DANA THOMPSON, MPH IMAN SHARIF, MD, MPH AILEEN FINK, PHD The Delaware ACE’s Story.
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Transcript of DANA THOMPSON, MPH IMAN SHARIF, MD, MPH AILEEN FINK, PHD The Delaware ACE’s Story.
DANA THOMPSON, MPHIMAN SHARIF, MD, MPH
AILEEN FINK, PHD
The Delaware ACE’s Story
Adverse Childhood Experiences (ACEs)
Stressful or traumatic experiences that occur before the age of 18
Cumulative ACE exposure is related to health, social, and behavioral problems later on in life obesity chronic health conditions premature death
Goals
Describe the intergenerational impact of ACEs exposure in Delaware.
Identify disparities in exposure to ACEs in Delaware.
Describe the relationship between child and parent ACEs exposure and the child’s ability to thrive in our communities.
Objectives
Determine the prevalence of ACEs exposure amongst children in Delaware
Test the hypotheses that:a) Children of racial/ethnic minority background and children with
disabilities have a greater exposure to ACEs
b) Children who live in a household with someone who has a mental illness are at higher risk of exposure to additional ACEs.
c) Children’s ability to function in the community is hindered by ACEs exposure, but improved by positive parental health and neighborhood supports.
Methods
Secondary Data Analysis
2011-2012 National Survey of Children’s Health (NSCH) National telephone survey conducted by National Center for Health Statistics Includes topics on child’s health and well-being
physical, emotional, and behavioral child health indicators child’s family context child’s neighborhood environment
Study Population: Delaware children, ages 0-17 years old (n=1,824)
Statistical Analysis: • Logistic Regression (adjusted for age, race, income) • SAS 9.3 (SAS Institute, Cary NC)
Measures- ACEs exposure
Measures
Flourishing (Thriving) Indicators in children 0-5 years old
Child is affectionate and tender with parent Child bounces back quickly when things don’t go his/her
way Child shows interest in learning new things Child smiles and laughs a lot
Indicators in children 6-17 years old Child finishes tasks and follows through with plans Child stays calm and in control when faced with a
challenge Child shows interest and curiosity in learning new things
Predictors
Primary Predictor
• Number of ACEs (0-1 vs. 2 or more)
Secondary Predictors
• Parental Factors• Overall Parental
Health• Parental Stress
• Neighborhood Factors• Support• Amenities• Safety• Risks (Detracting
Elements)
Demographics
• Age• Race/
Ethnicity• Special
Health Care Needs
• Federal Poverty Level (FPL)
Results
Study Population (n=1824)
Total n(%)
Age (years)0-5 497 (27%)
6-17 1278 (70%)
Race/Ethnicity
White, NH 1053 (58%)
Black, NH 275 (15%)
Hispanic 198 (11%)
Other 204 (11%)
% Federal Poverty Level (FPL)
Below 200% FPL 525 (29%)
At or above 200% FPL 1250 (68%)
Prevalence of ACEs
Racial Disparities
Disparities for children with disabilities
Results: Children who live with an adult with mental illness have a greater odds of exposure to other ACEs
Results: Factors that diminish a child’s ability to flourish
AOR (95% CI) p-value
2 or more ACEs 0.65 (0.48 – 0.86) 0.003
Black, non-Hispanic 0.61 (0.44 – 0.84) 0.012
School-aged children (6-17 years old)
0.27 (0.21 – 0.36) <0.001
Results: factors that promote child’s flourishing
AOR (95% CI)p-value
More neighborhood safety1.72 (1.17 – 2.52)
0.005
Decreased parental stress4.44 (2.90 – 6.81)
<0.001
Excellent parent health1.68 (1.31 – 2.16)
<0.001
Conclusions
Exposure to ACEs has an intergenerational impact.
Disparities exist Black children and children with special health care needs
are at greater risk of ACEs exposure.
It only takes 2 adverse childhood experience to have a significant impact on a child’s ability to flourish
Parental well-being and neighborhood safety play an important role in determining whether children flourish.
Implications
A holistic approach is needed to identify at-risk families and communities
Integrated systems of trauma informed care are needed across sectors- Health Care Education Public Health Criminal Justice
Acknowledgments
Work supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod). Additional generous support comes from the State of Delaware, the University of Delaware, Christiana Care Health System, Nemours, and the Medical University of South Carolina.