Early stressors like trauma can lead to developmental changes that have life-long negative health consequences (Merikangas et al., 2010; Anda et al., 2006). Approximately 1 in 4 youth experience substantial trauma during their developmental years (Merikangas et al., 2010; Duke, Pettingell, McMorris, and Borowsky, 2010). Such findings suggest the need for early intervention and treatment for adolescents exposed to traumatic events and adversity. Ideally, adolescents could be treated within primary care settings where parents overwhelmingly seek services for their children. Primary care settings are sought out at a 94% to 97% rate of services as compared to only a 4% to 33% rate of parents seeking out mental health services (Guevara et al., 2001). Unfortunately, no adolescent trauma-informed interventions have yet been adapted for use in primary care (Glowa, Olson, and Johnson, 2016). This study aimed to fill this critical gap between adolescent mental health issues associated with trauma and adverse childhood experiences and the lack of treatment in integrated primary care settings. The need for trauma-informed treatment for adolescents who have experienced trauma and adverse experiences is especially salient as evidence-based treatment for adolescents in this setting is limited. A modified Delphi approach was employed to address this gap in the research. Two rounds of questionnaires and focus groups were utilized with a panel of experts and youth stakeholders to gain consensus on treatment recommendations. Ultimately, expert panelists and youth stakeholders identified 59 recommendations for adolescent trauma treatment to be delivered in integrated primary care settings. / Doctor of Philosophy / Childhood trauma can have negative health, social, and educational outcomes that extend into adulthood and over one’s lifespan (Black, Woodworth, Tremblay, & Carpenter, 2012; Merikangas et al., 2010). Approximately 1 in 4 youth today experience trauma (Duke et al., 2010). Trauma can include a variety of things such as physical, sexual, or emotional abuse; being the victim of a crime; witnessing violence in the home; living through a natural disaster or experiencing an accident (Anda et al., 2006; APA, 2017). The frequency of trauma in adolescence suggests the need for early intervention and treatment. Ideally, adolescents could be treated within primary care settings where parents and adolescents frequently seek care services. Unfortunately, no adolescent trauma interventions have been created for this setting (Glowa, Olson, & Johnson, 2016). This study was designed to improve the treatment of adolescent trauma in primary care settings. For this research study a modified Delphi technique was used. Two rounds of questionnaires and focus groups were utilized with participants that consisted of a panel of experts from the field and youth aged 14-18 years old. Ultimately, the study participants made 59 recommendations for adolescent trauma treatment to be delivered in primary care settings.

Introduction: Adverse Childhood Experiences (ACEs) are known to increase risk of mental health challenges throughout development, and sleep is known to decrease risk of mental health challenges. These have not been studied in tandem in younger cohorts. We investigated whether interactions between sleep duration and sleep regularity would moderate the impact of ACE exposure on risk for the development of mental health disorders. Methods: We conducted secondary cross-sectional analyses on the 2020-2021 waves of the National Survey of Children's Health (NSCH) (n = 92,669). We used logistic and ordinal regression to replicate known main effects of ACEs (total, household, community, and single) and sleep (duration and irregularity) on mental health diagnostic status and symptom severity, and we examined the interaction of ACEs and sleep on mental health diagnostic status. To correct for multiple comparisons, all original models were performed with one half of the dataset and then replicated in the second half. Follow-up analyses by age cohort (0-5, 6-11, 12-17 years) further examined interaction effects across development. Poverty level, parental education status, child age, child sex, neighborhood safety, neighborhood support, and race/ethnicity were included as covariates, as indicated in a priori acyclic graph (DAG) modeling. Results: Known main effects for ACE and sleep on mental health diagnoses were replicated across all models. Interactions between ACE exposure and adequate sleep duration or increased sleep irregularity were not clinically significant, although some were statistically significant due to large sample size, such that adequate sleep duration was associated with marginally increased risk of mental health diagnosis (Omnibus B = 0.048, p < 0.0001) and greater bedtime irregularity was associated with marginally decreased risk of mental health diagnosis (Omnibus B = -0.030, p < 0.001). Discussion: Main effects in this analysis are consistent with previous literature on ACEs, sleep, and mental health. However, interaction effects were largely small and clinically insignificant. Dichotomous and categorical parent-report items assessing sleep health may not be sensitive to interaction effects, compared with continuous data or physiological measurements. Further, examining mental health symptoms (rather than diagnosis status) may also allow for more nuanced understanding of potential interaction effects.

