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The assessment of physical and mental health is an integral part of the process of choosing substitute carers for children and young people. It must be done during adoption, foster care or kinship and special guardian assessments. Medical Advisers for adoption and fostering from a paediatric or general practice background are ideally placed to undertake this review of the GP-completed Adult Health report. Having the knowledge and experience to write evidence-based advice for social workers undertaking the assessment of the substitute carers is paramount. While medical advisers are able to review health conditions in substitute carers which may impact on their ability to care and be emotionally available, they are also able to hold the possible short and long-term needs of a vulnerable and possibly damaged child at the centre of the process. The complexity of children for whom substitute carers are sought has increased and carers need to be resilient, emotionally available and healthy enough to care for and nurture a child until adulthood which can be at 18 years, or beyond if there are additional needs. [ABSTRACT FROM AUTHOR]

Experiencing multiple adverse childhood experiences (ACEs) is associated with alcohol use in female adolescents and emerging adults. Protective and compensatory experiences (PACEs) have been theorized to off-set the health and behavioral consequences from the accumulation of ACEs throughout childhood. This study examines the association between protective experiences and subsequent alcohol and binge alcohol use frequency over one month among female adolescent and emerging adults reporting high and low levels of two ACE dimensions (household dysfunction and emotional abuse/neglect). One hundred 43 females between the ages of 15–24 who indicated at least one binge episode in the past two weeks completed the six-item ACEs scale, the PACEs scale, and demographics at baseline. Alcohol consumption was measured prospectively over the next month during weekly appointments using the timeline follow back approach. Two PACEs factors had significant direct associations, a source of unconditional love was associated with less frequent alcohol use (β = −0.437, 95% confidence interval [CI] -0.744, −0.131, exp(β) = 0.65, p =.005) in the context of high household dysfunction; and having a trusted adult to count on for help and advice (β = −1.373, 95% CI -2.283, −0.464, exp(β) = 0.25, p =.003) predicted fewer binge occasions in the context of high emotional abuse/neglect. Regardless of ACE dimension exposure, nonsport social group membership was associated more frequent alcohol use over the month across all ACE dimensions (β = 0.11-0.74, 95% CI -0.11, 0.74, exp(β) = 1.37 – 1.62, p ≤.002); and having a trusted adult to count on for help and advice was associated with a 5.7 times more frequent of alcohol use among those with low household dysfunction (β = 1.74, 95% CI 0.83, 2.65, exp(β) = 5.70, p <.001). Few PACE items are associated with direct reductions in alcohol outcomes. Indeed, there is consistently heightened risk associated with nonsport group membership for alcohol use frequency, regardless of experiences of childhood adversity. Future research should identify which protective factors have the most potential to off-set alcohol use by ACE dimension. [ABSTRACT FROM AUTHOR]

The long-lasting influence of childhood adversity on mental health is well documented; however empirical research examining how this association extends into older adults is limited. This study operationalises adversity using cumulative risk and latent class analysis (LCA) models to assess how adversity exposure and typologies may predict anxiety and depression in older adults. Data came from the Personality and Total Health (PATH) Through Life Project (N = 2551, age 60–66). Participants retrospectively reported their childhood experiences of domestic adversity on a 17-item scale. Mental health was measured using four validated questionnaires of depression and anxiety. Linear and generalised additive models (GAM) indicated a dose-response relationship, where a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. LCA identified a four-class solution; with high adversity and high parental dysfunction being associated with poorer mental health outcomes while moderate parental dysfunction and low adversity groups scored at healthy levels. Women reported higher overall anxiety than men, but no notable interactions between ACEs and gender were observed. Patterns revealed by LCA were similar to patterns shown by the cumulative risk model. There is a large time gap from childhood to assessment, making our study susceptible to recall bias. Also, our findings were based on cross-sectional data, limiting causal inferences. Childhood adversity had independent and additive contributions to depression and anxiety in older adulthood, and both cumulative risk and person-centred approaches captured this relationship. • Cumulative childhood adversity is linked to anxiety and depression in older adults. • Latent ACE classes were differentially associated with anxiety and depression; but largely explained by cumulative risk. • Evidence suggests a long-term influence of childhood adversity on mental health that stretches into older adulthood. • Assessment of childhood adversity may be useful when screening for mental illness. [ABSTRACT FROM AUTHOR]

La littérature dans le champ des ACEs (Adverse Childhood Experiences) a permis, depuis l'étude princeps réalisée en 1998 par Felitti et son équipe, de rendre compte du lien entre le vécu d'adversité durant l'enfance et l'émergence de problématiques de santé à l'âge adulte. Cette relation entre l'histoire de vie et la santé s'appuie sur un modèle du risque cumulatif. Depuis, différents modèles ont été proposés, mais pour la plupart des études, le modèle cumulatif de l'adversité reste principalement considéré. Bien que pertinent, il présente des limites importantes qui doivent être prises en compte. Il apparaît donc essentiel de disposer d'un état des lieux des modèles existants dans la littérature en tenant compte de leurs intérêts et de leurs limites afin de mieux appréhender les relations entre adversité vécues durant l'enfance et santé à l'âge adulte. Au regard de ce constat, l'objectif de cet article est de dresser un état des lieux des modèles les plus pertinents dans la littérature afin d'en saisir l'importance pour la recherche dans le domaine. Enfin, nous mettrons en perspective les données de la littérature pour proposer le déploiement d'une recherche plus précise dans le champ des ACEs. The literature in the field of ACEs (Adverse Childhood Experiences) has, since the seminal study begun in 1998 by Felitti and his team, provided the link between childhood adversity and the emergence of health problems in adulthood. This relationship between life history and health is based on a cumulative risk model. Since then, different models have been proposed, but for most studies, the cumulative adversity model is the main one considered. This model, although relevant, has important limitations that must be taken into account. It therefore seems essential to take stock of the existing models in the literature in consideration of their interests and their limitations in order to better understand the relationship between adversity experienced during childhood and health in adulthood. The objective of this article is to provide an overview of the most relevant models in the literature so as to understand their importance for research in the field. Finally, we will put the data of the literature into perspective to propose the deployment of more precise research approaches in the field of ACEs. [ABSTRACT FROM AUTHOR]

Le vécu d'ACEs (Adverse Childhood Experiences) est à ce jour considéré comme un déterminant majeur dans la survenue à l'âge adulte de problématiques de santé physiques et psychologiques. Malgré le caractère prolifique de ce domaine de recherche, un certain nombre de flous conceptuels subsistent, dont témoignent notamment l'absence de définition claire des ACEs ou encore leur appellation dans la littérature. Cette faiblesse conceptuelle a des conséquences pour l'étude, non seulement de la gamme d'adversités à considérer et les paramètres à prendre compte (i.e., gravité, temporalité, durée), mais aussi en ce qui concerne les dysfonctionnements qui découlent de cette adversité. Au-delà de l'impact sur la compréhension de ce qu'est ou n'est pas un vécu d'adversité, ces flous rendent particulièrement délicats son évaluation, le recueil de données sur la base de critères suffisamment homogènes, ainsi que l'espoir d'une prévention efficiente. En effet, si l'on veut agir sur les maux de l'adversité, il convient de circonscrire l'objet pour mieux comprendre ses modalités d'expression, ses déterminants et ses conséquences sur la santé. L'objectif de cet article sera de proposer un état des lieux des différentes compréhensions de l'adversité pour clarifier ce concept. Dans le cadre de ce travail, nous avons souhaité nous focaliser sur deux axes principaux, le premier relatif à l'identification du contexte d'émergence des travaux sur les ACEs et le second qui concernera la question au combien crucial de leur conceptualisation. Adverse childhood experiences (ACEs) have been consistently linked with negative physical and mental health outcomes in adulthood. Despite decades of research dedicated this phenomenon, certain inconsistency exists in the literature regarding how ACEs are conceptually defined. This lack of clarification can impact study outcomes, not only in terms of the range of adversities to be considered and parameters to account for (i.e., severity, temporality, duration), but also with regard to the nature of dysfunctions that result from ACEs. Beyond impacting our overall understanding of what adverse experiences encompass, this obscurity concerning their operational definition complicates how they are assessed, the process of collecting data based on homogeneous criteria and ultimately can hinder effective prevention. Indeed, any meaningful advancement towards treating illness associated with ACEs will require more rigorous definition of ACEs to better understand how they manifest and their specific impact on health outcomes. Our objective in this article is to propose a comprehensive inventory of existing definitions of adversity with a view to clarifying this concept. Within the framework of that objective, we focused on two principal axes: the context of the emerging work on ACEs and the critical question of how ACEs are conceptually defined. [ABSTRACT FROM AUTHOR]

