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

INTRODUCTION: Approximately two-thirds of the U.S. population have had at least one adverse childhood experience (CDC-Kaiser Permanente Adverse Childhood Experiences [ACE] Study, 2009). Some consequences of ACEs are manifested as the child grows into late teenage years and young adulthood. Research suggests that children exposed to traumatic events during childhood subsequently experience negative health outcomes like substance abuse, engagement in risky and harmful sexual behavior, and STD occurrence. AIM: In this thesis I explore the associations of 18 year olds’ described use of alcohol, risky sexual behavior and sexually transmitted diseases (STDs) with childhood exposure to caregiver substance abuse, violence and family circumstances METHODS: Data were obtained from the Longitudinal Studies of Childhood Abuse and Neglect (LONGSCAN) Assessments 0 - 18 from the National Data Archive on Child Abuse and Neglect (NDACAN). Variables on adverse childhood experiences, sex behaviors, STDs and substance use were observed in SAS. Multiple logistic regression models were used to identify odds ratios and strength of associations. RESULTS: Results suggests significant associations among participants who were exposed to parent/caregiver use of illicit drugs during participant’s childhood and subsequent self-reported heavy alcohol use 1.60 (95% CI: 1.18, 2.22), having early sexual initiation (at age 13 or younger) 1.60 (95% CI: 1.18, 2.22), having 6 or more sexual partners 1.36 (95% CI: 1.09, 1.68) and having STDs 1.83 (95% CI: 1.36, 2.46). Eighteen year olds with who were African American, were at a greater odds of having greater than 6 sexual partners, having sexual intercourse at or before age 13 and having (an) STD(s). No significant associations were found between having a parent/caregiver or member of household who was incarcerated, being exposed to violence, being exposed to yelling often or parental often use of alcohol and subsequent alcohol abuse, having greater than 6 sexual partners, having sexual intercourse at or before age 13 and having (an) STD(s) . DISCUSSION: Based on the findings of these analyses, programs for adolescents should focus time and resources on young children who may be currently experiencing, or at risk for experiencing, parental/ caregiver illicit drug use in the home.

It has been well documented that Adverse Childhood Experiences (ACEs) lead to unfavorable outcomes in later life, especially with regard to health and psychological outcomes. Recent research has demonstrated the impact of early childhood adversity on the onset of aggression and illegal behavior. However, often those with mental illness diagnoses with comorbid behavioral problems exhibit trajectories that include both arrest and hospitalization. While some are arrested for their criminal behavior, others are hospitalized. This begs the question: are those with mental illness and behavioral problems more likely to be arrested, or hospitalized, for their early behavioral problems? In the current study, it was hypothesized that arrest precedes hospitalization for the majority of these offenders, and that specific diagnoses of a mental illness are related to outcome. It was also hypothesized that early exposure to environmental adversity, as measured by the age of earliest ACE and total ACE score, would significantly predict whether offenders were arrested or hospitalized first. Other socio-ecological factors were also studied. The data for this study were gathered from a sample of 182 adult psychiatric inpatients in a secure forensic facility. Data were archival and retrospective in nature. All participants had been hospitalized following acts of violence or aggression, exhibiting a history of both behavioral problems as well as mental illness. A series of logistic and linear regressions were used to examine the relationship between reason for first admission to a psychiatric facility, diagnosis of a mental disorder, and early childhood adversity to clarify whether early problematic behaviors resulted in initial arrest or psychiatric hospitalization. Results indicate that subjects were much more likely to be hospitalized initially than arrested (33.5% arrested first, 66.5% hospitalized first). A diagnosis of impulse control disorder was significantly related to whether initial incident led to arrest or hospitalization (p=0.030), while the diagnosis of ADHD neared significance (p=0.056). No significant relationship was found between incidence of initial arrest or hospitalization and age that drug/alcohol abuse began. Other findings and implications for future research will be discussed.

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.

