Current state of screening high-ACE youth and emerging adults in primary care

Pardee, Michelle; Kuzma, Elizabeth K; Dahlem, Chin Hwa; Boucher, Nathalie; Darling-Fisher, Cynthia S.

doi:10.1002/2327-6924.12531

Cited by 26 publications

(15 citation statements)

References 21 publications

(43 reference statements)

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“…Finkelhor (2017) has suggested that screening for these adverse childhood experiences may be premature, arguing that clinically efficient tools for such screening are currently lacking. Other scholars have noted a lack of specificity with regard to identifying individuals at greatest risk for future health problems and a lack of consensus as to which types of adversity are the most important predictors of higher CRP and cardiovascular risk (Pardee et al ., 2017). While our results and those of others (Danese et al ., 2007, 2008) confirm a relationship between childhood maltreatment and risk for chronic inflammation, these new findings suggest that caution is needed before screening for adverse childhood experiences with self-report inventories is implemented on a large-scale basis.…”

Section: Discussionmentioning

confidence: 99%

Do documented records and retrospective reports of childhood maltreatment similarly predict chronic inflammation?

Osborn

Widom

2019

Psychol. Med.

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BackgroundChildhood adversities have been associated with chronic inflammation and risk for cardiovascular disease. With some exceptions, existing knowledge of this relationship is based on retrospective self-reports, potentially subject to recall bias or memory problems. We seek to determine whether childhood maltreatment is associated with higher C-reactive protein (CRP) later in life and whether individuals with official and retrospective self-reports of maltreatment and men and women show similar increases in risk.MethodsData are from in-person interviews in 2009–2010 with 443 offspring (mean age = 23.4) of parents in a longitudinal study of the consequences of childhood maltreatment. Official reports of maltreatment were abstracted from 2011–2013 Child Protective Services records. Eleven measures were used to assess self-reported maltreatment retrospectively. Seventeen percent of offspring had official reports, whereas self-reported prevalence rates ranged from 5.4% to 64.8%. CRP was assessed through blood spot samples. Regression models were used to estimate the effect of maltreatment on inflammation, adjusting for age, sex, race, parent occupational status, current depression, smoking, and heavy drinking.ResultsIndividuals with official reports of child maltreatment and, specifically, physical abuse, had significantly higher levels of CRP than non-maltreated individuals. Maltreated females showed elevated CRP, independent of control variables, whereas no significant association was observed in males. Retrospective self-report measures of child maltreatment did not predict elevated CRP.ConclusionsIndividuals with documented histories of childhood maltreatment are at increased risk for chronic inflammation and may benefit from targeted interventions. The results strengthen inferences about the effects of childhood maltreatment on inflammation in females.

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Section: Discussionmentioning

confidence: 99%

Do documented records and retrospective reports of childhood maltreatment similarly predict chronic inflammation?

Osborn

Widom

2019

Psychol. Med.

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“…Despite results indicating the key role that positive experiences in childhood can play in predicting later health and wellbeing in the context of adversity, this body of research has not been fully integrated into public health and policy. Alternatively, screening for adults' histories of ACEs or their children's current ACEs is more commonly recommended in some areas of primary care and pediatrics, particularly in communities where children might be at high risk for ACEs (Bright et al 2015;Glowa, Olson, and Johnson 2016;Pardee et al 2017). The inclusion of instruments to examine positive childhood experiences, in addition to the more common screening of adversity, is essential to better understanding the resilience resources linked to better long-term adaptation and the mechanisms through which both adverse and positive childhood experiences interplay to predict adulthood and intergenerational adaptation.…”

Section: Positive Childhood Experiences As a Counterpart To Childhood Adversitymentioning

confidence: 99%

Assessment and screening of positive childhood experiences along with childhood adversity in research, practice, and policy

