Adverse Childhood Experiences and Health Outcomes Among Sexual and Gender Minorities: A Systematic Review.

Current research indicates a strong association between adverse childhood experiences (ACEs) and adverse health outcomes. Participants in frequently cited ACE research are predominantly heterosexual and cis gendered; the extent to which ACEs affect health outcomes among sexual and gender minorities (SGMs) is unclear. This systematic review examined the frequency of, and relationship between, ACEs and negative health outcomes among SGM. CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus, and PubMed databases were searched with no date restriction. After eliminating duplicates, titles and abstracts were reviewed resulting in 22 articles to be critiqued using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. A total of 22 studies met final inclusion criteria. The frequency of reporting at least one ACE among SGMs ranged from 51.4 to 91.6%, while the frequency of reporting four or more ACEs ranged from 18.1 to 60.7%. SGMs reported a higher frequency of ACEs than non-SGM. ACEs were associated with poorer mental and physical health outcomes, as well as increased risky behavior among SGMs. SGMs report a high frequency of ACEs, but current studies did not include data regarding ongoing stigma and adversities that may further contribute to their negative health outcomes. Further research is needed to fully understand the impact of adversities experienced due to the sexual and/or gender orientation of this minority group. Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-023-00576-4.

Public Perceptions of Opioid Use for Chronic Non-Cancer Pain.

Background: Chronic non-cancer pain affects 20% of Americans. This is significantly impacted by the ongoing opioid crisis and reduced opioid dispensing. Public perceptions additionally shape pain management strategies. Purpose: This study explores public attitudes toward prescription opioids for chronic non-cancer pain. We aim to understand how public attitudes are influenced by the evolving opioid crisis and shifting opioid use patterns. Methods: In Michigan, 823 adults participated in a Qualtrics survey on attitudes toward nonmedical and medical prescription opioid use. Multivariable logistic regression was performed to identify factors associated with beliefs that doctors prescribe opioids for too long (Model 1) and chronic pain patients should transition to alternative treatments (Model 2). Results: About half (49.4%) of respondents believed doctors keep patients on prescription opioids for too long, while two-thirds (65.7%) agreed chronic pain patients should be tapered off medications. Knowing someone who misused opioids and perceptions of substance use (e.g. perceived risk of prescription opioid misuse, stigma toward chronic pain patients, perceived prevalence of prescription opioid misuse, and awareness of fentanyl) were associated with greater odds of believing doctors keep patients on opioids too long. Demographics (age and education), substance use histories and perceptions (e.g. perceived risk and stigma) were associated with greater odds of believing patients should be tapered off their medication. Conclusions: These findings inform strategies to correct public misperceptions, emphasizing the importance of personal experience, perceived risks, and stigmatization of chronic pain patients. This insight can guide effective pain management for those with chronic non-cancer pain.

Evaluating the Psychometric Properties of the Sexual and Gender Minority Adverse Childhood Experiences Scale Among Sexual Minority Men and Women.

BACKGROUND: Adverse childhood experiences (ACEs) are known determinants of negative health outcomes. Sexual and gender minority (SGM) individuals have higher ACE scores than non-SGM individuals. The SGM-ACE scale was developed to better assess this population but is not yet validated in SGM subgroups. AIMS: This study aims to validate the sexual and gender minority adverse childhood experiences (SGM-ACE) scale among sexual minority men (SMM) and sexual minority women (SMW), while testing measurement invariance across both groups. METHODS: A cross-sectional survey included 530 sexual minority adults (265 men, 265 women) in the United States. Cronbach's alpha established internal consistency reliability. Validity was assessed via confirmatory factor analysis (CFA) for the SGM-ACE's theoretical structure and Pearson's correlations for concurrent validity with substance use outcomes (alcohol, cannabis, and drugs). Multigroup structural equation modeling (SEM) determined measurement invariance between SMM and SMW. RESULTS: The CFA of the original model exhibited good fit. Fit was improved after removing the institutionalization item, chi-square (χ2) = 14.26, degrees of freedom (df) = 9, p = 0.113, minimum discrepancy (CMIN/df) = 1.59, comparative fit index (CFI) = 0.99, root mean square error of approximation (RMSEA) = 0.03, 90% confidence interval (CI): (0.00-0.06), and standardized root mean square residual (SRMR) = 0.02. Internal consistency reliability was established (α = 0.78). SGM-ACE exhibited weak, yet significant relationships with each substance use outcome. Multigroup SEM indicated measurement invariance between SMM and SMW. CONCLUSION: This study provides psychometric validation of the SGM-ACE, establishing measurement invariance between SMM and SMW. Future research should explore its utility in diverse SGM minority subgroups.

Association of adversities and mental health among first- and second-generation Arab American young adults.

