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OBJECTIVE: To examine association between Adverse Childhood Experiences (ACE) and teeth extracted due to dental caries or periodontitis among young and middle-aged US adults. METHODS: Study sample included 15,474 and 17,430 respondents aged 18-64 completing 2010 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey respectively. Outcome was any self-reported tooth extraction due to caries or periodontitis. Primary predictor were self-reported 11 ACE answers (categorized into none, 1, 2, and 3+) before 18 years of age. Covariates included smoking, heavy alcohol consumption, diabetes, health coverage and access to dental care. Odds ratios were computed from unadjusted and adjusted logistic regression models. RESULTS: Overall ACE prevalence was 66.5% and 64.9% in BRFSS 2010 and 2012 study sample respectively. In unadjusted models we observed a graded association wherein adults reporting experienced 2 and 3+ ACE were more likely to experience tooth extractions compared to those reporting no ACE exposure. (BRFSS 2010 OR = 1.47,1.48; BRFSS 2012 OR = 1.33, 1.54 respectively; p<0.05). We found similar results in multivariate models after adjusting for covariates (BRFSS 2010 OR = 1.56,1.34; BRFSS 2012 OR = 1.36, 1.42 respectively; p<0.05). CONCLUSIONS: This study suggests potential long lasting impact of early adverse life events on oral health in young and middle adulthood. Young and middle-aged adults experiencing multiple ACE had significantly more extractions compared to adults who reported not experiencing any ACE. Multidisciplinary efforts between dentists, physicians and social therapists are needed to raise awareness about ACE as means of identifying and reducing dental health inequities. / 2020-06-13T00:00:00Z

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No description available.

Fostering a Trauma Informed Mindset in the Criminal Justice System Lauren Ledford, Mary Jo Oliver M.S., Meredith Jordan, Chloe Salyer, Adam Walker, Andrea D. Clements Ph.D. The presence of early childhood adversity and trauma is disproportionately high in individuals involved with the criminal justice system compared to the non-criminally involved population. Childhood adversity and trauma is consistently linked to many adverse lifelong outcomes such as increased mortality, increased risk of mental illness, and increased risk of substance use disorder. In order to respond to this increased risk, empathy and community-wide interventions have emerged as effective means of responding and resisting re-traumatization. Community and empathy-based training of law enforcement officials may assist in understanding trauma and combatting its effects as they are often some of the first people to come in contact with individuals experiencing the effects of childhood adversity and trauma. This study sought to evaluate the effectiveness of Trauma-Informed Care (TIC) training for police officers in their ability to have knowledge of, believe to be relevant, understand, feel confident implementing, and apply TIC principles. We hypothesized knowledge, relevance, understanding, implementation confidence, and application of TIC would all increase from pre-assessment to post-assessment. As part of an initiative to increase TIC awareness and implementation, 64 police officers participated in a one-day training that began with a pre-survey and ended with a post-survey. Both surveys contained measures concerning TIC knowledge, relevance, understanding, implementation confidence, and application. The post survey also included an additional measure regarding training quality satisfaction. The sample consisted primarily of White (N = 44), middle-aged males (M = 42.27, SD = 8.588). There was a significant difference between TIC knowledge t(56) = -4.593, p<.001, d = 1.096, TIC relevance t(56) = -2.488, p = .016, d = .912, TIC understanding t(56) = -8.611, p <.001, d = 2.932, and implementation confidence t(56)= -5.942, p <.001, d = 1.326 from the pre to post assessment. However, there was not a significant difference between TIC application t(56) = -1.826, p = .073, d = .585 from pre to post assessment. The consistently significant increase in TIC scores indicate that a TIC training is an effective means of improving officer perception of trauma and willingness to implement TIC practices.

Growing evidence of the health risks associated with adverse childhood experiences (ACEs) has prompted public health and community initiatives to promote awareness, detection, and responses that are trauma informed. Nationwide programs to integrate trauma-informed care into education, health care, and child serving agencies, have thus far led to the proposal and advancement of trauma-informed policies and practices in many communities. While Mississippi agencies include trauma-specific intervention and training, statewide ACEs initiatives and relevant data are still limited. This project aimed to contribute to the larger goal of a statewide trauma-informed paradigm shift, by increasing ACEs awareness and developing recommendations for the integration of such research into programs aimed at serving vulnerable populations. Sixty-one child-serving professionals participated in adversity and resilience training (ART), a 3-hour workshop addressing childhood adversity, traumatic stress, resilience, and secondary traumatization. Outcomes measured were changes in trauma knowledge, trauma informed attitudes, attributions regarding difficult child-behaviors, and secondary trauma knowledge and self-care. Participants also provided ratings on a training evaluation survey. There were significant changes in trauma knowledge (F(1,22) = 6.418, p = .000, ηρ2 = .226) and trauma-informed attitudes (F(1,22) = 11.014, p = .003, ηρ2 = .334) between pre- and post-training. Training evaluations were generally positive (M = 4.61, SD = 0.13, on a 1 to 5 Likert scale). The current study contributes to the research an evaluation of a training intervention that offers feasible strategies for scalable training and assessment of outcomes.

