Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St SE, # 385, Minneapolis, MN, USA.
Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, 717 Delaware St SE, # 389, Minneapolis, MN, USA.
Child Abuse Negl. 2018 Jul;81:380-388. doi: 10.1016/j.chiabu.2018.05.015. Epub 2018 May 26.
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.
初级努力筛查儿童期不良经历 (ACE/ACEs) 通常集中在健康儿童/青少年就诊时。本研究的目的是研究 ACEs 与青少年接受预防保健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 126868 名 8 、 9 和 11 年级学生，这是一项匿名的、自我报告的调查问卷，调查青少年的行为、经历和看法。使用逻辑回归模型来确定 10 种 ACEs（包括虐待、家庭功能障碍以及食品和住房不安全）在调整人口统计学协变量和自我报告的健康状况后，与接受推荐的预防医疗和牙科保健之间是否存在关联。将 ACE 分数输入回归模型，以测试逆境对预防保健结果的累积影响。超过三分之一（38.5%）的青少年确定至少有一种 ACE，最常见的是父母或监护人曾入狱或入狱。每种 ACE 都与接受预防保健的可能性降低显著相关。与食品不安全的关联幅度最大，与接受护理的可能性降低 0.32 [CI：0.64-0.72] 至 0.54 [CI：0.44-0.49] 相关。 ACE 总分每增加一分，与接受护理的可能性降低 0.07 [CI：0.92-0.94] 至 0.15 [CI：0.84-0.86] 相关。研究结果增加了越来越多的文献记录 ACEs 与健康之间的显著关系，在这种情况下，青少年错过了接受推荐的监测和预期指导的机会。
