS AND SETTING: The sample consisted of 206 low-income adults ages 18-55 who were living in a community in the Intermountain West. METHODS: Participants were recruited at a local food bank and community center where various services for low-income residents were offered. Each participant completed a 15-20-minute survey. The data were analyzed using a structural equation modeling (SEM) framework. RESULTS: Shame mediated the relationship between both ACEs and PCEs with depression in the expected direction. Among participants with low-to-moderate PCEs, ACEs were directly associated with shame and tobacco usage. Among participants with high PCEs, ACEs were not associated with shame, depression, nor stress, and the relationship between ACEs and tobacco usage was attenuated. CONCLUSION: Shame may be an important pathway through which childhood experiences affect adult health. Additionally, promoting high levels of PCEs may mitigate the negative effects of early adversity on adult health.

Intergenerational Transmission of Trauma: The Mediating Effects of Family Health.

Family health is important to the well-being of individual family members and the collective family unit, and as such, may serve as a mediator for the intergenerational transmission of trauma (ITT). This study aimed to understand the intergenerational impact of parent's adverse and positive childhood experiences (ACEs and PCEs) on their children's adverse family experiences (AFEs) and how family health mediated those relationships. The sample consisted of 482 heterosexual married or cohabiting couples (dyads) in the United States who had a child between the ages of 3 and 13 years old. Each member of the dyad completed a survey, and data were analyzed using structural equation modeling. Parental ACEs were associated with more AFEs. The fathers', but not the mothers', ACEs were associated with worse family health. Parental PCEs were associated with better family health, and family health was associated with lower AFE scores. Indirect effects indicated that parental PCEs decreased AFEs through their impact on family health. Family health also mediated the relationship between the father's ACEs and the child's AFEs. Interventions designed to support family health may help decrease child AFEs.

The Association of COVID-19 Stressors and Family Health on Overeating before and during the COVID-19 Pandemic.

Prior studies have examined how stress and the family environment affect overeating, but less is known about how COVID-19 stressors and family health may affect overeating during the COVID-19 pandemic. The research questions included: (1) Did COVID-19-related stressors increase the risk for overeating among adults in the United States? (2) Did family health protect against overeating during a pandemic? The sample included 443 participants aged 18 years and older living in the United States who were recruited via Amazon Mechanical Turk. Stata version 16 was used to analyze the data using multiple linear regression. The results indicate that one year into the pandemic, COVID-19 stressors were associated with increased overeating, even after adjusting for overeating before the pandemic. More family health resources were associated with less overeating. These results indicate that although COVID-19 stressors were associated with overeating, greater family health resources helped prevent overeating. Interventions and policies that aim to increase health resources for families may be particularly beneficial at preventing overeating and obesity in the face of long- and short-term stress.

Validation of the family health scale among heterosexual couples: a dyadic analysis.

BACKGROUND: The Family Health Scale (FHS) is a recently validated comprehensive measure of family health for use in survey research with the potential to also be used as a clinical measure. However, previous research has only validated the FHS among one member of the family rather than multiple family members. The objective of the study was to examine the psychometric properties of the FHS long- and short-form among married and cohabitating partners (dyads). METHOD: The sample for this study was comprised of 482 married or cohabitating heterosexual couples (dyads) who were parents of a child between the ages of 3-13, heterosexual, and living in the United States. Each member of the dyad completed a survey about his or her perception of family health, personal health, childhood experiences, and demographic characteristics. Confirmatory factor analyses (CFA) were conducted to examine the factor structure. Unidimensional, correlational, and second-order factor structures were examined using responses from both partners. The relationships between family health with individual health and demographic covariates were also examined. RESULTS: Women and men reported their family health similarly. The unidimensional factor structure had the best fit for the FHS short-form while either the unidimensional model or the second-order model would be appropriate for the FHS long-form. Household income, individual member mental health, and childhood experiences were associated with family health in the expected direction. CONCLUSION: The results demonstrate that the FHS is a valid and reliable family measure when examining family health among dyads including married and cohabitating heterosexual couples who have children.

Concurrent Childhood Experiences Impact Underage Substance Use.

Adverse and advantageous childhood experiences (ACEs and counter-ACEs) during adolescence are understudied. This study examined how childhood experiences affect youth tobacco/alcohol use. Participants included 489 U.S. adolescents (baseline 10-13 years; 51% female) from the first five waves of the Flourishing Families Project. Results of the cross-lagged model showed ACEs were predictive of early tobacco use only. Counter-ACEs in wave two and wave three predicted, respectively, decreased tobacco and decreased alcohol use in the following wave. Counter-ACEs were also correlated with reduced alcohol and tobacco use in later waves. These findings indicate the salience of counter-ACEs over ACEs in persistent and late adolescent substance use, though ACEs may be important to consider to prevent very early initiation of tobacco.