Explore factors associated with flourishing and family resilience among children aged 6 months to 5 years old in the 2016 National Survey of Children's Health (NSCH). Cross-sectional analysis of the 2016 NSCH was conducted using Kleinman and Norton's Regression Risk Analysis method to derive adjusted risk measures for logistic regression models to assess factors contributing to (1) child flourishing and (2) child flourishing stratified between resilient and non-resilient families. In multivariable models, resilient families less often reported a child with two or more lifetime ACE exposures (ARD −0.11, 95% CI −0.15, −0.08), more likely to live in a supportive neighborhood (ARD 0.08, 95% CI 0.05,0.11), and more likely to report emotional support in raising children (ARD 0.07, 95% CI 0.12, 0.40). Accounting for ACE exposures, within resilient families, child flourishing was more likely when the child lived in a supportive neighborhood (ARD 0.09, 95% CI 0.03, 0.15), received care in a patient centered medical home (ARD 0.09, 95% CI 0.02,0.15), and when parents reported having emotional support in raising children (ARD 0.10, 95% CI 0.05, 0.17) Within non-resilient families, child flourishing was more likely when parents had emotional support in raising children (ARD 0.15, 95% CI 0.04,0.27). Promoting emotional support for parents may bolster family resilience and help young children to flourish despite adversity. Further research and innovative models of care are needed to optimize the role of pediatric primary care in promoting safe, stable, nurturing relationships and environments for children and families. • Young children are able to flourish despite exposure to adversity. • Parent, family, and neighborhood support promote child flourishing. • When parents are emotionally supported, children are more likely to flourish. • Innovative pediatric primary care models may promote resilience and flourishing. [ABSTRACT FROM AUTHOR]

Since 2013 there have been at least 421 recorded incidents of gunfire on school grounds This study used a critical review of national and local media news reports of 25 American male school shooter cases from 2013 to 2019. Approximately 88% of school shooters had at least one social media account, and 76% posted disturbing content of guns and threatening messages. Over 72% of shooters had at least one reported adverse childhood experience, and 60% reported being bullied in-person or online Professionals who work with adolescents are front-line providers who routinely assess student safety. Social media use is often underassessed, demonstrating a knowledge gap that may reveal insights into the perspective and well-being of adolescents. Inclusion of questions on social media, adverse childhood experiences, and experiences of bullying by pediatric nurses and others may be proactive measures that can help identify, protect, and intervene with at-risk students. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are pervasive and well-recognized as having lasting deleterious effects on the physical and mental health of those who experience them, particularly with accumulated exposure. This study seeks to identify the perspectives of interprofessional health providers on their personal and professional experiences with ACEs, ACEs screening, how to work with people with ACEs, and make recommendations for the field. Sixty-two health professionals and PhD students who completed at least one module of an online course and at least one of the accompanying discussion board sub-prompts. Responses to five course discussion board assignments, each with multiple sub-prompts, were coded to determine and refine major themes and merged with demographic and other background data. From the 561 responses, six themes were identified and used to analyze response patterns. Twenty-nine percent of responses reflected a macro perspective on ACEs; 29 % of responses reflected workplace experiences; 28 % of responses reflected ACEs complexity, 8 % of responses reflected a personal relationship to ACEs, 3 % reflected perspectives on resilience; and 3 % were related to the course. Participants communicated complex understandings of ACEs, demonstrating the relevance and importance of the topic for public health training. Integrating ACEs training into the practice setting provides opportunities to improve the health and lives of those suffering from ACEs, especially when incorporating provider voice and perspectives. [ABSTRACT FROM AUTHOR]

Empirical studies have demonstrated associations between ten original adverse childhood experiences (ACEs) and multiple health outcomes. Identifying expanded ACEs can capture the burden of other childhood adversities that may have important health implications. We sought to identify childhood adversities that warrant consideration as expanded ACEs. We hypothesized that experiencing expanded and original ACEs would be associated with poorer adult health outcomes compared to experiencing original ACEs alone. The 11,545 respondents of the National Longitudinal Surveys (NLS) and Child and Young Adult Survey were 48.9 % female, 22.7 % Black, 15.8 % Hispanic, 36.1 % White, 1.7 % Asian/Native Hawaiian/Pacific Islander/Native American/Native Alaskan, and 7.5 % Other. This study used regression trees and generalized linear models to identify if/which expanded ACEs interacted with original ACEs in association with six health outcomes. Four expanded ACEs—basic needs instability, lack of parental love and affection, community stressors, and mother's experience with physical abuse during childhood —significantly interacted with general health, depressive symptom severity, anxiety symptom severity, and violent crime victimization in adulthood (all p -values <0.005). Basic needs instability and/or lack of parental love and affection emerged as correlates across multiple outcomes. Experiencing lack of parental love and affection and original ACEs was associated with greater anxiety symptoms (p = 0.022). This is the first study to use supervised machine learning to investigate interaction effects among original ACEs and expanded ACEs. Two expanded ACEs emerged as predictors for three adult health outcomes and warrant further consideration in ACEs assessments. [ABSTRACT FROM AUTHOR]

Background: Adverse Childhood Experiences (ACEs) are associated with numerous adverse health outcomes in adulthood. Our objective was to investigate associations between ACEs and sleep measures among 206 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study.Methods: ACEs (independent variable) was assessed using the ACE questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures.Results: The mean self-reported sleep duration was significantly lower among participants who reported ≥1 ACEs compared to those who reported no ACEs (6.0 ± 0.11 vs. 6.4 ± 0.14 h; multivariate-adjusted p = 0.035). Sleep efficiency was significantly lower among participants who reported ≥1 ACEs compared to those who reported none (mean = 88.7%, 95% CI = 87.7-89.6 vs. 90.2%, 89.2-91.2; unadjusted p = 0.031) but was slightly attenuated and lost statistical significance after multivariate-adjustment (88.8%, 87.8-89.7 vs. 90.1%, 88.9-91.1; p = 0.094). Compared to participants who reported no ACEs, those who reported ≥1 ACEs had a higher mean activity index score (36.9 ± 0.96 vs. 31.2 ± 1.25; multivariate-adjusted p = 0.001); a higher mean wake after sleep onset (WASO) (44.3 ± 2.24 vs. 35.3 ± 2.92 min; multivariate-adjusted p = 0.019); and a higher sleep fragmentation index (3.8 ± 1.65 vs. 3.3 ± 1.20 unadjusted p = 0.044 and 3.8 ± 0.13 vs. 3.3 ± 0.18; multivariate-adjusted p = 0.062). Among men (but not women) who reported ≥1 ACEs, self-reported sleep duration was significantly lower (5.9 ± 0.13 vs. 6.4 ± 0.15 h; multivariate-adjusted p = 0.025) and activity index was significantly higher (39.1 ± 1.3 vs. 33.2 ± 1.51; multivariate-adjusted p = 0.004) compared to those who reported no ACEs.Conclusion: Exposure to ≥1 ACE was associated with worse sleep measures. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of adverse childhood experiences (ACEs) and healthcare utilization patterns of children seen in pediatric emergency departments (PEDs).Study Design: In this cross-sectional study, caregivers of patients who presented to 2 urban PEDs completed a survey regarding their children's ACEs, health care utilization patterns, and acceptance of PED-based ACEs screening and resources. Inclusion criteria were English-speaking caregivers of patients 0-17 years of age not requiring acute stabilization. Prevalence estimates were compared with national and state data from the National Survey of Children's Health by calculating risk differences and 95% CIs. The association of cumulative ACEs with caregiver-reported health care utilization patterns was evaluated using ORs.Results: Among 1000 participants, 28.1% (95% CI 25.3-30.9) had 1 ACE; 17.8% (95% CI15.4-20.2) had ≥2 ACEs. Notably, children with higher cumulative ACEs were seen in the PED more frequently (0, 1, ≥2 visits) (OR 1.18, 95% CI 1.06-1.30, P = .002) and more likely to seek care in PEDs for sick visits (OR 1.16, 95% CI 1.04-1.30, P = .01). About 9% of children exposed to ACEs did not have a primary care provider. Over 85% of caregivers reported never discussing ACEs with their primary care provider. Most caregivers felt comfortable addressing ACEs in PEDs (84.4%) and would use referral resources (90.4%).Conclusions: Given higher PED utilization in children with more ACEs and caregiver acceptance of PED-based screening and intervention, PEDs may represent a strategic and opportune setting to both assess and respond to ACEs among vulnerable populations. [ABSTRACT FROM AUTHOR]

