Birth order moderates the association between adverse childhood experiences and externalizing behavior symptoms in adolescence.

Adverse childhood experiences (ACEs) are associated with externalizing behaviors. Whereas some ACEs affect individual children (i.e., child-specific; e.g., failing a grade), others affect the family unit (i.e., family-wide; e.g., parent losing a job); effects of ACEs on externalizing behavior may manifest differently across groupings of ACEs. Moreover, birth order may modify the association between child-specific and family-wide ACEs and externalizing behavior due to differences in the experience of being a younger versus older sibling. This study examined the externalizing behavior of siblings in relation to their experiences of child-specific and family-wide ACEs to test the hypothesis that younger siblings are at greater risk for developing externalizing symptoms following familial ACE exposure. Participants were 61 sibling pairs (younger sibling Mage = 11.37 years, 44.1% male; older sibling Mage = 13.1 years, 52.5% male) recruited from six schools in the northeastern United States. Parents rated each child's externalizing behaviors (e.g., bullying, meanness) and retrospectively reported on each child's experience of 34 ACEs; two raters categorized ACEs as child-specific (n = 10) or family-wide (n = 24). Multilevel modeling revealed that both child-specific and family-wide ACEs were associated with increased externalizing behaviors. Birth order moderated the effect of family-wide (but not child-specific) ACEs on externalizing behaviors, independent of sex and age. Externalizing behavior was higher for younger siblings as compared with older siblings, particularly when a high number of ACEs (6+) were reported. This research should prompt future exploration of mechanistic theories of the impact of family-wide and child-specific ACEs and the role of birth order.

Adverse Childhood Experiences in Mexico: Prevalence and Association with Sociodemographic Variables and Health Status.

Background: Adverse Childhood Experiences (ACEs) refer to a semantic field of negative childhood events that, in conjunction with insufficient personal, family, or contextual coping resources, have the potential of becoming traumatic. Objective: To assess the prevalence of Adverse Childhood Experiences (ACEs) and their association with sociodemographic variables and physical and mental illnesses in a Mexican sample. Design: A cross-sectional design was used. The sample included 917 Mexican adults who responded to the Adverse Childhood Experiences International Questionnaire (ACE-IQ). Most of the participants were female (79.3%) with an average age of 37 years, a monthly income between 500 and 2,500 USD (59.2%), had completed university education (45.6%) and were married or in a common-law marriage (53.1%). Data was collected through Google Forms, and the link to the form was shared through electronic social networks. Results: A total of 48.3% of the participants presented seven to nine types of ACEs. Among their responses, the most prevalent categories were emotional neglect (95.1%), family violence (83.3%), and emotional abuse (78.6%). A significant association was found between the number of ACEs and the mental illness diagnosis (x2(20) = 15.16; p<001). Women were found to report more experiences of sexual abuse (z = -6.62, p<. 001), whereas men reported more experiences of community violence (z= -4.27, p < .001) and collective violence (z = -3.94, p<.001). Conclusions: The prevalence of ACEs in the Mexican population is high. However, men and women reported differences in certain types of ACEs. It was found that people with a diagnosis and family history of mental illnesses presented a higher number of ACE categories.

Cultural and psychosocial moderators of the association between adverse childhood experiences and alcohol and marijuana use among Latinx college students on the U.S./Mexico border.

BACKGROUND: Adverse childhood experiences (ACEs) have been historically associated with negative life outcomes among the general population. OBJECTIVE: With limited research among Latinx college students, this study assessed how specific constructs moderate the association between ACEs and alcohol and marijuana use. PARTICIPANTS AND SETTING: Latinx participants recruited from a large U.S./Mexico border region university (Females: N = 283, Males: N = 168) completed an online survey which included: demographics, the Center for Youth Wellness Adverse Childhood Experience Questionnaire (CYW ACE-Q) Teen Self-Report, Drug Use Frequency (DUF), Experiences in Close Relationships Scale (ECR), General Self-Efficacy Scale (GSE), Attitudinal Familism Scale (AFS), The Machismo Measure or The Marianismo Beliefs Scale (MBS), and The Bicultural Self-Efficacy Scale (BSE). METHODS: Hierarchical linear regressions were conducted to test for main and interactive effects and to determine if the individual moderators (i.e., attachment style, self-efficacy, familism, traditional gender norms, bicultural self-efficacy) affect the relationship between ACEs and alcohol and marijuana use. RESULTS: Results indicated that among females, attachment style (ß = 0.04, p = .03), MBS (ß = -65.57, p = .01), and BSE (ß = 0.34, p = .04) moderate the relationship between ACEs and alcohol and marijuana use. No moderation analyses were statistically significant among males. CONCLUSIONS: Clinical implications include, for both substance use and trauma treatment among Latinx college students, the assessment of ACEs and attachment style to promote greater insight into the client's inner struggles and emotional processing in relation to marianismo beliefs and bicultural self-efficacy.

