Kayla N. Anderson’s research while affiliated with Strategy& and other places

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Publications (47)


Screening for Adverse Childhood Experiences: A Critical Appraisal
  • Literature Review

November 2024

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6 Reads

Pediatrics

Anna E Austin

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Kayla N Anderson

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Marissa Goodson

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[...]

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Sarah Bacon

Adverse childhood experiences (ACEs) are common and can impact health across the life course. Thus, it is essential for professionals in child- and family-serving roles, including pediatric and adult primary care clinicians, to understand the health implications of childhood adversity and trauma and respond appropriately. Screening for ACEs in health care settings has received attention as a potential approach to ACEs identification and response. Careful examination of the existing evidence on ACEs screening and consideration, from a clinical and ethical perspective, of the potential benefits, challenges, and harms is critical to ensuring evidence-informed practice. In this critical appraisal, we synthesize existing systematic and scoping reviews on ACEs screening, summarize recent studies on the ability of ACEs to predict health outcomes at the individual level, and provide a comprehensive overview of potential benefits, challenges, and harms of ACEs screening. We identify gaps in the existing evidence base and specify directions for future research. We also describe trauma-informed, relational care as an orientation and perspective that can help pediatric and primary care clinicians to sensitively assess for and respond to ACEs and other potentially traumatic experiences. Overall, we do not yet have sufficient evidence regarding the potential benefits, challenges, and harms of ACEs screening in health care and other settings. In the absence of this evidence, we cannot assume that screening will not cause harm and that potential benefits outweigh potential harms.


Prevalence of Adverse Childhood Experiences Among Adolescents

October 2024

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18 Reads

Pediatrics

OBJECTIVE Adverse childhood experiences (ACEs) are preventable, potentially traumatic events with lifelong negative impacts. Population-level data on ACEs among adolescents have historically relied on parent reports and excluded abuse-related ACEs. We present the self-reported prevalence of ACEs among a large population-based sample of US high school students. METHODS Using cross-sectional, state-representative data from 16 states that included core ACE questions on their 2021 Youth Risk Behavior Survey, we estimate the prevalence of 8 individual (lifetime emotional, physical, or sexual abuse, physical neglect, witnessed intimate partner violence, household substance use, household poor mental health, incarcerated parent or guardian) and cumulative ACEs (0, 1, 2–3, ≥4) among a large population-based sample of adolescents, overall and by demographic characteristics (sex, race and ethnicity, age, sexual orientation). RESULTS Emotional abuse (65.8%), household poor mental health (36.1%), and physical abuse (32.5%) had the highest prevalence. ACEs were very common, with 80.5% of adolescents experiencing at least 1 ACE and 22.4% experiencing ≥4 ACEs. Experiencing ≥4 ACEs was highest among adolescents who were female (27.7%), non-Hispanic multiracial (33.7%), non-Hispanic American Indian or Alaska Native (27.1%), gay or lesbian (36.5%), bisexual (42.1%), or who described their sexual identity some other way or were not sure of their sexual identity (questioning) (36.5%). CONCLUSIONS Self-reported ACE estimates among adolescents exceed previously published parent-reported estimates. ACEs are not equally distributed, with important differences in individual and cumulative ACEs by demographic characteristics. Collecting ACE data directly from adolescents at the state level provides actionable data for prevention and mitigation.


Population-attributable fractions for health conditions or risk behaviors among high school students aged <18 years, by cumulative adverse childhood experiences -Youth Risk Behavior Survey, United States, 2023
Adverse Childhood Experiences and Health Conditions and Risk Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023
  • Article
  • Full-text available