Several vulnerability factors for suicidal behavior in U.S. veterans have been identified. However, little is known about factors that differentiate veterans who contemplate suicide from those who attempt suicide. This study examined sociodemographic and clinical characteristics that distinguish veterans who think about suicide from those who attempt suicide. Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed a population-based sample of 4069 veterans. Analyses estimated the lifetime prevalence of suicide ideation (SI) and suicide attempts (SA); and examined differences between veterans with a history of attempt(s), and SI without a history of attempt(s). A total 25.9% of U.S. veterans reported lifetime SI and 3.9% reported a SA. Several factors distinguished veterans with a history of SA from those with SI only: the strongest were younger age (odds ratio [OR] = 0.97, 95% CI = 0.95–0.98), nonsuicidal self-injury (OR = 1.81, 95% CI = 1.11–3.03), adverse childhood experiences (OR = 1.14; 95% CI = 1.06–1.23), alcohol use disorder (OR = 1.99; 95% CI = 1.28–3.12), lower household income (OR = 0.62; 95% CI = 0.40–0.95), and physical disability (OR = 1.69; 95% CI = 1.07–2.70). Although a quarter of U.S. veterans contemplate suicide in their lifetimes, the majority do not attempt suicide. Specific sociodemographic and clinical features may differentiate veterans who contemplate versus attempt suicide. [ABSTRACT FROM AUTHOR]

Purpose: This population-based study explored the associations between childhood adversity and admission to emergency departments (EDs) with non-suicidal self-injury (NSSI) and with a suicide attempt.Methods: A nationally representative cross-sectional sample of 5-17-year-olds admitted to EDs (N = 143,113,677) from 2006 to 2015 was utilized to assess the associations between childhood adversities, NSSIs, and suicide attempts.Results: ED admissions with NSSI and admissions with a suicide attempt were associated with greater odds of exposure to individual childhood adversities (aORs: 1.34 to 5.86; aORs: 2.37 to 15.69, respectively). ED admissions with a suicide attempt were associated with greater odds of exposure to childhood adversities that might be perceived as less extreme or harmful (separation or divorce aOR: 15.69) than other adversities (death of a family member aOR: 13.38; history of physical abuse aOR: 9.56) as well as greater odds of exposure to three or more childhood adversities (aOR: 20.98).Conclusion: Early detection of childhood adversities is important for identifying potential risk factors for self-harm. ED admission data can provide population-level surveillance to aid in these efforts and lead to more targeted and effective interventions aimed at reducing the negative effects of toxic stress that can result from exposure to childhood adversities. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) have been understudied in low- and middle-income countries, especially in sub-Saharan Africa. We explored associations between mental distress, self-harm or suicidality, and HIV risk and individual and cumulative ACEs (sexual, emotional, and physical violence; witnessing community and interparental violence; orphanhood) among youth aged 13–24 in Lesotho. Multivariable logistic regressions stratified by sex using nationally representative 2018 Lesotho Violence Against Children and Youth Survey (n female = 7101; n male = 1467) data. Over 75 % of males and females experienced at least 1 ACE. Among males, physical and community violence were significantly associated with mental distress; orphan status and emotional violence was associated with self-harm/suicidality. Males who witnessed interparental violence had higher odds of disclosing 2 types and 3 or more types of HIV risk versus none. Among females, being a double orphan and having experienced sexual, emotional, physical, community, and interparental violence were significantly associated with mental distress and any self-harm/suicidality in both models. Females who experienced physical violence had higher odds of disclosing 3 or more risk types versus no risk. Statistically significant associations emerged between cumulative ACEs and mental distress, self-harm/suicidality, and higher levels of HIV risk for both males and females. Differential patterns of associations between ACEs and mental health problems and HIV risk emerged by sex. Scalable, integrated individual and community efforts to prevent ACEs, provide mental health supports, and encourage safer sexual behaviors among those exposed are needed and could benefit youth in Lesotho. [ABSTRACT FROM AUTHOR]

Adverse Childhood Experiences (ACEs) are associated with poor mental health outcomes and risk-taking behaviors. Positive childhood experiences (PCEs) may mitigate these negative impacts. This study 1) assessed the associations between ACEs and negative health outcomes and risk-taking behaviors among young adults, and 2) evaluated whether — and which — PCEs moderate the association between ACEs and these outcomes in sub-Saharan Africa. This multi-country analysis combined cross-sectional representative survey data from young adults, ages 18–24 years, from the 2019 Kenya, 2018 Lesotho, 2019 Mozambique, and 2019 Namibia Violence Against Children and Youth Surveys. The association between experiencing any ACEs and each health outcome was assessed using Wald's chi-square tests. Multivariable logistic regression analyses assessed the association between each PCE and each outcome of interest. Females who experienced any ACEs had higher odds of experiencing moderate to severe mental distress (aOR = 2.7, 95%CI: 1.9, 3.9). Males who experienced any ACEs had higher odds of experiencing suicidal/self-harm behaviors (aOR = 6.7, 95%CI: 2.8, 16.0) and substance use (aOR = 2.5, 95%CI: 1.4, 4.2). In females, strong mother-child relationship was protective against moderate to severe mental distress (aOR = 0.7, 95%CI: 0.6, 0.9), suicidal/self-harm behaviors (aOR = 0.6, 95%CI: 0.4, 0.9), and substance use (aOR = 0.6, 95%CI: 0.4, 0.9). For males, a strong mother-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.5, 95%CI: 0.2, 0.9), and a strong father-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.4, 95%CI: 0.2, 0.7) and substance use (aOR = 0.6, 95%CI: 0.4, 0.8). Strong parenting programs may likely play an important role in improving the psychosocial health of young adults. [ABSTRACT FROM AUTHOR]

Background: Research shows individuals experiencing adverse childhood experiences (ACEs) as well as identifying as a man who has sex with other men (MSM) are at an increased risk for mental health issues. Less has been studied, however, on ACEs in MSM; with even fewer studies investigating non-urban (e.g., rural/small town/suburban) MSM, as most research features urban samples. This is problematic due to studies showing that rurality can influence the behavior of MSM. The current study comparatively investigates the impact of ACEs on the mental health of rural/small town/suburban and urban MSM.Methods: Participants included 156 MSM residing in Oklahoma. Linear regression was used to test the association between ACEs' and mental health (anxiety, depressive symptoms, and loneliness). Split-sample regressions were conducted on rural/small town/suburban and urban MSM.Results: ACEs were associated with all three mental health outcomes in the full sample. However, ACEs were significantly linked to anxiety and depressive symptoms only in urban MSM.Limitations: Limitations include a smaller sample size with limited racial/ethnic variations.Conclusions: Results suggest that living in an urban environment may amplify the risks of ACEs, rural/small town/suburban MSM may acquire outside, unique support networks which work to limit the effect of ACEs, or that rural/small town/suburban MSM may manifest the effects of ACEs differently (or a combination of the three). Trauma-informed programming has been shown to effectively reduce mental health issues, yet consideration is generally not given with regards to rurality. Future programming and research should consider rurality/urbanity as influential factor. [ABSTRACT FROM AUTHOR]

Despite facing challenges to mental wellness from ongoing multifold trauma, Indigenous youth continue to galvanize their resilience. One pathway undertaken is embracing technology. The JoyPop™ youth resilience mobile application (app) was invited by Six Nations of the Grand River (SN) leadership to consider its use with their reserve youth. This study explored the feasibility of JoyPop™ research from the SN community adult perspective for appropriateness and relevance to SN youth, as a precursor to a user-experience study with community youth. Semi-structured, online interviews with 19 adult community members (26 % male) about JoyPop™ were conducted with nominated stakeholders from SN. Based on a standard presentation of the app, comments were solicited about app features, design, and relevance to Haudenosaunee culture. Interviews were transcribed, coded in a double-blind fashion, and analyzed for themes. Most offered positive feedback, with some level of support for each feature of JoyPop™. Themes were identified (Need for Indigenous Design , Incorporation of Indigenous Culture , Appreciation of Ease , Flexibility and Personalization), stemming from comments of appraisal and suggestions for adaptations (e.g., incorporating more cultural elements, localized resources, simplification of app). The JoyPop™ app was viewed as positive and relevant, based on feedback from adults within SN. Adaptations were identified by adults to better fit SN youth needs, and research with SN youth is pending before implementation of adaptations. Research with other communities is encouraged to expand the reach of technology interventions, to holistically support Indigenous youth mental health in a culturally relevant way. [ABSTRACT FROM AUTHOR]

