The moment is now: Strengthening communities and families for the future of our nation.

COVID-19 has highlighted the historical lack of investment in the conditions that children need to thrive, and demonstrates how a crisis can exacerbate children's vulnerability to disease and violence. Exposure to early adversity already affects millions of children across the country and puts them at risk for poor outcomes. With the uncertainty of the pandemic, many more families are struggling and subsequently, more children are at risk for exposure to adversity. Preventing early adversity and promoting the prosperity of our nation requires assuring that all children, regardless of sociodemographic characteristics, have what they need to reach their full health and life potential. Now is the time to address the social and structural conditions that contribute to the inequitable distribution of risk for some families and which contribute to their unequal burden and impacts of adversity, COVID-19, racial injustice, and other health crises. While many look forward to "a return to normal," returning to normal would be a missed opportunity to learn from our mistakes and ensure a bright future for our nation. We must invest in children and families for the future health of Americans.

Adverse Childhood Experiences Increase Risk for Prescription Opioid Misuse.

The United States is in the midst of an opioid overdose epidemic, with a significant portion of the burden associated with prescription opioids. In response, the CDC released a Guideline for Prescribing Opioids for Chronic Pain, which promotes access to treatment for opioid use disorder. Decades of research have linked childhood adversity to negative health and risk behavior outcomes, including substance misuse. Our present study builds upon this work to examine the relationship between adverse childhood experiences (ACEs) and prescription opioid misuse. We compiled data from the Behavioral Risk Factor Surveillance System implemented by Montana and Florida in 2010 and 2011, respectively. Logistic regressions (run in 2017) tested the associations between ACEs and subsequent prescription pain medicine/opioid misuse outcomes in adulthood. ACEs were prevalent, with 62.7% of respondents in Montana and 50% in Florida reporting at least one ACE. The presence of ACEs was positively associated with prescription opioid misuse across both samples. Respondents reporting three or more ACEs had increased odds of taking opioids more than prescribed, without a prescription, and for the feeling they cause. Our results support a strong link between ACEs and prescription opioid misuse. Opportunities to prevent opioid misuse start with assuring safe, stable, nurturing relationships and environments in childhood and across the lifespan to prevent ACEs from occurring, and intervening appropriately when they do occur. Substance use prevention programs for adolescents, appropriate pain management and opioid prescribing protocols, and treatments for opioid use disorder can address ACEs by enhancing treatment safety and effectiveness and can reduce the intergenerational continuity of early adversity.

Vital Signs: Estimated Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention - 25 States, 2015-2017.

INTRODUCTION: Adverse childhood experiences, such as violence victimization, substance misuse in the household, or witnessing intimate partner violence, have been linked to leading causes of adult morbidity and mortality. Therefore, reducing adverse childhood experiences is critical to avoiding multiple negative health and socioeconomic outcomes in adulthood. METHODS: Behavioral Risk Factor Surveillance System data were collected from 25 states that included state-added adverse childhood experience items during 2015-2017. Outcomes were self-reported status for coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, cancer (excluding skin cancer), kidney disease, diabetes, depression, overweight or obesity, current smoking, heavy drinking, less than high school completion, unemployment, and lack of health insurance. Logistic regression modeling adjusting for age group, race/ethnicity, and sex was used to calculate population attributable fractions representing the potential reduction in outcomes associated with preventing adverse childhood experiences. RESULTS: Nearly one in six adults in the study population (15.6%) reported four or more types of adverse childhood experiences. Adverse childhood experiences were significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges. Potential percentage reductions in the number of observed cases as indicated by population attributable fractions ranged from 1.7% for overweight or obesity to 23.9% for heavy drinking, 27.0% for chronic obstructive pulmonary disease, and 44.1% for depression. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Efforts that prevent adverse childhood experiences could also potentially prevent adult chronic conditions, depression, health risk behaviors, and negative socioeconomic outcomes. States can use comprehensive public health approaches derived from the best available evidence to prevent childhood adversity before it begins. By creating the conditions for healthy communities and focusing on primary prevention, it is possible to reduce risk for adverse childhood experiences while also mitigating consequences for those already affected by these experiences.

Associations between adverse childhood experiences and acquired brain injury, including traumatic brain injuries, among adults: 2014 BRFSS North Carolina.

