the impact of adverse childhood experiences on health · • living in foster care • experiencing...
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TheImpactofAdverseChildhoodExperiencesonHealth
SUMRSCHOLAR: MARIAHRAMIREZ
VANDERBILTUNIVERSITY
MENTOR: ROYWADE, MD, PHD, MPH, MSHP
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AgendaI.Significance
II.BackgroundonAdverseChildhoodExperiencesCDC-KaiserPermanenteOriginalStudyPhiladelphiaACEStudy
III.SummerProjectOne:
ImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring
IV.SummerProjectTwo:
FamilyMedicalHistoryProject
V.SummerProjectThree:
DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool
VI.MyRole/LearningExperiences
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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
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RelationshipbetweenHealthDisparitiesandSocialDeterminantsofHealth
HealthStatus/Outcomes
SocialEnvironment
AdaptedfromStark,2016
SocialNetworks
Physical/NeighborhoodEnvironmentChildhood
Experiences SocioeconomicStatus
FoodAccessibility
HealthServices
Culture
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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
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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
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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%
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PhiladelphiaACEStudyConventional/OriginalACES Additional/ExpandedACEs
• WitnessingViolence
• LivinginUnsafeNeighborhoods
• ExperiencingRacism
• LivinginFosterCare
• ExperiencingBullying
• Physicalabuse• EmotionalAbuse• SexualAbuse• PhysicalNeglect• EmotionalNeglect• DomesticViolence• HouseholdSubstanceAbuse
• IncarceratedCareProvider
• MentalIllnessinthehome
AdaptedfromWadeetal.,2016
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Findings:ManyofOriginalACEsareMorePrevalentinanUrban,DiversePopulations
AdaptedfromWadeetal.,2016
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FindingsofPhiladelphiaACEStudy:ConnectionbetweenSocioeconomicStatus,ACEs,andHealthACEsincreaseriskforpovertyinadulthood
BothSESandACEshaveinfluencesonpoorhealth
ACEscoresaffectfuturehealthoutcomes,andpossiblyhealthoutcomesofoffspring
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SummerProjectOneImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring
- EvidencetosuggestmaternalACEscorehasanimpactontheirchildren’shealthoutcomes
Whataboutdads??
FamilyMedicalHistoryProject
DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool◦ PI:KimberlyMitchell,PhDfromtheUniversityofNewHampshireinCollaborationwithRoyWade,MDfromChildren’sHospitalofPhiladelphia
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ImpactofPaternalChildhoodAdversityonOffspringHealthOutcomesPrimaryObjective:
AssesstheimpactofpaternalACEsontheirhealthoutcomes,onparentingstyles,andonthehealthoutcomesoftheirchildrenHypothesis:
HigherACEscoresoffatherisassociatedwithhigheroffspringACEscore,lowerparentingabilities,andincreasedhouseholdenvironmentchaosHigherACEscoreofoffspringwillleadtoincreasedriskofnegativehealthoutcomes
ACEsofFather
HarshPsychosocialEnvironmentalConditionsforOffspring
OffspringNegativeHealthOutcomes
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MethodsCase-ControlStudy◦ ~250childrenwithNeurocognitiveDisorder(NCD)diagnosis◦ ~250childrenwithnoNCDdiagnosis
SurveyindevelopmentPopulation◦ 500Parentsand/orcaregiversofchildrenreceivingcareat1of32CHOPclinicalpracticesites
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SummerProject#2ImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring
FamilyMedicalHistoryProject
DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool◦ PI:KimberlyMitchell,PhDfromtheUniversityofNewHampshireinCollaborationwithRoyWade,MDfromChildren’sHospitalofPhiladelphia
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FamilyMedicalHistoryProjectatMountZionBaptistChurch
HealthBehavior
EnvironmentCulture
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AnalysisPhase
•Demographics• FamilymedicaltreesReview•Preset/EmergentCodes•Codebook•CodeinterviewsCoding•Associationbetweenthemesandpatternsofillness•Associationbetweeninterventionselfreportedhealth/healthpromotionstrategies•PotentialopportunitiestointerveneAnalyze
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SummerProject#3:ImpactofPaternalChildhoodAdversityonHealthOutcomesofOffspring
FamilyMedicalHistoryProject
DevelopmentofaNationalYouthFirearmRiskandSafetyAssessmentTool◦ PI:KimberlyMitchell,PhDfromtheUniversityofNewHampshireinCollaborationwithRoyWade,MDfromChildren’sHospitalofPhiladelphia
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DevelopinganAssessmentToolisImportant..1,297childrendieannuallyfromagun-relatedinjury
Firearm-RelatedEvents:3rd LeadingCauseofdeathforchildren,ages1to17◦ Surpassesinfluenza,pediatriccongenitalanomalies,pneumonia,chroniclowerrespiratorydiseases
Source:Fowler&Dahlberg,2017
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FocusGroupDevelopment3AgeGroups:- 1:Parentsof2-9yearolds- 2:10-14yearolds- 3:15-17yearolds
PrimaryGoal:Developasetofquestionsforpediatricianstousewhentalkingtopatientsandpatients’parentsaboutgunsandgunsafety
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MyRoleFocusGrouprecruitment,organizationanddatacollectionPaternalsurveytranslationfromEnglishtoSpanishCodebookdevelopmentParticipantinweeklyteammeetingsPlantocontinueworkwithDr.Waderemotely◦ SystematicLiteratureReview:ImpactofParentalChildhoodAdversityonParenting
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MyLearningExperienceCloseobservationofthemanyroles,responsibilities,andsimultaneousprojectsofaclinicalresearcherQualitativeresearchskills◦ Qualitativecoding◦ Processofasystematicliteraturereview◦ Conductingfocusgroups
Utilizingresearchdatabase(REDCap)Importanceoftakinginitiative/voicingyourowninterests
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AcknowledgementsDr.RoyWadeResearchCoordinators◦ DanielleCollins◦ MacyMarcucci
JoanneLevySafa BrowneFellowResearchAssistantsatCHOP2017SUMRScholarsCohort
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Questions?