Suicide is the second most common cause of death among young individuals (10–25 years). The risk of first occurrence of suicidal behavior increases significantly at the start of adolescence, highlighting the importance of research regarding the association between early life factors, such as adverse childhood experiences (ACEs), and suicidal behaviors. To assess if ACEs are prospectively associated with lifetime suicide attempt and suicidal thoughts at young adulthood. Participants and Setting: Data from 3050 young adults from the 1993 Pelotas Birth Cohort. Discrimination (of any type), financial hardship, maternal common mental disorders (CMD – SRQ-20), parental death, parental divorce and physical abuse were assessed at the 11-year follow-up. Data regarding suicidal thoughts and suicide attempt was assessed at 22 years with Mini International Neuropsychiatric Interview (MINI), version 5.0. Crude and adjusted logistic regression models were estimated. In the adjusted model, those who suffered financial hardship (OR 2.51; 95 % CI 1.66–3.79), parental divorce (OR 1.44; 95 % CI 1.02–2.04) and maternal CMD (OR 1.72; 95 % CI 1.21–2.46) at 11 years were more likely to report suicidal thoughts at 22 years. Also, those who experienced financial hardship (OR 1.71; 95 % CI 1.13–2.58), physical abuse (OR 1.48; 95 % CI 1.08–2.04), discrimination (OR 1.74; 95 % CI 1.20–2.51), maternal CMD (OR 1.67; 95 % CI 1.20–2.32), or parental divorce (OR 1.41; 95 % CI 1.02–1.94) were more likely to report a lifetime suicide attempt. There was a strong association between financial hardship, maternal CMD and divorce during childhood, and suicidal thoughts, such as suicidal ideation or planning, at the beginning of adulthood. Financial hardship, discrimination, divorce, maternal CMD and physical abuse were associated with suicide attempt. These findings demonstrate that mental health support must be available following certain ACEs during childhood, alongside with ACEs prevention. More research is needed on the association between discrimination and suicide attempts, differentiating the nature and impact of each type of discrimination. [ABSTRACT FROM AUTHOR]

Research has consistently found poorer outcomes in adolescents who have been exposed to early interpersonal adversities, especially those in out-of-home placements. The presence of mental health problems also contributes to the perception of a more negative group climate and peer interactions through cascading effects. To analyze the sequential relationships between exposure to adverse childhood experiences (ACEs), trauma-related symptoms, psychological maladjustment, and the perception of group climate and peer interactions. In addition, the study analyzes the mediating role of trauma-related symptoms and psychological maladjustment. The sample comprised 161 adolescents in out-of-home care (46.6 % males, 49.7 % females, 3.7 % non-binary), aged 12–18 (M = 15.22, SD = 1.59) from 24 residential facilities in Spain. This study is part of the VRINEP project. Group care workers reported about ACEs and trauma-related symptoms through online questionnaires, whereas adolescents self-reported about psychological maladjustment, group climate, and peer interactions. Differential associations between ACEs with trauma-related symptoms and internalizing problems were found. The relationship between certain ACEs and externalizing problems was fully mediated by trauma-related symptoms. Likewise, psychological maladjustment was related to a more negative perception of the group climate and peer interactions. Although trauma-related symptoms were not directly associated with the perception of the residential environment, they were indirectly associated with peer relational aggression through externalizing problems. Mental health has a significant impact on the perception of the group climate and peer interactions among adolescents in residential care who have been exposed to ACEs. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs; eg, parental divorce, physical or sexual abuse) are more prevalent in individuals with chronic pain compared with the general population. Both increased maternal ACEs and chronic pain have been associated with poor physical and emotional functioning in offspring. However, the mechanisms driving these associations are poorly understood. Thus, this cross-sectional study evaluated the relation between maternal ACEs, mothers' current functioning, and children's physical and emotional functioning in a sample of mothers with chronic pain and their 8- to 12-year-old children. Results indicated a higher prevalence of ≥1 ACE in this sample of mothers with chronic pain (84%) compared with normative data from a community sample of women. Higher maternal ACE scores corresponded with lower physical and social functioning, greater anxiety and depressive symptoms, greater fatigue and sleep disturbances, and greater pain intensity and pain interference in mothers. Higher maternal ACE scores significantly correlated with higher child self-reported depressive symptoms, but not somatic symptoms or functional impairment. A path model indicated that maternal depressive symptoms accounted for the relation between higher maternal ACE scores and children's depressive symptoms. Intervening on maternal depression among mothers with chronic pain may reduce the impact of intergenerational ACE transmission. Perspective: This article presents evidence regarding the intergenerational impact of ACEs in a large sample of mothers with chronic pain and their school-aged children. Maternal depressive symptoms accounted for the relation between maternal ACEs and children's depressive symptoms providing evidence regarding targets for preventive interventions. [ABSTRACT FROM AUTHOR]

Background: Past research identified individuals who experienced adverse childhood experiences (ACEs) are at a higher risk of drug use. There is evidence to suggest that identifying as a man who has sex with other men (MSM) may increase the likelihood of drug use when adverse childhood experiences are prevalent. However, research has not addressed if this association is present in both rural and urban MSM, as other studies found that rurality/urbanity is a key determinant in detrimental outcomes for MSM. The current study uses ACEs as an independent variable in comparing rural and urban MSM's self-reported marijuana use.Methods: Participants included 156 MSM residing in Oklahoma. Linear regression was used to test ACEs' associations with reported marijuana use. To explore nuanced differences between rural and urban populations, split sample regressions were conducted.Results: ACEs were statistically associated with reported marijuana use in the full sample. However, after splitting the sample, ACEs only predicted reported marijuana use in the urban and not in the rural sample.Conclusions: Results suggest ACEs may affect rural and urban MSM dissimilarly. It is unclear, however, if rural MSM engage in maladaptive behaviors other than marijuana use, or if factors associated with urban environments make urban MSM more vulnerable to illicit drug use when ACEs are high. Regardless, trauma informed programming targeting MSM should consider geographic locale as an influential factor. Further investigation is needed with regards to geographic locale, ACEs, and other illicit drug use in MSM populations. [ABSTRACT FROM AUTHOR]

Abstract Background Prior research suggests that those experiencing adverse childhood experiences (ACEs) may be higher utilizers of the healthcare system. The frequency and financial impact of kept, cancelled and no-showed visits is largely unknown. Objective To examine the impact of adverse childhood experiences (ACEs) on healthcare utilization in a sample of US adults. Participants and Setting Two thousand thirty-eight adult patients who completed an ACE screening within the behavioral health department of a medium sized, Midwestern healthcare system during 2015–2017 were included. Methods Data was extracted retrospectively from 1-year post ACE screen. Results Individuals with high ACEs (4+) made more but kept fewer appointments than those with no or moderate (1–3) ACEs (p < 0.0001). Individuals with high ACES had more late-cancelled and no-showed appointments compared to those with no ACEs (p 's <.0001). Relationships were significant even after controlling for age, gender, and insurance type. Those with high ACEs had the greatest impact on potential lost revenue given that they late-cancelled and no-showed more appointments. Those with high ACEs also had more medical comorbidities, medications, and needed care coordinator than those with moderate or no ACEs (p 's <.05) Conclusions Results from this study should be used to inform providers and health care systems on the effects of adversity on patterns of utilization of health care and encourage innovative strategies to better address the needs of these patients. [ABSTRACT FROM AUTHOR]

Abstract Adverse childhood experiences (ACEs) devastate the lives of children, families and the community. Nearly 35 million children in the United States (US) have experienced one or more types of childhood trauma and nearly a third of youth between ages 12 and 17 have experienced two or more traumatic events. Adverse childhood experiences place an economic toll in the U.S., costing between $5.8 billion and $12.6 billion annually. Child maltreatment costs $124 billion, conservatively. Health Professionals play a major role to prevent and effectively intervene in ACEs. To this end, building a nursing workforce with necessary ACEs knowledge is critical as nursing graduates can make a sustainable impact as they translate knowledge in practice to improve health and health outcomes for children, families and communities. This paper describes how a College of Nursing initiated a systematic integration of ACEs knowledge across BSN curriculum from designing an ACEs Curriculum Integration Model, engaging and enabling faculty in the integration process and how ACEs concepts and contents were integrated. Suggestions are made for ongoing work and evaluations of the effects of ACEs curriculum integration. Highlights • Adverse childhood experiences are child traumatic events that devastate families. • Adverse childhood experiences impact 35 million children in the United States. • Childhood trauma has deleterious effects on adult health and the economy. • Many nurses lack a working knowledge about adverse childhood experiences. • New nursing curriculum model fully integrated adverse childhood experience content. [ABSTRACT FROM AUTHOR]