<p dir="ltr">Background—Adverse Childhood Experiences (ACEs) are events that occur before age 18, such as abuse and neglect, which are potentially traumatic. ACEs can lead to profound negative impacts on physical and psychological health and social relationships. Despite this, positive social connections can mitigate these effects. However, individuals with ACEs may struggle to form healthy relationships because of mistrust, leading to continued exposure to detrimental social environments. Additionally, ACE-exposed adults often internalize stigma.</p><p dir="ltr">Methods—Utilizing data spanning from 1995 to 2014, Chapter 2 examines 629 adults from the MIDUS II: Biomarker study. Employing counterfactual modeling, the study estimates the treatment effect of ACE exposure on well-being and employs weighted multilevel mixed models to analyze life course changes. Chapter 3 uses 1,243 respondents from the MIDUS II: Biomarker study, employing latent class analysis to identify social relationship patterns and assess their mediation between ACEs and the pursuit/enjoyment of new relationships. Chapter 4 uses experimental data from 493 respondents, employing vignette experiments to gauge perceptions of warmth and competence, with gender and happiness examined as moderators, and threat, status, four stigmatizing descriptions as mediators.</p><p dir="ltr">Results—ACE exposure is associated with increased chronic conditions, lower self-rated health, diminished psychological and social well-being. However, the strength of the treatment effects differs based on the type and number of ACE exposures. Latent Class Analysis of social relationships indicates four classes: healthy, ambivalent, kin-focused, and difficult, with higher ACEs linked to a decreased probability of being in the “healthy” class. ACEs also predict reduced enjoyment of interactions with new people, mediated 41% by the current social relationship class. ACE vignettes are perceived as less warm and competent, with happiness moderating some ACE-related perceptions. Status, “mentally ill”, and “damaged” emerged as strong mediators.</p><p dir="ltr">Conclusion—While ACE exposure is related to lower well-being, the rate of decline does not differ from non-ACE-exposed individuals across time. Those in strained relationships are less likely to enjoy new social interactions, potentially perpetuating ACE-related health consequences. Addressing interpersonal trust issues in ACE-exposed adults through social interventions may mitigate these effects. Additionally, there is stigma against each of the ten ACEs, and the medicalization of ACEs contributes to stigma.</p>

ABSTRACT INTRODUCTION: Studies on the topic of adverse childhood experiences (ACEs) and childhood obesity collectively indicate an association, but there is a lack of replication in nationally representative sample of children aged 10-17 years. This study aims to expand on the definition of ACEs to include: socio-economic hardship, racial discrimination, witness or victim of neighborhood violence, and bereavement, and to examine their individual and joint association with BMI levels, especially childhood obesity (primary outcome). METHODS: The 2011-2012 National of Children’s Health (NSCH) was used for this study (N=45,309). One child interview weight was produced; hence, the estimates are generalized to all non-institutionalized children 10-17 years of age in the US and each state. Statistical methods used included descriptive statistics and multivariable multinomial logistic regression models. ACEs examined included: (1) Socioeconomic hardship, (2) Parental divorce or separation, (3) Bereavement, (4) Incarcerated family member, (5) Witness to domestic violence, (6) Victim/witness of neighborhood violence, (7) Household mental illness, (8) Household substance abuse, (9) Racial discrimination. BMI for the same sex and age (10-17 years) percentile relative measurement, using growth charts recommended by CDC, among children and teens were used as indicators of BMI. BMI-95th percentile or greater was considered obese. RESULTS: The prevalence of childhood obesity and ACE exposure was higher for boys compared to girls. Controlling for gender, among those who were obese, White-non-Hispanic children had the highest prevalence of obesity compared to other races for both genders. Southern States constituted 80% and 60 % of top 10 states with the highest prevalence