October 2024

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43 Reads

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3 Citations

MMWR Supplements

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events occurring before age 18 years. Data on ACEs among adolescents in the United States have primarily been collected through parent report and have not included important violence-related ACEs, including physical, sexual, and emotional abuse. This report presents the first national prevalence of self-reported ACEs among U.S. high school students aged <18 years, estimates associations between ACEs and 16 health conditions and risk behaviors, and calculates population-attributable fractions of ACEs with these conditions and behaviors using cross-sectional, nationally representative 2023 Youth Risk Behavior Survey data. Exposures were lifetime prevalence of individual (emotional, physical, and sexual abuse; physical neglect; witnessed intimate partner violence; household substance use; household poor mental health; and incarcerated or detained parent or guardian) ACEs and cumulative ACEs count (zero, one, two or three, or four or more). Health conditions and risk behaviors included violence risk factors, substance use, sexual behaviors, weight and weight perceptions, mental health, and suicidal thoughts and behaviors. Bivariate analyses assessed associations between individual and cumulative ACEs and demographics. Adjusted prevalence ratios assessed associations between cumulative ACEs and health conditions and risk behaviors, accounting for demographics. Population-attributable fractions were calculated to determine the potential reduction in health conditions and risk behaviors associated with preventing ACEs. ACEs were common, with approximately three in four students (76.1%) experiencing one or more ACEs and approximately one in five students (18.5%) experiencing four or more ACEs. The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%). Students who identified as female; American Indian or Alaska Native; multiracial; or gay or lesbian, bisexual, questioning, or who describe their sexual identity in some other way experienced the highest number of ACEs. Population-attributable fractions associated with experiencing ACEs were highest for suicide attempts (89.4%), seriously considering attempting suicide (85.4%), and prescription opioid misuse (84.3%). ACEs are prevalent among students and contribute substantially to numerous health conditions and risk behaviors in adolescence. Policymakers and public health professionals can use these findings to understand the potential public health impact of ACEs prevention to reduce adolescent suicidal behaviors, substance use, sexual risk behaviors, and other negative health conditions and risk behaviors and to understand current effects of ACEs among U.S. high school students.

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Weighted Prevalence of Current Anxiety, Depression, and Behavioral or Conduct Problems Among U.S. Children Aged 6–17 Years, by Cumulative Number of Positive Childhood Experiences (PCEs), National Survey of Children’s Health, 2018–2019
Adjusted Prevalence Ratios for Associations between Cumulative Number of Positive Childhood Experiences (PCEs) and Current Anxiety, Depression, and Behavioral or Conduct Problems among U.S. Children Aged 6–17 Years, National Survey of Children’s Health, 2018–2019. Graphs in Panel A a are adjusted for demographics, including child sex, child age, child race and ethnicity, parental education, and family income as a percentage of federal poverty level; Graphs in Panel B b are adjusted for the demographics included above and cumulative ACEs. Graphs are plotted on an arithmetic, not logarithmic, scale, as these values represent the calculated adjusted prevalence ratios for the relationship between cumulative PCEs and each mental health condition. Prevalence ratios with error bars that do not cross the threshold of the dotted line at “1” are considered statistically significant. The prevalence ratios with error bars reflect comparisons between the indicated cumulative PCE category with the reference category of <16 PCEs, after adjusting for covariates. cTwenty–five PCEs were included in this analysis; this includes all PCEs except for receipt of preventive medical services, as this variable was only available for surveys administered in 2019. These categories were determined by examining the median and IQR for the number of PCEs for children in the sample. The 25th percentile was 16.0 PCEs, 50% percentile was 19.0 PCEs, and 75% percentile was 21.0 PCEs
Prevalence of Positive Childhood Experiences and Associations with Current Anxiety, Depression, and Behavioral or Conduct Problems among U.S. Children Aged 6–17 Years

May 2024

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110 Reads

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1 Citation

Adversity and Resilience Science

Positive childhood experiences (PCEs) have substantial potential to improve children’s mental health. We examined the prevalence of 26 specific PCEs, overall and by demographics, and the individual and cumulative effects of PCEs with current diagnosis of three mental health conditions using nationally representative, parent-reported data on U.S. children aged 6–17 years from the 2018–2019 National Survey of Children’s Health (n=35,583). The prevalence of each PCE varied, with a range between 22.6% (gets recommended amount of physical activity) to 92.1% (parent(s) have positive mental health). Accounting for demographics, there were associations between most specific PCEs and lower prevalence of current childhood anxiety (22 of 26 PCEs), depression (22 of 26 PCEs), and behavioral or conduct problems (21 of 26 PCEs). There was a dose-response relationship between children in higher cumulative PCE quartiles and lower proportions of anxiety, depression, and behavioral or conduct problems. Findings generally did not attenuate after further adjusting for adverse childhood experiences. PCEs are common among U.S. children, but vary substantially by type of PCE and subpopulation. This has critical implications for focusing prevention and intervention strategies to bolster PCEs in ways that could improve health equity and children’s mental health.