Abstract Objectives Educational and employment outcomes are critical elements in determining the life course of individuals, yet through health and other mechanisms, those who suffer adverse childhood experiences (ACEs) may experience barriers to achieve in these domains. This study examines the association between ACEs and poor educational outcomes, before considering the impact of ACEs and education on employment in adulthood. Study design Retrospective cross-sectional surveys were conducted in England and Wales using a random stratified sampling methodology. Methods During face-to-face household interviews (n = 2881), data were collected on demographic factors, ACEs, self-rated childhood affluence, the highest qualification level attained and the current employment status. Results While respondents with ≥4 ACEs were significantly more likely to have no formal qualifications (adjusted odds ratio [AOR] = 2.18; P < 0.001), among those who did achieve secondary level qualifications, the presence of ACEs did not further impact subsequent likelihood of going on to attain college or higher qualifications. However, results suggest a persisting independent impact of high (≥4) ACEs, which were found to be significantly associated with both current unemployment (AOR = 2.52, P < 0.001) and long-term sickness and disability (AOR = 3.94, P < 0.001). Modelled levels of not being in employment ranged from as little as 3% among those with 0 or 1 ACE and higher qualifications to 62% among those with no qualifications and ≥4 ACEs (adjusted for age, gender and childhood affluence effects). Conclusions Compulsory education may play a pivotal role in mitigating the effects of adversity, supporting the case for approaches within schools that build resilience and tackle educational inequalities. However, adults with ACEs should not be overlooked and efforts should be considered to support them in achieving meaningful employment. Highlights • Adverse childhood experiences (ACEs) more than double the risk of having no educational qualifications. • ACEs do not limit further attainment once initial educational hurdles are overcome. • Those with ACEs are at much greater risk of unemployment. • Two of the five adults with ≥4 ACEs and secondary qualifications were unemployed. [ABSTRACT FROM AUTHOR]

Abstract Study Objective To identify community priorities, foster awareness of existing supports, and recognize barriers and opportunities to enhance support services for pregnant and parenting teens (PPTs). Design and Setting A modified World Café event incorporated parallel, rotating focus groups with semistructured, case-based discussions of salient issues. The event was organized and took place in Forsyth County, North Carolina. Participants Seventy-eight local health and social service professionals and 15 PPT representatives. Interventions and Main Outcome Measures Qualitative coding was used to thematically analyze transcript data. Quantitative data pre-/post-event comparisons were made using Fisher exact test. Results Key community-based support services for PPTs were identified. Qualitative analysis yielded 10 key codes regarding barriers and opportunities to enhance community-based support services, resulting in 4 themes. Themes included maximizing access and efficient delivery of high-quality health care, engaging a 3-generation approach to meet the current and future needs of at-risk families, focusing efforts to meet the unique needs of each teen and his/her family, and emphasizing teen self-advocacy. Pre/post survey responses were overwhelmingly positive regarding use of the modified World Café format for discussion and network building. Conclusion The modified World Café Method offered a platform to collaboratively identify challenges and opportunities and to develop networks to improve health and well-being of PPTs. Engaging multiple stakeholders in meaningful dialogue might foster multidisciplinary, cross-sector collaboration that mitigates risk and enhances resilience among PPTs and their children. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are associated with negative outcomes over the life course and across generations, including domestic violence (DV) and child maltreatment. However, no studies have examined the connection between parents' ACEs and their child's risk of child protective services (CPS) involvement or possible mechanisms of transmission. In addition to describing the prevalence and correlates of CPS involvement, our primary aims are to test whether parental adversity in childhood is associated with CPS involvement and whether DV victimization mediates the ACE-CPS association. The sample included 3039 primary caregivers and 3343 children served by home visiting programs in Wisconsin between 2014 and 2019. Using matched home visiting and CPS records, we generated prevalence estimates of screened-in CPS reports and assessed bivariate associations between CPS involvement and ACEs, DV, and household demographics. We then conducted a two-stage path analysis to test the association between ACEs and CPS involvement and whether DV mediated the ACE-CPS association. Overall, 22.8 % of caregivers had a screened-in report. Prevalence rates were higher among women who endured ACEs and DV, and they varied by demographic characteristics. ACEs were directly linked to DV and CPS involvement, and there was an indirect pathway linking ACEs to CPS involvement through DV exposure. Home visiting programs serve families that frequently interact with the child welfare system. By enhancing the trauma-responsive potential of these interventions, it may be possible to interrupt intergenerational mechanisms that contribute to child abuse and neglect and CPS involvement. [ABSTRACT FROM AUTHOR]

• Of the 27 studies included, there were 26 instruments used to measure ACEs. • Comparison between studies was challenging due to different methodology approaches. • Many studies lacked explanations for using specific reliability and validity tests. • Standardization in ACE measurement is needed to improve ACE prevalence estimations. The study objectives were to 1) examine what methodological approaches have been used to determine adverse childhood experiences (ACE) prevalence and 2) determine the prevalence of different ACEs. A scoping review was conducted on 2009–2020 articles focused on persons 17 years and younger, highlighting screening and surveillance of ACEs, and evaluating the psychometrics of ACE screening tools. A descriptive analysis categorized results of 27 articles into key methodological themes (i.e., study design, self vs. caregiver reporting, location/setting). Majority of the studies were cross-sectional (81.5%), self-reporting (74.1%) and focused on neglect, bullying/victimization and violence. There were 26 unique instruments used to assess ACEs. The prevalence for ACEs reported in the literature varied widely based on factors such as the type of ACEs examined, instrument, self vs. caregiver reporting, age group, and setting. Synthesis of our findings highlights the need for standardization in ACE measurement as they contribute to variations in ACE prevalence estimations and understanding the overall burden ACEs have on a population. Recommendations for improving ACE measurement among U.S. children and adolescents were provided. [ABSTRACT FROM AUTHOR]

• Latent class analysis was conducted to identify the types of ACEs classes. • A set of regressions was performed to examine the association between ACEs classes and the sub-dimensions of social isolation. • The High abuse and household mental illness group had the most compromised outcomes in terms of social isolation among All ACEs group. • The group characterized by non-violent experiences showed a similar level of social support and loneliness as the Low ACEs group. • ACEs involving violence and ACEs that do not involve violence could result in different outcomes regarding social isolation. Social isolation has emerged as an increasingly important social risk among young South Koreans. Prior research has suggested that social isolation in young people can be the result of the accumulation of negative experiences during childhood. Negative events that occur in childhood leave psychological scars. Although previous studies have explored associations between adverse childhood experiences (ACEs) and psychosocial outcomes, there has been a lack of research into how different patterns of ACEs are associated with social isolation. Therefore, this study aims to (a) examine latent classes of ACEs among South Korean young adults and (b) investigate associations of each latent group of ACEs with social isolation. Data from the 2021 Youth Socio-Economic Reality Survey of Korean National Youth Policy Institute was used, and a total sample of 1,940 individuals aged 19–34 years old was included. For analyses, latent class analysis was conducted to identify the types of classes, and a set of regressions was performed to find the association between classes of ACEs and the sub-dimensions of social isolation (social support, loneliness, social contact). The LCA found four classes of membership within ACEs: High ACEs, High abuse and household mental illness, Moderate economic hardship and loss of close one, and Low ACEs. Unexpectedly, High abuse and household mental illness class showed the most prominent result, followed by High ACEs class. The class of Moderate economic hardship and loss of close one was only significantly associated with the social contact, and it had similar levels of social support and loneliness with the Low ACEs class. The results imply that ACEs involving violence and ACEs without violence could result in different psychosocial outcomes in young adulthood. [ABSTRACT FROM AUTHOR]