of childhood obesity and ACE, respectively. Approximately 25.4 million (89.5%) children aged 10-17 years had experienced 3 or less ACE. The most prevalent ACE category of nine asked about for child was-living with parents who were either divorced or separated after his/her birth (26.77%) and the least prevalent was living with a parent who died (4.84 %). ACEs were not mutually exclusive, and all nine categories of ACEs were interrelated. The adjusted odds ratio of covariates to their reference groups that were only statistically significant for childhood obesity relative to healthy weight encompassed: a) Place of residence in metropolitan statistical area, b) two or more chronic health conditions of 18 asked about, c) Watching TV, videos, or playing video games across categories >1 to≥4 hours, d) family members in the household eat a meal together 7 days of the week, e) and computer, cell phone or electronic device use ≤1 hour. Moreover, the explanatory variables, namely, age, sex, the physical health status of parents, and physical activity, were strongly related to childhood obesity (associated both with higher odds and lower odds of outcome) compared to overweight and underweight BMI categories. CONCLUSIONS: This is the first study to explore the co-occurrence, individual and joint association of ACEs with childhood obesity using nationally representative sample of children aged10-17 years in the U.S. Having childhood obesity, BMI-95th percentile or above was strongly related to ACE dichotomy, ACE score ≥2 and two ACE types (socioeconomic hardship and bereavement) than the probability of overweight, BMI-85th to 94th percentile. Underweight-BMI less than 5th percentile had only statistically significant association with socioeconomic hardship ACE category. Sociodemographic, parental, and childhood related factors were also independently associated with childhood obesity.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The impetus for this study is contextualised within social work teaching and learning and arose from the emergence of adverse childhood experiences (ACEs) of social work students. The researcher had become increasingly interested in the ways in which these ACEs impacted on students in social work classrooms and felt compelled to enquire what the responses of teaching and learning in social work should be. The rationale for the study was further established by the dearth of research in this focal area. The research goal was to gain an understanding of the experiences of third-year students and the perspectives of social work teachers with regard to the role of adverse childhood experiences during teaching and learning activities and to recommend meaningful teaching practices. There were seven research objectives that focused on obtaining theoretical perspectives from the literature and on exploring and describing the adverse childhood experiences of students within the context of teaching and learning in social work. The research objectives generated the central research question: What are the learning experiences of third-year social work students at a South African university with regard to the role of their own adverse childhood experiences? A qualitative approach and case study design was deemed the most appropriate research philosophy and method to address the study’s objectives and central research question. The case study design was used to explore how individuals (third-year social work students at the University of the Western Cape) experienced a particular phenomenon (in this case adverse childhood experiences) in relation to teaching and learning within a social work context. To provide credence to the two purposes of this research, namely exploring and describing, two methods and two sources of data were utilised: (i) a reflective assignment in a specific social work third-year module from which 20 assignments were selected using purposive sampling; and (ii) individual interviews with ten student participants (derived from the sample of assignments) and two teaching staff participants. Three overarching topics emerged from the findings, namely the adverse childhood experiences of student participants; the after-effects of adverse childhood experiences in the context of teaching and learning in social work; and suggestions by participants for social work teaching and learning in the context of adverse childhood experiences. Each topic was delineated further into themes, sub-themes, and categories. The conclusions are that there was compelling evidence showing students to have endured formidable adverse childhood experiences; that students experienced overwhelming emotional reactions and responses during teaching and learning that exposed vicarious traumatisation; and that gaps present in current teaching and learning practices in social work render these practices insufficient to meet the learning needs of students. Three core recommendations relating to teaching and learning are offered: To develop the content of professional learning in the social work curriculum regarding the professional use of self, self-awareness and virtue ethics; to reconstruct and reaffirm the signature pedagogy regarding teaching and learning approaches and methods in social work; and to align fieldwork and placement learning with student profiles while also focusing on lecturer attentiveness and responsiveness. / AFRIKAANSE OPSOMMING: Die impetus vir hierdie studie is vervat in die onderrig en leer in maatskaplike werk van maatskaplike werk studente wat afbrekende kindertydse ervarings (AKE’s) deurgemaak het. Die navorser, wie se belangstelling al hoe meer geprikkel is deur die wyse waarop hierdie AKE’s studente in maatskaplike werk in die lesingsaal beïnvloed, is genoodsaak om inligting in te win oor wat die reaksie op onderrig en leer in maatskaplike werk behoort te wees. Die rasionaal vir die studie is verder deur die gebrek aan navorsing in hierdie fokusarea versterk. Die doel van die navorsings was om begrip vir die ervarings van derdejaarstudente en die perspektiewe van maatskaplikewerkdosente te ontwikkel oor die rol van AKE’s tydens onderrig- en leeraktiwiteite, en om betekenisvolle onderrigpraktyke aan te beveel. Die fokus van die sewe navorsingsdoelwitte was die inwin van teoretiese perspektiewe, asook die eksplorering en beskrywing van studente se AKE’s binne die konteks van die onderrig en leer van maatskaplike werk. Die navorsingsdoelwitte het die sentrale navorsingsvraag gegenereer: Hoe ervaar derdejaarstudente hul eie afbrekende kindertydse ervarings in maatskaplike werk aan ’n Suid-Afrikaanse universiteit? n Kwalitatiewe benadering en gevallestudiemetode is as geskikte metodes beskou om die studie se doelwitte en sentrale navorsingsvraag te ondersoek. Die gevallestudiemetode is gebruik om na te vors hoe individue (derdejaarstudente in maatskaplike werk aan die Universiteit van Wes-Kaapland) ’n spesifieke fenomeen (in hierdie geval AKE’s) ten opsigte van onderrig en leer binne die konteks van maatskaplike werk ervaar. Om geloofwaardigheid te verleen aan die twee doelwitte van hierdie navorsing, naamlik ’n verkennings ondersoek en beskrywing, is van twee metodes en twee databronne gebruik gemaak: (i) ’n Reflektiewe taak in ’n spesifieke derdejaarmodule in maatskaplike werk waaruit 20 take met behulp van ’n doelbewuste steekproef gekies is; en (ii) individuele onderhoude met tien deelnemende studente (gekies uit die steekproef van take), en twee deelnemende dosente. Drie oorkoepelende onderwerpe het uit die bevindinge na vore gekom, naamlik die AKE’s van studentedeelnemers; die nagevolge van afbrekende kindertydse ervarings binne die konteks van die onderrig en leer van maatskaplike werk; en voorstelle van deelnemers vir onderrig en leer van maatskaplike werk binne die konteks van AKE’s. Elke onderwerp word verder in temas, subtemas en kategorieë weergegee. Die gevolgtrekking is dat oortuigende bewyse bestaan wat toon dat studente ontsaglik AKE’s deurgemaak het; dat studente oorweldigende emosionele reaksies en response ervaar tydens onderrig en leer wat tot indirekte traumatisering lei; en dat daar tekortkominge is in die huidige onderrig- en leermetodes vir maatskaplike werk wat nie genoegsaam aandag gee aan die leerbehoeftes van studente nie. Daar is drie kernaanbevelings rakende onderrig en leer: Om die omvang van professionele leer ten opsigte van die professionele gebruik van die self, selfbewustheid en deugsaamheid in die maatskaplike werk-kurrikulum te ontwikkel; om maatskaplike werk se kenmerkende pedagogie oor onderrig- en leerbenaderings en metodes te rekonstrueer en te herbevestig; en om praktiese plasing en leer tydens plasing met die profiel van ’n student te belyn, terwyl die fokus ook op die oplettendheid en reaksie van die dosent moet wees.

No description available.