Adverse childhood experiences (ACEs) can negatively affect lifelong health and opportunity. Acquired brain injury (ABI), which includes traumatic brain injury (TBI) as well as other causes of brain injury, is a health condition that affects millions annually. The present study uses data from the 2014 North Carolina Behavioral Risk Factor Surveillance System to examine the relationship between ACEs and ABI. The study sample included 3454 participants who completed questions on both ABI and ACEs. Multivariable logistic regression models were used to determine the relationship between ACEs and ABI as well as ACEs and TBI. Sexual abuse, emotional abuse, physical abuse, household mental illness and household substance abuse were significantly associated with ABI after adjusting for age, race/ethnicity, gender and employment. Compared with those reporting no ACEs, individuals reporting three ACEs had 2.55 times the odds of having experienced an ABI; individuals reporting four or more ACEs had 3.51 times the odds of having experienced an ABI. Examining TBI separately, those who experienced sexual abuse, physical abuse, household mental illness and had incarcerated household members in childhood had greater odds of reported TBI, after adjusting for age, race/ethnicity, gender and income. Respondents reporting three ACEs (AOR=4.16, 95% CI (1.47 to 11.76)) and four or more ACEs (AOR=3.39, 95% CI (1.45 to 7.90)) had significantly greater odds of reporting TBI than respondents with zero ACEs. Prevention of early adversity may reduce the incidence of ABI; however, additional research is required to elucidate the potential pathways from ACEs to ABI, and vice versa.

Adverse Childhood Experiences and the Presence of Cancer Risk Factors in Adulthood: A Scoping Review of the Literature From 2005 to 2015.

Exposure to Adverse Childhood Experiences (ACEs) is associated with a host of harmful outcomes, including increased risk for cancer. A scoping review was conducted to gain a better understanding of how ACEs have been studied in association with risk factors for cancer. This review includes 155 quantitative, peer-reviewed articles published between 2005 and 2015 that examined associations between ACEs and modifiable cancer risk factors, including alcohol, environmental carcinogens, chronic inflammation, sex hormones, immunosuppression, infectious agents, obesity, radiation, ultraviolet (UV) radiation, and tobacco, among U.S. adults. This review highlights the growing body of research connecting ACEs to cancer risk factors, particularly alcohol, obesity, and tobacco. Fewer studies investigated the links between ACEs and chronic inflammation or infectious agents. No included publications investigated associations between ACEs and environmental carcinogens, hormones, immunosuppression, radiation, or ultraviolet radiation. Mitigating the impact of ACEs may provide innovative ways to effect comprehensive, upstream cancer prevention.

The Harmful Effect of Child Maltreatment on Economic Outcomes in Adulthood.

OBJECTIVES: To examine the effect of maltreatment during childhood on subsequent financial strain during adulthood and the extent to which this effect is mediated by adolescent depressive symptoms, adolescent substance abuse, attenuated educational achievement, and timing of first birth. METHODS: We specified a multilevel path model to examine the developmental cascade of child maltreatment. We used data from a longitudinal panel study of 496 parents participating in the Rochester Intergenerational Study, in Rochester, New York. Data were collected between 1988 and 2016. RESULTS: Child maltreatment had both a direct and indirect (via the mediators) effect on greater financial strain during adulthood. CONCLUSIONS: Maltreatment has the capacity to disrupt healthy development during adolescence and early adulthood and puts the affected individual at risk for economic difficulties later in life. Maltreatment is a key social determinant for health and prosperity, and initiatives to prevent maltreatment and provide mental health and social services to victims are critical.

Childhood Maltreatment Predicts Poor Economic and Educational Outcomes in the Transition to Adulthood.

OBJECTIVES: To test whether childhood maltreatment was a predictor of (1) having low educational qualifications and (2) not being in education, employment, or training among young adults in the United Kingdom today. METHODS: Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative UK cohort of 2232 twins born in 1994 to 1995. Mothers reported on child maltreatment when participants were aged 5, 7, 10, and 12 years. Participants were interviewed about their vocational status at age 18 years. RESULTS: The unadjusted odds of having low educational qualifications or of not being in education, employment, or training at age 18 years were more than 2 times greater for young people with a childhood history of maltreatment versus those without. These associations were reduced after adjustments for individual and family characteristics. Youths who reported having a supportive adult in their lives had better education outcomes than did youths who had less support. CONCLUSIONS: Closer collaboration between the child welfare and education systems is warranted to improve vocational outcomes for maltreated youths.

Intergenerational Continuity in Adverse Childhood Experiences and Rural Community Environments.