Outcomes up to age 36 months after congenital Zika virus infection—U.S. states

September 2023

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50 Reads

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6 Citations

Pediatric Research

Background: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. Methods: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. Results: Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. Conclusion: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. Impact: We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.


Child-Focused and Economic Stability Service Requests and Barriers to Service Access Among Intimate Partner Violence Survivors With and Without Children, 2017–2021

July 2023

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58 Reads

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1 Citation

Journal of Family Violence

Purpose Intimate partner violence (IPV) exposure in childhood is common, with impacts on lifespan well-being. However, there are knowledge gaps about needs and barriers to services for IPV survivors with children. Method We analyzed data from adults aged ≥ 19 years who resided in the U.S., were experiencing IPV, and who contacted the National Domestic Violence Hotline from 1/1/ 2017–12/31/2021 (N = 599,207). Adjusted prevalence ratios (aPRs) and 95% CIs were calculated to compare differences in IPV exposure, service requests, and service access barriers for IPV survivors with and without children at home, adjusting for age, gender, and race/ethnicity. We examined time trends (2017–2021), with comparisons before and during the COVID-19 pandemic. Results Many adult IPV survivors (42.6%) reported having a child at home; survivors with children reported greater polyvictimization (mean IPV types: 2.27, SD: 1.03) than those without children (M: 2.06, SD: 1.04). A small proportion of those with children requested support identifying child-focused services (4.1%); a greater proportion of those with children (30.8%) requested economic stability services compared to those without children (25.2%) (aPR: 1.16, 95% CI: 1.15–1.17). Additionally, 33.1% of survivors with children at home reported having any service access barrier; this was 16% higher than adult IPV survivors without children (28.7%) (aPR: 1.16, 95% CI: 1.15–1.17). There were changes over time, including during the COVID-19 pandemic. Conclusions IPV survivors with children need additional supports; organizations serving IPV survivors with children may consider the unique needs and victimization profile of this population when designing interventions and services.


A National Approach to Preventing Adverse Childhood Experiences (ACEs): Findings from Two Federal Initiatives

July 2023

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13 Reads

Exposure to adverse childhood experiences (ACEs) can have lasting effects into adulthood. ACEs are potentially traumatic events that occur in childhood (0–17 years), including experiencing violence, abuse, and neglect. ACEs are linked to negative effects on well-being and opportunity, but they are preventable. The Centers for Disease Control and Prevention has invested resources in understanding the impact of ACEs on violence, injury, and other harmful health outcomes. This work has culminated in the development of several technical packages that provide the best available evidence for preventing violence and its significant health consequences. This chapter highlights two funding initiatives with emphasis on implementing prevention strategies at the state and local levels to affect community-level change: Essentials for Childhood and Preventing Adverse Childhood Experiences: Data to Action. Both focus on reaching those with the highest burden of risk for violence and related ACEs; and work with multisector partners to develop, implement, evaluate, and sustain prevention activities. These programs use the public health approach and comprehensive primary prevention strategies to create and to sustain safe, stable, nurturing relationships and environments for children so that they can live to their full life and health potential.KeywordsPublic healthAdverse childhood experiencesChild abuse and neglectViolence preventionEvidence based; state levelSurveillance; data to action


FIGURE. Mean weekly number (A) and percentage (B) of emergency department visits* , † for mental health conditions overall, § all suiciderelated behaviors, ¶ and all drug overdoses** among persons aged 12-17 years -National Syndromic Surveillance Program, United States, January 2019-February 2023 † †
Emergency Department Visits Involving Mental Health Conditions, Suicide-Related Behaviors, and Drug Overdoses Among Adolescents - United States, January 2019-February 2023