An increasing number of companies develop innovative vehicle solutions to further sustainable transportation. One promising direction is the combination of automated, connected, electric and shared (ACES) vehicles. Due to the multitude of stakeholders involved in such an undertaking and their diverging interests, capabilities and roles, a shared vision is essential to foster productive collaboration. This study takes a brand development perspective and evaluates the degree to which stakeholders align regarding the ambition, potential and strategic pathway of the ACES brand. An expert survey involving 28 ACES stakeholders identifies numerous themes on which stakeholders agree, for example, the potential social and environmental benefits of ACES, but also a number where they disagree, for example, the legitimacy of different stakeholders in managing the stakeholder network or the degree to which all four technologies are necessary to create more sustainable mobility solutions. Consequently, the research proposes a shared brand understanding for ACES to help align the often conflicting expectations of different stakeholders. The key recommendation is to ask consumers and cities to play a central role in fostering stronger co-creation and cooperation within the stakeholder network. While the former group is essential to motivate technology providers to continue research efforts, the latter plays a decisive role in creating a regulatory framework that enhances the appeal of ACES in comparison to alternative modes of transport. Further research is necessary to understand the most appealing incentives (whether economic, social or moral) to leverage joint efforts in shaping the ACES brand. [ABSTRACT FROM AUTHOR]

The recent rise in homicide has led to ongoing debate on the role of law enforcement due to research that suggests cynicism in the legal system can be criminogenic and lead to violence. Understanding how and why legal cynicism develops is important to improve police-community relationships and to lower crime. The current study uses a national data set and structural equation modeling to understand how familial factors such as parental incarceration, experiencing adverse childhood experiences, and youth race are predictive of legal cynicism and how this might be mediated through experiencing police stops. Findings suggest race, parental incarceration, and ACEs are all directly predictive of police stops and indirectly predictive of legal cynicism. Only race and parental incarceration directly predict legal cynicism. Given the current concerns over rising violent crime rates in urban cities and the quality and nature of police-citizen interactions, our results provide a timely analysis of risk factors contributing to the development of legal cynicism. Findings suggest that, not only must we be concerned with the well-documented impact of police contact, we should expand our view to include experiences with parental incarceration. Implications for practitioners and criminal justice professionals are discussed. • Understanding how and why legal cynicism develops is important to improve police-community relationships and to lower crime. • Identifying as Black is directly predictive of being stopped by police and directly predictive of exhibiting legal cynicism. • Experiencing parental incarceration is directly predictive of being stopped by police and exhibiting legal cynicism. • Other ACEs are directly predictive of being stopped by police but not directly predictive of exhibiting legal cynicism. • Police stops directly predict legal cynicism. Black race, parental incarceration, and ACEs indirectly predict legal cynicism. [ABSTRACT FROM AUTHOR]

Building on decades of research into the long-term developmental impacts of adverse childhood experiences (ACEs), researchers have called for expanding the ACEs framework to include experiences specific to minoritized identities. Recent empirical research has led to the development of a measure of sexual and gender minority adverse childhood experiences (SGM-ACEs). Within the SGM-specific ACEs framework, research on the long-term impact to adult mental health and the role of perceived social support are not well studied. The purpose of this paper was two-fold. First, examine whether SGM-ACEs adversely impact mental health in SGM adults. Second, examine the role of perceived social support in the association between SGM-ACEs and adult mental health. Data were collected using a multifaceted sampling strategy. In total, 1819 self-identified SGM Texans completed an online survey inquiring about ACEs, SGM-ACEs, mental health, and demographic characteristics. We estimated two competing structural equation models (SEM) examining the associations between SGM-ACEs and anxiety and depressive symptoms, and whether perceived social support may moderate or mediate his association. While both models demonstrated that SGM-ACEs were significantly associated with higher anxiety and depressive symptoms. However, we found more support for the mediation model such that SGM-ACEs had direct effects on anxiety and depressive symptoms, and an indirect effect on anxiety symptoms through family support. Our findings confirmed that exposure to SGM-ACE is associated with poorer adult mental health. Additionally, SGM-ACEs exposure undermines SGM individuals' perceptions of family support, which increases symptoms of anxiety. [ABSTRACT FROM AUTHOR]

Abstract Currently, in the U.S. and worldwide, childhood trauma is a public health crisis. Childhood adversities, such as abuse, neglect, and related household stressors, are common, interrelated and contribute to multiple adverse social, behavioral and health outcomes throughout the lifespan. The present article provides further discussion regarding adverse childhood experiences (ACEs) screening in healthcare utilizing the etic and emic perspectives. Screening in the healthcare system leans toward the etic view: objective observations of symptoms, which may then lead to intervention delivery. Whereas the emic view provides the subjective perspective as experienced by participants of a system, culture, or common group. Finkelhor's argument about cautions regarding widespread screening is relevant in the current allopathic healthcare system, which utilizes an etic perspective and where evidence-based ACEs interventions within a biomedical-centric model are lacking. Therefore, in healthcare settings, universal ACEs screening may serve the clinicians with a surveillance tool to inform and guide medical practice and policy as they relate to delivering trauma-informed care. The Public Health Code of Ethics and Basis for Action reminds us about the values approach for collecting and using data ethically to protect population health. Practitioners and researchers across the globe are beginning to take community-engaged action, with an emic view of all community members involved. [ABSTRACT FROM AUTHOR]

Highlights • A scoping review investigating biological measures of adverse childhood experiences (ACEs) in adulthood. • Forty studies were identified, with ACEs often measured retrospectively. • Studies identified biomarkers related to inflammation, cardio/metabolic systems, genetics, and endocrine systems. • Studies also identified biomarkers related to composite indices of multiple physiological systems. • Health behaviors, social relationships, psychopathology and socioeconomic factors may help explain some associations. Abstract Adverse Childhood Experiences (ACEs) are stressful and/or traumatic experiences that occur during childhood. Research has demonstrated a link between ACEs and risk of physical and mental health disorders, where early life adversity may become "biologically embedded" and have wide-ranging effects on various physiological systems. The aim of this study was to identify the extent and breadth of recent research activity relating to biological measures of ACEs in adulthood. We undertook a scoping review including published research articles. Medline and PsycINFO were searched for articles from 2007 to July 2017. Articles were eligible if they included adult participants, were written in English, and reported on a biomarker of childhood adversity in adulthood. Forty articles met our inclusion criteria. Studies investigated a range of ACEs that were often measured retrospectively. The studies identified biomarkers related to inflammation (e.g., CRP), cardio/metabolic systems (e.g., BMI), genetics (e.g., telomere length), and endocrine systems (e.g., cortisol), as well as composites of multiple physiological systems. However, not every study identified found significant associations. Health behaviours, emotional distress, social relationships, and socioeconomic factors may help explain some of these associations. Further research is needed to better understand biomarkers of ACEs in adulthood and their relationship to health conditions. [ABSTRACT FROM AUTHOR]

Abstract Exposure to childhood adversity can result in negative behavioral and physical health outcomes due to potential long-term embedding into regulatory biological processes. Screening for exposure to adversity is a critical first step in identifying children at risk for developing a toxic stress response. We searched PubMed, PsycArticles, and CINAHL for studies published between January 1, 2012, and December 31, 2016, as well as other sources, to identify potential tools for measuring cumulative adversity in children and adolescents. We identified 32 tools and examined them for adversity categories, target population, administration time, administration qualifications and method, and reliability and validity. We also created a list of recommended tools that would be feasible for use by pediatric practitioners in most types of practice. This review provides a starting point for mobilizing screening in pediatric settings, highlighting the challenges with existing tools, and potential issues in the development and evaluation of future tools. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are important public health concerns, with links to higher prevalence rates of both health-risk behaviors and physical health difficulties in adulthood. Research has demonstrated an association between early adversity and long-term health-risk behavior development. The current study assessed the role of emotion dysregulation and facets of impulsivity as potential mediators in the relation between ACEs and general health-risk behaviors, including alcohol-related consequences and risky sexual behavior. College students (N = 668) completed online questionnaires that assessed history of ACEs, emotion regulation difficulties, impulsivity under extreme affect, and current engagement in health-risk behaviors. Emotion dysregulation and impulsivity under extreme positive emotion, but not negative emotion, demonstrated a significant serial mediation between ACEs and alcohol-related consequences. Results also suggest that emotion dysregulation mediates the relation between early adversity and all three outcomes (i.e., overall engagement in maladaptive behavior, alcohol-related consequences, and risky sexual behavior). Impulsivity under positive or negative affect did not demonstrate a mediation effect on the three outcomes. Results of this study highlight the importance of assessing for emotion regulation skills when working with young adults with histories of adversity. [ABSTRACT FROM AUTHOR]

