Is fair representation good for children? effects of electoral partisan bias in state legislatures on policies affecting children's health and well-being.

Increasing evidence suggests that state policies impact constituents' health, but political determinants of health and health inequities remain understudied. Using state and year fixed-effects models, we determined the extent to which changes in electoral partisan bias in lower chambers of U.S. state legislatures (i.e., discrepancy between statewide vote share and seat share) were followed by changes in five state policies affecting children and families (1980-2019) and a composite of safety net programs (1999-2018). We examined effects on each policy and whether the effect was modified when bias was accompanied by unified party control. Next, we determined whether the effect differed depending on which party it favored. Less bias resulted only in higher AFDC/TANF benefits. Both pro-Democratic and pro-Republican bias was followed by decreased AFDC/TANF benefits and increased Medicaid benefits. AFDC/TANF recipients, unemployment benefits, minimum wage, and pre-K-12 education spending increased following pro-Democratic bias and decreased following pro-Republican bias. Estimated effects on the composite measure of safety net policies were all close to null. Some effects were modulated by unified party control. Results demonstrate that increasing fairness in elections is not a panacea by itself for increasing generosity of programs affecting children's well-being. Indeed, bias can be somewhat beneficial for the expansiveness of some policies. Furthermore, with the exception of unemployment benefits and AFDC/TANF recipients, Democrats have not been using the additional power that comes with electoral bias to spend more on major programs that benefit children. Finally, after decades in which electoral bias was in Democrats' favor, bias has started to shift toward Republicans in the last decade. This trend forecasts more cuts in almost all the policies in this study, especially education and AFDC/TANF recipients. There is a need for more research and advocacy emphasis on the political determinants of social determinants of health, especially at the state level.

The role of adverse childhood experiences (ACEs) in predicting academic problems among college students.

BACKGROUND AND OBJECTIVE: The complex associations between adverse childhood experiences (ACEs) and academic performance among college students are not well understood. The following aims were examined in this longitudinal study: the direct association of ACEs on academic problems after 4 years without (1) and with accounting for other academic risk factors (2a), the possible mechanisms linking ACEs and academic problems (2b). PARTICIPANTS AND SETTING: First-semester freshmen (N = 268; 71.3% female; Mage = 18.30; 76.9% White, 14.6% Asian, 3.7% Black, 2.6% multiracial, 1.1% Native American, and 1.1% other) were recruited from a Midwestern U.S. university. METHODS: Participants reported their ACEs, intrinsic motivation, psychological distress, and financial status as first-semester freshmen. Administrative records (i.e., SAT/ACT scores, GPA, courses taken not counted toward degree progress, and graduation) were collected prospectively over 4 years. Structural equation modeling was used to test the research aims. Post-hoc analyses without SAT/ACT scores were conducted. RESULTS: ACEs were associated with academic problems assessed 4 years later, when studied in isolation (ß = 0.36, p < .001) but not after adjusting for other risk factors (ß = 0.08, p = .278). Psychological distress and SAT/ACT scores during the first semester predicted academic problems 4 years later (ß = 0.33 and - 0.38, p < .001). There was an indirect effect of ACEs on academic problems through psychological distress (ß = 0.13, p < .001). CONCLUSIONS: There is a need to expand mental health services and address barriers to utilization on college campuses.

Characteristics of Disclosing Childhood Victimization and Risk of Revictimization in Young Adulthood.