May 2023

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58 Reads

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18 Citations

MMWR. Morbidity and mortality weekly report

The U.S. adolescent mental and behavioral health crisis is ongoing,* with high pre-COVID-19 pandemic baseline rates† (1) and further increases in poor mental health (2), suicide-related behaviors (3), and drug overdose deaths (4) reported during 2020-2021. CDC examined changes in U.S. emergency department (ED) visits for mental health conditions (MHCs) overall and for nine specific MHCs,§ suicide-related behaviors (including suspected suicide attempts), and drug-involved overdoses (including opioids) among children and adolescents aged 12-17 years (adolescents) during January 2019-February 2023, overall and by sex. Compared with fall 2021, by fall 2022, decreases in weekly ED visits were reported among all adolescents, and females specifically, for MHCs overall, suicide-related behaviors, and drug overdoses; weekly ED visits among males were stable. During this same period, increases in weekly ED visits for opioid-involved overdoses were detected. Mean weekly ED visits in fall 2022 for suicide-related behaviors and MHCs overall were at or lower than the 2019 prepandemic baseline, respectively, and drug overdose visits were higher. Differences by sex were observed; levels among females were at or higher than prepandemic baselines for these conditions. These findings suggest some improvements as of fall 2022 in the trajectory of adolescent mental and behavioral health, as measured by ED visits; however, poor mental and behavioral health remains a substantial public health problem, particularly among adolescent females. Early identification and trauma-informed interventions, coupled with expanded evidence-based, comprehensive prevention efforts, are needed to support adolescents' mental and behavioral health.


Citations (37)


... It's important to acknowledge that a one-size-fits-all approach may not be effective, and tailored strategies are needed to address the unique challenges of proxy reporting. Many studies that address the challenges with proxy reporting focus on other populations like children and teens [18][19][20] and proxy use in a singular context such as dementia or aphasia research [12,21,22], so they often do not adequately address the myriad of challenges that researchers using proxy reports face in different settings. This paper summarizes the literature on proxy reporting, provides an overview of a wide range of challenges with proxy reporting, specifically in the older adult population, and presents possible solutions and examples that might enhance the quality of proxy reports and improve research participation among older adults. ...

Reference:

Challenges and Recommendations for Proxy Reporting in Aging Research: A Brief Commentary
Alignment of parent-proxy report and teen self-report of adverse childhood experiences among U.S. teens
  • Citing Article
  • September 2024

Annals of Epidemiology

... Emotional support encompasses feelings of safety, love, and care shared among family members. Research indicates that children receiving emotional support from their parents have a 50% lower risk of developing anxiety or depression later in life (Anderson et al., 2024;Gariépy et al., 2016;Parenteau et al., 2020). From an economic perspective, meeting basic needs such as food, clothing, and shelter is also vital. ...

Prevalence of Positive Childhood Experiences and Associations with Current Anxiety, Depression, and Behavioral or Conduct Problems among U.S. Children Aged 6–17 Years

Adversity and Resilience Science

... This is a national surveillance system that began during the ZIKV epidemic to monitor pregnancies with laboratory evidence of ZIKV infection and the outcomes of offspring from those pregnancies in the US states and territories. One hundred and twenty-two infants (5.4%) of 2248 infants reported to the US registry had a ZIKVrelated congenital disability [28]. While children with ZIKV-related congenital disabilities had a greater frequency of neurologic sequelae and neurodevelopmental delays, those without ZIKV-related congenital disabilities still had risk. ...

Outcomes up to age 36 months after congenital Zika virus infection—U.S. states
  • Citing Article
  • September 2023

Pediatric Research

... Self-esteem, or an individual's overall evaluation of their self-worth, is connected to the challenges inherent to adolescence and emerging adulthood, including developing a sense of self and beginning to form intimate relationships (e.g., Erikson, 1968). Psychological distress, including symptoms of depression and anxiety (e.g., Kessler et al., 2002), has, alarmingly, been on the rise in young people in recent years and is linked to mental health difficulties, suicidal behavior, and drug use (e.g., Anderson et al., 2023). That there are associations between romantic relationships and both of these metrics (Mirsu-Paun & Oliver, 2017;Wagner et al., 2013), suggests that being able to discuss romantic relationships with a caregiver may help foster more positive relationship experiences and buoy psychological health. ...