Background: Adverse childhood experiences (ACEs) are a major public health problem in the US, and have been linked to risky sexual behavior and psychopathology. However, studies examining the link between the wide range of ACEs and sexual health outcomes and behaviors, and the associated mediational role of psychopathology are lacking. Objectives: The main objectives of this dissertation project were: 1) To determine the association between ACEs and sexual health outcomes and behaviors (early sexual debut, intimate partner violence (IPV) perpetration, and HIV/STIs); 2) To examine the disparities among selected populations; and 3) To assess the mediational role of psychopathology in the association between ACEs and sexual health. Methods: Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to determine the association between ACEs (neglect, physical/psychological abuse, sexual abuse, witnessing parental violence, and parental incarceration/psychopathology) and early age at sexual debut by sex and sexual orientation. Structural equation modeling (SEM) was used to determine the mediational role of psychopathology (PTSD, substance abuse, and depression) in the association between ACE constructs and IPV perpetration, and the role of psychopathology, early sexual debut and IPV perpetration in the association between ACEs and HIV/STIs. Results: The association between ACEs and early sexual debut was generally stronger for women and sexual minorities. Among men, PTSD mediated the association between sexual abuse and IPV perpetration (z=0.004, p = 0.018). However, among men and women, substance abuse mediated the association between physical/psychological abuse and IPV perpetration: z=0.011, p=0.036 and z=0.008, p=0.049, respectively. Among men, PTSD mediated abuse (physical/psychological, and sexual) and parental incarceration/psychopathology; substance abuse mediated abuse and neglect; depression and early sexual debut mediated abuse; and IPV perpetration mediated sexual abuse, and HIV/STIs. Among women, substance abuse mediated neglect and physical/psychological abuse, and depression mediated physical/psychological abuse and HIV/STIs. Conclusions: Intervention and prevention programs geared towards preventing sexual health outcomes and behaviors should employ a life course approach and address ACEs. Treatment components addressing PTSD, substance abuse, and depression should also be added to IPV perpetration and HIV/STI prevention programs.

Childhood sexual abuse (CSA) has been linked to a number of adverse effects in adulthood including higher levels of depression, shame, guilt, self-blame, somatic concerns, anxiety, dissociation, repression, denial, relationship problems, and sexual problems. Little is known, however, about the influence CSA has on parenting, specifically among African American mothers, as previous researchers have primarily focused on the trauma experienced by survivors. Examining the impact of CSA on African American mothers' parenting is important as those children of survivors will often also experience the impact of the long-term sequelae associated with CSA. Guided by womanist theory, the purpose of this hermeneutic phenomenological qualitative inquiry was to explore the lived experiences in relation to parenting of African American mothers who survived CSA. Experiential anecdotes of data collected from interviews with 7 participants were hand coded for emergent themes; analysis generated 4 essential themes and 10 subthemes of experience. Themes included impact of abuse, bonding, efforts to protect, spirituality, and desires. This study's implications for positive social change include contributing to the knowledge base about the process of parenting experienced by African American female survivors of CSA. Findings may add insight shedding light on cultural nuances in parenting and coping with trauma and inform culturally-competent practice. Using study findings, mental health providers may be able to develop tailored treatment interventions and better support services for the prevention of adverse long-term effects of CSA in African American women.

This DNP project addresses the healthcare issue of intimate partner, domestic, and sexual violence (IPDSV), its impact on survivors, and reducing the potential for retraumatization by those who care for them in the clinical, behavioral, and social settings. Trauma-informed care interventions are designed to address the sequelae of trauma, promote recovery, and support resilience. Since IPDSV is a global health issue, supporting cultural needs of all clients is an essential aspect of trauma-informed care. This project was guided by a central research question that examined if trauma-informed, culturally competent curriculum be viewed by community stakeholders as an appropriate intervention for the education of their workforce in preventing survivor retraumatization. The framework for this project was informed by the sanctuary model, the 4 major tenets of Leininger's theory of culture care diversity and universality, and the 5 constructs of cultural competence by Campinha-Bacote. The focal site was a domestic violence shelter that provides care for a multitude of culturally diverse trauma survivors. Demographic data were collected, and a descriptive analysis performed to determine the diversity and needs of the residents. These data were then used to develop a culturally competent program using trauma-informed principles to prevent the effects of recidivism, and to promote healing, empowerment, and resilience in survivors.