The prevalence of mental health problems among young adults is widely recognized. However, limited research has examined the mental health of Arab American young adults specifically. To address this gap in the literature, this study aimed to investigate the effects of multiple stressors including adverse childhood experiences (ACEs), discrimination, and bullying victimization on the mental health of first- and second-generation Arab American young adults. The participants (N = 162) were recruited from a Midwest university using online and in-person methods. They were screened and completed a demographic questionnaire and self-report measures of ACEs, discrimination, bullying victimization, and mental health. Hierarchical multiple regression analysis was conducted to examine the effect of psychosocial stressors on mental health and the moderating effect of generation (first vs. second) on that relationship. Female gender, increased perceived discrimination, and more ACEs were associated with lower mental health scores (ß = -0.316, p < 0.001, ß = -0.308, p < 0.001, and ß = -0.230, p = 0.002, respectively). There was a significant negative relationship between victimization and mental health for first-generation Arab Americans (ß = -0.356, p = 0.010). However, that association all but disappeared for second-generation participants (ß = 0.006, p = 0.953). The results highlight the impact of multiple adversities on Arab American young adults' mental health and indicate important nuances related to their generation in the association between bullying victimization and mental health. Implications for practice and future research are discussed.

Trends in coping reasons for marijuana use among U.S. adolescents from 2016 to 2022.

OBJECTIVE: This study examines historical trends in coping reasons for marijuana use among adolescents (1976-2022) and explores sociodemographic variations in recent years (2016-2022). METHOD: Data from U.S. national samples of 12th grade adolescents in the Monitoring the Future (MTF) study were used to examine long-term trends (1976-2022, N = 43,237) and recent differences by sociodemographic characteristics (2016-2022, N = 3,816). Measures included marijuana use, coping reasons for use, and sociodemographic characteristics. RESULTS: The most prevalent coping reason across time was "relax," endorsed by 52.9% of past 12-month users. Coping reasons mostly exhibited significant increases over time. Sociodemographic factors were associated with coping reasons. Females had higher odds of using marijuana to escape problems and get through the day (vs. males). Black respondents were more likely to use marijuana to get through the day, and Hispanic respondents were more likely to use to relax (vs. White respondents). Those with lower (vs. higher) parental education were more likely to use due to anger/frustration and to escape problems. Adolescents who used marijuana frequently (vs. less often) had higher odds of endorsing all coping reasons. There was no robust evidence of interactions between sociodemographic characteristics and year. CONCLUSIONS: Results indicate a consistent increase in coping reasons for adolescent marijuana use over time, with variations based on sociodemographic characteristics. The findings highlight the importance of understanding subpopulations of adolescents who have higher risk of coping-related marijuana use.

Health Disparities Among Sexual and Gender Minorities With Adverse Childhood Experiences: Insights From the 2021 Behavioral Risk Factor Surveillance System Data.

Objectives. To identify the prevalence of adverse childhood experiences (ACEs) among sexual or gender minorities (SGMs) and examine the impact of ACEs on their health. Methods. We analyzed 2021 Behavioral Risk Factor Surveillance System (BRFSS) data. Respondents from Arkansas, Iowa, Mississippi, Nevada, and Wisconsin completed modules on 10 individual ACEs, sexual orientation and gender identity, and health. Results. Among the 38 483 eligible respondents, 2329 (6.1%) identified as an SGM. SGMs reported higher ACE prevalence than did their non-SGM counterparts. ACEs partially attenuated relationships between SGMs and a higher risk for depression, cardiovascular disease, chronic kidney disease, electronic nicotine delivery system use, and cannabis use. Conclusions. Evaluating and better understanding the ACE and health outcome relationship among SGMs should be prioritized. Targeted interventions are needed to mitigate the impact of ACE-associated sequelae in this population. (Am J Public Health. 2023;113(12):1343-1351. https://doi.org/10.2105/AJPH.2023.307420).

The Psychometric Properties of the Brief COPE Among Young Adults.

Background and Process: Although the Brief COPE is a widely used instrument to measure coping, its factor structure is understudied in young adults. The purpose of this article was to determine the psychometric properties of the dispositional version of the Brief COPE among young adults. Methods: Two hundred young adults completed the dispositional version of the Brief COPE. Measures of depression, anxiety, and stress tested predictive validity. Confirmatory factor analyses and exploratory structural equation modeling were conducted. Results: The final model achieved good fit (minimum discrepancy/degrees of freedom [CMIN/df] = 1.59; comparative fit index [CFI] = .93; standardized root mean square residual [SRMR] = .07). Three second-order factors were identified: adaptive (α = .81), support (α = 78), and disengaged coping (α = 71). Adaptive and disengaged coping were differentially associated with mental health outcomes. Conclusions: The results are consistent with a growing body of evidence to support the construct validity of the Brief COPE.

Does Coping Mediate the Relationship Between Adverse Childhood Experiences and Health Outcomes in Young Adults?