Recent research on adverse childhood experiences (ACEs) has used factor analysis to categorize ACEs. Further research is needed to determine if these previously identified factors are related to specific health outcomes. Using data obtained from the 2014–2015 South Carolina Behavioral Risk Factor Surveillance System, this study assessed the association between categories (household dysfunction; emotional and physical abuse; sexual abuse) and combinations of categories of ACEs on mental and physical health outcomes in adulthood ( n = 15,638). Respondents who had all three categories of abuse were much more likely to report poor health and mental distress. Sexual abuse in childhood increased the odds of reporting poor health and mental distress; some ACEs may have stronger associations to long term health than others. These findings can help lead to effective and targeted prevention or intervention strategies that incorporate the new insight on the combination of ACE categories that are likely to co-occur. [ABSTRACT FROM AUTHOR]

Previous work has found that child welfare professionals have both higher self-report prevalence of adverse childhood experiences (ACEs) (Howard et al., 2015) and higher rates of insecure attachment (Howard et al., 2013) than normative samples. Although adult attachment and ACEs are both prolific areas of research in the developmental literature, little is known about how attachment representations may affect an individual's report of attachment-related ACEs. The current study investigated the role of attachment classification on disclosure of adverse childhood experiences on a self-report questionnaire and a semi-structured clinical interview in a sample of 228 child welfare professionals. Participants completed the Adult Attachment Interview (AAI) and ACE Questionnaire. Data revealed significant differences in self-report and rated disclosure of adverse childhood experiences by attachment classification. No significant differences were found for participants classified as secure-autonomous. Participants classified as dismissing reported fewer ACEs in their self-report questionnaire than independent scorers rated in their AAI. Participants classified as preoccupied reported more ACEs in their self-report questionnaire than independent scorers rated in their AAI. These differences raise questions and may be concerning for both the child welfare professionals and the families they serve. Specifically, future research should focus on possible consequences of having an insecure internal working model and ways to facilitate secure status for professionals if attachment classification is impacting their decisions regarding families. The current study provides a first step in investigating such relations. [ABSTRACT FROM AUTHOR]

Currently, some trauma-informed education practices use "ACE scores," a number that represents the sum of endorsed items from a survey derived from the Adverse Childhood Experiences (ACEs) study in 1998. We caution that the survey provides limited information within education, and such scores have limited utility for designing and delivering individualized intervention to support students who have experienced adversity. We sought to illustrate why ACEs are not well-suited for use in trauma-informed education, provide definitions for adversity-related terms from which a broader and common understanding of adversity can stem, and provide recommendations for integration of adversity-informed approaches to the educational context. We compiled definitions of adversity-related constructs and made recommendations based on review of relevant research from the fields of psychology and education. Rather than tailoring educational practices to specific children based on the "traumatic" events they experience, we recommend educators focus their efforts on building supportive classrooms geared toward supporting students with best practices drawn from the Science of Learning, and with the understanding that early adversity can influence heterogeneous trajectories in student development and behavior. In addition, further research on educational practices, including the use of a shared language for describing and defining adversity-related experiences, are the concrete steps needed to better support a goal of adversity-informed education. [ABSTRACT FROM AUTHOR]

Implementing trauma-informed care (TIC) practices in educational settings requires preparing school staff to understand adverse childhood experiences (ACEs) and their impact to provide a restorative rather than a punitive response. To assess learning outcomes of a TIC training delivered to kindergarten to 12-grade (K −12) staff. A TIC training informed by the Substance Abuse and Mental Health Service Administration (SAMHSA) Framework was delivered August to December 2017 to twenty-seven K-12 staff in Southeastern U.S. Majority were women (93 %) aged 25 to 58 years; 52 % were White and 48 % were Black/African American (48 %). Curricular content included an overview of ACEs; stress physiology; recognition of symptoms in self and others; strategies for response; and self-care. A post-training questionnaire with 11 learning statements was administered to assess participants' level of agreement with learning each concept using a 5-point Likert scale. Self-reflective narratives of challenging situations with students were also submitted and qualitatively analyzed for applications of TIC. Between 62.9 % to 96 % of participants agreed/strongly agreed with learning new concepts related to ACEs and their symptoms. Qualitative data indicated that participants were able to recognize stress symptoms in students and in themselves and integrate strategies learned such as breathing and creating safe space to allow students to have voice and choice. TIC training curriculum that includes ACEs and toxic stress science is a critical component that promotes recognition of trauma symptoms in themselves and others. Self-reflective practice using narratives is an essential training tool for implementing TIC. [ABSTRACT FROM AUTHOR]

A large body of literature has noted detrimental effects of childhood adversity on young adult behavioral health, yet few studies have assessed how early childhood adversity influences the development of alcohol and cannabis co-use. In the present study we use data from an ongoing longitudinal cohort (N = 2507) to understand how early childhood adversity influences transitions into alcohol and cannabis co-use trajectories. We also explore how sex, depression, and anxiety are associated with transition probabilities. We used latent transition analysis to examine transitions from emergent childhood adversity classes to classes of parallel alcohol and cannabis co-use from ages 17 to 24 years. Those who reported high levels of childhood adversity were more likely to transition into classes with relatively chronic and rapidly increasing alcohol and cannabis co-use during young adulthood. Young adults who both experienced high levels of childhood adversity and transitioned into increasing alcohol and cannabis co- use trajectories were more likely to be male and meet clinical cutoff for depression. Our results indicate an incrementally more nuanced set of risk profiles, with differential risk of alcohol and cannabis co-use trajectories, dependent on one's experience of childhood adversity. Results of the present study note important heterogeneity in alcohol and cannabis co-use throughout young adulthood, with general trends showing increases in co-use. The present study also shows differential risk of alcohol and cannabis co-use dependent on prior experience of childhood adversity. [ABSTRACT FROM AUTHOR]

• Make available a validated French version of the ACE-IQ. • The French translation of the ACE-IQ has good psychometric properties organized around three dimensions (Childhood maltreatment, Family dysfunction, Violence outside the home) • The ACE-IQ is a reliable and valid measure for assessing ACEs in French-speaking populations, both for research purposes and clinical practice. • To enable a measurement of a dose–response relationship between adverse childhood experiences (ACEs) and health decline in adulthood. Since Dr. Vincent Felitti conducted his seminal work on adverse childhood experiences (ACEs) in the 1980′s, a large body of literature has emerged concerning the relation between early life adversity and physical and psychological health outcomes in adulthood. The objective of this study was to assess the psychometric properties of the French version of the Adverse Childhood Experiences International Questionnaire (ACE-IQ). A validated translation of the ACE-IQ will facilitate comparing data in French-speaking countries where this tool is used to measure a dose–response relationship between adverse childhood experiences (ACEs) and health decline in adulthood. The ACE-IQ is a 29-item measure designed to assess exposure to ACEs categorized into three groups: maltreatment (all forms of physical and emotional ill-treatment, sexual abuse, neglect), family dysfunction and violence outside the home. The questionnaire was translated and back-translated according to guidelines and methodology defined by the World Health Organization, 2011 (WHO). A total of 367 participants were recruited to take part in this study. After analyzing descriptive statistics, we assessed the questionnaire's internal structure using principal component factor analysis. Based on classical test theory we calculated internal consistency and test–retest reliability. We then performed an item response theory (IRT) analysis using a partial credit model (PCM) for polytomous data, which was applied to each of the three dimensions of the ACE-IQ. Taken together, our results suggest that while the original three-factor structure was not fully supported, the psychometric properties were good. A high degree of overall internal consistency was demonstrated with an alpha coefficient of 0.80. For the three dimensions of the questionnaire Cronbach's alphas ranged between 0.77 and 0.41. In terms of temporal stability, we observed a good intra-class correlation of 0.79 for the entire questionnaire, with temporal stability for the three dimensions ranging between 0.78 and 0.61. Finally, our IRT analysis revealed discrepancies on certain items for each of the three dimensions, which confirm, and complete findings previously obtained through classical analysis. The French translation of the ACE-IQ has good psychometric properties which make it a reliable and valid measure for assessing ACEs in French-speaking populations, both for research purposes and clinical practice. Further validation will be necessary, however, to account for different cultural characteristics and perspectives between French speaking countries. [ABSTRACT FROM AUTHOR]

