Thurston Holly, Bell Janice F, Induni Marta
Betty Irene Moore School of Nursing, UC Davis, Sacramento, CA, USA.
Public Health Institute, Sacramento, CA, USA.
J Pediatr Nurs. 2018 Sep-Oct;42:25-33. doi: 10.1016/j.pedn.2018.06.008.
The association of adverse childhood experiences (ACEs) with negative health outcomes is well established, and the concept of allostatic load has been proposed as a possible causal mechanism. Most studies measure conventional (household) ACE exposures without accounting for non-conventional (community) ACE exposures, which may underrepresent the adversity experienced by racial/ethnic minorities. We address this gap by calculating the prevalence of both types of ACE exposures for racial/ethnic subgroups. We also examine associations of ACE exposures and emotional regulation in school aged children and youth.
This study used data (n = 65,680) for a nationally representative sample of children ages 6 to 17 years in the National Survey of Children's Health (2011-2012). Confirmatory factor analysis, descriptive statistics and regression models were used to examine the relationships between ACEs and emotional regulation.
Community level ACE events disproportionately affect ethnic minorities. Some but not all ACEs were significantly and inversely associated with the ability to emotionally regulate in children. Experiencing racism had the strongest negative effect of all ACE variables. The strength of the child-caregiver relationship was associated with increased odds of emotional regulation, independent of exposure to ACEs.
The study supports the need to refine and expand ACE health screenings to fully capture the adversity faced by all children. Emotional regulation is identified as a possible intervention point.
Expansion of programs that strengthen the child-caregiver relationship and reduce ACEs in early childhood may be a key approach to increasing coping abilities in youth.
童年不良经历（ACEs）与负面健康结果之间的关联已得到充分证实，而应激负荷的概念已被提出作为一种可能的因果机制。大多数研究测量的是传统（家庭）ACE暴露情况，而未考虑非传统（社区）ACE暴露情况，这可能无法充分体现种族/族裔少数群体所经历的逆境。我们通过计算种族/族裔亚组中这两种类型ACE暴露的患病率来填补这一空白。我们还研究了ACE暴露与学龄儿童和青少年情绪调节之间的关联。
本研究使用了《全国儿童健康调查》（2011 - 2012年）中6至17岁具有全国代表性的儿童样本数据（n = 65,680）。采用验证性因素分析、描述性统计和回归模型来研究ACEs与情绪调节之间的关系。
社区层面的ACE事件对少数族裔的影响尤为严重。部分但并非所有的ACEs与儿童的情绪调节能力呈显著负相关。在所有ACE变量中，经历种族主义的负面影响最为强烈。儿童与照顾者关系的紧密程度与情绪调节几率的增加相关，且不受ACE暴露情况的影响。
该研究支持了完善和扩展ACE健康筛查以全面了解所有儿童所面临逆境的必要性。情绪调节被确定为一个可能的干预点。
扩大加强儿童与照顾者关系并减少幼儿期ACEs的项目，可能是提高青少年应对能力的关键途径。