Family well-being and individual mental health in the early stages of COVID-19.

BACKGROUND: The objective of the study was to examine the association of COVID-19 with family well-being and adult mental health 1 month into the COVID-19 pandemic in the United States. Prior pandemics have had long-term effects on mental health. COVID-19 and its related stressors, such as loss of work and social distancing requirements, may have a profound impact on short-term and long-term mental health. Family stress theory indicates that subjective family meaning making and family resources affect how stressors lead to outcomes. METHOD: Participants, adults ages 18 years and older (N = 416), completed a cross-sectional online survey measuring depressive and anxiety symptoms, family health, subjective family meaning making, and loss of work resulting from COVID-19. Data were analyzed using a structural equation modeling framework. RESULTS: Results indicated that subjective negative family meaning and effects were associated with more depression and anxiety. Higher family health resources were associated with less depression and anxiety. Family health resources mediated the relationships between COVID-19 loss of work with depression and anxiety. CONCLUSION: COVID-19 associated stressors 1 month into the pandemic had modest effects on family meaning making and family health resources. Individuals from families whose health resources were negatively impacted by COVID-19 reported more anxiety and depressive symptoms. Health care and public health systems should consider family health resources to help reduce the negative effects of COVID-19 on mental health. Longitudinal research is needed to examine the accumulation of stressors over time and the directionality of relationships. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The effects of adverse and advantageous childhood experiences on adult health in a low-income sample.

BACKGROUND: Previous studies have indicated the advantageous childhood experiences (counter-ACEs) may improve health in adulthood regardless of adverse childhood experiences (ACEs) scores. However, these studies have primarily been conducted in low-risk communities, and little is known whether the results are similar in low-income settings. OBJECTIVE: The purpose of this study was to examine the effects of ACEs and counter-ACEs on mental and physical health in a low-income sample. A secondary objective was to assess the effects of repeated and prolonged exposure to ACEs on later health. PARTICIPANTS AND SETTING: The sample included 206 low-income adults living in the western United States who completed a survey about their childhood experiences and adult health. METHODS: A series of logistic regression analyses were performed to examine the effects of ACEs and counter-ACEs on adult health. RESULTS: Irrespective of ACEs, counter-ACEs were associated with lower odds of having two or more emotional and cognitive health problems and lower odds of suicidality in the past 12 months. When accounting for counter-ACEs, ACEs were associated with higher odds of having ever smoked and suicidality in the past 12 months, though these odds were attenuated compared to the unadjusted models. In the presence of repeated or prolonged ACEs exposure, counter-ACEs were associated with lower odds of having ever smoked and emotional and cognitive health problems. CONCLUSIONS: The findings suggest that helping children develop healthy relationships within their family, community, and school may lead to improved health in adulthood even in the presence of poverty and childhood adversity.

Self-Regulation and Shame as Mediators Between Childhood Experiences and Young Adult Health.

The purpose of this study was to determine whether self-regulation and shame mediated the relationship between adverse and positive childhood experiences (ACEs and PCEs) and young adult health. Data came from the Flourishing Families Project (FFP), a 10-year longitudinal study. Adolescent participants (N = 489; 51% female) completed an annual survey. Data were analyzed using structural equation modeling. Results indicated that PCEs negatively predicted shame and positively predicted self-regulation while ACEs negatively predicted self-regulation. Shame mediated the relationship between PCEs and depression. Self-regulation mediated the relationship between both ACEs and PCEs with anxiety; self-regulation also mediated the relationship between ACEs and substance abuse. Childhood experiences appear to affect the development and maintenance of self-regulation in adolescence. Self-regulation appears to be especially important in protecting against depression, anxiety, and substance abuse in young adulthood.

Effects of positive and negative childhood experiences on adult family health.

BACKGROUND: The objective of the study was to determine the association between adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with family health in adulthood. Prior research indicates that ACEs and PCEs affect individual physical and mental health in adulthood. However, little is known about how ACEs and PCEs affect family health. Families develop and function through patterns and routines which are often intergenerational. Therefore, a person's early experiences may influence their family's health in adulthood. METHOD: A survey was administered to 1030 adults through Qualtrics, with participants recruited using quota-sampling to reflect the demographic characteristics of U.S. adults. Participants completed a survey about their childhood experiences, four domains of family health (family social and emotional health processes, family healthy lifestyle, family health resources, and family external social supports), and demographic characteristics. Data were analyzed using structural equation modeling. RESULTS: After controlling for marriage, education, gender, race and age, ACEs were negatively associated with family social and emotional health processes and family health resources when accounting for PCEs; PCEs were positively associated with all four family health domains irrespective of ACEs. CONCLUSION: Childhood experiences affect family health in adulthood in the expected direction. Even in the presence of early adversity, positive experiences in childhood can provide a foundation for creating better family health in adulthood.