Adverse childhood experiences, known as ACEs, have been shown to negatively impact an individual’s health as an adult. While efforts to decrease children’s exposure to these traumatic experiences are beneficial, they are not able to fully eliminate these experiences and do not address how to help children who have already been exposed. Resilience, which has been defined as managing and adapting to significant sources of trauma, has been thought to be a protective factor against the toxic stress of ACEs. While the relationship between ACEs and poor health outcomes has been established, the relationship between resilience and health outcomes is largely unknown.  This study seeks to determine the association between resilience scores on a validated resilience questionnaire and health outcomes in adolescents. Looking specifically at body mass index, blood pressure, and depression scores on a validated depression screen we hypothesize that higher resilience scores will be associated with better health outcomes. In addition, we examine the relationship between ACE scores and resilience scores. If this validated resilience instrument is able to help predict health outcomes, this can direct development of intervention programs to build resilience in those living in ACE-heavy environments. / Urban Bioethics

Objective: To examine the prevalence of adverse childhood experiences and associations with early alcohol use initiation and alcohol use patterns among high-risk urban youth in Kampala, Uganda. Methodology: Data from the Kampala Youth Survey (N=457) conducted in May through June 2011 in Kampala, Uganda was used for analysis. Indicators of adverse childhood experiences (ACEs) included: hunger, having parents, talking to parents, ever having lived on the street, parents hitting each other, parents hitting children and parental use of alcohol. These were dichotomized as either possessing the characteristic or not. Alcohol outcomes assessed were; age at alcohol initiation (age 13 was the cutoff point), frequent drinking and heavy drinking. Bivariate and multinomial logistic regression analyses were computed to determine statistical association between ACEs and alcohol use. Results: Findings in this study showed that parents hitting the youth, parental alcohol use, hunger, having ever lived on the street, and having been raped were significantly associated with the youth’s age of alcohol initiation by age 13, frequent drinking and heavy drinking in bivariate analyses. Results also showed gender differences for: parental alcohol use, parents hitting each other, being hungry, ever having lived on the street and having been raped. Girls reported higher values for most measures. Parental use of alcohol, having ever lived on the street and having been raped were particularly significant included in a multivariate model. Conclusion: This study demonstrates that adverse childhood experiences are strongly associated with early alcohol use initiation as well as frequent and heavy drinking.

Adverse childhood experiences (ACEs) have long been linked to poor physical, mental, and behavioral outcomes in adulthood. Individuals with exposure to more types of ACEs are at greater risk of engaging in delinquent and criminal offending and also are relatedly more likely to be involved in the criminal justice system. The high prevalence of ACEs and other co-morbid risk factors in forensic populations calls for further investigation into how differential exposure to adversities influence the onset and nature of offending behaviors. Additionally, there are few studies investigating structural elements that precede offending behaviors (e.g., social and economic factors) in varied communities. Thus, the present study aims to examine the role of individual adversities and community factors on the development of nonsexual delinquent behaviors and juvenile justice involvement in a treatment sample of male adolescents. Data for the present study were derived from two sources. First, data were collected from archival records at a private nonprofit facility in rural Appalachia that provides treatment to adolescents who have engaged in sexually abusive behavior. Variables of interest include exposure to ACEs, indicators of sexual boundary problems within the home of origin (exposure to pornography by adult in home, witnessing sexual behaviors between others), and lifetime arrest history. Second, county-level secondary data were downloaded and delineated by county from the County Health Rankings & Roadmaps (CHR&R) program website, which provides publicly available data compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation. The CHR&R data has been published annually since 2010 and includes county-level markers of overall health and various factors that impact the health of counties. A standardized z-score was calculated to indicate social and economic environment compared to other counties in the state. Participants were assigned a z-score based on documented zip code of origin. To test the hypothesized model, confirmatory factor analysis was used, first examining indicators of individual adverse experiences and exposure to sexual behaviors in the home of origin. A three-factor model emerged: Factor 1 represented emotional abuse, physical abuse, and neglect; Factor 2 included indicators of household dysfunction; and Factor 3 included sexual abuse and more passive indicators of sexual boundary concerns in the home. Next, structural equation modeling revealed the association between individual experiences of adversity, county-level social/economic environment, and nonsexual delinquent behaviors with socioecological influences as a moderator. Results reveal varying relationships between exposures to adversity and arrest-related outcome variables. Additional discussion regarding findings, implications, and areas for future research will be explored.

Trauma has been found to be highly prevalent and associated with many negative health and social outcomes (i.e., heart disease, higher suicide risk, high-risk behaviors) in the general population. Despite these associations, trauma detection is relatively rare in service-providing organizations. Trauma-informed care (TIC) is a proposed solution that encourages trauma detection, understanding the symptoms associated with trauma, and treating trauma while actively avoiding re-traumatization to the service user. Although research about TIC efficacy has been fairly limited, there are some promising potential benefits of the practice to the client, provider, and the population as a whole. For this study, we looked at service providers’ reported familiarity with TIC and implementation of TIC in their organization across seven timepoints. We found familiarity increased more than implementation, and we discuss potential reasons that may cause this discrepancy.