JAMA子刊:敲响警钟,关注儿童期不良事件

创作:洪翔 审核:Epi汪 01月11日
纳入行为风险因素监测系统(BRFSS)中20多万名成年人为研究对象,调查其童年不良事件(ACE)经历情况;
61.6%的被调查对象至少经历1 次ACE,24.6%经历3次或以上ACE;
黑人、西班牙人或混血儿、低教育背景、低经济收入、失业及同性/双性恋的人ACE暴露水平明显较高;
在父母分居或离婚,家庭成员有药物滥用的环境下,儿童经历精神虐待的风险增高;
与男性相比,女性儿童期经历性侵犯、家庭药物滥用及家庭精神疾病的比率更高。
延伸阅读
JAMA Pediatrics [IF:12.004]

Prevalence of Adverse Childhood Experiences From the 2011-2014 Behavioral Risk Factor Surveillance System in 23 States

基于2011-2014年美国23个州的行为危险因素监测系统的儿童期不良经历发生率

2018-11-01, Article, 10.1001/jamapediatrics.2018.2537.more

Abstract:
Importance: Early adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities.
Objective: To provide an updated prevalence estimate of adverse childhood experiences (ACEs) in the United States using a large, diverse, and representative sample of adults in 23 states.
Design, Setting, and Participants: Data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an annual, nationally representative telephone survey on health-related behaviors, health conditions, and use of preventive services, from January 1, 2011, through December 31, 2014. Twenty-three states included the ACE assessment in their BRFSS. Respondents included 248 934 noninstitutionalized adults older than 18 years. Data were analyzed from March 15 to April 25, 2017.
Main Outcomes and Measures: The ACE module consists of 11 questions collapsed into the following 8 categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. Lifetime ACE prevalence estimates within each subdomain were calculated (range, 1.00-8.00, with higher scores indicating greater exposure) and stratified by sex, age group, race/ethnicity, annual household income, educational attainment, employment status, sexual orientation, and geographic region.
Results: Of the 214 157 respondents included in the sample (51.51% female), 61.55% had at least 1 and 24.64% reported 3 or more ACEs. Significantly higher ACE exposures were reported by participants who identified as black (mean score, 1.69; 95% CI, 1.62-1.76), Hispanic (mean score, 1.80; 95% CI, 1.70-1.91), or multiracial (mean score, 2.52; 95% CI, 2.36-2.67), those with less than a high school education (mean score, 1.97; 95% CI, 1.88-2.05), those with income of less than $15 000 per year (mean score, 2.16; 95% CI, 2.09-2.23), those who were unemployed (mean score, 2.30; 95% CI, 2.21-2.38) or unable to work (mean score, 2.33; 95% CI, 2.25-2.42), and those identifying as gay/lesbian (mean score 2.19; 95% CI, 1.95-2.43) or bisexual (mean score, 3.14; 95% CI, 2.82-3.46) compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively. Emotional abuse was the most prevalent ACE (34.42%; 95% CI, 33.81%-35.03%), followed by parental separation or divorce (27.63%; 95% CI, 27.02%-28.24%) and household substance abuse (27.56%; 95% CI, 27.00%-28.14%).
Conclusions and Relevance: This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and life outcomes throughout the lifespan and across generations

First Authors:
Melissa T Merrick

Correspondence Authors:
Melissa T Merrick

All Authors:
Melissa T Merrick,Derek C Ford,Katie A Ports,Angie S Guinn