Adverse childhood experiences (ACEs) affect 22-75% of American young adults. ACEs are associated with adverse health outcomes that begin in young adulthood. Yet, scant research has examined if coping can mediate the relationship between ACEs and adverse outcomes. The current study determined if coping mediates the relationship between ACEs and body mass index (BMI), substance use, and mental health outcomes in young adults. A community sample of 100 White and 100 Black young adults 18-34 years of age participated in a cross-sectional study conducted via Zoom conferencing. Participants provided demographic data, height/weight, and completed measures of ACEs, coping, substance use, and mental health outcomes. Coping was measured using an established three-factor model consisting of adaptive, support, and disengaged coping. Structural equation modeling (SEM) examined the relationships of ACEs to outcomes as mediated by coping. Participants were predominantly female (n = 117; 58.5%) and mid-young adult (M = 25.5 years; SD = 4.1). SEM results indicated good model fit: (CMIN/df = 1.52, CFI = 0.94, RMSEA = 0.05 [90% CI = 0.03-0.07], SRMR = 0.06). Only disengaged coping mediated the ACE and substance use (ß = 0.36, p = .008), smoking (ß = 0.13, p = .004), and mental health (ß=-0.26, p = .008) relationships. Disengaged coping styles may be a critical mechanism in developing adverse mental health and substance use outcomes among ACE-exposed individuals. Future ACE and health outcomes research should examine the role of coping. Interventions focusing on adaptive coping may improve the health of individuals exposed to ACEs.

The Relationship of Adverse Childhood Experiences and Emotional Distress in Young Adults.

BACKGROUND: Emerging evidence notes increased depression, anxiety, and stress among the general population during the COVID-19 pandemic. However, little is known about populations at increased risk for emotional distress as the pandemic continues. Persons with adverse childhood experiences (ACE) are one group that may be at higher risk for emotional distress. AIM: The aim of this study is to examine whether young adults, particularly Black young adults, with histories of ACEs report more emotional distress during the pandemic than those with no ACE exposure. METHOD: Using a cross-sectional, quota sampling approach, 100 Black and 100 White young adults were recruited using online sources (e.g., University website, Facebook). Due to the pandemic, participants were screened via Zoom and, if eligible, completed a demographic questionnaire, emotional distress measures (i.e., anxiety, depression, stress), and the ACE Questionnaire online via a Qualtrics survey. Structural equation modeling (SEM) analysis examined the ACE and emotional distress relationship, and multigroup SEM assessed racial differences. RESULTS: High levels of both emotional distress and ACEs were observed. Black young adults reported significantly more ACEs than Whites. ACEs were significantly associated with each measure of emotional distress regardless of race or other covariates. CONCLUSIONS: Findings reveal that during the pandemic, persons exposed to ACEs reported greater emotional distress than those with no ACE exposure. Nurses must screen patients for both emotional distress and ACE to target those at higher risk for early intervention and initiate treatment as needed to mitigate long-term mental health consequences.

The Factor Structure of the Brief Cope: A Systematic Review.

The Brief COPE is a widely used measure of coping that contains 28 items on 14 factors. Researchers have shortened the inventory, but the factor structure remains debated. A systematic review of peer-reviewed studies published in English between 1997 and 2021 was conducted to determine if a more parsimonious number of factors could be identified. Cumulative Index for Nursing and Allied Health, PsycINFO, PsycARTICLES, Medline, PubMed, and Scopus databases were searched using keywords "Brief COPE" and "factor, valid*, or psychometric.*" Searching yielded 1,303 articles; cited references added 38; 85 articles met inclusion criteria. Principal components analysis and confirmatory factor analysis were major analytic strategies used (28% and 27%, respectively). Only eight studies analyzed the original 14-factor structure. Factors identified ranged from 2 to 15, with dichotomous factors most frequently identified (25%; n = 21). A smaller number of factors may be able to represent the Brief COPE. Research is needed to test a condensed instrument.

Psychometric Properties of the Brief COPE Among Pregnant African American Women.

This paper describes the assessment of the psychometric properties of the Brief COPE in a sample of 189 pregnant African-American women. Confirmatory factor analysis (CFA) tested the original 14-factor model, and exploratory structural equation modeling (ESEM) determined whether a reduced number of factors still accounted for inter-item covariances. The CFA replicated 13 of the 14 original factors. After deleting substance use items and allowing for correlated error across the support factors, the 13-factor model achieved an acceptable fit (CMIN/df = 1.77; RMSEA = 0.06, 95% CI = 0.05-0.07). ESEM resulted in three second-order factors: disengaged, active, and social support coping. Factor items were summed to create subscales with good internal consistency reliability (α = .74-.89). Social support coping and active coping were strongly correlated and accounted for nearly the same variance in four different psychological/affect scales, while disengaged coping was clearly distinct.

Adverse Childhood Experiences in Non-Westernized Nations: Implications for Immigrant and Refugee Health.

As the immigrant and refugee population continues to increase in the United States, healthcare providers need to be aware of Adverse Childhood Experiences (ACEs) these populations may have endured, and the potential health effects of these events. ACE research has been conducted with predominantly highly-educated, older Caucasians living in high-income countries which limits generalizability. A systematic review examined ACE prevalence and outcomes in persons living in poor, low-, and middle-income nations, often the home countries of U.S. immigrants and refugees. Fourteen studies conducted in 17 nations were included. Two main ACE measures were used. Prevalence of reporting at least one ACE ranged from 1.9% (Lebanon) to 80% (Saudi Arabia). Analysis established a graded dose-response, with increases in ACEs associated with increased risky behavior and negative health outcomes across all countries. Results reveal immigrants and refugees within the U.S. need to be evaluated for ACE exposure.