Adverse Childhood Experiences: Assessing The Impact On Health And School Engagement And The Mitigating Role Of Resilience
Adverse Childhood Experiences: Assessing The Impact On Health And School Engagement And The Mitigating Role Of Resilience
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DOI：
10.1377/hlthaff.2014.0914
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发表时间：
2014-12-01
期刊：
影响因子：
9.7
通讯作者：
Halfon, Neal
中科院分区：
文献类型：
--
作者：
Bethell, Christina D.;Newacheck, Paul;Halfon, Neal
正在进行的成人纵向不良童年经历研究发现慢性疾病；生活质量和成年期预期寿命；以及与不良童年经历相关的创伤和压力，包括身体或精神虐待或忽视、剥夺或接触暴力。对美国儿童不良童年经历的基于人群的流行病学了解较少。利用2011- 2012年全国儿童健康调查，我们评估了不良童年经历的患病率以及它们与影响儿童发展和终身健康的因素之间的关系。在我们对混杂因素进行调整后，我们发现在有不良童年经历的儿童中，学校参与率较低，慢性病发病率较高。我们的研究结果表明，对于6-17岁的儿童来说，建立韧性——调查中定义为“面对挑战时保持冷静和控制”——可以改善童年不利经历的负面影响。我们发现，在有不良童年经历的儿童中，表现出适应力的儿童的学校参与度更高，在以家庭为中心的医疗院里接受治疗的儿童中，有这种经历的儿童的适应力也更高。我们建议采取协调一致的努力，填补知识空白，并将有关儿童不良经历和复原力的现有知识转化为国家、州和地方政策，重点是在正在进行的改革中解决卫生系统中的儿童创伤问题。
The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience-defined in the survey as "staying calm and in control when faced with a challenge," for children ages 6-17-can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform.