[Editor's note: Dr. Harise Stein at Stanford University edits a web site — abuseresearch.info — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]
LGBTQ Concerns
Tran NM, Mann S, Cortez MG, Harrell B, Nettuno L.
Adverse childhood experiences (ACEs) and mental health by gender identity in the United States, 2019-2021. Prev Med. 2023;175:107705. PMID: 37722459
“The sample included 141,615 adults, 556 of whom identified as gender minority. Gender minority respondents were 18% more likely to be exposed to 3+ ACEs relative to cisgender respondents. Among respondents exposed to 3+ ACEs, gender minority adults were 25% more likely to report current frequent mental distress and 26% more likely to report a lifetime depression diagnosis.”
Race/Cultural Concerns
The Long Shadow: A Historical Perspective on Racism in Medical Education. Acad Med. 2023 Apr 19:10.1097/ACM.0000000000005253. PMID: 37071703
The authors trace racist ideology through the history of medicine, examine how it manifests in medical education in the United States today, and how it affects admissions, assessments, faculty and trainee diversity, retention, racial climate, and the physical environment. The authors then recommend steps for confronting racism in medical education.
Barber Doucet H, Wilson T, Vrablik L, Wing R.
Implicit Bias and Patient Care: Mitigating Bias, Preventing Harm. MedEdPORTAL : the journal of teaching and learning resources. 2023;19:11343. PMID: 37731596
“Learners were presented with a case of a classic toddler's fracture in an African American child. The learners interacted with an orthopedic resident who insisted on child welfare involvement, with nonspecific and increasingly biased concerns about the child/family. The learners were expected to identify that this case was not concerning for nonaccidental trauma and that the orthopedic resident was demonstrating bias. They were expected to communicate with both the resident and the parent effectively to defuse the situation and prevent harm from reaching the family.” Full article with teaching materials
Stephens KC, Redman T, Williams R, Bandstra B, Shah R.
Considering Culture and Conflict: A Novel Approach to Active Bystander Intervention. MedEdPORTAL : the journal of teaching and learning resources. 2023;19:11338. PMID: 37649621
“While bystander workshops customarily provide guidance on direct interventions to a general audience, the literature does not yet address workshops in an academic setting that consider the individual's motivations and behavior patterns. We implemented a psychologically informed approach to microaggression training to increase participants' understanding and willingness to undergo behavioral change.” Full article and teaching materials.
Phillips JA, Davidson TR, Baffoe-Bonnie MS.
Identifying latent themes in suicide among black and white adolescents and young adults using the National Violent Death Reporting System, 2013-2019. Soc Sci Med. 2023;334:116144. PMID: 37678110
Using national data for suicides in black and white individuals aged 10-29, “Our findings reveal distinct patterns by race. Guns, violence and the criminal justice system are prominent features of Black suicide, whether through the mechanism used in the suicide, either by firearm or other violent means such as fire or electrocution, the existence of criminal or legal problems/disputes, the location of death in a jail, or the presence of police. In contrast, the narratives of white adolescent/young adults are more likely to reference mental health or substance abuse problems.”
Castaneda Y, Jacobs J, Margellos-Anast H, et al.
Developing and Implementing Racial Health Equity Plans in Four Large US Cities: A Qualitative Study. J Public Health Manag Pract. 2023 Nov-Dec 01;29(6):780-790. PMID: 37290120
“In the United States, health departments have begun to develop and implement strategic health plans focused on equity. However, the extent to which these plans result in actual initiatives (both internal and external) varied across cities. The current study increases our understanding of how different partners are working to implement structural changes, programs, and policies to reach equity-related goals in our largest urban areas, providing valuable insight for urban health advocates across the country.”
Main EK, Chang SC, Tucker CM, et al.
Hospital-level variation in racial disparities in low-risk nulliparous cesarean birth rates. Am J Obstet Gynecol MFM. 2023:101145. PMID: 37648109
“A population cross-sectional study was performed on 1,267,493 California live births from 2018 through 2020 using birth certificate data linked with maternal patient discharge records…A total of 29 hospitals with a low first-birth cesarean delivery rate among Black patients were identified using the Healthy People 2020 target of 23.9% and compared with 106 hospitals with higher rates. Among the 106 hospitals that did not meet the target for Black patients, 63 met it for White patients with a mean rate of 21.4%. In the same hospitals, the mean rate for Black patients was 29.5%. There were no significant differences between the groups in hospital characteristics (ownership, delivery volume, neonatal level of care, proportion of midwife deliveries) or patient characteristics (age, education, insurance, onset of prenatal care, body mass index, hypertension, diabetes mellitus)...suggests that unconscious bias and structural racism potentially play important roles in creating these racial differences.”
