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PACEs Research Corner — January 2023, Part 2


[Editor's note: Dr. Harise Stein at Stanford University edits a web site — — that focuses on the effects of abuse, and includes research articles on PACEs. Every month, she posts the summaries of the abstracts and links to research articles that address only ACEs, PCEs and PACEs. Thank you, Harise!! — Rafael Maravilla]

Race/Cultural Concerns

LaBrenz C, Kim Y, Baiden P, et al.
State Child Maltreatment Policies and Disparities in Substantiation: A Study of State-Administered Child Welfare Systems in the U.S. Child Maltreat. 2022:10775595221143136. PMID: 36458462
“We examined the relationship between state child maltreatment policies and substantiation, with child race/ethnicity as a moderator of this relationship…inclusion of exposure to domestic violence, harsh punishment, or educational neglect in state policy was more strongly associated with substantiation for children of color than white children. Implications for policy and research are explored.”

Coimbra BM, Hoeboer CM, Yik J, Mello AF, Mello MF, Olff M.
Meta-analysis of the effect of racial discrimination on suicidality. SSM Popul Health. 2022;20:101283. PMID: 36387016
“Research implicates RD [racial discrimination] in diminished well-being, lower life satisfaction and self-esteem, and mental health disorders.”  In this research review, RD was also found to have a small but significant effect on increased risk of both suicidal ideation and suicide attempts.

Crouch E, Srivastav A, McRell AS.
Examining Racial/Ethnic Differences in Positive Childhood Experiences Among Respondents in a Southern State. Journal of child & adolescent trauma. 2022;15(4):1191-8. PMID: 36439661
Analyzing data from South Carolina 2019, “Our analyses revealed that people of color were less likely to be supported by friends, have an adult who took interest in them, and have a family who stood by them during difficult times…Findings from this study may be used to promote health equity in early childhood through programs, policies, and practices that seek to address historic, systemic, and intergenerational trauma.”

McCuistian C, Kimball SL, Buitron de la Vega P, et. al.
Consideration of racism experiences in the implementation of trauma-focused therapy in primary care. Health Serv Res. 2022 Dec;57 Suppl 2(Suppl 2):235-248. PMID: 35521941
“The current study presents qualitative findings from interviews with clinical stakeholders in primary care regarding how racism impacts patients and providers, and identifies recommendations for PTSD treatment in racism-based trauma.

Cooper SM, Hurd NM, Loyd AB.
Advancing scholarship on anti-racism within developmental science: Reflections on the special section and recommendations for future research. Child Dev. 2022 May;93(3):619-632. PMID: 35596641
In this introduction to a special journal section, authors review scholarship in the development of anti-racism in children across contexts (e.g., families, schools) and developmental stages (e.g., early childhood through emerging adulthood), and make recommendations for future research.

Rizzo MT, Britton TC, Rhodes M.
Developmental origins of anti-Black bias in White children in the United States: Exposure to and beliefs about racial inequality. Proc Natl Acad Sci U S A. 2022;119(47):e2209129119. PMID: 36378643
“It is important to identify what leads children to form prejudicial beliefs and biases and what steps can be taken to preempt their development. This study examined how children's exposure to and beliefs about racial inequalities predicted anti-Black biases in a sample of 646 White children (4 to 8 years) living across the United States. We found that for children with more exposure to racial inequality in their daily lives, those who believed that racial inequalities were caused by intrinsic differences between people were more likely to hold racial biases, whereas those who recognized the extrinsic factors underlying racial inequalities held more egalitarian attitudes…racial biases emerge in part from the explanatory beliefs that children construct to understand the racial inequalities they see in the world around them.”

Draper JK, Feltner C, Vander Schaaf EB, Mieses Malchuk A.
Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula. Acad Med. 2022 Aug 1;97(8):1226-1235. PMID: 35476779
Some medical schools are adopting social justice curricula (SJC) that teach students to recognize and address health disparities. “Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved…Future research should consider the long-term influences of these curricula on students, patients, and the community.”