Merrick

Narayan

2020

Journal of Children and Poverty

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Despite empirical evidence documenting the role of positive childhood experiences in predicting adaptation over the lifespan and across generations, this research has not yet been fully integrated into public health and policy efforts. We argue that adults' benevolent childhood experiences (BCEs) should be measured in large-scale data collection efforts, such as statewide surveys, alongside more routinely collected adverse childhood experiences (ACEs). We also outline several recommended strategies in which the assessment and screening of positive childhood experiences could be implemented as a counterpart to community health and primary care screening for childhood adversity in adults, with short-and long-term benefits. Pediatric physicians should screen children and adolescents for their current positive childhood experiences as well. The assessment of positive childhood experiences is essential to empirically identifying resilience resources linked with better long-term adaptation, understanding how positive experiences may counteract the longterm effects of childhood adversity in underserved and traumatized individuals, informing medical providers' knowledge about patients' strengths in addition to challenges, and instilling hope in individuals and families experiencing stress.

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“…There is an urgent need to develop interventions to mitigate the impact of ACEs on adolescent and women’s sexual and reproductive health, especially in delaying sexual initiation among Black women. The incorporation of ACE screening during routine care can help identify the most at-risk individuals to facilitate referrals, undergo targeted interventions, and help to delay sexual initiation and its associated consequences [45, 46]. Parent-based interventions and adolescent-only interventions have demonstrated success in delaying sexual initiation.…”

Section: Discussionmentioning

confidence: 99%

Adverse childhood experiences (ACEs) are associated with forced and very early sexual initiation among Black women accessing publicly funded STD clinics in Baltimore, MD

et al. 2019

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Purpose To examine the association between adverse childhood experiences (ACEs) and early sexual initiation. Methods We analyzed retrospective data of (n = 241) Black women recruited from public STD clinics in Baltimore, MD. Multinomial logistic and linear regression models estimated associations between ACEs and early sexual initiation; contextual variables at initiation were examined as mediators. Results Twelve percent of our sample reported very early sexual initiation (11–12 years) and 29% reported early sexual initiation (13–14 years). Each additional ACE reported was associated with greater risk of very early sexual initiation (RRR = 1.49; 95%CI:1.23,1.80). Specifically, emotional abuse (RRR = 3.71; 95%CI:1.55,8.89), physical abuse (RRR = 9.45; 95%CI:3.56,25.12), sexual abuse (RRR = 8.60; 95%CI:3.29,22.51), witnessing maternal abuse (RRR = 5.56; 95%CI:2.13,14.52), and household substance misuse (RRR = 3.21; 95%CI:1.38,7.47) at or before the age of 18 were associated with very early sexual initiation. As for context of initiation, age at sexual initiation was younger if the man at initiation was a non-partner (ß = -0.88; 95%CI:-1.36,-0.40), was ≥3 years older (ß = -1.30; 95%CI:-1.82,-0.77), had pressured or forced sexual intitiation (ß = -1.09; 95%CI:-1.58,-0.59), and was under the influence of drugs/alcohol (ß = -0.97; 95%CI:-1.62,-0.32). Contextual variables at first sex, including being pressured or forced, and the man being ≥3 years older fully mediated the association between ACEs and early sexual initiation. Conclusions This study highlights the critical need to develop interventions that reduce the impact of ACEs on women’s health and delay age at sexual initiation. Health education efforts are needed for clinicians and parents to identify and prevent childhood abuse and to identify and report sexual coercion and abuse for girls and adolescents.

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Current state of screening high-ACE youth and emerging adults in primary care

Cited by 26 publications

References 21 publications

Do documented records and retrospective reports of childhood maltreatment similarly predict chronic inflammation?

Do documented records and retrospective reports of childhood maltreatment similarly predict chronic inflammation?

Assessment and screening of positive childhood experiences along with childhood adversity in research, practice, and policy

Adverse childhood experiences (ACEs) are associated with forced and very early sexual initiation among Black women accessing publicly funded STD clinics in Baltimore, MD

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