Salahshurian E, Moore TA.
Integrative Review of Black Birthing People's Interactions With Clinicians During the Perinatal Period. West J Nurs Res. 2023:1939459231202493. PMID: 37772363
“The following themes emerged from synthesizing Black patients' interactions with perinatal clinicians: Care Quality, Communication, Power Dynamic, and Established Relationships. Mutual respect, effective communication, and shared decision-making may be key modifiable factors to address through clinician education to improve perinatal care for many Black persons.”
Pham TV, Doorley J, Kenney M, et al.
Addressing chronic pain disparities between Black and White people: a narrative review of socio-ecological determinants. Pain Manag. 2023 Aug;13(8):473-496. PMID: 37650756
This research review showed “how chronic pain within the Black community is influenced by implicit bias among providers, psychological and physical comorbidities, experiences of societal and institutional racism and biomedical distrust, and the interplay among these factors.”
Stevenson MC, Rivers MA.
When Disclosure Fails to Substantiate Abuse: Child and Perpetrator Race Predict Child Sexual Abuse Substantiation. Child Maltreat. 2023;28(4):621-33. PMID: 36932825
“We coded child sexual abuse disclosure, abuse substantiation, and race of 315 children (80% girls, mean age = 10, 75% White, 9% Black, 12% Biracial, 3% Hispanic, 1% Asian) who underwent a child forensic interview in a Midwestern child advocacy center…abuse substantiation was more likely in cases involving (a) abuse disclosure (vs. no disclosure), (b) White children (vs. children of color), and (c) perpetrators of color (vs. White perpetrators)…the effect of abuse disclosure on increased abuse substantiation was greater for White children than for children of color. This research suggests that even when children of color disclose their experiences of sexual abuse, they nonetheless face barriers to abuse substantiation.”
Smith SM, Parkash V.
Normalized "medical inferiority bias" and cultural racism against international medical graduate physicians in academic medicine. Acad Pathol. 2023;10(4):100095. PMID: 37767366
“IMGs – physician graduates of non-US, non-Canadian medical schools – fill a critical gap in American healthcare delivery and represent ~23% of physicians nationally and up to 38% in some Northeastern states. IMPs disproportionately work in densely populated, low-income communities and are increasingly over-represented in primary care and the lowest paying specialties. A disproportionate number died from COVID-19 from caring for patients. Approximately 60% are foreign citizens and 40% US citizens. IMPs complete the identical licensing examination sequence as American medical graduate physicians and a communication skills test to enter graduate medical education training in the US. After completion of training, 75% of IMGs join the US workforce, with many joining academic medicine, and many eventually become naturalized citizens.” Authors discuss the cultural racism and inferiority bias against IMGs that is subtle but prevalent.
Perpetrators
Salter M, Wong T.
Parental Production of Child Sexual Abuse Material: A Critical Review.
Trauma Violence Abuse. 2023:15248380231195891. PMID: 37650246
“The review showed that parental CSAM [child sexual abuse material] production is common, more likely to involve pre-pubescent victims, more severe abuse, female as well as male perpetrators, and produces high-demand illegal content with serious long-term sequelae. However…the focus of child trafficking and sexual exploitation scholarship on ‘commercial’ and profit-driven abuse has marginalized and obscured parental CSAM production…These findings warrant a reorientation of research, policy, and practice approaches to technology-facilitated child sexual exploitation, as well as a reflection on the resistance of researchers and policymakers to acknowledging the problem of family-based sexual exploitation.”
Police and Court Systems
Hernandez-Meier J, Xu Z, Kohlbeck SA, et al.
Linking emergency care and police department data to strengthen timely information on violence-related paediatric injuries. Emerg Med J. 2023 Sep;40(9):653-659. PMID: 37611955
Combining ED, police department (PD) and EMS data for a US city, “Many violence locations in ED and EMS data were not present in PD records. A combined PD, ED and EMS database resulted in new knowledge of the geospatial distribution of violence-related paediatric injuries and can be used for data-informed and targeted prevention of violence in which children are injured-especially in and around schools and parks.”
Providers
Gilgoff R, Schwartz T, Owen M, Bhushan D, Burke Harris N.
