DANA THOMPSON, MPH IMAN SHARIF, MD, MPH AILEEN FINK, PHD The Delaware ACE’s Story.

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DANA THOMPSON, MPH IMAN SHARIF, MD, MPH AILEEN FINK, PHD The Delaware ACE’s Story

Transcript of DANA THOMPSON, MPH IMAN SHARIF, MD, MPH AILEEN FINK, PHD The Delaware ACE’s Story.

Page 1: 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

Page 2: DANA THOMPSON, MPH IMAN 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

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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.

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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.

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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)

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Measures- ACEs exposure

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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

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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)

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Results

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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%)

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Prevalence of ACEs

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Racial Disparities

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Disparities for children with disabilities

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Results: Children who live with an adult with mental illness have a greater odds of exposure to other ACEs

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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

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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

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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.

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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

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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.