Miller E, Nambiar-Greenwood G.
Exploring the lived experience of student nurses perspective of racism within education and clinical practice: Utilising the flipped classroom. Nurse Educ Today. 2022;119:105581. PMID: 36257078
From a study of Black African-Caribbean student nurses at a UK university, “direct and indirect racism was experienced by student nurses in both practice and educational environments. Common issues centred on patient's refusal of care, poor support of students, discomfort or denial of staff in addressing sensitive issues, questioning of students' clinical competencies, and educators using 'otherness' (ethnicity, and related stereotypes) to emphasise limitations of certain groups of students…The flipped classroom can be one way of creating inclusive safe spaces for discussing sensitive topics pertaining to racism, inequity, and social injustice.”

Woolston C.
'Beyond anything I could have imagined': graduate students speak out about racism. Nature. 2022 Dec;612(7940):573-575. PMID: 36450957
In a Nature worldwide survey of master and PhD students, 35% of respondents from minority racial or ethnic groups say that they have experienced discrimination or harassment during their current training, more than twice the rate reported by respondents who do not identify as members of those groups (15%). “A master’s student in the United States wrote: “Supervisors do not care about how their trainees face racism, homophobia, sexism and other barriers, but will pretend they do by using pronouns and rainbow flags.”


Winters GM, Jeglic EL, Terry KJ.
The Prevalence of Sexual Grooming Behaviors in a Large Sample of Clergy. Sex Abuse. 2022;34(8):923-47. PMID: 35220824
“The study used archival data from a victim survey of 10,667 cases of alleged CSA within the U.S. Catholic Church…there was evidence of sexual grooming behaviors used by clergy in gaining access and isolation (e.g., using their role in the church to meet victims and socialize with their families), trust development (e.g., using a variety of gifts or other enticements), and desensitization (e.g., introducing sexualized conversations and physical contact with increased sexual touching) stages…Overall, the results suggest that while clergy used tactics consistent with sexual grooming in general, there are some unique aspects of sexual grooming by this population given their institutional role and position.”


Bravo LG, Ahmed C, Choi K.
Addressing Social Context in Adverse Childhood Experience Screening Policy: Implications for Children With Special Health Care Needs. J Pediatr Health Care. 2022 Nov 29:S0891-5245(22)00341-8. PMID: 36460544
“Adverse childhood experiences (ACEs) disproportionately affect children with special health care needs, especially racial and ethnic minority children whose ACEs may be less likely to be identified…deriving an ACE score from a preestablished, policy-defined set of adversities is not the end goal of screening. Rather, ACE scores may be used as a starting point to assess the most significant stressors in a child’s life, which may include stressors beyond those included in common ACE screening instruments. By taking a holistic view of ACEs and thinking beyond scores alone, clinicians can ensure that ACE-related policies are implemented with maximum benefit to diverse children with special health care needs.”

McLellan AT, Koob GF, Volkow ND.
Preaddiction-A Missing Concept for Treating Substance Use Disorders. JAMA Psychiatry. 2022 Aug 1;79(8):749-751. PMID: 35793096
“Treatment efforts and public health policies have focused almost exclusively on those with serious, usually chronic addictions, virtually ignoring the much larger population with early-stage SUDs [substance use disorders]…Importantly, even low-level substance misuse is a major cause of motor vehicle crashes, interpersonal assaults, and overdose deaths among young adults…The diabetes field likely succeeded owing to a broad, well-organized, and sustained strategy applied concurrently at the clinical, public, and policy levels [for “prediabetes”]. If an analogous approach is to be effective in the SUD field, it will require similarly integrated efforts in 3 important areas” – measures to define and detect pre-addiction; engaging, effective interventions for pre-addiction; and public and clinical advocacy.

Jagielski CH, Harer KN.
Working with Trauma in the Gastroenterology Setting. Gastroenterol Clin North Am. 2022;51(4):867-83. PMID: 36376001
Very helpful, practical article. “History of trauma is considered a risk factor for the development of disorders of gut-brain interaction…Gastroenterology patients are at high risk for re-traumatization secondary to the sensitive and invasive nature of GI examinations and testing...This article discusses key points for providers in understanding how various aspects of trauma can affect patients' physical and mental health and medical interactions, as well as trauma-informed strategies providers can use to increase patient comfort, improve communication, and improve effectiveness of treatment.”