Emergency Department Visits Involving Mental Health Conditions, Suicide-Related Behaviors, and Drug Overdoses Among Adolescents - United States, January 2019-February 2023

MMWR. Morbidity and mortality weekly report

... Patient concerns regarding privacy, safety, and stigma must be addressed through culturally aware, trauma-informed approaches [40]. strengthsbased approaches to addressing aces incorporate discussion of protective factors such as social support [41] and positive childhood experiences [42,43]; strategies to mitigate stress/build resilience; as well as connection to resources to support social determinants of health [44] study limitations First, our study had more missing ace data compared to other variables and did not capture social and environmental adversity factors highlighted in growing literature such as neighborhood violence, discrimination, war, extreme weather events, and pandemics [45,46]. assuming participants missing aces data were more likely to have or had more aces, or that we failed to capture other meaningful aces, this would bias estimates downward. ...

Adverse Childhood Experiences Among US Adolescents Over the Course of the COVID-19 Pandemic
  • Citing Article
  • May 2023

Pediatrics

... Again, they relied on cross-sectional data to identify mediation. Verlenden et al. used longitudinal data collected during the pandemic, reporting both a direct effect of childhood adversities on depression symptoms and a path mediated by pandemic stressors [35]. However, most studies have only examined whether childhood adversities were associated with mental health outcomes, not whether they interacted synergistically with pandemic-related stressors. ...

Associations between Adverse Childhood Experiences and Pandemic-Related Stress and the Impact on Adolescent Mental Health during the COVID-19 Pandemic

Journal of Child & Adolescent Trauma

... Salameh et al.'s systematic review on COVID-19's impact on mental health showed an increased prevalence of PTSD; psychological disorders; symptoms of anxiety, stress, and depression; and symptoms of mental ill-health among different population groups in Jordan [46]. Additionally, COVID-19 has been associated with an increased number of reported ACEs among adolescents, in line with our findings [50,51]. Such an increase been linked to the impact of lockdown and subsequent social and educational disruptions on individuals' mental health globally [43,[50][51][52]. ...

Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students - Adolescent Behaviors and Experiences Survey, United States, January-June 2021

MMWR. Morbidity and mortality weekly report

... Additionally, this study found no significant associations between mental health problems and physical comorbidities, or length of hospital stay. This is in line with earlier research on this topic (Wu et al. 2020, Tomasoni et al. 2021, although some studies suggest that longer length of hospital stay might be associated with mental health conditions such as anxiety, depression, schizophrenia, and bipolar disorder in hospitalized COVID-19 patients (Koyoma et al. 2022) Limitations in this study include response bias as patients were invited to follow-up consultations after hospitalization without obligation. Selection bias could also be present as some patients who were not able to present at follow-up consultation (e.g. with less physical mobility) have been excluded. ...

Mental Health Conditions and Severe COVID-19 Outcomes after Hospitalization, United States

Emerging Infectious Diseases

... In recent years, there has been a rise in public health programmes to support vulnerable first-time families with ACEs in the early years (prenatal period to age 2 years), [10][11][12][13] including perinatal mental health services, nurse-led intensive home visiting, [14][15][16] family hubs, and nationally funded targeted family interventions (UK Family Early Help System). 17 However, early-year interventions are only available to a small proportion of vulnerable families for a limited time, 18,19 and are often perceived to focus exclusively on the needs of the individual child or mother. ...

Leveraging Surveillance and Evidence: Preventing Adverse Childhood Experiences Through Data to Action

American Journal of Preventive Medicine

... The original ACE study, a basic retrospective survey assessing ten adversities that often co-occur and predict poor health outcomes, offered no empirical or theoretical rationale for item inclusion or exclusion and no clear factor structure [12]. Critics note that many common, potentially significant experiences were omitted [13], especially those that occur outside the home [14]. ...

Building Infrastructure for Surveillance of Adverse and Positive Childhood Experiences: Integrated, Multimethod Approaches to Generate Data for Prevention Action

American Journal of Preventive Medicine