Katie A. Ports

Adverse childhood experiences and sexual victimization in adulthood

Understanding the link between adverse childhood experiences (ACEs) and sexual victimization (SV) in adulthood may provide important information about the level of risk for adult SV and sexual re-victimization among childhood sexual abuse (CSA) survivors. In the present paper, we explore the relationship between ACEs, including CSA, and SV in adulthood. Data from the CDC-Kaiser ACE Study were used to examine the effect of experiences of early adversity on adult SV. Adult HMO members (n=7,272) undergoing a routine health exam provided detailed information about ACEs that occurred at age 18 or younger and their experiences of SV in adulthood. Analyses revealed that as ACE score increased, so did risk of experiencing SV in adulthood. Each of the ACE variables was significantly associated with adult SV, with CSA being the strongest predictor of adult SV. In addition, for those who reported CSA, there was a cumulative increase in adult SV risk with each additional ACE experienced. As such, early adversity is a risk factor for adult SV. In particular, CSA is a significant risk factor for sexual re-victimization in adulthood, and additional early adversities experienced by CSA survivors may heighten adult SV risk above and beyond the risk associated with CSA alone. Given the interconnectedness among various experiences of early adversity, adult SV prevention actions must consider how other violence-related and non-violence-related traumatic experiences may exacerbate the risk conferred by CSA on subsequent victimization.

The Association Between Adverse Childhood Experiences and Risk of Cancer in Adulthood: A Systematic Review of the Literature

CONTEXT: Adverse childhood experiences (ACEs) can affect health and well-being across the life course. OBJECTIVE: This systematic review summarizes the literature on associations between ACEs and risk of cancer in adulthood. DATA SOURCES: We searched PubMed to identify relevant publications published on or before May 31, 2015. STUDY SELECTION: We included original research quantifying the association between ACEs and adult cancer incidence. Case reports and reviews were excluded. DATA ABSTRACTION: Two reviewers independently abstracted and summarized key information (eg, ACE type, cancer type, risk estimates) from included studies and resolved all discrepancies. RESULTS: Twelve studies were included in the review. In studies in which ACE summary scores were calculated, significant associations were observed between the scores and an increased risk of cancer in adulthood. Of the different types of ACEs examined, physical and psychological abuse victimization were associated with risk of any cancer in 3 and 2 studies, respectively. Two studies also reported significant associations with regard to sexual abuse victimization (1 for cervical cancer and 1 for any cancer). However, 2 other studies reported no significant associations between childhood sexual or physical abuse and incidence of cervical or breast cancer. LIMITATIONS: Because of heterogeneity across studies, we were unable to compute a summary effect estimate. CONCLUSIONS: These findings suggest that childhood adversity in various forms may increase a person’s cancer risk. Further research is needed to understand the mechanisms driving this relationship and to identify opportunities to prevent and mitigate the deleterious effects of early adversity on long-term health.

Unpacking the impact of adverse childhood experiences on adult mental health

Exposure to childhood adversity has an impact on adult mental health, increasing the risk for depression and suicide. Associations between Adverse Childhood Experiences (ACEs) and several adult mental and behavioral health outcomes are well documented in the literature, establishing the need for prevention. The current study analyzes the relationship between an expanded ACE score that includes being spanked as a child and adult mental health outcomes by examining each ACE separately to determine the contribution of each ACE. Data were drawn from Wave II of the CDC-Kaiser ACE Study, consisting of 7465 adult members of Kaiser Permanente in southern California. Dichotomous variables corresponding to each of the 11 ACE categories were created, with ACE score ranging from 0 to 11 corresponding to the total number of ACEs experienced. Multiple logistic regression modeling was used to examine the relationship between ACEs and adult mental health outcomes adjusting for sociodemographic covariates. Results indicated a graded dose-response relationship between the expanded ACE score and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood. In the adjusted models, being spanked as a child was significantly associated with all self-reported mental health outcomes. Over 80% of the sample reported exposure to at least one ACE, signifying the potential to capture experiences not previously considered by traditional ACE indices. The findings highlight the importance of examining both cumulative ACE scores and individual ACEs on adult health outcomes to better understand key risk and protective factors for future prevention efforts.

