A Critique of the Adverse Childhood Experiences Framework in Epidemiology and Public Health: Uses and Misuses

Adverse childhood experiences (ACEs) have emerged as a major research theme. They make reference to an array of potentially harmful exposures occurring from birth to eighteen years of age and may be involved in the construction of health inequalities over the lifecourse. As with many simplified concepts, ACEs present limitations. They include diverse types of exposures, are often considered cumulatively, can be identified using prospective and retrospective approaches, and their multidimensional nature may lead to greater measurement error. From a public health perspective, ACEs are useful for describing the need to act upon complex social environments to prevent health inequalities at a population level. As the ACEs concept becomes popular in the context of policy interventions, concerns have emerged. As a probabilistic and population-level tool, it is not adapted to diagnose individual-level vulnerabilities, an approach which could ultimately exacerbate inequalities. Here, we present a critique of the ACEs framework, discussing its strengths and limits.

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Continuing conversations about adverse childhood experiences (ACEs) screening: A public health perspective

Child Abuse & Neglect ◽

10.1016/j.chiabu.2018.03.007 ◽

2018 ◽

Vol 85 ◽

pp. 180-184 ◽

Cited By ~ 42

Author(s):

Shanta R. Dube

Keyword(s):

Public Health ◽

Adverse Childhood Experiences ◽

Public Health Perspective ◽

Childhood Experiences ◽

Adverse Childhood

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The Empower Action Model: A Framework for Preventing Adverse Childhood Experiences by Promoting Health, Equity, and Well-Being Across the Life Span

Health Promotion Practice ◽

10.1177/1524839919889355 ◽

2019 ◽

Vol 21 (4) ◽

pp. 525-534 ◽

Cited By ~ 1

Author(s):

Aditi Srivastav ◽

Melissa Strompolis ◽

Amy Moseley ◽

Kelsay Daniels

Keyword(s):

Public Health ◽

Protective Factors ◽

Life Span ◽

Adverse Childhood Experiences ◽

Ecological Model ◽

Well Being ◽

Childhood Experiences ◽

Adverse Childhood ◽

Action Model ◽

Equity And Inclusion

The empower action model addresses childhood adversity as a root cause of disease by building resilience across multiple levels of influence to promote health, equity, and well-being. The model builds on the current evidence around adverse childhood experiences and merges important frameworks within key areas of public health—the socio-ecological model, protective factors, race equity and inclusion, and the life course perspective. The socio-ecological model is used as the foundation for this model to highlight the multilevel approach needed for improvement in public health. Five key principles that build on the protective factors literature are developed to be applied at each of the levels of the socio-ecological model: understanding, support, inclusion, connection, and growth. These principles are developed with actions that can be implemented across the life span. Finally, actions suggested with each principle are grounded in the tenets of race equity and inclusion, framing all actionable steps with an equity lens. This article discusses the process by which the model was developed and provides steps for states and communities to implement this tool. It also introduces efforts in a state to use this model within county coalitions through an innovative use of federal and foundation funding.

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Exploring practitioner and policymaker perspectives on public health approaches to address Adverse Childhood Experiences (ACEs) in South Carolina

Child Abuse & Neglect ◽

10.1016/j.chiabu.2020.104391 ◽

2020 ◽

Vol 102 ◽

pp. 104391 ◽

Cited By ~ 1

Author(s):

Aditi Srivastav ◽

Mindi Spencer ◽

Melissa Strompolis ◽

James F. Thrasher ◽

Elizabeth Crouch ◽

...

Keyword(s):

Public Health ◽

South Carolina ◽

Adverse Childhood Experiences ◽

Childhood Experiences ◽

Adverse Childhood

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Should early intervention in autism be provided?

BJPsych Advances ◽

10.1192/apt.22.3.147 ◽

2016 ◽

Vol 22 (3) ◽

pp. 147-150

Author(s):

David Foreman

Keyword(s):

Public Health ◽

Autism Spectrum Disorder ◽

Early Intervention ◽

High Intensity ◽

Cochrane Review ◽

Population Level ◽

Autism Spectrum ◽

Public Health Perspective ◽

Individual Level ◽

The Individual

SummaryRates of detected autism spectrum disorder (ASD) are currently rising, and there is a need for effective treatments to manage the symptoms. In this commentary I outline the challenges that autism presents to service delivery and consider a Cochrane review that evaluates one of the best-known classes of treatment for ASD, parent-mediated early intervention. I discuss effect size and bias in the interpretation of the review's results, and consider also the rationale for low- and high-intensity intervention at both the individual level and, from a public health perspective, at population level.

