Identifying adverse childhood experiences in pediatrics to prevent chronic health conditions

Barnes, Andrew J.; Anthony, Bruno J.; Karatekin, Canan; Lingras, Katherine A.; Mercado, Rebeccah; Thompson, Lindsay A.

doi:10.1038/s41390-019-0613-3

Cited by 77 publications

(58 citation statements)

References 84 publications

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“…Notably, ACEs surveys do not typically include housing status, so even if ACEs surveillance became a routine part of pediatric or community healthcare, housing experiences and/or needs might not be considered without additional screening. While some clinical systems have piloted methods to screen for social determinants of health, including housing and ACEs, efforts are widely variable and lack consistent protocols across the field [ 50 – 53 ]. As such efforts advance, our results – and those of others showing that even unstable or precarious housing is associated with health risks for children [ 54 , 55 ] – suggest that the context of housing will be important to specify (i.e., within social determinants of health screening protocols that may include ACEs) because it is differentially associated with health risks.…”

Section: Discussionmentioning

confidence: 99%

Health and adverse childhood experiences among homeless youth

et al. 2021

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Background Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health. Methods Using data from 119,254 8th–11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates. Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p < 0.001), such that ACE-related health risks were moderated by housing status. Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Experiencing homelessness, whether unaccomapnied or with family, is associated with increased health risk, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

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Section: Discussionmentioning

confidence: 99%

Health and adverse childhood experiences among homeless youth

et al. 2021

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“…While some clinical systems have piloted methods to screen for social determinants of health, including housing and ACEs, efforts are widely variable and lack consistent protocols across the field. [45][46][47][48] As such efforts advance, our results -and those of others showing that even unstable or precarious housing is associated with health risks for children 49,50 -suggest that the context of housing will be important to specify (i.e., within social determinants of health screening protocols that may include ACEs) because it is differentially associated with health risks.…”

Section: Discussionmentioning

confidence: 52%

Health and Adverse Childhood Experiences Among Homeless Youth

Barnes

Gower

Sajady

et al. 2020

Preprint

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Background and Objectives Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.Methods Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p<0.001), such that ACE-related health risks were moderated by housing status.Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Being homeless unaccompanied is also riskier than being homeless with family, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

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“…In spite of these limitations, the devastating nature of toxic stress is too extreme to ignore 31 . Ongoing research suggests the benefit of screening for ACEs and intervening to reduce their negative effects 32 . The results of this survey indicate that parents of children with CF and adults with CF are willing to disclose ACEs for research, prefer categorical ACE screening like that created by CYW to disclosure of specific events, and prefer not to disclose ACES during routine CF care.…”

Section: Discussionmentioning

confidence: 94%

Preferences for disclosing adverse childhood experiences for children and adults with cystic fibrosis

Williams

Jain

Laguna

et al. 2021

Pediatric Pulmonology

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Introduction The 2017–2018 National Survey of Children's Health estimates that 30 million (42%) US children have experienced at least one adverse childhood experience (ACE), including abuse, neglect, and household dysfunction. ACEs negatively impact long‐term health, and there has been no study of ACEs in cystic fibrosis (CF). We assessed willingness to disclose ACEs experienced by children with CF by surveying their parents and adults with CF. Methods We anonymously surveyed parents of children with CF and adults with CF at the Northwestern University/Lurie Children's CF Center to determine their willingness to disclose ACEs. Results The survey was completed by 46/157 (29%) parents and 36/105 (34%) adults with CF. Few parents (22%) and adults (17%) were willing to discuss most or all specific ACEs, more were willing to disclose the number of ACEs experienced in a category (57% parents, 47% adults), and the majority were willing to participate in anonymous research about ACEs (76% parents, 67% adults). Most parents (63%) and adults (50%) would prefer to have ACEs screened separately from their CF appointment, and most parents (63%) and adults (56%) wanted to learn more about ACEs from a member of their care team. Conclusions Participants preferred to disclose the number of categorical ACEs rather than specific ACEs and most were open to participating in anonymous ACEs research. More research is needed before implementing screening. Educating patients, parents, and providers about ACEs and appropriate interventions when ACES are identified is needed for both research and clinical applications of ACEs screening.

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Identifying adverse childhood experiences in pediatrics to prevent chronic health conditions

Cited by 77 publications

References 84 publications

Health and adverse childhood experiences among homeless youth

Health and adverse childhood experiences among homeless youth

Health and Adverse Childhood Experiences Among Homeless Youth

Preferences for disclosing adverse childhood experiences for children and adults with cystic fibrosis

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