• Foster parents' adverse childhood experiences (ACEs) related to adult attachment anxiety and avoidance. • Foster parents' number of ACEs related to attachment avoidance. Emotional abuse related to attachment anxiety. • Foster parents' ACEs related to higher levels of parenting stress. Parental distress related to sexual abuse. • Foster parents' attachment anxiety related to parental distress and defensive responding. Connections between parents' trauma histories, adult attachment, and parenting stress are well established; those who have experienced trauma are more likely to have higher levels of insecure attachment (Jacobvitz & Reisz, 2019) and are more vulnerable to parenting stress (Steele et al., 2016) These processes in foster parents are understudied, even though they care for vulnerable children. This study examined relations between foster parents adverse childhood experiences (ACEs), adult attachment, and parenting stress. This is important to address because foster parents care for vulnerable children who can present unique stressors to caregivers. Examine links between ACEs, adult attachment, and parenting stress in foster parents. Participants were 55 foster parents from central Texas, US, recruited from a larger RCT study. Participants completed the ACEs questionnaire, Experiences in Close Relationships questionnaire, and Parenting Stress Inventory. Foster parents who reported higher total ACEs were more likely to report higher levels of attachment avoidance and higher levels of overall parenting stress. Foster parents who reported experiencing childhood emotional abuse reported higher levels of attachment anxiety. Those who reported experiencing childhood sexual abuse reported higher levels of parental distress. Lastly, those who reported higher levels of attachment anxiety reported higher levels of parental distress and defensive responding. ACEs are an important factor for foster parents, particularly for parenting stress. It is crucial that appropriate support is provided to help foster parents manage parenting stress and provide optimal care for their foster children. [ABSTRACT FROM AUTHOR]

The purpose of this study was to understand the extent to which teachers experience costs to caring (e.g. secondary traumatic stress, burnout, and intent to leave the profession) and to test a Teacher Costs to Caring Resilience Model (TCCRM) using structural equation modeling. Participants consisted of 542 teachers in the Northeastern U.S. Findings suggested that the personal protective factors of resilience and compassion satisfaction showed a negative direct effect on costs to caring. Further, the professional protective factor of working in a positive school climate showed a negative indirect effect specifically on burnout. Focusing on improving teacher resilience, compassion satisfaction, and school climate using a systems-based approach modeled on the TCCRM is suggested. [ABSTRACT FROM AUTHOR]

Background Low levels of empathy among nursing students can adversely impact patient-centered care (PCC) and patient outcomes. Methods An Advancing Care Excellence for Seniors simulation scenario was delivered to 50 nursing students to improve empathy and PCC by improving active listening and self-awareness. Results Active listening, empathy, and PCC scores in the intervention group compared with the control group and baseline significantly differed at postintervention and four-week follow-up ( p s < .001). Self-awareness scores between the groups were significantly different only at four-week follow-up ( p < .001). Conclusions Using the Advancing Care Excellence for Seniors simulation scenario was effective in improving the four variables. [ABSTRACT FROM AUTHOR]

Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) are typically assessed within two subscales: child maltreatment (CM) and household dysfunction (HD). More research is needed about how the CM and HD subscales differentially contribute to adult posttraumatic stress symptoms (PTSS), accounting for additional adversities. In a sample of 137 pregnant women exposed to recent intimate partner violence (IPV) in the United States, this study aimed to (1) explore the contributions of ACEs subscales to pregnant women's PTSS severity, (2) examine the inclusion of the witnessing IPV ACE in the CM subscale, and (3) contextualize the contributions of the ACEs subscales to women's PTSS by examining the moderating effect of age of first ACE exposure. The study used linear, multiple, and hierarchical regression analyses and the Hotelling-Williams test. The CM subscale predicted pregnant women's PTSS significantly better than the HD subscale, controlling for past-year IPV (t (134) = 2.69, p =.008). Adding the witnessing IPV ACE to the CM subscale did not significantly improve the subscale's prediction of PTSS (Δ R 2 = 0.07, p =.290). Age of first exposure did not significantly moderate the effects of the CM (β = 0.12, p =.140) or HD (β = −0.10, p =.238) ACEs subscales on PTSS. Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of CM have stronger predictive validity for PTSS than HD. Cumulative victimization may be more influential than age of exposure to adversity. • Child maltreatment ACEs significantly related to women's PTSS. • Household dysfunction ACEs were not significantly related to women's PTSS. • Adding witnessing IPV did not increase predictive effects of maltreatment subscale. • Prenatal IPV was consistently linked with women's posttraumatic stress symptoms. • Age of exposure to ACEs did not moderate effects of ACEs subscales on women's PTSS. [ABSTRACT FROM AUTHOR]

Environmental factors such as adverse childhood experiences (ACEs) may affect neurocognition, an endophenotype for several mental illnesses. This study examines the effect of ACEs on neurocognitive performance in first-degree relatives (FDRs) of patients with severe mental illness to determine whether familial risk has a moderating effect on the relationship between ACEs and neurocognition. Unaffected FDRs from multiplex families with severe mental illnesses (schizophrenia, bipolar disorder, obsessive-compulsive disorder, or alcohol use disorder) (n = 324) and healthy controls (with no familial risk) (n = 188) underwent neurocognitive tests for processing speed, new learning, working memory and Theory of Mind. ACEs were measured using the WHO ACE-International Questionnaire (ACE-IQ). Regression models were done to predict each neurocognitive domain by the effect of familial risk, ACE-IQ Score and their interaction (familial risk*ACE-IQ score). The main effect of familial risk predicted poor performance in all domains of neurocognition (p < 0.01), and the interaction had a negative association with global neurocognition (β = −0.093, p = 0.009), processing speed (β = −0.109, p = 0.003) and working memory (β = −0.092, p = 0.01). Among the ACEs sub-domains, only maltreatment (specifically the main effect of physical neglect and the interaction effect of sexual abuse with familial risk) predicted poorer neurocognition. In FDRs of schizophrenia and bipolar disorder, only the main effects of familial risk were significantly associated with poorer neurocognition. We conclude that there is a relationship between ACEs (especially maltreatment) and neurocognitive functioning, which is moderated by the familial risk of mental illnesses. Genetic/familial vulnerability may have a stronger association with neurocognition in schizophrenia and bipolar disorder. • Childhood adversity was associated with poorer neurocognitive performance. • Maltreatment was significantly related to neurocognition. • Several of these relationships were moderated by familial risk of mental illnesses. • Global neurocognitive ability, processing speed and working memory were predicted by the combined effect. • In schizophrenia and bipolar disorder, familial risk alone predicted neurocognitive performance. [ABSTRACT FROM AUTHOR]

We examined the relationship between parent-child nativity, race/ethnicity, and adverse childhood experiences (ACEs) among US children. We found that a high proportion of Black/Hispanic children experienced ACEs, with variation by generation for Hispanic but not Black children, and a lower but increasing proportion of White children experienced ACEs by generation. [ABSTRACT FROM AUTHOR]

Understanding the link between adverse childhood experiences (ACEs) and sexual victimization (SV) in adulthood may provide important information about the level of risk for adult SV and sexual re-victimization among childhood sexual abuse (CSA) survivors. In the present paper, we explore the relationship between ACEs, including CSA, and SV in adulthood. Data from the CDC-Kaiser ACE Study were used to examine the effect of experiences of early adversity on adult SV. Adult HMO members ( n = 7,272) undergoing a routine health exam provided detailed information about ACEs that occurred at age 18 or younger and their experiences of SV in adulthood. Analyses revealed that as ACE score increased, so did risk of experiencing SV in adulthood. Each of the ACE variables was significantly associated with adult SV, with CSA being the strongest predictor of adult SV. In addition, for those who reported CSA, there was a cumulative increase in adult SV risk with each additional ACE experienced. As such, early adversity is a risk factor for adult SV. In particular, CSA is a significant risk factor for sexual re-victimization in adulthood, and additional early adversities experienced by CSA survivors may heighten adult SV risk above and beyond the risk associated with CSA alone. Given the interconnectedness among various experiences of early adversity, adult SV prevention actions must consider how other violence-related and non-violence-related traumatic experiences may exacerbate the risk conferred by CSA on subsequent victimization. [ABSTRACT FROM AUTHOR]

Prevention of disease is a cornerstone of nursing care. Through our endeavors in research, teaching, and clinical care, nurses consistently seek to change the trajectory of disease development. The theoretical framework known as the Developmental Origins of Health and Disease (DOHaD) offers a new lens that shifts the current disease prevention paradigm upstream, encouraging intensified care of pregnant girls/women, neonates, and infants. This new focus parallels other emerging ecobiodevelopmental, life-course theories, which identify the long-term impact of early environments and stressors on the later risk of chronic adult diseases. Nurses have the potential to influence the health of multiple generations by incorporating DOHaD perspectives and interventions into their research and patient care. [ABSTRACT FROM AUTHOR]