1. The Influence of Protective Factors on Perceived Impact of Adverse Childhood Experiences Laura Kenny, MPHc Thomas Jefferson University
Background
Results
Discussion
** p<.001. *p<.05.
The protective factors predictor was significant, p < .05.
The protective factors predictor was non-significant, p > .05.
Strong associations found between Adverse Childhood Experiences (ACES) and negative health risks, including depression, alcoholism, suicide attempts, criminal activity, and illicit drug use.
Conversely, some individuals reported that ACES “made them stronger”, motivated them to be better parents.
Contrast in outcomes have led to studies in…
Resilience - An interactive concept which describes an individual’s ability to overcome stress or adversity.
Centrality - The personal narrative of an event that will ultimately shape the understanding of who we are as individuals.
Perception of the ACE – Perceived levels of impact of ACEs were strong predictors of health related quality of life (HQRL) after controlling for ACE scores.
Protective Factors - Environmental conditions or individuals characteristics that reduce the negative effects of traumatic events.
My study’s aim is to identify if there is a correlation between the perception of the impact of the ACE with the presence or absence or protective factors.
Greater ACE score is correlated with increased magnitude.
Greater ACE score is correlated with decreased valence.
Protective factors are correlated with lower ACE scores, lower perception of magnitude, and increased perception of valence, representing the importance of protective factors in preventing ACEs, viewing them as less central to one’s identity, and helping to shape traumatic events in a more positive schema in the memory-making process.
Unique to our study…
The perception of the magnitude of the ACE was no longer correlated to protective factors after controlling for the ACE score.
The perception of valence, ranging from very negative to very positive, has a positive correlation to the identified protective factors when controlling for ACE score.
Separate studies have identified the positive association between HRQL and protective factors and the association between perception of the ACE and HRQL. Our research helps us to understand that increased perception of valence may be due to the impact of protective factors on the memory-making process of the ACE.
Therefore, this finding justifies the promotion of protective factors with the goal of altering the perception of the ACE to decrease the prevalence of criminal activity, depression, illicit drug use, suicide attempts, and more affecting our communities.
Before our study, we knew…
ACES are associated with criminal activity, depression, illicit drug use, suicide attempts, and more affecting our communities. However, some report ACES made them “stronger”.
The perception of the ACE (when controlling for ACE score) is correlated with HRQL. Protective factors positively correlated with HRQL.
Our study contributed to this area of research by identifying…
Protective factors have the ability to alter the perception of valence of the ACE (when controlling for ACE score).
Continuous research is needed to identify and promote individual protective factors that have the capability to alter the perception of the ACE with the goal of preventing adverse health outcomes.
Table 1
Mean and Standard Deviation of Key Variables for Population Studied
Variable Mean SD
Ace Score (Range: 0-5)
Valence (Range: -2 – 2)
Magnitude (Range: 0 -3)
Protective Factors (Range: 0-3)
Table 2
Strength of Bivariate Correlation between Key Study Variables
Ace Score
Mean Magnitude
Mean Valence
Protective Factor
Ace Score Pearson Correlation
Sig(2-tailed) N 1
456
.318**
.000
283
-.297**
268
-.191**
449
Mean Magnitude Pearson Correlation
-.482**
-.138*
.020
Mean Valence Pearson Correlation
.191*
.002
Protective Factors Pearson Correlation
Methods
Recoded and merged data from the following three separate data sets containing survey responses on ACES (N = 456).
The “Relationship between adverse childhood events and adult emergency utilization study” consisted of 272 participants and began in 2013 in an urban emergency department.
2. The “Coping, Health, Happiness, Adversity and Mental Health” (CHHARM) study consisted of 154 participants and was conducted at the University of New Mexico School of Medicine.
3. The “Psychosocial Predictors of Super Utilizers and Longitudinal Outcomes after Care Management” study consisted of 30 participants made up of high-utilizers of healthcare services in Camden, NJ.
Key Variables
ACE Scores – Participants asked about physical abuse, sexual abuse, neglect, violence between parents, and/or psychological abuse as a child.
Magnitude – Participants were asked “how much of an impact does this ACE continue to have on your life now?” Response options included none, a little, some, or a lot, which were numerically valued on a scale of 0-4, respectively.
Valence - “How would you describe the impact of (ACE) on your life now?” very negative, mostly negative, 50/50, mostly positive or very positive, which were numerically valued from -2 to 2, respectively.
Protective Factors - Close relationship outside of the family, if the participant liked going to school, and if participants felt connected to a group growing up.
Future Research
Table 3
Coefficients of Regression Analysis of Mean Valence
Standardized Coefficients
Protective Factors
Beta t
Sig.
0.128
2.139
.033
Limitations
Previous Data Sets
Limited on asking about other protective factors outside of liking going to school, close relationships outside of family, and/or feeling connected to a group.
Potential for Recall Bias
Generalizability
Datasets utilized for this study consisted of individuals recruited at Emergency Departments, through recruitment flyers seeking participants who self-identified as having ACEs, and “high-utilizers” of health care services.
Table 4
Coefficients of Regression Analysis of Mean Magnitude
Standardized Coefficients
Protective Factors
Beta t
Sig.
0.071
-1.229
.220
Design and Analysis
Acknowledgements
I calculated if the strength of bivariate associations (correlations) between ACE score and perceived magnitude, ACE score and perceived impact, ACE score and presence or absence of the identified protective factors, the presence of the identified protective factors and the perceived magnitude, and the presence of the identified protective factors and perceived valence of the ACE is statistically significant.
I performed a series of regressions to answer if protective factors are predictive of impact ratings (valence and magnitude) when controlling for ACES.
Marianna LaNoue, PhD for serving as my chair. I offer my sincere appreciation for her time, expertise, and exceptional teaching capabilities. This study would not have been possible without her, and for that I am truly grateful.
Amy Cunningham, PhD for serving as my preceptor and providing her valuable insight.