BACKGROUND: The social causation of preterm birth remains elusive, without an adequate explanatory framework. Thus, this study proposed and evaluated a conceptual model of the social determinants of perinatal health for the understanding of perinatal health disparities. METHODS: A prospective cohort study was conducted with pregnant women between 20 and 35 weeks gestation who were participating in two Healthy Start programs in Central Florida, from July 2011-August 2013. Perinatal health was operationalized based on gestational age, birth weight, and healthy start infant risk screen score. The predictors were: early life adversity, social position, maternal health-related quality of life, maternal stress, racism and discrimination, lack of social support, father involvement during pregnancy, intimate partner violence, and adverse maternal behaviors. Data collection consisted of a self-administered survey and birth outcome data was obtained from Healthy Start administrative databases. The statistical framework was structural equation modeling. RESULTS: The study sample was racially and ethnically diverse (N, Hispanics=72; N, non-Hispanic blacks=61; and N, non-Hispanic whites=48). The majority of mothers in this study were single or not married (cumulative 76%), US born (74.6%), and with English speaking preference (74.6%). The sample tended to cluster in low income groups (cumulative 58% less than $25,000 annual household income) and with education levels of less than high school (79.6%). A greater proportion of Hispanic mothers were married (66.7%) compared to non-Hispanic blacks (34.4%) and non-Hispanic whites (47.9%). Only 41.7% had completed high school, compared to 63.9% non-Hispanic blacks and 64.6% non-Hispanic whites. Nearly all non-Hispanic blacks and non-Hispanic whites were born in the US, compared to only 43.1% Hispanic mothers. Only 40% of non-Hispanic blacks reported on currently living with the baby's father at the time of the survey, compared to 66.2% for Hispanic mothers, and 58.3% for non-Hispanic whites. Furthermore, non-Hispanic blacks reported a greater proportion of discriminatory experiences in daily situations (mean = 4.74), compared to the other groups (mean for Hispanics was 2.14, and mean for non-Hispanic whites was 1.95). Non-Hispanic whites reported the greater proportion of daily alcohol use (mean 3.8 beverages per month), compared to other groups (Hispanic mean was 0.69, and non-Hispanic blacks mean was 1.68). Non-Hispanic white mothers also presented a higher mean of adverse childhood experiences before 18 years of life (mean = 3.4), compared to other groups (mean for Hispanics was 1.63, mean for non-Hispanic blacks was 2.48). With the exception of the confirmatory factor analysis for intimate partner violence (low correlations with common factor), all other confirmatory factor analyses demonstrated an acceptable Chi-square to degrees of freedom ratio (<6), and the RMSEA was less than 0.08 (minimum for acceptance). Thus, structural equation models were estimated subsequently. The first model was a model of direct effects between social position and perinatal health (hypothesis 1: direct effects), which demonstrated a good fit as indicated by X2/DF ratio of 1.4 (Chi-Square = 19, DF =13) and a RMSEA of 0.05. However, the direct effect of social position was very small and non-significant (Beta=-.02, p-value =.76), supporting the conclusion that a simple direct effect of social position on perinatal health was not found in this population. The second model explored indirect effects of social position through intermediate factors (hypothesis 2: indirect effects), which demonstrated a good fit to the data, as indicated by a Chi-square/df ratio = 1.45 and RMSEA=.05. Social support was a statistically significant mediator between social position (Beta=0.284, p<0.05) and perinatal health (Beta=0.22, p<0.05). The third model incorporated adverse childhood experiences as predictor of social position effects. Adverse childhood experiences were significantly associated with social position (Beta=.363, p<0.05) and moderated the effects of social position on social support and perinatal health. In the presence of adverse childhood experiences, the social position was significantly associated to maternal health-related quality of life (Beta=-0.226, p<0.05) and maladaptive maternal behaviors (Beta=0.654, p<0.05). CONCLUSION: This study demonstrated synergistic effects of social determinants of health. Controlling for all factors considered, social support was significantly associated with perinatal health, which presents implications for strengthening prenatal programs that provide support to pregnant women. Findings need to be replicated in larger studies with the US general population. Policy makers and researchers need to pay greater attention to the role of early life adversity on perinatal health outcomes.