Depressive feelings as mediator in the relation between adverse childhood events and lower urinary tract symptoms in males and females.

BACKGROUND: Adverse childhood events (ACEs) are prevalent and lead to well-established adverse health sequelae in adulthood. Recent literature has claimed that exposure to trauma in early life may worsen lower urinary tract symptoms (LUTS) because emotion can alter the perception of bodily distress in the brain. Specifically, depressive symptoms might influence the association between ACEs and LUTS. We aimed to describe the associations between ACEs and LUTS among males and females and to determine whether depressive symptoms mediated these associations. METHODS: This study was a secondary analysis of the Coevorden observational cohort study (n = 1691, age ≥16 years). For this observational study participants filled in the male or female modules of the International Consultation on Incontinence Questionnaire for LUTS (ICIQ-MLUTS and ICIQ-FLUTS, respectively), the NEMESIS Childhood Trauma Questionnaire (emotional neglect, psychological abuse, physical abuse, and sexual abuse within the family), and the Patient Health Questionnaire (PHQ-9) for depression. RESULTS: Overall, 564 males and 811 females answered all required items related to LUTS and ACEs. A series of regression models were then estimated to test for mediation: LUTS on ACEs, depression on ACEs, and LUTS on both ACEs and depression. The models were also adjusted for the following covariates: age, body mass index, diabetes mellitus, current smokers, educational level, and vaginal delivery (if female). Depressive symptoms were shown to mediate the association between ACEs and LUTS in both males and females. CONCLUSION: Childhood adversity and depression are areas of interest during the clinical assessment of patients with LUTS. Early detection of these conditions might help to manage risk, aid in the prevention of LUTS, and facilitate trauma-informed care.

Adverse childhood events and mental health problems in cancer survivors: a systematic review.

PURPOSE: The purpose of this study was to systematically review the literature on the association between adverse childhood events (ACEs) and mental health problems in cancer survivors. METHODS: This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Four databases (PubMed, PsychINFO, Web of Science, and Cochrane) were searched on 27-08-2023. RESULTS: Of the 1413 references yielded by the literature search, 25 papers met inclusion criteria and were reviewed. Most studies were performed in the USA, most included breast cancer survivors, and the number of included participants ranged between 20 and 1343. ACEs were relatively prevalent, with self-report rates ranging between 40 and 95%. Having been exposed to ACEs was a risk factor for heightened levels of emotional distress, anxiety, depressive symptoms, and fatigue during cancer treatment. Results varied depending on the variables included, and per subscale, but were consistent across different cultures and heterogenous patient groups. CONCLUSION: The association between ACE and mental health outcomes was significant in most studies. In order to improve treatment for this vulnerable population, it may be necessary to screen for ACEs before cancer treatment and adjust treatment, for example, by means of trauma-informed care (TIC), which recognizes and responds to the impact of trauma on individuals seeking healthcare.

Adverse childhood events and self-harming behaviours among individuals in Ontario forensic system: the mediating role of psychopathy.

BACKGROUND: Adverse childhood events (ACEs), psychopathy, and self-harming behaviours are prevalent among individuals in the forensic psychiatry system. While existing literature suggests that ACEs, self-harm, and psychopathy are interrelated, little is known about the interplay of psychopathic traits in this relationship. The present study aimed to determine the mediating role of psychopathy in the relationship between ACEs and self-harming behaviours in forensic patients. METHODS: This was a retrospective study of patients under the Ontario Review Board (ORB) between 2014 and 2015. In the analysis, we included patients with complete data on ACEs, self-harming behaviours, and a Psychopathy Checklist-Revised (PCL-R) score - a measure of psychopathic traits and their severity conducted during the reporting period. Mediation analysis was based on the Baron and Kenny approach, and sensitivity analysis was performed based on the types of ACEs. RESULTS: ​​​The sample population (n = 593) was made up of adults, with a mean age of 41.21 (± 12.35) years and were predominantly males (92.37%). While there was a partial mediating effect of psychopathy on the relationship between ACEs and incidents of self-harming behaviours in the past year, the mediation was complete in the relationship between ACEs and a lifetime history of self-harming behaviours. Following sensitivity analysis based on the types of ACE, the mediating effects were more attributed to specific ACEs, especially having experienced child abuse or having an incarcerated household member before 18 years. CONCLUSION: Among forensic patients in Ontario, psychopathy mediates​ ​the relationship between experiencing ACEs and engaging in self-harming behaviours. Effective intervention to mitigate self-harming behaviours in this population should consider the potential role of psychopathy, especially among individuals who have experienced ACEs involving a history of child abuse and a family who was incarcerated.