Experiencing victimization in childhood increases risk of adulthood revictimization, and it is important to understand what may contribute to such risk. One factor that may help to explain the increased risk of future victimization is disclosure. However, the literature is mixed as to whether disclosure of prior victimization is helpful for protecting against adverse outcomes, and much of the research on disclosure focuses solely on sexual victimization. The current study examines the relationship between various forms of childhood and adulthood victimization and whether disclosure moderates this relationship. In addition, this study investigates whether characteristics of disclosure are associated with revictimization risk. The sample included 275 undergraduates (M age = 19.52 years; 75.6% female, 77.5% non-Hispanic White or Caucasian). Participants reported on previous history of various forms of childhood and adulthood victimization. They also reported whether or not they had disclosed childhood victimization, and, if so, characteristics related to disclosure. Results revealed that number of childhood victimization experiences significantly predicted number of adulthood victimization experiences, and nearly every type of childhood victimization significantly increased risk of experiencing each type of adulthood victimization. Disclosure did not moderate the relationship between childhood and adulthood victimization. Participants who disclosed were more likely to disclose crime and peer/sibling victimization and disclose to parents or friends. Positive reactions to disclosure were more common than negative reactions; however, 75% of disclosers received at least one negative reaction. Finally, revictimized individuals received more overall negative reactions than nonrevictimized individuals. They also received more reactions characterized by the person they disclosed to trying to take control of their decisions or treating them differently. Results highlight the importance of examining relationships between various forms of victimization, considering how characteristics of disclosure relate to risk of revictimization, and the importance of educating potential support networks about appropriate responses to disclosure.

Adverse childhood experiences as a predictor of attendance at a health-promotion program.

This short-term longitudinal study examined whether adverse childhood experiences predicted attendance at a fitness program. We asked undergraduates participating in a group fitness program at a university to complete measures of mental health and adverse childhood experiences at the start of the semester. Attendance data were obtained from the recreational center at the end of the semester. Adverse childhood experiences predicted attendance after parental education and mental health were taken into account. To our knowledge, this is the first study to demonstrate that more adverse childhood experiences predict lower attendance at a health-promotion program. Findings suggest a need for adverse childhood experiences screening to prevent drop-out.

What do undergraduates with high levels of childhood adversity want to cope with stress?

OBJECTIVES: We aimed to determine how universities can tailor delivery of stress-related interventions and intervention-related messages for students with adverse childhood experiences (ACEs). METHOD: We assessed 762 undergraduates (76% female; average age = 20.3) on an expanded ACEs measure, stress, health, and past use of interventions and what types of interventions they would like to cope with stress. We also experimentally manipulated websites advertising mental health services to test whether certain message frames and types of intervention delivery would appeal differentially to students with more ACEs. RESULTS: ACEs were associated with worse health, more stress, and a greater likelihood of having used health-related interventions. Students with more ACEs were more willing to try the interventions on the websites, regardless of messaging and type of delivery. They also expressed a greater desire for face-to-face interactions centered on mental health. CONCLUSIONS: School-wide adoption of ACE-informed policies can change lifelong trajectories of students with ACEs.

Identifying adverse childhood experiences in pediatrics to prevent chronic health conditions.

Despite evidence that over 40% of youth in the United States have one or more adverse childhood experiences (ACEs), and that ACEs have cumulative, pernicious effects on lifelong health, few primary care clinicians routinely ask about ACEs. Lack of standardized and accurate clinical assessments for ACEs, combined with no point-of-care biomarkers of the "toxic stress" caused by ACEs, hampers prevention of the health consequences of ACEs. Thus, there is no consensus regarding how to identify, screen, and track ACEs, and whether early identification of toxic stress can prevent disease. In this review, we aim to clarify why, for whom, when, and how to identify ACEs in pediatric clinical care. To do so, we examine the evidence for such identification; describe the efficacy and accuracy of potential screening instruments; discuss current trends in, and potential barriers to, the identification of ACEs and the prevention of downstream effects; and recommend next steps for research, practice, and policy.

Effects of Adverse Childhood Experiences, Stress, and Social Support on the Health of College Students.