OBJECTIVES: To understand the role of the community environment on intergenerational continuity in adverse childhood experiences (ACEs) among a rural White sample. METHODS: Parents in 12 counties in rural Iowa reported retrospectively on their own ACEs in 1989. We measured their child's ACEs retrospectively and prospectively across adolescence (n = 451 families). We measured structural and social process-related measures of community environment (i.e., community socioeconomic status, parents' perception of community services, perceived community social cohesion, and neighborhood alcohol vendor density) on multiple occasions during the child's adolescence. RESULTS: The 4 measures of community environment were all correlated with the child's ACEs, but only alcohol vendor density predicted ACEs after inclusion of covariates. Intergenerational continuity in ACEs was moderated by both social cohesion (b = -0.11; SE = 0.04) and alcohol vendor density (b = -0.11; SE = 0.05). CONCLUSIONS: Efforts to increase community social cohesion and manage alcohol vendor density may assist families in breaking the cycle of maltreatment across generations.

Adverse childhood experiences and life opportunities: Shifting the narrative.

Substantial research shows that early adversity, including child abuse and neglect, is associated with diminished health across the life course and across generations. Less well understood is the relationship between early adversity and adult socioeconomic status, including education, employment, and income. Collectively, these outcomes provide an indication of overall life opportunity. We analyzed data from 10 states and the District of Columbia that used the adverse childhood experiences (ACE) module in the 2010 Behavioral Risk Factor Surveillance System to examine the association between ACEs and adult education, employment, and income. Compared to participants with no ACEs, those with higher ACE scores were more likely to report high school non-completion, unemployment, and living in a household below the federal poverty level. This evidence suggests that preventing early adversity may impact health and life opportunities that reverberate across generations. Current efforts to prevent early adversity might be more successful if they broaden public and professional understanding (i.e., the narrative) of the links between early adversity and poverty. We discuss our findings within the context of structural policies and processes that may further contribute to the intergenerational continuity of child abuse and neglect and poverty.

Evidence of natal habitat preference induction within one habitat type.

Natal habitat preference induction (NHPI) is a mechanism for habitat selection by individuals during natal dispersal. NHPI occurs in wild animal populations, and evidence suggests it may be a common, although little studied, mechanism for post-dispersal habitat selection. Most tests of NHPI examine the influence of distinct, contrasting natal habitat types on post-dispersal habitat selection. We test the hypothesis that NHPI can occur within a single habitat type, an important consideration for habitat specialists. The Mount Graham red squirrel (Tamiasciurus hudsonicus grahamensis) is an endangered forest obligate restricted to a single mountain primarily within mixed-conifer forest. We test for NHPI by comparing intra-individual differences in natal and settlement habitat structure and composition to expected random pairwise differences. Dispersing juveniles appear to select settlement locations that are more similar to natal areas than expected in several forest structure and composition variables that include canopy cover and live basal area. Our results provide support for NHPI as a mechanism for post-dispersal habitat selection in habitat specialists that occupy a single vegetation community type.

Child Maltreatment: A Public Health Overview and Prevention Considerations.

Child maltreatment (CM) is a significant public health problem, affecting hundreds of millions of children globally. CM has been linked to a variety of short- and long-term health consequences, including poor physical and mental health, changes to brain architecture and development, altered biological factors, reduced cognitive ability and educational achievement, and impaired psychosocial functioning. This article will define and describe the various types of CM and its epidemiology from a public health perspective that considers incidence, prevalence, and consequences. The authors discuss risk and protective factors and approaches for the prevention of CM, including key considerations for nurses to help identify potential victims and provide treatment and/or referrals.

Prevention of child sexual abuse in the United States: Scoping review of United States legislative policies.

BACKGROUND: States in the United States (US) have passed and enacted legislation for the purpose of preventing child sexual abuse (CSA) since 2000, but it is unknown whether these legislative policies reduce adult-perpetrated CSA. OBJECTIVE: Review the literature from 2000 to 2023 to understand which US CSA prevention policies have been evaluated, the effectiveness of these policies, study populations, and barriers and facilitators associated with the implementation of CSA prevention policies. METHODS: The study protocol was published prior to undertaking the review: PMC10603531. The review follows Joanna Briggs Institute methodology and is reported according to the PRISMA-ScR Checklist. We searched 27 databases, hand searched reference lists of included studies, and sent notice via listserv to other researchers in the field. Articles were included if the content focused on CSA prevention policies and the effects. No limits to methodology were applied. Methodological rigor was assessed. RESULTS: 2209 potentially relevant articles were identified; 20 articles advanced to full-text review, three satisfied the inclusion criteria. Three eligible studies focused on CSA prevention education policies, while the other focused on mandated reporting policies. Effects of these policies were mixed in relation to CSA reporting and substantiation rates. No study considered child demographics. CONCLUSIONS: Despite decades of legislative action for CSA prevention across the US, only a few studies have assessed the effects of these policies. These findings highlight the need for additional research to ensure that CSA prevention policies such as CSA prevention education in schools and mandated reporting practices are working as intended.

Child Maltreatment During the Pandemic.