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Relationship Between Adverse Childhood Experiences and Age at Sexual Debut among Men Who Sex with Men in Shenzhen, China

10.21203/rs.2.10401/v1 ◽

2019 ◽

Author(s):

Hanlin Fu ◽

Tubao Yang ◽

Atipatsa C. Kaminga ◽

Tingting Wang ◽

Tiejian Feng

Keyword(s):

Public Health ◽

Logistic Regression ◽

Adverse Childhood Experiences ◽

Sexual Debut ◽

Early Sexual Debut ◽

Childhood Experiences ◽

Adverse Childhood ◽

History Of ◽

Sex With Men ◽

The Relationship

Abstract Background Early sexual debut (ESD) is considered an important public health issue. Previous studies have indicated age at sexual debut is affected by multiple factors, including adverse childhood experiences (ACEs). However, studies specifically exploring the relationship between ACEs and age at sexual debut among men who have sex with men (MSM) are lacking. This study aims to explore the relationship between ACEs and age at sexual debut among MSM in China. Methods From March 2013 to August 2015, MSM who came to the Sexually Transmitted Diseases Clinic of Shenzhen Center for Chronic Disease Control were recruited in our study. Using an anonymous questionnaire, we collected information about their social-demographics, age at sexual debut and ACEs. Logistic regression and linear regression were performed to acquire the estimates for the relationships between ACEs and early sexual debut (ESD). Results A total of 546 MSM were recruited. The median age at MSM sexual debut was 20.0 years, and 40.5% of the MSM were exposed to at least one ACEs. Multivariable logistic regression analysis indicated that MSM with a history of ACEs was approximately twice (aOR=2.15; 95%CI:1.32-3.48) as likely to report a history of ESD and tended to experience sexual debut approximately one year (β:-1.10; 95%CI: -1.70,-0.50) earlier than those without. Conclusions ACEs are associated with ESD, suggesting that sexual health education and public health programs aimed at delaying early sexual debut among young Chinese MSM should consider addressing ACEs.

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Adverse Childhood Experiences and Resilience Factors Associated with Higher Education Success

10.35831/sor/er/rb2019 ◽

2019 ◽

Author(s):

Ritika Bhawal ◽

Tyler Smith ◽

Besa Smith

Keyword(s):

Public Health ◽

Higher Education ◽

Academic Success ◽

Adverse Childhood Experiences ◽

College Success ◽

Well Being ◽

Educational Success ◽

Childhood Experiences ◽

Adverse Childhood ◽

Health And Well Being

Abstract Introduction: Student success in institutions of higher education is of mounting importance as the link between education, health, and well-being grows. This study investigates adverse childhood experiences (ACE) that may confer resilience or may negatively impact a student’s educational success independent of other known factors for educational achievement. Methods: A cross-sectional survey-based study was conducted using the 2012 Behavioral Risk Factor Surveillance System (BRFSS) data to investigate a large representative US Population of 25-35-year-olds (n=2,543) that were surveyed on ACE measures. Univariate and weighted multivariable logistic regression models focused on educational success in those with and without ACE factors are presented. All data management and analyses were conducted using SAS® 9.4. Results: Each single level increase of ACE reporting indicated an unadjusted 5% decrease in odds for obtaining some college or a college degree. Adjusting for other ACEs, demographic, socioeconomic, behavioral, and health factors, parental depression and mental illness in childhood was associated with college success, while those who experienced parental drug use, prison time, divorce, and being physically hurt at home as a child had statistically significantly lower odds of college success. Other significant predictors of academic success included being female, normal weight, never smoking, never being married, reporting good/excellent health, and exercising with a c-statistic of .88 indicating a strong prediction model. Conclusions: Higher education success and the myriad of associated public health benefit requires significant student and institutional interaction to be flexible enough to engage traditional as well as adult, non-traditional, and underserved student populations. Understanding the modifiable and non-modifiable constellation of health and well-being factors will better allow a more population-based student-centered approach to higher education. Keywords: education; public health; learning; Resilience

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A lot we still don't know

Early Years Educator ◽

10.12968/eyed.2020.22.1.8 ◽

2020 ◽

Vol 22 (1) ◽

pp. 8-8

Author(s):

Kirsten Asmussen

Keyword(s):

Public Health ◽

Early Intervention ◽

Adverse Childhood Experiences ◽

Early Years ◽

Public Health Approach ◽

Childhood Experiences ◽

Adverse Childhood

Latest research from the Early Intervention Foundation highlights that adverse childhood experiences do not occur in isolation. A wider public health approach is urgently needed in which early years practitioners can play a dynamic role.

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