Nuako K, Sule A.
Using The Wire in medical education. Lancet Psychiatry. 2022;9(11):858-9. PMID: 36244358
“The Wire could be a useful tool in medical education to begin conversations about challenging topics…allows educators to discuss how economic instability, unsafe physical environments, social policy, social norms, and structural racism intertwine to contribute to negative psychiatric outcomes…trainees can observe the progression of mental health outcomes over the course of several episodes…helps to transform social determinants of health from a checklist to discussions about how these determinants have dynamic impacts…and in doing so integrates discussions of determinants of health with the systems that shape them, which could ultimately help medical students to advocate for their patients.”


Duva IM, Murphy JR, Grabbe L.
A Nurse-Led, Well-Being Promotion Using the Community Resiliency Model, Atlanta, 2020-2021. Am J Public Health. 2022 Jun;112(S3):S271-S274. PMID: 35679550
This description of a brief, simple, online widely-disseminated Community Resilience Training provided by Georgia nurses during the pandemic included trauma awareness and resiliency skills. The program targeted all Georgians, beginning with front-line health care workers, and included caregivers of the most vulnerable children and families in 16 multicounty Georgia regions, community coalitions, and staff from state-level organizations such as the Department of Education, Department of Juvenile Justice, the Division of Family and Children Services, and Georgia School Nurses and Social Workers.

Branco MSS, Altafim ERP, Linhares MBM.
Universal Intervention to Strengthen Parenting and Prevent Child Maltreatment: Updated Systematic Review. Trauma Violence Abuse. 2022;23(5):1658-76. PMID: 33973499
This research review of 14 different parenting programs in general showed improved parenting, decreased child behavior problems, and additional benefits of improved parental mental health, couple relationships, coparenting, and coping ability of parents. “The positive changes in parenting and child behavior outcomes encourage the implementation of parenting programs as a universal prevention strategy.”

Morello L, Caputi M, Scaini S, Forresi B.
Parenting Programs to Reduce Recurrence of Child Maltreatment in the Family Environment: A Systematic Review. Int J Environ Res Public Health. 2022;19(20). PMID: 36293863
Of 8 randomized, controlled research studies looking the the effects of a brief, manualized behavioral parenting program (PP) to reduce recurrent child maltreatment, “three reported a significant reduction in recidivism rates and maltreatment risk, and five improvements in parent-child relationships…More studies are needed to give further support to PP effectiveness in protecting children from recurrent maltreatment.”

Rudolph JI, Walsh K, Shanley DC, Zimmer-Gembeck MJ.
Child Sexual Abuse Prevention: Parental Discussion, Protective Practices and Attitudes. J Interpers Violence. 2022;37(23-24):Np22375-np400. PMID: 35098765
From a survey of 248 Australian and UK parents on how they discussed a variety of sensitive topics with their elementary school children, “Almost all parents were supportive of CSA [child sexual abuse] prevention education and felt they should provide this education. However, two-thirds of parents thought CSA education may be associated with harms for the child and two-thirds of parents believed children could prevent their own abuse.” Authors also highlight the need for parents to be more protective around their children's access to online devices.

Scott LJ, Wilson R, Davies P, et. al.
Educational interventions to prevent paediatric abusive head trauma in babies younger than one year old: A systematic review and meta-analyses. Child Abuse Negl. 2022;134:105935. PMID: 36308894
This research review of parental educational and behavioral programs to reduce pediatric abusive head trauma found weak to no evidence of their effectiveness.

Chiu DT, Hamlat EJ, Leung CW, Epel ES, Laraia BA.
Childhood stress and midlife depression in women: the influence of diet quality. Nutr Neurosci. 2022;25(12):2668-79. PMID: 34844523
For 382 midlife California women, “Higher current diet quality, particularly as aligned with chronic disease prevention guidelines, predicted lower depression risk in women with low childhood adversity. Diet quality did not buffer depression risk in women with high childhood stress.”