Adverse Childhood events of individuals and its relationship with resilience.

OBJECTIVE: The aim of this study is to examine the relationship between childhood trauma and psychological resilience in the Turkish Cypriot community and to identify the predictors of psychological resilience. METHOD: The research was conducted with 354 individuals in a web-based online environment in Northern Cyprus. Data were collected using a "Personal Information Form", the "Adverse Childhood Events Scale", and the "Resilience Scale for Adults". Percentage, mean, standard deviation, and Pearson's correlation analysis were used in the data analysis. RESULTS: In the study, 16.67 % of the participants were exposed to war or conflict when they were young and 10.17 % had a mental illness. In addition, it was determined that there were statistically significant and negative correlations between the Adverse Childhood Events Scale scores and the scores they got from the Adult Resilience Scale and the sub-dimensions of the scale. Female gender and education level predicted the scores on the Resilience Scale for Adults positively, and the presence of mental disease and the scores on the Adverse Childhood Events Scale negatively predicted the scores on the Resilience Scale for Adults. CONCLUSION: In this study, gender, educational status, presence of mental illness, and the total score on the Adverse Childhood Events Scale were determined to be predictive variables affecting resilience. Considering the research findings, it is recommended that nurses plan studies for the protection of the mental health of children and adolescents and the groups exposed to trauma should be psychologically supported to raise individuals with high resilience.

Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events: BRFSS 2019.

Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH. Data from the 2019 Behavioral Risk Factor Surveillance System was used to explore ACEs and CVH among 86,584 adults ≥18 years from 20 states. CVH was defined as poor (0-2), intermediate (3-5), and ideal (6-7) from summation of survey indicators (normal weight, healthy diet, adequate physical activity, not smoking, no hypertension, no high cholesterol, and no diabetes). ACEs was summed by number (0,1, 2, 3, and ≥4). A generalized logit model estimated associations between poor and intermediate CVH (ideal as referent) and ACEs accounting for age, race/ethnicity, sex, education, and health care coverage. Overall, 16.7% (95% Confidence Interval[CI]:16.3-17.1) had poor, 72.4% (95%CI:71.9-72.9) had intermediate, and 10.9% (95%CI:10.5-11.3) had ideal CVH. Zero ACEs were reported for 37.0% (95%CI:36.4-37.6), 22.5% (95%CI:22.0-23.0) reported 1, 12.7% (95%CI:12.3-13.1) reported 2, 8.5% (95%CI:8.2-8.9) reported 3, and 19.3% (95%CI:18.8-19.8) reported ≥4 ACEs. Those with 1 (Adjusted Odds Ratio [AOR] = 1.27;95%CI = 1.11-1.46), 2 (AOR = 1.63;95%CI:1.36-1.96), 3 (AOR = 2.01;95%CI:1.66-2.44), and ≥ 4 (AOR = 2.47;95%CI:2.11-2.89) ACEs were more likely to report poor (vs. ideal) CVH compared to those with 0 ACEs. Those who reported 2 (AOR = 1.28;95%CI = 1.08-1.51), 3 (AOR = 1.48;95%CI:1.25-1.75), and ≥ 4 (AOR = 1.59;95%CI:1.38-1.83) ACEs were more likely to report intermediate (vs. ideal) CVH compared to those with 0 ACEs. Preventing and mitigating the harms of ACEs and addressing barriers to ideal CVH, particularly social and structural determinants, may improve health.

Adverse Childhood Events and Chronic Pain in Adolescents: The Role of Sleep Disturbance.

OBJECTIVES: This study aimed to (1) examine the extent to which the association between exposure to adverse childhood events (ACEs) and having chronic pain in adolescents is explained by the association between exposure to ACEs and sleep disturbance and (2) explore the role of sleep disturbance in the association between exposure to ACEs and anxiety and depressive symptoms in adolescents with chronic pain. METHODS: Cross-sectional data from 469 adolescents aged 13-18 years old were drawn from an epidemiological study on pediatric chronic pain conducted in Catalonia (Spain). Participants provided self-reports of demographic characteristics, exposure to ACEs, pain characteristics, sleep disturbance, anxiety, and depressive symptoms. Mediation and moderation models were conducted. RESULTS: Sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and the presence of chronic pain. Moreover, sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and depressive symptoms and moderated the association between exposure to ACEs and anxiety in adolescents with chronic pain. CONCLUSION: The study findings suggest the possibility that addressing sleep disturbance in adolescents exposed to ACEs may help to prevent the development of chronic pain, anxiety, and depressive symptoms in those adolescents who already have chronic pain.