The goal of the study was to describe the nature of adverse childhood experiences (ACEs) reported by undergraduates and to examine the effect of ACEs, perceived stress, and perceived social support on their health. Although respondents (N = 321) had parents with relatively high levels of education and indicated generally high levels of social support, results nevertheless showed a relatively high level of mental health problems and rates of ACEs that were similar to those in the general population in the state. Those with higher levels of ACEs had greater levels of stress and lower levels of social support. ACEs, social support, and stress explained more than half the variance in mental health scores, with stress making the greatest contribution. Despite the fact that we used different measures and an independent sample, findings generally replicated a previous study. Results point to a need to increase awareness of the association between ACEs and health on college campuses, to examine the effects of ACEs in more detail, and to design ACE-informed programs for this population.

Adverse Childhood Experiences 101: A Primer for Clinicians.

We provide an overview of adverse childhood experiences (ACEs), including a brief history and critique of ACEs as a cumulative risk factor, how ACEs are measured, prevalence of ACEs in epidemiological studies, and associations between ACEs and negative outcomes. Next, we list current hypotheses about potential mechanisms of risk between ACEs and negative outcomes and highlight the importance of examining the social determinants of ACEs. We point out the paucity of research on protective factors in studies on ACEs. Finally, we briefly review potential interventions (broadly defined) to prevent and address the consequences of ACEs. We end with several suggestions on what clinicians can do to help patients with a history of ACEs.

Expanding the Original Definition of Adverse Childhood Experiences (ACEs).

We report two studies examining psychometric properties of an expanded measure of adverse childhood experiences (ACEs) that combined the original ACEs items with items from the Juvenile Victimization Questionnaire. In Study 1, we examined its factorial structure, internal consistency, and concurrent validity in undergraduates (N = 1479). In Study 2, we also examined replicability of frequencies of ACEs, test-retest reliability, and convergent and predictive validity. Results suggested a model with four inter-related factors: maltreatment, household dysfunction, community dysfunction, and peer dysfunction/property victimization. Internal consistency, test-retest reliability, concurrent and convergent validity were acceptable, and findings were replicated across samples. We suggest that this expanded measure is assessing early experiences of victimization and helplessness in the face of perceived intentional emotional and physical threats or actual harm by others, and that although they may not all be "traumatic," their cumulative impact is associated with poor mental health in young adults.

Adverse Childhood Experiences (ACEs) and Help-Seeking for Health-Related Interventions in Young Adults.

Although college students have increasingly higher health needs, they underutilize interventions. Given the association between adverse childhood experiences (ACEs) and poor health, the goal of this study was to examine the contribution of ACEs in undergraduates to seeking help for problems related to health. An online survey of students (N = 321, 76% female, 72% Caucasian) in a large public university showed that respondents with more ACEs were more likely to seek help, including both professional and informal types of help. However, they were less likely to find interventions helpful and more likely to quit prematurely. Common reasons for seeking help were anxiety, stress, and depression, with depression more prevalent in the high-ACEs group. More ACEs were associated with more unmet needs and greater likelihood of obtaining health information from school, another professional, or the media. More research is needed on how to harness the power of informal sources of help to improve the health of students with more ACEs, how to tailor health-related messages to fit their needs, and why students with more ACEs find interventions less helpful. Finally results suggest that ACEs shape not only lifelong health but also behaviors related to seeking help in young adults.

Parent- and Sibling-Directed Aggression in Children of Domestic Violence Victims.

This study examines the nature of parent- and sibling-directed aggression and involvement in other victimization among children living with female caregivers in a domestic violence shelter. Caregivers were interviewed about their children's (N = 79; Mage = 9.0 years) parent- and sibling-directed aggression. Physical and verbal aggression and emotional blackmail were the most common forms of aggression against caregivers. Physical and verbal aggression were most common against siblings. No age or gender differences in aggression characteristics were found. A large minority of children displayed both parent- and sibling-directed aggression. Children exhibiting parent- or sibling-directed aggression were significantly more likely to be victimized. Findings highlight the importance of incorporating parent- and sibling-directed aggression into definitions of family violence and recognizing children can be victims and victimizers.

Mental and Physical Health Profiles of Maltreated Youth.

To examine both mental and physical health profiles of children diagnosed as maltreated in the community, we studied diagnoses in the electronic health records (EHRs) of youth assigned maltreatment-related diagnoses (N = 406) and well-matched youth without a maltreatment-related diagnosis (N = 406) during a four-year period in a large healthcare system that covers eight hospitals and over 40 clinics. Data extracted automatically from the EHRs was supplemented by manual chart review. The odds of the maltreated group being assigned a code for mental illness was 2.69 times higher than the odds for the comparison group, with large differences in mood and anxiety disorders and suicidality. The odds of having an injury or poisoning diagnosis were 3.45 times higher in maltreated than in comparison youth. Maltreated youth were also less likely to have been immunized. Nevertheless, contrary to our hypothesis, maltreated youth had significantly lower rates of diagnoses across almost all major physical disease categories assessed and did not differ from comparison youth in terms of body mass index (BMI). Furthermore, maltreated youth were assigned fewer diagnoses than comparison youth whether they came in for at least one preventive visit or not. Findings suggest a need for health care professionals to be prepared to address the high rates of mental disorders in maltreated youth, to be more vigilant about possible physical disorders in this population, and to take greater advantage of opportunities to immunize these youth.

Tailoring health-related messages for young adults with adverse childhood experiences (ACEs).

The goal was to identify factors that might affect likelihood of seeking health-related interventions for young adults with adverse childhood experiences (ACEs). We tested whether ACEs were associated with (1) regulatory focus (tendency toward promoting good outcomes versus preventing bad outcomes), and (2) patient activation (the intention to take active charge of one's health). We further tested whether promotion and prevention and patient activation were associated with each other and with health. Students at a public university (N = 321) completed online questionnaires assessing ACEs, regulatory focus, patient activation, and health. Greater childhood adversity showed small but significant associations with being a less activated patient and being less focused on promoting good outcomes. In contrast, greater childhood adversity had a much stronger association with focusing on preventing negative outcomes. Students with a more significant mental health history were more likely to have been exposed to childhood adversity, to be less activated patients, and to focus more on prevention. Results suggest that using a prevention focus may be effective in health messages aimed to reach individuals with high levels of ACEs. Furthermore, individuals with high levels of ACEs may benefit from interventions aimed at increasing patient activation.

Health-Care Utilization Patterns of Maltreated Youth.

To examine in detail the health-care utilization patterns of maltreated children, we studied electronic health records (EHRs) of children assigned maltreatment-related codes in a large medical system. We compared youth with maltreatment-related diagnoses (N = 406) with those of well-matched youth (N = 406). Data were based on EHRs during a 4-year period from the University of Minnesota's Clinical Data Repository, which covers eight hospitals and over 40 clinics across Minnesota. A primary care provider (PCP) was assigned to over 80% of youth in both groups. As expected, however, the odds of not having a PCP were twice as high in the maltreated as in the comparison group. Also as expected, maltreated youth had higher rates of emergency department visits. We ruled out differences in age, gender, race, public insurance, duration in the medical system, type of specialty department, and clinic location as potential explanations for these differences. On the other hand, there were no significant differences between maltreated and comparison youth in hospitalizations, preventive visits, or office visits. Contrary to expectations, maltreated youth were not in the medical system for just a brief period of time and were not more likely to cancel or miss appointments. The current study adds to the research literature by providing more detailed information about the nature of health-care services used by children with maltreatment-related diagnoses.

Parental reactions to parent- and sibling-directed aggression within a domestic violence context.

Parent- and sibling-directed aggression by minor children are two forms of family violence that often co-occur and have strong relations to prior exposure to domestic violence, yet are often overlooked in intervention efforts. In addition, current research does not examine these forms of family violence in tandem, and there is very limited research with samples exposed to domestic violence. To better understand how these forms of aggression operate within a domestic violence context, we interviewed 44 women residing in a domestic violence shelter with at least one child over 3.5 years of age who was aggressive toward them and/or siblings. Caregivers reported on their emotional reactions to children's parent-directed aggression and the types of and effectiveness of help they sought for parent- and/or sibling-directed aggression. In line with previous literature, caregivers endorsed a complex mix of emotional reactions to their children's parent-directed aggression, including anger, sadness, guilt, forgiveness, and worthlessness. In contrast to other studies, most caregivers (89%) had sought help for children's parent- and/or sibling-directed aggression and found it effective. Findings contribute to the literature on parent- and sibling-directed aggression and provide implications for how to effectively intervene.