What happened with child abuse and neglect during the pandemic? Emergency department and child welfare data suggest a decline in reports; however other sources of data suggest that risk for abuse and neglect remained high during COVID-19. In this commentary, the authors highlight the complicated, and at times contradictory, evidence as to what occurred with child abuse and neglect during the pandemic. The commentary concludes with suggestions for future research.

Prevention of child sexual abuse in the USA: a scoping review protocol of US legislative policies.

INTRODUCTION: Child sexual abuse (CSA) poses a significant threat to the health and well-being of children in the USA and globally. Many states have introduced or implemented policies to address and prevent CSA, but little research has linked the effects of this legislation on the reduction of adult-perpetrated CSA. The objective of this scoping review is to identify US policies which aim to prevent CSA, explain the components of these types of legislation, review evidence of effectiveness, describe the populations included in the literature, and identify barriers and facilitators to the implementation of said policies. METHODS AND ANALYSIS: This scoping review will follow Joanna Briggs Institute methodology for scoping reviews and will use the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Sources of peer-reviewed evidence from January 2000 to July 2023 will be included. Relevant publications will first be searched in PubMed/MEDLINE database, then 25 other databases. The reference lists of included studies and high-yield journals will be hand searched. Articles which focus on the types of CSA prevention policies and their effects will be included. Studies must clearly demonstrate a connection between policies and CSA outcomes. Title, abstract, full-text screening and extraction will be completed by a team of three researchers. Critical appraisal of the included studies will be performed. Extracted data will be displayed in tabular form and a narrative summary will describe the results of the review. ETHICS AND DISSEMINATION: This scoping review will provide an extensive overview of legislative policies which aim to prevent CSA in the USA. Results of this review will inform future CSA prevention policies in the USA, particularly regarding policy development, evaluation and implementation. Results will be disseminated through a peer-reviewed publication.

Paid Family Leave: An Upstream Intervention to Prevent Family Violence.

Purpose: Family violence imposes tremendous costs on victims and society. Rarely are policies focused on the primary prevention of family violence. Given the prevalence of family violence-including child maltreatment and intimate partner violence (IPV)-during the perinatal period, policies targeting this vulnerable time period may be successful in primary prevention. Paid family leave (PFL) programs provide income-replacement during particularly stressful family events, such as the birth of a child. Method: In this commentary, we describe the conceptual links between PFL, child maltreatment, and IPV, suggesting that PFL may be a promising strategy for the primary prevention of child maltreatment and IPV. Results: There is emerging evidence that policies targeting the early years of life may reduce child maltreatment and IPV. Conclusion: Addressing the concrete and economic challenges faced by caregivers is one promising strategy for the prevention of family violence.

Using the Core Components of a Public Health Framework to Create a Child and Family Well-being System: Example from a National Effort, Thriving Families, Safer Children.

Thriving children require safe, stable, nurturing relationships and environments. When caregivers have the resources and support they need, at the appropriate time, and in culturally meaningful ways, they can structure environments and experiences for their children that optimize development. However, all too many caregivers and children experience trauma and adversity that consistently threaten such environments. The USA currently lacks a universal system of care and support for children and families leaving the child welfare system as the only option for many families to get help. This forces child welfare agencies to address problems and issues they are ill-equipped to address. In this paper, we review how a new national effort in the USA, Thriving Families, Safer Children is integrating the core components of a public health framework to create a child and family well-being system across the country. Case study examples are provided from 4 Thriving Families, Safer Children sites. Thriving Families, Safer Children sites are utilizing the core components of a public health framework to address social and structural determinants of health including systemic racism, with a strong focus on changing systems and contexts, through participatory methods of engaging those with lived expertise, to ensure the service context where families can get what they need, when they need it, with an emphasis on promoting race equity. Efforts to transform child welfare through the Thriving Families, Safer Children movement are aligned with the core components of a public health framework.

Childcare Subsidy Enrollment Income Generosity and Child Maltreatment.

In the United States, childcare subsidies are available to low-income working parents to assist with the cost of childcare. The subsidies are provided as block grants to states, which allows for a great deal of flexibility in the specific policies guiding their distribution. Prior research has found a protective link between childcare subsidies and child maltreatment, but the variations in policies have been much less explored. The current study used longitudinal administrative child welfare data from 10 years (2009-2019) linked with state policies regarding the income eligibility requirements of states to examine the impact of these policies on child abuse and neglect among young children (0-5); early school-age children (6-12), and older children (13-17). Using multiple regression and controlling for state demographic characteristics, the study found that more generous policies surrounding income eligibility were related to lower rates of child abuse and neglect investigations at the state level.