The functions of binge eating scale (FBES): Development and preliminary psychometric validation.

OBJECTIVE: Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs). METHOD: The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity. RESULTS: Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs. DISCUSSION: Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.

The impact of maternal childhood maltreatment on child externalizing behaviour and the mediating factors underlying this association: a three-level meta-analysis and systematic review.

Child maltreatment can negatively impact not only survivors but also survivors' children. However, research on the intergenerational effect of maternal childhood maltreatment on child externalizing behaviour has yielded contradictory results and has not yet been systematically synthesised. The current three-level meta-analysis and systematic review aimed to provide a quantitative estimate of the strength of the association between maternal childhood maltreatment and child externalizing behaviour and to summarise research on potential mediating factors of this association. PsycINFO, PubMed, and Embase were searched and 39 studies with 82 effects sizes were included in the meta-analysis. Results revealed a small significant association between maternal childhood maltreatment and child externalizing behaviour (r = 0.16; 95% CI 0.12-0.19; publication bias-adjusted effect size: r = 0.12, 95% CI 0.08-0.16). Maternal mental health, particularly depressive symptoms, maternal parenting and children's maltreatment exposure were the most frequently examined mediators of this association, with relatively robust mediating effects for children's maltreatment exposure and maternal depressive symptoms, but mixed evidence for the mediating role of maternal parenting. This meta-analysis provides evidence for a small but significant association between maternal childhood maltreatment and children's externalizing behaviour, emphasizing the need to develop effective preventive and intervention strategies to minimise the effects of childhood maltreatment on the next generation.

Childhood maltreatment and trauma is common and severe in body dysmorphic disorder.

BACKGROUND: Childhood maltreatment and trauma may be risk factors for the development of body dysmorphic disorder (BDD). However, the limited research to date on these topics has been constrained by either the absence of a matched healthy control group or non-comprehensive assessments. METHODS: This study assessed the prevalence and severity of childhood maltreatment and other traumatic events in 52 BDD participants (56% female) and 57 matched controls (51% female) with no history of mental illness, using the Childhood Trauma Questionnaire and a checklist assessing broader traumatic events. RESULTS: In comparison with controls, participants with BDD showed a higher prevalence of emotional abuse (61.5% vs. 33.3%) and physical neglect (59.6% vs. 28.1%), as well as more severe overall maltreatment, emotional abuse, and emotional and physical neglect. BDD participants were also more likely to meet cut-offs for multiple types of maltreatment and reported an elevated number and variety of broader traumatic childhood events (e.g., life-threatening illness). In BDD, increasingly severe maltreatment was correlated with greater severity of BDD symptoms, anxiety and suicidal ideation. CONCLUSIONS: These data suggest that childhood maltreatment and exposure to other traumatic events are common and severe in BDD and are cross-sectionally associated with the severity of clinical symptoms. Adversity linked to maladaptive family functioning during childhood may therefore be especially relevant to people with BDD and could relate to social and emotional processing problems in the disorder.

Factors Related to Providers Screening Children for Behavioral Health Risks in Primary Care Settings.

PURPOSE: To provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks. DESIGN AND METHODS: Participants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview. RESULTS: Almost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health. CONCLUSIONS: Findings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks. PRACTICE IMPLICATIONS: Protocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.

Child and Adolescent Forensic Psychiatry Examination and Analysis of U.S. Citizen Children with Illegal Immigrant Parents Facing Deportation.

Although the citizenship clause of the fourteenth amendment guarantees citizenship to persons born in the United States, the 1996 Immigration Act does not allow illegal immigrant parents to avoid deportation unless such deportation would cause extreme and exceptional hardship to a U.S. citizen relative. This paper reviews the potential adverse effects of such deportation on a child. It presents 12 cases where child and adolescent forensic psychiatric evaluations of U.S. citizen children supported their immigrant parents' petitions for legal resident status. Parent-child attachment, as well as the child's educational status, language proficiencies, acculturation to U.S. culture, and psychiatric distress at the potential deportation, are the factors most helpful in elucidating a child's reaction to this threatened deportation. During the child and adolescent psychiatry evaluations, the parents were interviewed, school records were reviewed and, where appropriate, pediatric records were considered. All the children were examined alone and then as a family unit with their parents using standard DSM-IV-TR diagnostic criteria [1]. Firstly, considering their clinical diagnoses, a clinical prognosis was made for the possibility if the child were to be forced to go to their parents' country of origin with their deported illegal immigrant parent(s). Secondly, each case was examined and analyzed individually to determine the clinical prognosis of the U.S. citizen child if they were to stay in the United States while the illegal immigrant parent(s) was forced to leave. In all of the 12 cases, there was already pre-existing anxiety in the children secondary to the fear of a negative outcome for the parents in the immigration legal cases. In all of the 12 cases it was also determined that the prognosis for the child's adjustment to being without their parent but remaining in the US would have produced a significant exacerbation of the psychopathology already seen. Furthermore, in all of the 12 cases, were the children to be relocated to their parental culture, unfamiliar to the child's American culture, again, the prognosis was made that a significant exacerbation of psychopathology would occur. On the basis of the findings of the child and adolescent psychiatric evaluations and analyses presented to the court, all of the illegal immigrant parents were permitted to receive permanent resident status.

How Do We Move Forward With Trauma-Informed Care?

Trauma is not limited to adverse childhood events or abuse, but also a host of situations of loss, chronic stressors, and now the COVID-19 pandemic. Interprofessional teams must be able to recognize and treat trauma on the frontlines and behind the scenes. Understanding, assessing, and educating staff and patients on trauma, its physical and mental effects, and using trauma-informed approaches in practices throughout the health care system is vital for nursing and the multidisciplinary team. We provide an overview of trauma and its effects and how to help patients at all levels of recovery moving forward.

Screening for Adverse Childhood Experiences: Literature Review and Practice Implications.

Adverse childhood experiences (ACEs) are linked with negatively impacting child and adult health outcomes. Clinicians are integral in identifying childhood adversities and offering supportive measures to minimize negative effects. This systematic literature review included 13 ACE studies that examined the acceptability, feasibility, and implementation of ACE screenings from the perspectives of clinicians and patients. The findings of this review can assist clinicians in considering the appropriateness of ACE screenings for their patients and the ethical and practical issues that must be addressed for effective screening implementation.

Association between adverse childhood experiences, bullying, self-esteem, resilience, social support, caries and oral hygiene in children and adolescents in sub-urban Nigeria.

BACKGROUND: Adverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases. METHODS: This was a secondary analysis of data collected through a cross-sectional school survey of children 6-16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression. RESULTS: Of the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85-0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97-1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09-1.17; p = 0.03). CONCLUSION: There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort.

BACKGROUND: Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset. METHODS: Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes. RESULTS: T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2-3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (ORadj = 1.14; 95% CI 1.02-1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI). CONCLUSION: ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.

Adverse Childhood Experiences and Early Initiation of Marijuana and Alcohol Use: The Potential Moderating Effects of Internal Assets.

INTRODUCTION: Early adolescence is a critical risk period for initiation of substance use. Internal assets (IAs), which are individual qualities guiding positive choices, and adverse childhood experiences (ACEs) are important protective and risk factors, respectively, against substance use. The purpose of this study is to investigate whether IAs modify associations between ACEs and early initiation of alcohol and marijuana use. METHOD: Data were from 9th and 11th graders who completed the 2013 Minnesota Student Survey (n = 79,339). Students reported on experiences of abuse, household dysfunction, and substance use. Multivariable logistic regressions examined associations between different types of ACEs and substance use. Interactions between IAs and ACEs were added to models to test effect modification. For significant interactions, main effects models were re-estimated at different percentiles of IAs. RESULT: IAs moderated associations of both abuse and household dysfunction with early initiation of marijuana (p <.003) and alcohol (p =.007) for females but not for males. For females with low IAs, odds of early initiation of marijuana were approximately twice as high as students without any ACEs. A similar pattern was detected for females' initiation of alcohol use. No effect modification was detected for IAs and experiencing only abuse or household dysfunction on initiation. CONCLUSION: Special attention should be paid to improving IAs among girls who have already experienced ACEs. Future research should examine protective factors that buffer the effects of ACEs for boys.

Childhood Stress and Adversity is Associated with Late-Life Dementia in Aboriginal Australians.

