Bethell Christina D, Newacheck Paul, Hawes Eva, Halfon Neal
Christina D. Bethell (
Paul Newacheck is a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.
Health Aff (Millwood). 2014 Dec;33(12):2106-15. doi: 10.1377/hlthaff.2014.0914.
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.
正在进行的针对成年人的纵向童年不良经历研究发现，慢性病、成年期的生活质量和预期寿命与童年不良经历相关的创伤和压力（包括身体或情感虐待、忽视、贫困或接触暴力）之间存在显著关联。关于美国儿童中基于人群的童年不良经历流行病学情况，人们了解得较少。利用2011 - 12年全国儿童健康调查，我们评估了童年不良经历的患病率及其与影响儿童发育和终身健康的因素之间的关联。在对混杂因素进行调整后，我们发现有童年不良经历的儿童上学参与率较低，慢性病发病率较高。我们的研究结果表明，培养复原力（在调查中定义为“面对挑战时保持冷静和自控”）对于6至17岁的儿童而言，可以减轻童年不良经历的负面影响。我们发现，表现出复原力的有童年不良经历的儿童上学参与率较高，在以家庭为中心的医疗之家接受护理的有此类经历的儿童复原力也较高。我们建议做出协调一致的努力，填补知识空白，并将有关童年不良经历和复原力的现有知识转化为国家、州和地方政策，并在卫生系统随着持续改革而发展过程中，重点关注解决儿童期创伤问题。
