TheImpactofAdverseChildhoodExperiencesonHealth

SUMRSCHOLAR: MARIAHRAMIREZ

VANDERBILTUNIVERSITY

MENTOR: ROYWADE, MD, PHD, MPH, MSHP

AgendaI.Significance

II.BackgroundonAdverseChildhoodExperiencesCDC-KaiserPermanenteOriginalStudyPhiladelphiaACEStudy

III.SummerProjectOne:

ImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring

IV.SummerProjectTwo:

FamilyMedicalHistoryProject

V.SummerProjectThree:

DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool

VI.MyRole/LearningExperiences

Healthdisparitiesarenotimproving

10 Introduction� Health, United States, 2010 | Chartbook

Introduction�Life Expectancy at Birth

The�gap�in�life�expectancy�at�birth�between�white�persons�and�black�persons�persists�but�has�narrowed�since�1990.�

Life expectancy is a measure often used to gauge the overall health of a population. As a summary measure of mortality, life expectancy represents the average number of years of life that could be expected if current death rates were to remain constant. Shifts in life expectancy are often used to describe trends in mortality. Life expectancy at birth is strongly influenced by infant and child mortality.

From 1980 through 2007, life expectancy at birth in the United States increased from 70 years to 75 years for men and from 77 years to 80 years for women (Table 22). Women have had longer life expectancy at birth in all decennial periods since 1900–1902, with white females having the longest life expectancy (1).

Racial disparities in life expectancy at birth persisted in 2007 but had narrowed since 1990. During this period, the gap in life expectancy between white males and black males narrowed from 8 years to

6 years and the gap in life expectancy between white females and black females decreased from 6 years to 4 years.

Reference�

1. Arias E, Curtin LR, Wei R, Anderson RN. U.S. Decennial life tables for 1999–2001, United States life tables. National vital statistics reports; vol 57 no 1. Hyattsville, MD: NCHS; 2008. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_01.pdf.

90�Figure 1. Life expectancy at birth, by race and sex: United States, 1980–2007

Life�e

xpec

tanc

y�in�y

ears�

Black�female�

White�female�

White�male�

80�

70�

Black�male�

0�1980� 1990�

Year�2000� 2007�

NOTE: See data table for Figure 1. SOURCE: CDC/NCHS, National Vital Statistics System.

60�

Source:NationalCenteronHealthcareStatistics,HealthoftheUnitedStates2010

RelationshipbetweenHealthDisparitiesandSocialDeterminantsofHealth

HealthStatus/Outcomes

SocialEnvironment

AdaptedfromStark,2016

SocialNetworks

Physical/NeighborhoodEnvironmentChildhood

Experiences SocioeconomicStatus

FoodAccessibility

HealthServices

Culture

Background:AdverseChildhoodExperiences(ACE)

ACEstandsforAdverseChildhoodExperiences(1998)

17,000surveyrespondents◦ (79%white)

Abuse- Psychological- Physical- Sexual

HouseholdStressors

- Mentalillness- Substanceabuse- Intimatepartnerviolence- Divorce- Criminalbehavior

Neglect- Emotional- Physical

ConventionalACEs

AdaptedfromFelitti etal.,1998

ACEEffectonHealthOutcomes

0

0.5

1

1.5

2

2.5

3

3.5

4

0 1 2 3 4 5to6 7to8

ACEScoreAd

justed

Odd

sRatio

AdaptedfromDongetal.,2004

AssociationbetweenACEScoreandRiskforCardiovascularDiseaseHealth Risk

BehaviorsMentalHealthConditions

PhysicalHealthConditions

Alcohol Abuse Depression CardiovascularDisease

Smoking Anxiety Diabetes

DrugAbuse/IllicitDrugUse

PTSD Emphysema

HighRiskSexualBehavior

Suicide/SuicideAttempt Cancer

PhiladelphiaACEStudy:OriginalACEStudynotrepresentativeofUrbanorDiversePopulations

AdaptedfromWadeetal.,2016

Demographics ACEStudy Philadelphia

Meanage 56 34

Race/ethnicity

79%White 45%White

5%AfricanAmerican 44%AfricanAmerican

5%Hispanic 14%Hispanic

High schoolgraduates 94% 81%

Collegegraduates 43% 24%

PercentbelowFPL Notmeasured 27%

PhiladelphiaACEStudyConventional/OriginalACES Additional/ExpandedACEs

• WitnessingViolence

• LivinginUnsafeNeighborhoods

• ExperiencingRacism

• LivinginFosterCare

• ExperiencingBullying

• Physicalabuse• EmotionalAbuse• SexualAbuse• PhysicalNeglect• EmotionalNeglect• DomesticViolence• HouseholdSubstanceAbuse