Persons exposed to adverse childhood experiences (ACEs) are at increased risk of developing long-term negative health consequences. ACEs have a cumulative negative impact on mental health outcomes in particular. Evidence suggests that those in forensic psychiatric settings are disproportionally exposed to ACEs, lending to potentially greater complexity in the relationship between ACEs, psychiatric comorbidity, and behavioral problems. Additionally, within this population a common intervention for mental health symptomology includes pharmacology, particularly as health issues compound. As a medication regimen becomes more complex, the risk for negative consequences – including drug interactions, side effects, and even death – increases. Limited empirical research describing associations between ACEs, mental health outcomes, and polypharmacy is available. Furthermore, no published studies to date have examined these relationships in forensic inpatient mental health populations, despite the evidence that these populations are disproportionately exposed to maltreatment and household dysfunction in childhood, frequently have higher rates of physical and mental health problems, and are usually treated with multiple forms of medications in response to health and behavioral needs. To address gaps in existing research, the relationship between ACEs, mental health outcomes, and prescription practices will be examined within a forensic inpatient sample. The current study seeks to investigate the impact of ACEs on mental health outcomes and the relationship to polypharmacy practices within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101) or African American (40.1%, n=73), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). It is expected that greater experiences of childhood maltreatment and household dysfunction will result in greater negative mental health outcomes and associated behaviors. This relationship is expected to contribute to polypharmacy practices among prescribing physicians. Because high rates of polypharmacy yield a potential for increased aversive health outcomes, understanding the association between ACEs and other predictive factors and polypharmacy practice has valuable implications for the treatment and rehabilitation of persons in forensic mental health settings.

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.

Adverse childhood experiences (ACEs) are traumatic events during a person’s early life that can influence their later mental health, physical health, and wellbeing. Internalizing symptoms such as anxiety and depression are common mental health outcomes associated with these events. Two factors, religiosity/spirituality (R/S) and mindfulness, are possible protecting factors to help lessen the effect of traumatic experiences on later mental health. This study examined whether R/S and mindfulness are protective factors in the relationship between ACEs and future internalizing symptoms. Further, this study examined whether the impact of R/S was influenced by an individual’s mindfulness (moderated moderation). Participants (N = 769, age M = 20.43, SD = 4.507) for this study were recruited through the SONA research platform at East Tennessee State University as a part of the REACH (Religion, Emotions, and Current Health) self-report survey. Results from the current study did not support either mindfulness or R/S as moderating factors for the relationship between ACEs and internalizing symptoms. However, exploratory mediation suggested mindfulness was a mediator for this relationship. This study, while it did not demonstrate the buffering capacity of study variables, provides information about the implications of ACEs in a Northeast Tennessee sample. Future research should examine new variables as potential protective factors for this relationship and more detailed information about the mediating effect of mindfulness.

Pregnancy is a unique developmental period in a woman’s life, characterized by numerous psychological, behavioural, and biological changes. How a biologically female woman experiences her pregnancy is impacted by her previous life experiences, including early experiences of adversity. In particular, maternal history of Adverse Childhood Experiences (ACEs) before age 18, has been shown to exert distal effects on mental health and behaviour in pregnancy. The current study explored the associations between ACEs and mental health symptoms in pregnancy via structural equation modelling within a sample of 330 Canadian women. This statistical approach permitted the use of a latent ACE variable comprised of abuse, neglect, and household dysfunction as indicator variables, as well as a latent mental health variable comprised of symptoms of depression, anxiety, and fear of childbirth. A direct effect emerged whereby maternal ACEs predicted mental health symptoms. This permitted subsequent testing of the following mediating pathways: sleep, health-risk behaviours, resilience, and social support. In the mediation analyses, further support emerged for the total indirect effect of maternal ACEs on mental health symptoms in pregnancy, once mediation pathways were added. In reviewing individual indirect pathways, sleep and social support mediated the association between ACEs and mental health symptoms in pregnancy. However, health risk behaviours and resilience did not. In addition, social support mediated the relationship between resilience and mental health symptoms in pregnancy. This study contributes to the existing research on maternal ACEs and their relationship with mental health symptoms during pregnancy. The concurrent testing of several pathways in the structural model served to characterize possible mechanisms through which early adversity relates to current mental health symptoms in pregnancy. Implications of these findings include identification of possible targets for intervention in pregnancy, in order to lessen the burden of ACEs on maternal mental health. / Graduate