As researchers, we often try to pinpoint the causes of negative outcomes in adults. What factors contribute to obesity? What about heart disease? Why are some people more prone to depression and anxiety while others are not? Surely it is not a random chance why some individuals are more prone to these outcomes while others are not. This article, by Keshika Vasuja, examines sexual abuse disparities in more detail. While each outcome may be linked to something specific (i.e., a person’s chance of getting lung cancer increases exponentially if they smoke), there is one factor that has been linked to a variety of negative outcomes like lung cancer, heart disease, anxiety, depression, obesity, unemployment, divorce, and even poor athletic performance. What’s the factor that is linked to all of these outcomes? The term is called “adverse childhood experiences,” or ACEs for short. The Adverse Childhood Experiences (ACE) scale is a standardized measure that captures multiple developmental risk factors beyond sexual, physical and emotional abuse. Lesbian, gay, and bisexual (i.e., sexual minority) individuals may experience disproportionately higher prevalence of adverse childhood experiences. In the 1980s, a researcher named Vincent Felitti ran an obesity clinic in California. Around 50% of the participants dropped out, while the other 50% successfully completed the program. He decided to interview many of the dropouts, and found a common theme: Nearly all of them experienced some form of sexual, physical, or mental abuse as children. Interviews from the group that completed the program revealed only a very small percentage reported the same abuse. Felitti eventually collaborated with a colleague, Robert Anda, in a large study of 17,000 individuals. In that study, Felitti and Anda identified eight domains of ACEs: physical abuse, sexual abuse, emotional abuse, parental separation/divorce, interpersonal violence, incarcerated family member, family mental illness, and family substance use. Regardless of the event, Felitti and Anda found that the more numerical experiences an individual had, the more likely they were to have negative outcomes as adults. Essentially, every person has an ACE score, ranging from 0 (no adverse events before the age of 18) to 8 (adverse events in all 8 categories). Compared with heterosexual respondents, gay/lesbian and bisexual individuals experienced increased odds of six of eight and seven of eight adverse childhood experiences, respectively. Sexual minority persons had higher rates of adverse childhood experiences (IRR = 1.66 gay/lesbian; 1.58 bisexual) compared to their heterosexual peers. The US Department of Health & Human Services reported that 3.6 million cases of childhood maltreatment received an intervention from Child Protective Services in 2010 [3]. The majority of these cases (86%) involved multiple forms of maltreatment. The most common types of maltreatment included neglect (78.3%), physical abuse (17.6%) and sexual abuse (9.2%). Parents were the most common perpetrators (81%). Nearly one-third of the instances of child maltreatment were from homes where a caregiver was an alcoholic and/or drug user (28.9%) or involved in domestic violence (25.7%). Moreover, studies suggest that certain minority populations, such as lesbian, gay and bisexual (i.e., sexual minority) populations, experience disproportionately higher prevalence of adverse childhood experiences. Childhood maltreatment has been linked to a number of negative health outcomes including autoimmune conditions, cancer, heart disease, sexual and reproductive health problems, mental health (e.g., depression, panic, memory, impulse control and anxiety), risky health behaviours (e.g., smoking, drug and alcohol abuse, promiscuity), HIV, and somatic symptoms. Felitti and colleagues reported a dose response relationship between the number of adverse childhood experiences and both health risk behaviours and chronic disease [4]. Specifically, odds of risk behaviours and mental health conditions increased exponentially with the number of adverse childhood experiences reported. For example, individuals reporting ≥2 or ≥4 adverse childhood experiences were significantly more likely to be smokers (OR = 1.5 & 2.2, respectively), depressed (OR = 2.4 & 4.6 respectively), or have attempted suicide (OR = 3.0 & 12.2, respectively). Similarly, for chronic disease outcomes, individuals reporting ≥4 or more adverse childhood experiences exhibited a twofold increase in odds of ischemic heart disease (OR = 2.2), any cancer (OR = 1.9), and stroke (OR = 2.4). So what does this all mean? There are several implications to the study. First, the more we know about ACEs, the greater the chances we have in both preventing ACEs and lessening their effect. Next, ACEs are not equally distributed amongst the general population. Some groups have a higher likelihood of experiencing ACEs, making them uniquely more prone to negative outcomes due to ACEs. Having insight into which groups are particularly vulnerable to ACEs is helpful for professionals that work in fields dealing with the repercussions of ACEs (like mental health counsellors). Knowledge about which groups have a higher likelihood of ACE exposure will aid in tailoring programmatic responses to these groups.
Works Cited: https://www.nspcc.org.uk/what-is-child-abuse/types-of-abuse/child-sexual-abuse/ http://europepmc.org/article/MED/18447763 http://blogs.biomedcentral.com/bmcseriesblog/2020/09/10/females-younger-adults-sexual-minorities-and-multiracial-individuals-most-vulnerable-to-adverse-childhood-experiences/ https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054691 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3134495/
0 Comments
Leave a Reply. |
Welcome to our blog, Medquity!Here we will post extra articles on health disparities to display the profound health inequities in our healthcare system. These are updated every other weekend, so check back regularly! Archives
July 2021
CategoriesHealthNeedsRx ©
Copyright 2021 |