How community resources mitigate the association between household poverty and the incidence of adverse childhood experiences.
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ABSTRACT: Objectives
To assess what proportion of the association between household low income and incidence of adverse childhood experiences (ACE) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counselling, and parks.Methods
Using Growing Up in Scotland birth cohort data (N?=?2816), an inverse probability-weighted regression-based mediation technique was applied to assess associations between low-income status (ResultsThe protective effects of resources were heterogeneous. Only access to transportation was associated with lower ACE incidence in both low- and higher-income households. If all had access to transportation, 21% (95% CI 3%, 41%) of the income-based inequality in incidence of 3 or more ACEs could be eliminated.Conclusions
While second best to the elimination of child poverty, measures to improve families' access to community resources such as transportation may mitigate the effects of poverty on ACE incidence.
SUBMITTER: Blair A
PROVIDER: S-EPMC6677714 | biostudies-literature | 2019 Sep
REPOSITORIES: biostudies-literature
Publications
How community resources mitigate the association between household poverty and the incidence of adverse childhood experiences.
Blair Alexandra A Marryat Louise L Frank John J
International journal of public health 20190528 7
<h4>Objectives</h4>To assess what proportion of the association between household low income and incidence of adverse childhood experiences (ACE) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counselling, and parks.<h4>Methods</h4>Using Growing Up in Scotland birth cohort data (N = 2816), an inverse probability-weighted regression-based mediation technique was applied to assess associations between low-income status (< £11,000 i ...[more]
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Project description:ObjectiveAdverse childhood experiences (ACEs) are linked to worsening overall health outcomes and psychological diagnoses. Routine screening, particularly in patients with postpartum depression (PPD), would identify patients who could benefit from interventions to prevent the perpetuation of ACEs and establish a system of preventative care to mitigate the risks of adverse health outcomes associated with high ACE scores. The purpose of this study is to explore the link between ACEs and PPD to advocate for the use of the ACE questionnaire as a routine screening tool in all pregnant patients diagnosed with PPD. We hypothesize that a cohort of patients with PPD will be more likely to have high-risk ACE scores than the general female population.Study designOur IRB approved, retrospective cohort study identified all patients diagnosed with PPD at an academic medical center between January 2015 and December 2019. The subjects were identified using retrospective chart review. Subjects were recruited via telephone and asked to complete an ACE questionnaire. Questionnaires were sent via RedCap. ACE scores were calculated, categorized as 0, 1, 2, 3, or 4 or more ACEs, and compared to the prevalence in the original Kaiser-CDC ACE study female cohort using a chi-square goodness-of-fit test.ResultsThere were 132/251 surveys completed (53% response rate). In our PPD population, 19.3% had 0 ACEs, 17.0% had 1 ACE, 13.1% had 2 ACEs, 16.5% had 3 ACEs, and 34.1% had 4 or more ACEs. These percentages were significantly different from the Kaiser-CDC ACE Study percentages of 34.5, 24.5, 15.5, 10.3, and 15.2%, respectively (p < 0.001).ConclusionOur unique study showed that women with PPD are more likely to have high-risk ACE scores than the general female population. This finding has important implications in regards to counseling, intervening to prevent perpetual ACEs, and establishing important provider-patient relationships for life-long preventative care.Non-gendered language is used when possible throughout. However, the wording from studies cited in this paper was preserved.
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Project description:We used the Southern Community Cohort Study of people residing in 12 states in the southeastern United States (n=38,200 participants) to examine associations between adverse childhood experiences (ACEs) and chronic disease risk. After adjustment for confounding, there were statistically significant positive associations for people reporting four or more ACEs relative to those reporting no ACEs, and this was true for all chronic diseases except hypertension. The most elevated risk was seen for depression when measured as a yes/no variable (odds ratio (OR) 2.84, 95% confidence interval (CI) 2.64-3.06) or when using the 10-item Center for Epidemiologic Student Depression (CESD) scale (OR 1.88, 95% CI 1.75-2.02). There were also statistically significant monotonic increases in risk with worsening ACE score for all chronic diseases except hypertension, cancer, and high cholesterol. The need to establish programs that build resilience during childhood is paramount for preventing chronic diseases that may result from childhood abuse, neglect, and household dysfunction.
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