Parent-Child Nativity, Race, Ethnicity, and Adverse Childhood Experiences Among U.S. Children.

We examined the relationship between parent-child nativity, race/ethnicity, and adverse childhood experiences (ACEs) among US children. We found that a high proportion of Black/Hispanic children experienced ACEs, with variation by generation for Hispanic but not Black children, and a lower but increasing proportion of White children experienced ACEs by generation.

Adverse Childhood Experiences and Healthcare Utilization of Children in Pediatric Emergency Departments.

OBJECTIVE: To determine the prevalence of adverse childhood experiences (ACEs) and healthcare utilization patterns of children seen in pediatric emergency departments (PEDs). STUDY DESIGN: In this cross-sectional study, caregivers of patients who presented to 2 urban PEDs completed a survey regarding their children's ACEs, health care utilization patterns, and acceptance of PED-based ACEs screening and resources. Inclusion criteria were English-speaking caregivers of patients 0-17 years of age not requiring acute stabilization. Prevalence estimates were compared with national and state data from the National Survey of Children's Health by calculating risk differences and 95% CIs. The association of cumulative ACEs with caregiver-reported health care utilization patterns was evaluated using ORs. RESULTS: Among 1000 participants, 28.1% (95% CI 25.3-30.9) had 1 ACE; 17.8% (95% CI15.4-20.2) had ≥2 ACEs. Notably, children with higher cumulative ACEs were seen in the PED more frequently (0, 1, ≥2 visits) (OR 1.18, 95% CI 1.06-1.30, P = .002) and more likely to seek care in PEDs for sick visits (OR 1.16, 95% CI 1.04-1.30, P = .01). About 9% of children exposed to ACEs did not have a primary care provider. Over 85% of caregivers reported never discussing ACEs with their primary care provider. Most caregivers felt comfortable addressing ACEs in PEDs (84.4%) and would use referral resources (90.4%). CONCLUSIONS: Given higher PED utilization in children with more ACEs and caregiver acceptance of PED-based screening and intervention, PEDs may represent a strategic and opportune setting to both assess and respond to ACEs among vulnerable populations.

Adverse childhood experiences and delinquent behaviour: Predictors and mediating variables

ABSTRACT Background: Adverse childhood experiences (ACEs) have been identified as a risk factor for the development of mental health and behavioural outcomes throughout life, including delinquent behaviours. This article focuses on the relationship between ACEs and delinquent behaviour (DB), seeking to identify predictors and mediating variables. Methods: The quantitative study comprised 175 Portuguese adolescents, aged 12 and 17 years of age (M = 14.99, SD = 2.26). Results: ACEs and exposure to traumatic events (ETE) are predictive of DB. Antisocial traits (AT) was found to be mediating the relationship between ACEs and DB, as well as the relation between ETE and DB. Conclusion: The results indicate that it is necessary that professionals in health behaviour field prevent and intervene in ACEs and in ETE, both predictors of DB. The results of this study allow to understand the role of ACEs in DB and its mediating variables, which must be considered to mitigate the harmful impact of ACEs in DB.

Adaptation measures in dental care for children with history of Adverse Childhood Experiences: A practical proposal.

Adverse Childhood Experiences (ACEs) such as maltreatment, abuse, or neglect can disrupt childhood development and increase the risk of health issues, including dental health. Such a vulnerable population frequently may deny dental treatment due to fear of intimate contact in the oral cavity, resulting in a vicious cycle that further leads to detrimental oral health. It is important for dentists, particularly pediatric dentists, to not only understand how to identify potential cases of abuse or maltreatment but also how to treat these patients so that the dental treatment does not become a negative experience. The purpose of this paper is to understand the psychological and physical implications of pediatric patients who have had ACEs and to identify the best methods to manage these patients during the dental treatment.

The Implementation of Screening for Adverse Childhood Experiences in Pediatric Primary Care.

OBJECTIVE: To assess the implementation of screening, screening rates, and prevalence of adverse childhood experiences (ACEs) in a large integrated healthcare system. STUDY DESIGN: Kaiser Permanente Southern California is a large integrated healthcare system with 15 medical centers/hospitals and 233 medical office buildings that serve approximately 1.5 million children. Screening for ACEs began in July 2018 at 1 medical center (Downey, Bellflower medical office) for 3- and 5-year-old well-child visits (yearly physical examination). It quickly expanded to 3 other medical centers (6 clinics in total) and now also includes the 10- and 13-year-old well-child visits. RESULTS: Since July 2018 we have screened 3241 3-year-olds (53% of the target population), 2761 5-year-olds (53%), 545 10-year-olds (37%), and 509 13-year-olds (13%). Of the 3-year-olds who were screened, 15% had an ACEs score of 1 or higher. Of the 5-year-olds that were screened, 17.5% had an ACEs score of 1 or higher. Of the 10-year-olds, 30.5% had an ACEs score of 1 or higher and of the 13-year-olds, 33.8% had an ACEs score of 1 or higher. CONCLUSIONS: Although we have encountered some challenges, particularly with follow-up for those screening positive for ACEs, screening was feasible. The data show an increasing trend of ACEs in 3- to 13-year-old children, highlighting the need for early education about ACEs to mitigate the effects of toxic stress.

Impact of adverse childhood experiences on cardiovascular disease risk factors in adulthood among Mexican women.

BACKGROUND: Childhood adversities are prevalent worldwide and might affect adult cardiovascular health. However, in middle-income countries such as Mexico, research on the impact of childhood adversities on cardiovascular disease (CVD) in adulthood is lacking. OBJECTIVE: To evaluate the prevalence of adverse childhood experiences (ACEs) and their association with risk factors for CVD in adult Mexican women. PARTICIPANTS AND SETTING: The study population comprised 9853 women from the Mexican Teachers´ Cohort. METHODS: Participants responded to an online questionnaire including a 10-item instrument on ACEs and questions on CVD risk factors, between 2014 and 2017. Multivariate logistic regression models were used to evaluate the association between ACEs and adult behavioral and medical CVD risk factors. RESULTS: About 61% of participants reported at least one ACE and 14% reported four or more. After multivariable adjustment, women who reported ≥4 ACEs had 58% (95%CI 1.37, 1.81) higher odds of having ever smoked and 17% (95%CI 0.69, 0.99) lower odds of being physically active, compared with women who reported no ACEs. Women who reported ≥4 ACEs also had higher odds of hypertension (OR = 1.19; 95%CI 1.00, 1.43), diabetes (OR = 1.49; 95%CI 1.13, 1.96), high cholesterol (OR = 1.49; 95%CI 1.26, 1.75), and obesity (OR = 1.37; 95%CI 1.19, 1.57). In addition, individual ACE components were independently associated with several CVD risk factors. CONCLUSION: ACEs are common and associated with CVD risk factors in adult Mexican women.

Adverse childhood experiences and adjustment: A longitudinal study of street-involved youth in Brazil.

Most research on adverse childhood experiences (ACEs) has been conducted in high-income countries in the global North. The current longitudinal study examined the prevalence, overlap, and impact of ACEs in a sample of Brazilian children and adolescents who use city streets as spaces for socialization and survival (i.e., street-involved youth). Participants (N = 113; M age = 14.18 years) were recruited in three cities following standardized procedures. Most youth were male (80.5%) and non-White (91%). Lifetime exposure to ACEs was assessed at the first study time point; six indicators of psychological, behavioral, and physical adjustment were assessed 6 months later. Analyses addressed three research goals. First, the prevalence of seven ACEs was examined. Youth reported an average of 4.8 ACEs (SD = 1.25); no significant age or gender differences were found in ACEs exposure (all ps > .05). Second, the overlap between different ACEs was explored. Family dysfunction was correlated with family disruption and physical abuse; poverty and physical abuse were related (ps < .05). Third, prospective associations between ACEs and adjustment were tested. Total number of ACEs was not significantly correlated with any outcome, but several associations emerged for specific ACEs. For example, death of a close friend or family member was prospectively associated with negative affect; sexual abuse was associated with illicit drug use and physical health symptoms (ps < .05). Findings highlight the prevalence of ACEs in this vulnerable population and underscore the value of extending research on ACEs into novel populations and contexts.

Adverse Childhood Experiences Are Associated with Unmet Healthcare Needs among Children with Autism Spectrum Disorder.

OBJECTIVE: To explore associations between level of adverse childhood experiences (ACEs) and unmet healthcare needs among children with autism spectrum disorder (ASD) using a population-based sample. STUDY DESIGN: Cross-sectional data from the 2011-2012 National Survey of Child Health were analyzed to estimate prevalence of unmet healthcare needs among children with ASD, aged 2-17 years (ASD = 1624; estimated population = 1 174 871). Multivariate Poisson and logistic regression models were used to estimate the relationship between reported ACEs and unmet healthcare needs among children with ASD. RESULTS: After we adjusted for all other variables, children with ASD who experienced 1-2 ACEs and 3+ ACEs were associated with 1.78 (P < .05) and 2.53 (P < .01) times the incidence rate of unmet healthcare needs in comparison with children without ACEs. Compared with children who experienced 0 ACEs, the adjusted odds of any unmet healthcare need were 2.34 (P < .01) and 2.66 (P < .01) for children with 1-2 ACEs and 3 + ACEs, respectively. CONCLUSION: Although limited to cross-sectional data, our study provides compelling evidence on the link between ACEs and unmet healthcare needs among children with ASD. It advances understanding of risk factors in the child and community context that contribute to health disparities and negatively impact healthcare access and use in this population.

Dificuldades de acesso ao tratamento de pacientes com indicação de cirurgia de catarata nos Sistemas de Saúde Público e Privado / Difficulties in access to treatment for patients undergoing cataract surgery in public and private health systems

OBJETIVO: Estimar o valor dos Projetos Catarata para a comunidade, identificando características e dificuldades de acesso ao diagnóstico e ao tratamento da catarata na rotina de atendimento de diversos Sistemas de Saúde. MÉTODOS: Durante uma campanha de catarata realizada em um hospital universitário foi aplicado um questionário de múltipla escolha somente aos pacientes selecionados para a cirurgia de catarata. Foram avaliadas, dentre outras, as seguintes variáveis: acesso prévio à consulta oftalmológica (serviço público ou privado); motivo(s) para a não realização da cirurgia no serviço inicial. RESULTADOS: Foram avaliados 627 pacientes com diagnóstico de catarata. A maioria 595 (95 por cento) já havia consultado um oftalmologista previamente, sendo que em 63 por cento das situações (375 pacientes) a consulta havia sido realizada há menos de um ano. A última avaliação oftalmológica foi realizada pelo Sistema Único de Saúde (SUS) em 52 por cento dos casos (307 pacientes), e entre estes, a fila de espera foi apontada pela maioria como sendo a causa da não realização da cirurgia. Com relação aos pacientes previamente atendidos em serviços privados, o motivo da não realização da cirurgia foi o custo da cirurgia e custo da lente intraocular. CONCLUSÃO: Os resultados deste estudo sugerem que a rotina de atendimento oftalmológico no SUS em São Paulo não está preparada para atender a demanda por cirurgias de catarata, e o sistema de saúde privado ainda exclui uma parcela da população que possuí acesso à consulta clínica da cirurgia de catarata. É importante a continuidade da realização de campanhas comunitárias para atender a população que não teria como acessar a cirurgia pelas vias convencionais.

PURPOSE: To identify the difficulties in access to diagnosis and treatment of cataract in patients attended during a cataract campaign. METHODS: A questionnaire was administered to patients selected for cataract surgery. We evaluated, among others, the following variables: prior access to ophthalmologists (public or private), reason(s) for not having surgery early in the initial service, the average cost charged by cataract surgery and intraocular lens (IOL) (private services and agreements). RESULTS: A total of 627 patients was evaluated. Most of them - 595 (95 percent) had previously attended an ophthalmologist, and in 63 percent of cases (375 patients) the consultation had been held for less than a year. The last evaluation was performed by the Brazilian Public Health System (SUS) in 52 percent of the cases (307 patients). Regarding the reason for not having surgery in the initial service, the high cost of the surgery (R$ 2.000 - R$ 4.000) and the cost of IOLs (R$ 1.000 - R$ 1.500) was the main obstacle for most attended services and private covenants. CONCLUSION: The results of this study suggest that the routine of ophthalmologic care in SUS at São Paulo is not prepared to answer the demand for cataract surgeries and private healthcare system still excludes a portion of the population. It is important to continue the implementation of community campaigns to serve the population that would be unable to access the surgery through conventional ways.