IMPACT OF VIOLENCE RELATED ADVERSE CHILDHOOD EXPERIENCES ON HEALTH

摘要

BACKGROUND: Growing evidence suggests a graded relationship between Adverse Childhood Experiences (ACE) and unfavorable health outcomes. But most studies were conducted with adults. The importance of ACEs on future health outcomes was demonstrated by Felitti &?Anda. OBJECTIVES: To document the prevalence of violence related ACEs in a representative sample of students and explore their contribution to different health indicators or outcomes. DESIGN/METHODS: Data are derived from a large multidimentional study on interpersonal violence in teens. A?questionnaire was completed by 8,194 students 14–18 yo. in school, after a one-stage stratified cluster sampling of high schools students in the province. Adverse childhood experiences included: being victim of physical and/or sexual abuse, witnessing violence, witnessing father-to-mother and mother-to-father psychological and physical violence. Health outcomes considered: use of health care services, medication, serious accident, drug abuse, condom use, pregnancy, psychological distress, suicide ideations. The study was accepted by the?ERB. RESULTS: 76% of girls and 68% of boys reported at least one ACE, and 24% of girls and 16.5% of boys reported 3 or more ACEs, for a difference statistically significant between sexes for 3 or more ACEs. We found a statistically significant and increasing difference between 0 and 2 or 3 ACEs for the following health outcomes, ie, more teens reporting: use of health services, medication in past year, serious accident, substance use 3 times or more/week for boys, psychological distress, suicide ideation. We found a statistically significant difference between 0 and 3 ACEs for the following health outcomes, ie, more teens reporting: substance use 3 times or more/week for girls, higher number of sexual partners, pregnancies; and lower condom use for girls. Logistic regression analysis controlling for age shows that number of ACEs increases the risk for all health outcomes with OR ranging from 1.2 to 1.7, the highest being suicidal ideation and medication use, for both sexes; sexuality related indicators for girls; use of health services, injuries and psychological distress for?boys. CONCLUSION: Violence related adverse events have a major burden on subsequent health and health risks in teens. It is important to inquire, when teens are consulting, about personnal / family violent events, being either victimized or witness. We should also pay more attention to cumulative effects of these events. At least for those with 2 ACEs or more, intervention should be offered. Articles from Paediatrics & Child Health are provided here courtesy of Oxford University Press.