Adverse childhood experiences: Evidence for screening beyond preventive visits
Adverse childhood experiences: Evidence for screening beyond preventive visits
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DOI：
10.1016/j.chiabu.2018.05.015
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发表时间：
2018-07-01
影响因子：
4.8
通讯作者：
Borowsky, Iris W.
中科院分区：
文献类型：
--
作者：
Duke, Naomi N.;Borowsky, Iris W.
筛查不良童年经历 (ACE/ACE) 的主要工作通常集中在儿童/青少年健康访视上。本研究的目的是探讨 ACE 与青少年接受预防性护理的可能性之间的关系。数据来自参加 2016 年明尼苏达州学生调查的 126,868 名 8 年级、9 年级和 11 年级学生，这是一项匿名的自我报告调查问卷，旨在检查青少年的行为、经历和看法。在对人口协变量和自我报告的健康状况进行调整后，使用逻辑回归模型来确定 10 种类型的 ACE（包括虐待、家庭功能障碍以及食品和住房不安全）是否与接受推荐的预防性医疗和牙科护理相关。将 ACE 评分输入回归模型，以测试逆境对预防性护理结果的累积影响。超过三分之一 (38.5%) 的青少年至少有一项 ACE，最常见的是其父母或监护人曾入狱或入狱。每种类型的 ACE 都与去年接受预防性护理的几率降低显着相关。与粮食不安全的关联最为显着，与接受护理的几率降低 0.32 [CI：0.64-0.72] 至 0.54 [CI：0.44-0.49] 相关。 ACE 总分每增加 1 分，去年进行预防性护理就诊的几率就会降低 0.07 [CI：0.92-0.94] 至 0.15 [CI：0.84-0.86]。越来越多的文献记录了 ACES 与健康之间的重要关系，研究结果进一步丰富了这一点，在这种情况下，青少年错失了接受建议的监测和预期指导的机会。
Primary efforts to screen for adverse childhood experiences (ACE/ACEs) are often focused on the well child/adolescent visit. The purpose of this study was to examine relationships between ACEs and youth likelihood of receiving preventive care. Data are from 126,868 students in the 8th, 9th, and 11th grades who participated in the 2016 Minnesota Student Survey, an anonymous, self report questionnaire examining youth behaviors, experiences, and perceptions. Logistic regression models were used to determine if 10 types of ACEs, including abuse, household dysfunction, and food and housing insecurity were associated with receipt of recommended preventive medical and dental care after adjustment for demographic covariates and self-reported health. ACEs scores were entered into regression models to test for cumulative impact of adversities on preventive care outcomes. More than one third (38.5%) of youth identified at least one ACE, most commonly having a parent or guardian who had ever been in jail or prison. Each type of ACE was significantly associated with reduced odds of receiving preventive care in the last year. Associations with food insecurity were of greatest magnitude, associated with 0.32 [CI: 0.64-0.72] to 0.54 [CI: 0.44-0.49] decreased odds of receiving care. Each one point increase in the total ACE score was associated with 0.07 [CI: 0.92-0.94] to 0.15 [CI: 0.84-0.86] decreased odds of having had a preventive care visit in the last year. Findings add to the growing literature documenting significant relationships between ACES and health, in this case, youth missing opportunities to receive recommended surveillance and anticipatory guidance.