OBJECTIVES: High rates of dementia have been observed in Aboriginal Australians. This study aimed to describe childhood stress in older Aboriginal Australians and to examine associations with late-life health and dementia. DESIGN: A cross-sectional study with a representative sample of community-dwelling older Aboriginal Australians. SETTING: Urban and regional communities in New South Wales, Australia. PARTICIPANTS: 336 Aboriginal and/or Torres Strait Islander Australians aged 60-92 years, of whom 296 were included in the current analyses. MEASUREMENTS: Participants completed a life course survey of health, well-being, cognition, and social history including the Childhood Trauma Questionnaire (CTQ), with consensus diagnosis of dementia and Alzheimer disease. RESULTS: CTQ scores ranged from 25-117 (median: 29) and were associated with several adverse childhood indicators including separation from family, poor childhood health, frequent relocation, and growing up in a major city. Controlling for age, higher CTQ scores were associated with depression, anxiety, suicide attempt, dementia diagnosis, and, specifically, Alzheimer disease. The association between CTQ scores and dementia remained significant after controlling for depression and anxiety variables (OR: 1.61, 95% CI: 1.05-2.45). In contrast, there were no significant associations between CTQ scores and smoking, alcohol abuse, diabetes, or cardiovascular risk factors. CONCLUSIONS: Childhood stress appears to have a significant impact on emotional health and dementia for older Aboriginal Australians. The ongoing effects of childhood stress need to be recognized as people grow older, particularly in terms of dementia prevention and care, as well as in populations with greater exposure to childhood adversity, such as Aboriginal Australians.

The Relationship of Adverse Childhood Events to Smoking, Overweight, Obesity and Binge Drinking Among Women in Hawaii.

OBJECTIVES: To evaluate how the associations of adverse childhood events (ACEs) with smoking, overweight, obesity and binge drinking differ by race/ethnicity among women, including a large, understudied cohort of Asians and Native Hawaiians/Pacific Islanders (NHOPIs). METHODS: The number and type (household dysfunction, and physical, verbal and sexual abuse) of ACEs were examined in relation to adulthood smoking, overweight, obesity and binge drinking among 3354 women in Hawaii using the 2010 Behavioral Risk Factor Surveillance System data using Poisson regression with robust error variance. We additionally investigated for interaction by race/ethnicity. Covariates included age, race/ethnicity, education, emotional support, healthcare coverage, and the other health outcomes. RESULTS: Overall, 54.9 % reported at least 1 ACE. The prevalence of smoking (PR = 1.40 (1 ACE) to PR = 2.55 [5+ ACEs]), overweight (PR = 1.22 [1 ACE] to PR = 1.31 [5+ ACEs]) and obesity (PR = 1.00 [1 ACE] to PR = 1.85 [5+ ACEs]) increased with increasing ACE count. Smoking was associated with household dysfunction (PR = 1.67, CI = 1.26-2.22), and physical (PR = 2.04, CI = 1.50-2.78) and verbal (PR = 1.62, CI = 1.25-2.10) abuse. Obesity was also significantly related to household dysfunction (PR = 1.22, CI = 1.01-1.48), and physical (PR = 1.36, CI = 1.10-1.70), verbal (PR = 1.35, CI = 1.11-1.64) and sexual (PR = 1.53, CI = 1.25-1.88) abuse. Among Asians, sexual abuse was associated with a lower prevalence of binge drinking (PR = 0.26, CI = 0.07-0.93), which was significantly different from the null association among Whites (interaction p = 0.02). CONCLUSION: Preventing/addressing ACEs may help optimize childhood health, and reduce the likelihood of smoking/obesity among women including Asians/NHOPIs. Further studies are warranted to evaluate the sexual abuse-binge drinking association among Asians, which may support the need for culturally-tailored programs to address ACEs.

Double whammy: Adverse childhood events and pain reflect symptomology and quality of life in women in substance abuse treatment.

BACKGROUND: This study examined the profiles of symptoms and health-related quality of life (QOL) of women in substance abuse treatment, comparing those with higher versus lower histories of adverse childhood events (ACE), and those with versus without current pain. METHODS: Adult women in outpatient substance abuse treatment (n = 30) completed questionnaires (cross-sectional study) on topics including drug use, adverse childhood events (ACE), QOL, functional ability, current pain, and depression. RESULTS: Women with pain indicated significant differences in emotional (p < 0.05), and functional ability (p < 0.01); but no significant differences were found between women with high versus low levels of ACE. Yet, radar plots of women with both current pain and high levels of ACE, versus those without, portrayed a distinctive profile indicating high levels of anxiety and depression. CONCLUSIONS: Rather than a checklist, visual composites of symptoms experienced by women in substance abuse treatment illustrates areas of concern in the overall status of women in substance abuse treatment.