Spanking and adult mental health impairment: The case for the designation of spanking as an adverse childhood experience

Adverse Childhood Experiences (ACEs) such as child abuse are related to poor health outcomes. Spanking has indicated a similar association with health outcomes, but to date has not been considered an ACE. Physical and emotional abuse have been shown in previous research to correlate highly and may be similar in nature to spanking. To determine if spanking should be considered an ACE, this study aimed to examine 1): the grouping of spanking with physical and emotional abuse; and 2) if spanking has similar associations with poor adult health problems and accounts for additional model variance. Adult mental health problems included depressive affect, suicide attempts, moderate to heavy drinking, and street drug use. Data were from the CDC-Kaiser ACE study (N=8316, response rate=65%). Spanking loaded on the same factor as the physical and emotional abuse items. Additionally, spanking was associated with increased odds of suicide attempts (Adjusted Odds Ratios (AOR)=1.37; 95% CI=1.02 to1.86), moderate to heavy drinking (AOR)=1.23; 95% CI=1.07 to 1.41), and the use of street drugs (AOR)=1.32; 95% CI=1.4 to 1.52) in adulthood over and above experiencing physical and emotional abuse. This indicates spanking accounts for additional model variance and improves our understanding of these outcomes. Thus, spanking is empirically similar to physical and emotional abuse and including spanking with abuse adds to our understanding of these mental health problems. Spanking should also be considered an ACE and addressed in efforts to prevent violence.

Adverse Childhood Experiences and Suicide Risk: Toward Comprehensive Prevention

Division of Violence Prevention, National Center for Injury and Control, Centers for Disease Control and Prevention, orgia; Division of Analysis, Research, and Practice Integration, enter for Injury Prevention and Control, Centers for Disease d Prevention, Atlanta, Georgia; and Education Development ., Suicide Prevention Resource Center, Waltham, Massachusetts correspondence to: Katie A. Ports, PhD, Division of Violence Centers for Disease Control and Prevention, 4770 Buford ailstop F-63, Atlanta GA 30341. E-mail: kports@cdc.gov. 97/

Intergenerational Continuity in Adverse Childhood Experiences and Rural Community Environments

36.00 oi.org/10.1016/j.amepre.2017.03.015 The field of suicide prevention has had numerous promising advances in recent decades, including the development of evidence-based prevention strategies, the National Suicide Prevention Lifeline (1-800-273-TALK), the Suicide Prevention Resource Center, and a revised National Strategy for Suicide Prevention. Despite these important advances, suicide prevention still lacks the breadth and depth of the coordinated response truly needed to reduce suicide morbidity and mortality. Suicide prevention requires a comprehensive approach that spans systems, organizations, and environments, combining treatment and intervention with primary prevention efforts beginning in childhood so they can set the stage for future health and well-being. Adverse childhood experiences (ACEs), including exposure to child abuse and neglect, are welldocumented risk factors for suicidality, and a viable suicide prevention target; however, suicide prevention efforts seldom focus here. The following provides an overview of suicide prevention and intervention, and suggestions for comprehensive suicide prevention programs that address ACE prevention. The context for suicide prevention in the U.S. is sobering. In 2015, a total of 44,193 individuals died by suicide, and between 1999 and 2015, suicide rates increased more than 25%. Emergency departments recorded 1.4 million discharges for self-inflicted injuries, and acute care hospitals recorded an additional 758,000 discharges in 2013. These numbers represent only a fraction of individuals experiencing suicidal ideation. According to self-report survey data, 1.3 million adults attempted suicide, 2.7 million made plans for suicide, and 9.7 million adults seriously considered suicide in 2015. These events exact a large emotional and human cost on families, friends, workplaces, and communities. Based on conservative estimates, death by suicide totals

