BACKGROUND Developmental trauma depending on a number of factors may lead to later adult health risks and is an increasing public health concern especially in states with predominantly rural populations. Oklahoma remains one of the highest states in America of ACEs counts, therefore more refined research methods in quantifying ACEs are vital for ensuring proper statewide interventions. OBJECTIVE Create the methodology to assess ACE severity in Oklahoma at the county level by both quantity of ACE rates as well as severity over time. METHODS County-level data for six ACEs (mental illness, divorce, neglect, physical abuse, and substance use) were collected from Oklahoma Department of Human Services, Oklahoma State Department of Health, and Oklahoma Community Mental Health Centers for the years 2010-2018. First, an All ACEs Score (AAS) was created by standardizing and adding county rates for each ACE. Second, an Adversity Severity Index (ASI) was calculated through above-mean tabulation of county ACE rates compared to the state mean, over the years of study data. Data analysis was conducted in 2022. RESULTS Mental illness and substance use showed the highest rates at the state level. ASI scores ranged from 0 to 6, with four nonmetro counties (Adair, McCurtain, Muskogee, and Pittsburg) receiving a score of 6. CONCLUSIONS OASIS involves identification of counties where ACEs are most prevalent, allowing for the prioritization of interventions in these “hot spot” counties. A further analysis of other upstream factors, including Social Determinants of Health, can be explored and examined for correlation. Future efforts will center on adding additional ACEs, improving data collection, adding adverse outcome rates (such as violence, medical disorder prevalence, etc), and validity testing.
Background Developmental trauma depending on several factors may lead to later adult health risks and is an increasing public health concern, especially in states with predominantly rural populations. Oklahoma remains one of the states in America with the highest count of adverse childhood experiences (ACEs); therefore, more refined research methods for quantifying ACEs are vital for ensuring proper statewide interventions. Objective While data sets already exist at the state level measuring specific ACEs like divorce or child abuse, the state currently lacks a single source for specific ACEs that can incorporate regions to allow for the identification of counties where ACEs are especially high. This county identification will allow for assessing trends in adversity prevalence over time to indicate where targeted interventions should be done and which counties experience amplified long-term consequences of high ACE rates. Thus, the model for the Oklahoma Adversity Surveillance Index System (OASIS) was born—a public health tool to map ACEs at the county level and grade them by severity over time. Methods County-level data for 6 ACEs (mental illness, divorce, neglect, child abuse, domestic violence, and substance use) were collected from the Oklahoma Department of Human Services, Oklahoma State Department of Health, and Oklahoma Community Mental Health Centers for the years 2010 to 2018. First, a potential ACEs score (PAS) was created by standardizing and summing county rates for each ACE. To examine the temporal change in the PAS, a bivariate regression analysis was conducted. Additionally, an ACEs severity index (ASI) was created as a standardized measure of ACE severity across time. This included scoring counties based on severity for each ACE individually and summing the scores to generate an overall ASI for each county, capturing the severity of all ACEs included in the analysis. Results Mental illness and substance use showed the highest rates at the state level. Results from the regression were significant (F1,76=5.269; P=.02), showing that county PAS showed an increase over years. The ASI scores ranged from 0 to 6, and 4 Oklahoma counties (Adair, McCurtain, Muskogee, and Pittsburg) received a score of 6. Conclusions OASIS involves the identification of counties where ACEs are most prevalent, allowing for the prioritization of interventions in these “hot spot” counties. In addition, regression analysis showed that ACEs increased in Oklahoma from 2010 to 2018. Future efforts should center on adding additional ACEs to the ASI and correlating adverse outcome rates (such as violence and medical disorder prevalence) at the county level with high ASI scores.
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