Moyes E, Nutman G, Mirman JH.
The Efficacy of Targeted Mindfulness-Based Interventions for Improving Mental Health and Cognition Among Youth and Adults with ACE Histories. Journal of child & adolescent trauma. 2022;15(4):1165-77. PMID: 36439656
In a research review, MBIs (mindfulness-based interventions) were effective for improving mental health and cognition for individuals with ACEs. Resarch quality shortcomings included lack of reporting of methodological details and not reporting adverse events. “Recommendations are made for future research to strengthen the evidence base for MBIs for individuals with ACEs.”

Lassri D, Gewirtz-Meydan A.
Self-Compassion Moderates the Mediating Effect of Self-Criticism in the Link Between Childhood Maltreatment and Psychopathology. J Interpers Violence. 2022;37(23-24):Np21699-np722. PMID: 34963361
From an online survey of 914 adults, self-compassion was a robust resilience factor related to reduced psychopathology, and moderated the link between self-criticism, a potent risk factor, and psychopathology in the context of child maltreatment. “These results thus provide empirical evidence for the relevance of compassion and mindfulness in counseling settings.”


Wathen CN, Schmitt B, MacGregor JCD.
Measuring Trauma- (and Violence-) Informed Care: A Scoping Review. Trauma Violence Abuse. 2023;24(1):261-77. PMID: 34235986
Authors reviewed 13 existing measures of trauma/violence-informed care (TVIC), and concluded that “The items and measures are roughly split in terms of assessing individual-level knowledge, attitudes and practices, and organizational policies and protocols. Few measures examine structural factors, including racism, misogyny, poverty and other inequities…existing measures do not generally cover the full potential range of T(V)IC…such a measure would need to adapt and/or combine two or more existing tools.”

Hayashi M.
Child psychological/emotional abuse and neglect: A definitional conceptual framework. Journal of child & adolescent trauma. 2022;15(4):999-1010. PMID: 36439673
Authors use a framework to evaluate different definitions of psychological/emotional abuse and neglect (PEA).  “Policy, practice, and research on PEA are unlikely to progress without clarity about the definitions being used (in terms of their conceptual components) and the rationale for using the specific definitions chosen. The framework provided by the study is an effective tool for describing the components used in PEA definitions and thus distinguishing the differences between definitions.”

Other of Interest

Owen C, Crane J.
Trauma-Informed Design of Supported Housing: A Scoping Review through the Lens of Neuroscience. Int J Environ Res Public Health. 2022;19(21). PMID: 36361166
“Formalizing the intersection of built environment design with neuroscience (e.g., establishment of The Academy of Neuroscience for Architecture) has provided considerable insights into both established and emerging design principles…This study sought to examine the scope of existing evidence on the relationship between trauma, housing and design, and to identify gaps and opportunities for future research related to the key domains of safety and security; control; and enriched environments.”

Purtle J, Bowler S, Boughter-Dornfeld M, et. al.
Newspaper Coverage of ACEs and Toxic Stress in the United States, 2014-2020: Consequences, Causes, and Solutions. Trauma Violence Abuse. 2023;24(1):313-23. PMID: 34269132
“News media can shape public opinion about child adversity and influence the translation of research into public policy…content analysis was conducted of 746 newspaper articles mentioning "adverse childhood experience(s)" and/or "toxic stress" published in 25 U.S. newspapers between January 1, 2014, and May 30, 2020…We found that newspaper coverage of ACEs and toxic stress increased dramatically between 2014 and 2018 and then sharply declined. Only 13.3% of articles mentioned both ACEs and toxic stress. There were many statistically significant differences in the causes, consequences, and solutions identified. Coverage of both concepts predominantly focused on consequences for individuals, not society. Increased volume in newspaper coverage about ACEs and toxic stress could increase public awareness about the relationship between childhood adversity and adult outcomes. There is a need to portray ACEs and toxic stress more coherently in news media.”

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