The Family Health Scale: Reliability and Validity of a Short- and Long-Form.

Families strongly influence the health of communities and individuals across the life course, but no validated measure of family health exists. The absence of such a measure has limited the examination of family health trends and the intersection of family health with individual and community health. The purpose of this study was to examine the reliability and validity of the Family Health Scale (FHS), creating a multi-factor long-form and a uniform short-form. The primary sample included 1,050 adults recruited from a national quota sample Qualtrics panel. Mplus version 7 was used to analyze the data using a structural equation modeling framework. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) confirmed a 32-item, 4-factor long-form scale. The four factors included (1) family social and emotional health processes; (2) family healthy lifestyle; (3) family health resources; and (4) family external social supports. A 10-item short-form of the FHS was also validated in the initial sample and a second sample of 401 adults. Both the long-form and short-form FHS correlated in the expected direction with validated measures of family functioning and healthy lifestyle. A preliminary assessment of clinical cutoffs in the short-form were correlated with depression risk. The FHS offers the potential to assess family health trends and to develop accessible, de-identified databases on the well-being of families. Important next steps include validating the scale among multiple family members and collecting longitudinal data.

Supporting and Engaging Families: An Examination of Publicly-Funded Health Promotion Programs in the Intermountain West, USA.

Public health programming efforts have traditionally focused on either an individualistic or population approach, neglecting the family as a setting for or partner in health promotion efforts. Due to the multi-faceted influence of families on individual health, family-focused, and family-friendly public health interventions are important to making lasting changes for individual and community health. The purpose of this study was to examine the degree to which health promotion programs in a state in the US Intermountain West involve and support families across four family impact principles: family engagement, family stability, family responsibility, and family diversity. A survey was completed by 67 health promotion administrators and practitioners from 12 out of 13 county health departments with additional responses from public health practitioners at the State Health Department. The results of the survey indicated that health promotion efforts were best at supporting family responsibility and a diverse group of families but were weaker in family engagement and family stability. Applying a more family-centered and family-focused approach to health promotion efforts can be achieved by employing interdisciplinary efforts and by taking advantage of tools like the Public Health Family Impact Checklist to intentionally engage and support families in programs and interventions.

Families as a Cornerstone in 21st Century Public Health: Recommendations for Research, Education, Policy, and Practice.

Families are vastly overlooked in US initiatives to promote population health and health equity despite being the most proximal context for health across the life course. We urge the public health sector to take the lead in recognizing families as essential for promoting 21st century population health. We highlight ways families influence health by providing context, care, continuity, and connections. The dual private and public aspect of families has contributed to how they have been overlooked in the public health sector. We provide recommendations for better integrating families into population health initiatives through national health goals, research, education, policy, and practice.

The influence of adverse and advantageous childhood experiences during adolescence on young adult health.

BACKGROUND: Research indicates that adverse childhood experiences (ACEs) can lead to poorer adult health, but less is known how advantageous childhood experiences (counter-ACEs) may neutralize the negative effects of ACEs, particularly in young adulthood. PURPOSE: We examined the independent contributions of Adverse Childhood Experiences (ACEs) and Advantageous Childhood Experiences (counter-ACEs) that occur during adolescence on five young adult health indicators: depression, anxiety, risky sexual behaviors, substance abuse, and positive body image. PARTICIPANTS AND SETTING: The sample included 489 adolescents from a large northwestern city in the United States who were 10-13 years at baseline (51 % female). METHODS: Flourishing Families Project survey data were used for this secondary analysis using structural equation modeling. Adolescents and their parents completed an annual survey. ACEs and counter-ACEs were measured over the first five years of the study. The five health indicators were measured in wave 10 when participants were 20-23 years old. RESULTS: Participants had on average 2.7 ACEs and 8.2 counter-ACEs. When both ACEs and counter-ACEs were included in the model, ACEs were not predictive of any of the health indicators and counter-ACEs were predictive of less risky sex (-.12, p < .05), substance abuse (-.12, p < .05), depression (-.11, p < .05), and a more positive body image (.15, p < .01). Higher ratios of counter-ACEs to ACEs had a particularly strong effect on improved young adult health. CONCLUSIONS: Counter-ACEs that occur in adolescence may diminish the negative effects of ACEs on young adult health and independently contribute to better health.