Opportunities to Treat Toxic Stress. Pediatrics. 2023 Jan 1;151(1):e2021055591. PMID: 36450652
“The field of ACEs and toxic stress has advanced beyond “What is wrong with you?” to “What happened to you?” and “What is right with you?” We believe we need to go one step further and also ask, “What is healing for you?” The answer is multifactorial and can include evidence-based interventions that specifically target an individual’s underlying neurologic, endocrine, metabolic, immune, and genetic dysregulation if they have toxic stress. We believe the field of pediatrics has a vital opportunity to advance a multidisciplinary approach to treatment and healing from toxic stress.”
Williams RC.
From ACEs to early relational health: Implications for clinical practice. Paediatr Child Health. 2023;28(6):377-93. PMID: 37744756
“This statement describes how clinicians can bring a relational health approach to any medical encounter by understanding: what toxic stress is and how it can affect the developing brain, family relationships, and child development; how positive relationships, experiences, and behaviours can help buffer such effects and build resilience; observable signs of relational health and risk in parent-child interactions; the attributes of trustful, therapeutic relationships with families; and how to optimize these benefits through conversation and clinical practice.” (ERH = early relational health)
Sherin KM, Stillerman AJ, Chandrasekar L, et al.
Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine. AJPM Focus. 2022 Oct 8;1(2):100039. PMID: 37791246
This position statement by the American College of Preventive Medicine (ACPM) reviews available research and related statements from other major medical organizations on use of ACEs. “ACPM’s recommendation is to expand the implementation of population-level surveillance and research but not universal or risk-based ACE screening. Sensitive trauma inquiry rather than ACE screening can be an important part of individual patient care encounters in the context of therapeutic relationships, shared decision making, and concomitant emphasis on the celebration and enhancement of strengths and positive experiences. Because childhood experiences shape the trajectory of health across the lifespan, investment in further research on strategies that strengthen protective factors and prevent, mitigate, and treat the consequences of childhood adversity is essential.”
Findley E.
"It's already stressful being a foster parent": A qualitative inquiry into foster parenting stress during COVID-19. Child Abuse Negl. 2023;146:106455. PMID: 37717544
“Findings from this study demonstrated foster parents experienced both shared and unique parenting challenges during COVID-19. Three areas for further consideration and development in practice included improving online service delivery, strengthening guidance for online parent-child visitation, and enhancing support for foster parents of children with special needs. Developing social support and self-care practices should continue to be ongoing priorities for foster parents and foster parent-serving agencies.”
Shah AN, Goodman E, Lawler J, et al.
Inpatient Screening of Parental Adversity and Strengths. Hosp Pediatr. 2023 Oct 1;13(10):922-930. PMID: 37724391
“Identifying and addressing adversities has been linked to improved child outcomes. Screening for social adversities and strengths in the inpatient setting may contribute to better transitions from hospital to home…We interviewed 18 parents who identified 3 major themes around screening: 1. factors that promote parents to respond openly and honestly during screening; 2. feedback about screening tools and the prototype; and 3. screening should include resources…Using qualitative parent feedback, we developed the family friendly Collaborate to Optimize Parent Experience (COPE) screening tool.”
Stokes Y, Lewis KB, Tricco AC, et al.
Trauma-Informed Care Interventions Used in Pediatric Inpatient or Residential Treatment Mental Health Settings and Strategies to Implement Them: A Scoping Review. Trauma Violence Abuse. 2023:15248380231193444. PMID: 37694809
From a research review, “we emphasize the complexity of TIC [trauma-informed care] and of TIC interventions, and the importance of identifying and clearly reporting TIC intervention goals, intervention details, and implementation strategies. We suggest applying intervention frameworks or reporting guidelines to support clear and comprehensive reporting, which would better facilitate replication and synthesis of published TIC interventions.”
Mirhosseini T, Guastello AD, Dale LP, et al.
Effects of COVID-19 stress, proximity, and adverse childhood experiences on healthcare workers' mental health. Frontiers in psychology. 2023;14:1228515. PMID: 37727750
From interviews with 438 healthcare workers in Florida in 2020, findings indicate that adverse childhood experiences strengthen the relationship between COVID-19 worry/proximity and negative psychological symptoms of depression and anxiety. “Vulnerable populations such as individuals who have experienced ACEs could benefit from targeted and specific interventions to cope with the collective trauma experienced globally due to COVID-19.”
Begeny CT, Arshad H, Cuming T, et al.
Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. Br J Surg. 2023 Oct 10;110(11):1518-1526. PMID: 37697690
From a survey of UK surgical workforce members, compared with men, women were significantly more likely to report witnessing, and being a target of, sexual misconduct. Among women, 63.3% reported being the target of sexual harassment versus 23.7% of men (89.5% witnessing versus 81.0% of men). Additionally, 29.9% of women had been sexually assaulted versus 6.9% of men (35.9% witnessing versus 17.1% of men), with 10.9% of women experiencing forced physical contact for career opportunities (a form of sexual assault) versus 0.7% of men. Being raped by a colleague was reported by 0.8% of women versus 0.1% of men (1.9% witnessing versus 0.6% of men). Evaluations of organizations' adequacy in handling sexual misconduct were significantly lower among women than men…Accountable organizations are not regarded as dealing adequately with this issue.”
Prevention
Weissman DG, Hatzenbuehler ML, Cikara M, et al.
State-level macro-economic factors moderate the association of low income with brain structure and mental health in U.S. children. Nat Commun. 2023 May 2;14(1):2085. PMID: 37130880
In an adolescent study across 17 states, lower income was associated with smaller hippocampal volume (brain hippocampus is involved in memory and is sensitive to effects stress and PTSD), and higher internalizing psychopathology such as depression and anxiety. These associations were stronger in states with higher cost of living. However, in high cost of living states that provide more generous cash benefits for low-income families, hippocampal volume resembled that in the lowest cost of living states, with similar patterns for internalizing psychopathology…These findings suggest that state-level macrostructural characteristics, including the generosity of anti-poverty policies, are potentially relevant for addressing the relationship of low income with brain development and mental health.”
Marçal K, Chang OD, Park Y, Maguire-Jack K.
Material hardship in the postpartum year: Links to child maltreatment. Child Abuse Negl. 2023;145:106438. PMID: 37657171
For 3966 at-risk mothers, compared to "Stable" mothers, "Cost-Burdened" mothers - who displayed high levels of missed rent and utility payments - were significantly more likely to psychological abuse or neglect their children. "Severely Housing Insecure Mothers" - characterized by elevated rates of doubling up, eviction, and homelessness - were significantly more likely to engage in physical assault, psychological aggression, and neglect. “Difficulty maintaining stable and affordable housing is associated with elevated risk of child maltreatment. Efforts to prevent child maltreatment must incorporate access to housing screening and supports, particularly among families with infants.”
Altafim ERP, Magalhães C, Linhares MBM.
Prevention of Child Maltreatment: Integrative Review of Findings From an Evidence-Based Parenting Program. Trauma Violence Abuse. 2023:15248380231201811. PMID: 37753719
Twenty-five studies conducted in the United States, Brazil, Portugal, and Peru evaluated the ACT Raising Safe Kids Program. The program improved parenting practices in general and targeted populations such as incarcerated parents, mothers with a history of childhood violence, and mothers of preterm children. Additionally, the program was effective in decreasing child behavioral problems. Overall, the ACT Program effectively decreased hostile, aggressive, and coercive parenting and child behavior problems, which are key predictors of family violence.”
Bődi CB, Ortega DP, Hawkins LB, James TG, Bright MA.
Parents' and professionals' perspectives on school-based maltreatment prevention education for children with intellectual and developmental disabilities. Child Abuse Negl. 2023;145:106428. PMID: 37647780
“Previous research has indicated an unmet need for child maltreatment programs among children with IDD [intellectual and developmental disabilities]…The analysis identified several challenges to implementing child maltreatment prevention to students with IDD and pedagogical strategies to overcome those, such as the use of visuals, standardized vocabulary, and relatable examples. Benefits of a prevention program were also mentioned, including feelings of empowerment that can be cultivated by providing opportunities where children with IDD practice being assertive.”
Researchers
Cappa C, Cecchetti R, Jijon I.
Ending violence against children: A new international standard to foster data availability. Child Abuse Negl. 2023;144:106330. PMID: 37566972
“The newly released International Classification of Violence against Children (ICVAC) holds potential for filling data gaps and thus promoting accountability towards the ambitious global goal of ending violence against children.”
Molock SD, Boyd RC, Alvarez K, et al.
Culturally responsive assessment of suicidal thoughts and behaviors in youth of color. Am Psychol. 2023 Mar 13:10.1037/amp0001140. PMID: 36913280
“While suicide rates for White groups have declined, there has been a precipitous rise in suicide deaths and suicide-related phenomena in Black youth; rates remain high among Native American/Indigenous youth. Despite these alarming trends, there are very few culturally tailored suicide risk assessment measures or procedures for youth from communities of color. This article attempts to address this gap in the literature…and concludes with recommendations for factors that should be considered in suicide risk assessment for youth from communities of color.”
Huerta C, Gutschow B, Bañales J, et al.
Developing a Youth Participatory Action Research Program for Latine Youth in an Emerging Community. Health Promot Pract. 2023 May 22:15248399231176248. PMID: 37212204
“Our community-academic team partnered to cocreate a curriculum focused on supporting Latine youth in learning about research and developing their own research projects…We reviewed lessons learned from this work, including challenges engaging young people and creating linguistically inclusive spaces.”
Agarwal AR, Prichett L, Jain A, Srikumaran U.
Assessment of Use of ICD-9 and ICD-10 Codes for Social Determinants of Health in the US, 2011-2021. JAMA Netw Open. 2023 May 1;6(5):e2312538. PMID: 37159201
“This cross-sectional study examines trends in the use of International Classification of Diseases, Ninth Revision (ICD-9) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for social determinants of health in the US from 2011 to 2021.”
King LS, Humphreys KL, Shaw GM, Stevenson DK, Gotlib IH.
Validation of the Assessment of Parent and Child Adversity (APCA) in Mothers and Young Children. J Clin Child Adolesc Psychol. 2023;52(5):686-701. PMID: 35500216
“We present preliminary psychometric properties of a novel measure of adversity, the Assessment of Parent and Child Adversity (APCA), which simultaneously characterizes parents' and children's adversity…Using the APCA, we distinguished between maternal adversity during different life periods and obtained metrics of child witnessing of and direct exposure to adversity…The APCA has good usability and validity. Leveraging the ability of the APCA to distinguish between adversity during different life stages and originating from different sources, our findings highlight potentially distinct effects of different aspects of maternal and child adversity on difficulties in maternal and child mental health.”
Other of Interest
Lanfear CC, Bucci R, Kirk DS, Sampson RJ.
Inequalities in Exposure to Firearm Violence by Race, Sex, and Birth Cohort From Childhood to Age 40 Years. JAMA Netw Open. 2023 May 1;6(5):e2312465. PMID: 37159198
The study followed multiple groups of children in Chicago over time. “Male respondents were much more likely than female respondents to have been shot (adjusted hazard ratio [aHR], 4.23), but only moderately more likely to have seen someone shot (aHR, 1.48). Compared with White individuals, Black individuals experienced higher rates of all 3 forms of exposure (been shot: aHR, 3.05; seen someone shot: aHR, 4.69; nearby shootings: adjusted incidence rate ratio [aIRR], 12.40), and Hispanic respondents experienced higher rates of 2 forms of violence exposure (seen someone shot: aHR, 2.59; nearby shootings: aIRR, 3.77). Respondents born in the mid-1990s who grew up amidst large declines in homicide but reached adulthood during city and national spikes in firearm violence in 2016 were less likely to have seen someone shot…However, the likelihood of having been shot did not significantly differ between these cohorts.”
Song Z, Zubizarreta JR, Giuriato M, Koh KA, Sacks CA.
Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members. Health Aff (Millwood). 2023 Nov;42(11):1541-1550. PMID: 37931194
Of 2,052 child and adolescent survivors compared to 9,983 matched controls who did not incur firearm injuries, along with 6,209 family members of survivors compared to 29,877 matched controls, and 265 family members of decedents compared to 1,263 matched controls, “Through one year after firearm injury, child and adolescent survivors experienced a 117% increase in pain disorders, a 68% increase in psychiatric disorders, and a 144% increase in substance use disorders relative to the controls. Survivors' health care spending increased by an average of $34,884-a 17.1-fold increase-with 95% paid by insurers or employers. Parents of survivors experienced a 30-31% increase in psychiatric disorders…and 5-14% reductions in mothers' and siblings' routine medical care. Family members of decedents experienced…at least 15.3-fold more mental health visits among parents. Firearm injuries in youth have notable health implications for the whole family, with large effects on societal spending.
Cuartas J, Bhatia A, Carter D, Cluver L, Coll C, Donger E, et al.
Climate change is a threat multiplier for violence against children. Child Abuse Negl. 2023:106430. PMID: 37648573
“We examine how the climate crisis exacerbates the risk of violence against children at the continually intersecting and interacting levels of society, community, family, and the individual levels. We propose increased risk of armed conflict, forced displacement, poverty, income inequality, disruptions in critical health and social services, and mental health problems as key mechanisms linking the climate crisis and heightened risk of violence against children. Furthermore, we posit that the climate crisis serves as a threat multiplier, compounding existing vulnerabilities and inequities within populations.”
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