1. Parental Adverse Childhood Experiences:
Parent Perception of Health Impact and Screening
Brooke Sweeney, MD1,2 Denise Dowd, MD, MPH3, Amy R Beck, PhD1,4, Amanda Bruce, PhD1,5
John D Cowden, MD, MPH2 & Kimberly A Randell, MD, MSc1,3
1 Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri 2 Division of General Academic Pediatrics, Children’s Mercy Kansas City
3 Division of Emergency and Urgent Care Services, Children’s Mercy Kansas City 4 Division of Developmental and Behavioral Sciences, Children’s Mercy Kansas City The University of Kansas Medical Center, Kansas City, Kansas
Background
ACEs (adverse childhood experiences) are repeated and/or prolonged stressful or traumatic experiences occurring prior to age 18.
Nearly two-thirds of adults have experienced one ACE and 9-12% have experienced four or more ACEs.
Adult studies demonstrate a dose-response relationship between ACEs and adult obesity.
ACEs may be associated with childhood obesity.
Parent ACEs may be associated with increased risk for child ACEs.
Screening parents for their own ACEs has been suggested as a way to enhance child health care; however, parent opinion of such screening has not been explored.
Objective:
To determine parent perception of:
ACEs impact on their own health and their child’s health;
Their parenting;
Screening for parent ACEs at pediatric visits.
Results
Results
Participants:
78 Parent/guardians Female: 84% Male: 16%
African American: 51% Latino/a: 25%
Caucasian: 24% Multiracial: 12%
Immigrant status: 15% Publically insured: 77%
GED/high school degree or less education: 42%
ACE score 4+ :
Conventional: 16% Expanded: 25% Total ACE: 35%
No significant differences by insurance, education, income or gender.
Immigrant parents (N=7) perceived less effect of ACEs on parenting and child health (p=0.04).
Multiracial parents (N=9) were more likely to agree that ACEs affected their weight (p<0.01) and parenting (p=0.01).
Child:
Parent:
Figure 3. Agreement with Screening for Parental ACEs
Methods
Parents of children aged 6-12 years attending the general pediatric or weight management clinics of two children’s hospitals were surveyed.
Measurement of acceptability of parental ACE screening; perception of impact of their own ACEs on their health, their child’s health and their parenting practices – with Likert Scales
ACE score = total number of ACEs experienced
Conventional ACEs: child abuse (physical, sexual, emotional), neglect (physical, emotional), household dysfunction (family violence, mental illness, substance abuse, criminal activity)
Expanded ACEs: community violence, homeless, racism, unsafe neighborhood, bullying, poverty
Analysis:
Responses dichotomized:
Strongly agree/agree VS Not sure/disagree/strongly disagree.
Chi-square or Fisher’s exact tests.
Figure 1. Percent of parents agreeing ACEs affect health, weight, and parenting.
Child:
Conclusions
A minority of parents agreed that ACEs impact their health, parenting and their child’s health.
More parents agreed that ACEs impact their child’s health, compared to their own health or parenting.
Parents with ACE score > 4 were more likely to agree that ACEs impact their health, their child’s health, and their parenting.
Most parents felt screening for parental ACEs is acceptable at child’s appointment.
Differences by race, ethnicity, immigration status, and parent ACE history warrant further exploration in larger samples.
Limitations:
This is a relatively small sample of patients presenting to an academic general pediatric or weight management clinic in a single geographic area, limiting generalizability.
Answers are potentially altered by recall bias, selection bias, and social desirability bias.
Parent:
Acknowledgments
This work supported in part by the Center for Children’s Healthy Lifestyles & Nutrition Pilot Grant and the Children’s Mercy Summer Scholars Program.
Figure 2. Percent of parents agreeing ACEs affect health, by number of parent ACEs.
N for each category are as follows: 0 ACEs (N=23); 1-3 ACEs (N=27); 4+ ACEs (N=16).
Significant results from crosstab analysis are represented with * (* p<0.05, ** p<0.01, *** p<0.001)