Exploring Parents’ Adversities in Pediatric Primary Care

Bair-Merritt, Megan; Zuckerman, Barry

doi:10.1001/jamapediatrics.2015.4459

Cited by 25 publications

(19 citation statements)

References 7 publications

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“…Mental health treatment also has been effective [47,48]. Clinical integration of screening for early life adversity is important [49][50][51] In addition to screening, health care providers should address behavioral risks associated with ACEs, including alcohol and drug use, smoking, weight problems, and eating disorders [17,19,24,[52][53][54][55][56][57][58].…”

Section: Discussionmentioning

confidence: 99%

Disease burden of adverse childhood experiences across 14 states

et al. 2020

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Objective To examine whether the relationship between Adverse Childhood Experiences (ACEs) and health outcomes is similar across states and persists net of ACEs associations with smoking, heavy drinking, and obesity. Methods We use data from the Behavioral Risk Factor Surveillance System for 14 states. Logistic regressions yield estimates of the direct associations of ACEs exposure with health outcomes net of health risk factors, and indirect ACEs-health associations via health risk factors. Models were estimated for California (N = 22,475) and pooled data from 13 states (N = 110,076), and also separately by state. Results Exposure to ACEs is associated with significantly higher odds of smoking, heavy drinking, and obesity. Net of these health risk factors, there was a significant and graded relationship in California and the pooled 13-state data between greater ACEs exposure and odds of depression, asthma, COPD, arthritis, and cardiovascular disease. Four or more ACEs were less consistently associated across states with cancer and diabetes and a dose-response relationship was also not present. There was a wide range across individual states in the percentage change in health outcomes predicted for exposure to 4+ ACEs. ACEs-related smoking, heavy drinking, and obesity explain a large and significant proportion of 4+ ACEs associations with COPD and cardiovascular disease, however some effect, absent of risk behavior, remained. Conclusions ACE's associations with most of the health conditions persist independent of behavioral pathways but only asthma, arthritis, COPD, cardiovascular disease, and depression consistently exhibit a dose-response relationship. Our results suggest that attention to child

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Section: Discussionmentioning

confidence: 99%

Disease burden of adverse childhood experiences across 14 states

et al. 2020

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“…Numerous studies have explored the effectiveness of screening of childhood adversities in primary care, and have seen promising findings overall in improved outcomes related to healthcare costs, quality of care, feasibility, and reduced maltreatment prevalence [40][41][42][43]. However, careful consideration of clinical integration of screening for early life adversity is also important and requires ongoing research [44][45][46]. In addition to screening, health care providers should address behavioral risks associated with ACEs, such as alcohol and drug use, smoking, weight problems, and eating disorders [19,[47][48][49][50].…”

Section: Discussionmentioning

confidence: 99%

Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences

Miller

Waehrer

et al. 2020

PLoS ONE

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ObjectivesTo estimate the adult health burden and costs in California during 2013 associated with adults' prior Adverse Childhood Experiences (ACEs). MethodsWe analyzed five ACEs-linked conditions (asthma, arthritis, COPD, depression, and cardiovascular disease) and three health risk factors (lifetime smoking, heavy drinking, and obesity). We estimated ACEs-associated fractions of disease risk for people aged 18+ for these conditions by ACEs exposure using inputs from a companion study of California Behavioral Risk Factor Surveillance System data for 2008-2009, 2011, and 2013. We combined these estimates with published estimates of personal healthcare spending and Disability-Adjusted-Life-Years (DALYs) in the United States by condition during 2013. DALYs captured both the years of healthy life lost to disability and the years of life lost to deaths during 2013. We applied a published estimate of cost per DALY.Estimates of the costs of childhood adversity are far greater than previously understood and provide a fiscal rationale for prevention efforts. PLOS ONE | https://doi.org/10.1371/journal.pone.

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“…Health professionals providing maternity care may consider screening for ACEs and current adversities, depressive symptoms, and caregiver health, and in response provide services or refer to other providers before delivery. 47,48 Examples of such would be home visiting services to help alleviate the stress of parenting and to foster mother-child attachment. 49,50 With mothers' consent, maternity care providers may also consider communicating with the infants' pediatricians about maternal exposure to adversity, because pediatric settings can often connect families to social and economic supports that may prevent further risks.…”

Section: Discussionmentioning

confidence: 99%

“…51,52 Pediatric clinical settings may also use evidence-based screeners to assess parents for risk factors known to be associated with ACEs, such as intimate partner violence, substance abuse, and mental health problems. 48 Beyond the clinic, attempts to promote positive parenting include Triple P (Positive Parenting Program) and the Nurse-Family Partnership. 53 If future studies can identify clear evidence that depression and maternal health mediate the association between ACEs and PEDS, providing comprehensive treatment for mothers with depression and with overall fair/poor health may also mitigate associations between maternal ACEs and her child's developmental risk.…”

Section: Discussionmentioning

confidence: 99%