• IncarceratedCareProvider

• MentalIllnessinthehome

AdaptedfromWadeetal.,2016

Findings:ManyofOriginalACEsareMorePrevalentinanUrban,DiversePopulations

AdaptedfromWadeetal.,2016

FindingsofPhiladelphiaACEStudy:ConnectionbetweenSocioeconomicStatus,ACEs,andHealthACEsincreaseriskforpovertyinadulthood

BothSESandACEshaveinfluencesonpoorhealth

ACEscoresaffectfuturehealthoutcomes,andpossiblyhealthoutcomesofoffspring

SummerProjectOneImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring

- EvidencetosuggestmaternalACEscorehasanimpactontheirchildren’shealthoutcomes

Whataboutdads??

FamilyMedicalHistoryProject

DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool◦ PI:KimberlyMitchell,PhDfromtheUniversityofNewHampshireinCollaborationwithRoyWade,MDfromChildren’sHospitalofPhiladelphia

ImpactofPaternalChildhoodAdversityonOffspringHealthOutcomesPrimaryObjective:

AssesstheimpactofpaternalACEsontheirhealthoutcomes,onparentingstyles,andonthehealthoutcomesoftheirchildrenHypothesis:

HigherACEscoresoffatherisassociatedwithhigheroffspringACEscore,lowerparentingabilities,andincreasedhouseholdenvironmentchaosHigherACEscoreofoffspringwillleadtoincreasedriskofnegativehealthoutcomes

ACEsofFather

HarshPsychosocialEnvironmentalConditionsforOffspring

OffspringNegativeHealthOutcomes

MethodsCase-ControlStudy◦ ~250childrenwithNeurocognitiveDisorder(NCD)diagnosis◦ ~250childrenwithnoNCDdiagnosis

SurveyindevelopmentPopulation◦ 500Parentsand/orcaregiversofchildrenreceivingcareat1of32CHOPclinicalpracticesites

SummerProject#2ImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring

FamilyMedicalHistoryProject

DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool◦ PI:KimberlyMitchell,PhDfromtheUniversityofNewHampshireinCollaborationwithRoyWade,MDfromChildren’sHospitalofPhiladelphia

FamilyMedicalHistoryProjectatMountZionBaptistChurch

HealthBehavior

EnvironmentCulture

AnalysisPhase

•Demographics• FamilymedicaltreesReview•Preset/EmergentCodes•Codebook•CodeinterviewsCoding•Associationbetweenthemesandpatternsofillness•Associationbetweeninterventionselfreportedhealth/healthpromotionstrategies•PotentialopportunitiestointerveneAnalyze

SummerProject#3:ImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring

FamilyMedicalHistoryProject

DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool◦ PI:KimberlyMitchell,PhDfromtheUniversityofNewHampshireinCollaborationwithRoyWade,MDfromChildren’sHospitalofPhiladelphia

DevelopinganAssessmentToolisImportant..1,297childrendieannuallyfromagun-relatedinjury

Firearm-RelatedEvents:3rd LeadingCauseofdeathforchildren,ages1to17◦ Surpassesinfluenza,pediatriccongenitalanomalies,pneumonia,chroniclowerrespiratorydiseases

Source:Fowler&Dahlberg,2017

FocusGroupDevelopment3AgeGroups:- 1:Parentsof2-9yearolds- 2:10-14yearolds- 3:15-17yearolds

PrimaryGoal:Developasetofquestionsforpediatricianstousewhentalkingtopatientsandpatients’parentsaboutgunsandgunsafety

MyRoleFocusGrouprecruitment,organizationanddatacollectionPaternalsurveytranslationfromEnglishtoSpanishCodebookdevelopmentParticipantinweeklyteammeetingsPlantocontinueworkwithDr.Waderemotely◦ SystematicLiteratureReview:ImpactofParentalChildhoodAdversityonParenting

MyLearningExperienceCloseobservationofthemanyroles,responsibilities,andsimultaneousprojectsofaclinicalresearcherQualitativeresearchskills◦ Qualitativecoding◦ Processofasystematicliteraturereview◦ Conductingfocusgroups

Utilizingresearchdatabase(REDCap)Importanceoftakinginitiative/voicingyourowninterests

AcknowledgementsDr.RoyWadeResearchCoordinators◦ DanielleCollins◦ MacyMarcucci

JoanneLevySafa BrowneFellowResearchAssistantsatCHOP2017SUMRScholarsCohort

Questions?