Effect of the Earned Income Tax Credit on Hospital Admissions for Pediatric Abusive Head Trauma, 1995-2013

50.8 billion in lifetime medical and work-loss costs, and nonfatal self-harm injuries treated in U.S. emergency departments accounted for more than

Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States

11.9 billion in lifetime medical and work-loss costs. Although informative, these estimates are considerable underestimates of the true cost of suicidality. Many additional costs, such as psychological care, costs to family members, and the broader impacts on children, schools, and communities are not included in these cost estimations. Despite these limitations, these estimates demonstrate the significant public health burden of suicidality, and make a strong case for increased investments in comprehensive prevention programs that include evidence-based, primary prevention strategies. What suicidologists have recommended for quite some time, but has yet to be systematically achieved, is a truly comprehensive approach to suicide prevention— one that occurs across the social ecology (i.e., at the individual, family/relationship, school/community, and societal levels) in schools, workplaces, and healthcare settings, and includes both “downstream” prevention efforts (i.e., secondary and tertiary prevention efforts that focus on treatment and interventions for at-risk individuals or groups to decrease the likelihood of future suicide attempts) and “upstream” prevention efforts (i.e., primary prevention efforts that focus on preventing suicidal ideation, behavior, and risk before they occur). Suicide prevention strategies are being implemented in many settings, communities, and states, but these strategies often involve only one level of the social ecology— typically the individual or family/relational level. These models tend to focus on downstream prevention, and occur in isolation from other relevant suicide prevention strategies. Downstream prevention activities at the individual level include safety planning, screening for suicide,

Associations between adverse childhood experiences and acquired brain injury, including traumatic brain injuries, among adults: 2014 BRFSS North Carolina

Objectives To understand the role of the community environment on intergenerational continuity in adverse childhood experiences (ACEs) among a rural White sample. Methods Parents in 12 counties in rural Iowa reported retrospectively on their own ACEs in 1989. We measured their child’s ACEs retrospectively and prospectively across adolescence (n = 451 families). We measured structural and social process-related measures of community environment (i.e., community socioeconomic status, parents’ perception of community services, perceived community social cohesion, and neighborhood alcohol vendor density) on multiple occasions during the child’s adolescence. Results The 4 measures of community environment were all correlated with the child’s ACEs, but only alcohol vendor density predicted ACEs after inclusion of covariates. Intergenerational continuity in ACEs was moderated by both social cohesion (b = −0.11; SE = 0.04) and alcohol vendor density (b = −0.11; SE = 0.05). Conclusions Efforts to increase community social cohesion and manage alcohol vendor density may assist families in breaking the cycle of maltreatment across generations.

A cross-national exploration of societal-level factors associated with child physical abuse and neglect

Objectives: Policies that increase household income, such as the earned income tax credit (EITC), have shown reductions on risk factors for child maltreatment (ie, poverty, maternal stress, depression), but evidence is lacking on whether the EITC actually reduces child maltreatment. We examined whether states’ EITCs are associated with state rates of hospital admissions for abusive head trauma among children aged <2 years. Methods: We conducted difference-in-difference analyses (ie, pre- and postdifferences in intervention vs control groups) of annual rates of states’ hospital admissions attributed to abusive head trauma among children aged <2 years (ie, using aggregate data). We conducted analyses in 14 states with, and 13 states without, an EITC from 1995 to 2013, differentiating refundable EITCs (ie, tax filer gets money even if taxes are not owed) from nonrefundable EITCs (ie, tax filer gets credit only for any tax owed), controlling for state rates of child poverty, unemployment, high school graduation, and percentage of non-Latino white people. Results: A refundable EITC was associated with a decrease of 3.1 abusive head trauma admissions per 100 000 population in children aged <2 years after controlling for confounders (P = .08), but a nonrefundable EITC was not associated with a decrease (P = .49). Tax refunds ranged from