Documentation of Child Maltreatment in Electronic Health Records.

International Classification of Diseases codes for child maltreatment can aid surveillance and research, but the extent to which they are used is not well established. We documented prevalence of the use of maltreatment-related codes, examined demographic characteristics of youth assigned these codes, and compared results with previous studies. Data were extracted from electronic health records of 0- to 21-year-olds assigned 1 of 15 maltreatment-related International Classification of Diseases, Ninth Revision, codes who had encounters in a large medical system over a 4-year period. Only 0.02% of approximately 2.5 million youth had a maltreatment-related code, replicating other studies. Results provide a dramatic contrast to much higher rates based on self-report or informant-report and referrals to Child Protective Services. Lack of documentation of maltreatment in electronic health records can lead to missed chances at early intervention, inadequate coordination of health care, insufficient allocation of resources to addressing problems related to maltreatment, and flawed public health data.

Adverse Childhood Experiences (ACEs), Stress and Mental Health in College Students.

The goal of this short-term longitudinal study was to examine whether adverse childhood experiences (ACEs) could be used to identify college students at risk for mental health problems and whether current level of stress mediates the relationship between ACEs and mental health. Data on ACEs and mental health (depression, anxiety and suicidality) were collected at the beginning of the semester, and data on current stressors and mental health were collected toward the end of the semester (n = 239). Findings indicated that ACEs predicted worsening of mental health over the course of a semester and suggested current number of stressors as a mediator of the relationship between ACEs and mental health. Results suggest that screening for ACEs might be useful to identify students at high risk for deterioration in mental health. Results further suggest that stress-related interventions would be beneficial for students with high levels of ACEs and point to the need for more research and strategies to increase help-seeking in college students.

Gyrification differences in children and adolescents with velocardiofacial syndrome and attention-deficit/hyperactivity disorder: a pilot study.

We used magnetic resonance imaging to investigate brain gyrification patterns between 19 children with attention-deficit/hyperactivity disorder (ADHD), 9 children with velocardiofacial syndrome (VCFS), and 23 control children. We found that VCFS is associated with widespread decreases in gyrification. In ADHD, we found minor differences from control children. No evidence was found for common gyrification patterns between VCFS and ADHD children.

Memory-guided saccades in youth-onset psychosis and attention deficit hyperactivity disorder (ADHD).

AIM: Working memory deficits have been shown to be present in children and adolescents with schizophrenia and attention deficit hyperactivity disorder. Considering the differences in clinical characteristics between these disorders, it was the goal of this study to assess differences in the specific components of working memory in children and adolescents with psychosis and attention deficit hyperactivity disorder. METHODS: Children and adolescents (age range 8-20 years) with either a non-affective psychotic disorder (n = 25), attention deficit hyperactivity disorder (n = 33) and controls (n = 58) were administered an oculomotor delayed-response task using both a recall and a control condition. Memory-guided saccades were measured during delay periods of 2, 8 and 20 s. RESULTS: Although both clinical groups were less accurate than controls, there was no evidence of a disproportionate impairment in recall. In addition, there was no evidence of a delay-dependent impairment in psychosis; however, there was a delay-dependent impairment in attention deficit hyperactivity disorder when corrective saccades were included. Speed of information processing was correlated with distance errors in psychosis, suggesting that speed of encoding the stimulus location may have constrained the accuracy of the saccades. CONCLUSIONS: Our findings support impairments during encoding in the psychosis group and a delay-dependent deficit in the attention deficit hyperactivity disorder group.