More Than What You Eat: A Review on the Association Between Childhood Maltreatment and Elevated Adult BMI.

PURPOSE OF REVIEW: Obesity is an overwhelmingly common medical entity seen in the adult population. A growing body of research demonstrates that there is a significant relationship between child maltreatment and adult obesity. RECENT FINDINGS: Emerging research demonstrates a potential dose-response relationship between various types of child abuse and adulthood BMI. Recent work also explores the potential role of the hypothalamic-pituitary-adrenal (HPA) axis, and other hormonal mediators such as sex-hormone binding globulin and leptin. There are also studies that suggest factors such as depression and socioeconomic and environmental influences mediate this relationship. Comorbidities that have been reported include cardiovascular and metabolic disease, diabetes, and insulin resistance. Preliminary work also demonstrates potential gender and racial disparities in the effect of abuse on adulthood obesity. In this narrative review, we summarize the existing work describing the different child maltreatment types (physical, sexual, emotional, verbal, and child neglect) and their relation to adult obesity, what is known about a potential dose-response relationship, potential mediators and pathophysiology, comorbidities, and preliminary work on gender and racial/ethnic disparities. We review the limited data on interventions that have been studied, and close with a discussion of implications and suggestions for clinicians who treat adult obesity, as well as potential future research directions.

The Trauma of Separation: Lifelong Health Implications on Children.

In the United States, there are millions of globally displaced children who travel with family to seek immigration relief, many of whom have experienced family separation or live under the constant threat of separation. Family separation constitutes a significant trauma with lifelong impacts on a child's mental health, physical health, and development. This review provides a summary of the various contexts within which family separation occurs as well as the current literature on long-term health sequelae. These include mental illness, externalizing behaviors, developmental challenges, family stability, economic impacts, and educational attainment. Given the number of newcomer children in the US, it is paramount that pediatric clinicians develop a holistic understanding of their needs and the effects of separation to provide evidence-based care and to advocate for the prevention of this trauma for all future migrant families. [Pediatr Ann. 2024;53(5):e167-e170.].

Global Perspectives on the Health and Social Impacts of Child Trafficking.

BACKGROUND AND OBJECTIVES: Survivors of child sex trafficking (CST) experience many health and social sequelae as a result of stigma, discrimination, and barriers to health care. Our objective was to obtain a cross-cultural understanding of these barriers and to explore the relationship between stigmatization and health outcomes through application of the Health Stigma and Discrimination Framework (HSDF). METHODS: In-depth, semistructured interviews were conducted with 45 recognized CST expert service providers. Interview data were analyzed using established content analysis procedures and applied to the HSDF. RESULTS: Barriers to medical and mental health services span each socioecological level of the HSDF, indicating the various contexts in which stigmatization leads to adverse health and social outcomes. Stigmatization of CST survivors is a complex process whereby various factors drive and facilitate the marking of CST survivors as stigmatized. Intersecting stigmas multiply the burden, and manifest in stigma experiences of self-stigmatization, shame, family and community discrimination, and stigma practices of provider discrimination. These lead to reduced access to care, lack of funding, resources, and trained providers, and ultimately result in health and social disparities such as social isolation, difficulty reintegrating, and a myriad of physical health and mental health problems. CONCLUSIONS: The HSDF is a highly applicable framework within which to evaluate stigmatization of CST survivors. This study suggests the utility of stigma-based public health interventions for CST and provides a global understanding of the influence and dynamics of stigmatization unique to CST survivors.

Share our stories: An exploration of the healthcare experiences of child sex trafficking survivors.

BACKGROUND: The trafficking of children and adolescents is widespread, and pediatric providers are on the front line. Current research demonstrates that trafficked children do access health care. However, few studies describe these interactions from their perspectives. In order to elucidate the healthcare experiences of sex trafficked children, we designed a qualitative study utilizing semi-structured interviews to explore their health care interactions. PARTICIPANTS AND SETTING: Homeless youth currently aged 18-21 who were sex trafficked before age 18. METHODS: Semi-structured interviews were conducted with seventeen youth who met the study criteria. Interview transcripts were coded and analyzed using constant comparative methods. Themes were inductively extracted by consensus with the study team, and thematic saturation was determined when no new themes emerged. RESULTS: Themes included: victims endured serious injuries and illnesses without being brought to medical attention, traffickers limited victims' access to care, logistical barriers limited access, traffickers directed victims to lie to providers, and medical providers rarely separated victims to interview them separately resulting in missed opportunities. CONCLUSIONS: These themes illustrate the experiences of sex trafficked youth experiencing homelessness and provide pediatric practitioners the opportunity to become more informed and equipped to recognize them. They also highlight serious health consequences of not being identified and egregious examples of providers exhibiting denial or inappropriate responses to their disclosure.

A Survivor-Derived Approach to Addressing Trafficking in the Pediatric ED.

OBJECTIVES: Our objective was to elicit the perspectives of survivors of child trafficking on addressing trafficking in the pediatric emergency department (ED) and, secondarily, to provide a survivor-derived framework to help pediatric emergency medicine (PEM) providers discuss trafficking with their patients. METHODS: We conducted in-depth, semistructured interviews with young adults who experienced trafficking as children and/or as adolescents. In the interviews, we employed a novel video-elicitation method designed by the research team to elicit detailed participant feedback and recommendations on the pediatric ED through an interactive, immersive discussion with the interviewer. A grounded theory approach was employed. RESULTS: Seventeen interviews were conducted revealing the following themes, which we present in an integrated framework for PEM providers: (1) fear is a significant barrier; (2) participants do want PEM providers to ask about trafficking, and it is not harmful to do so; (3) PEM providers should address fear through emphasizing confidentiality and privacy and encouraging agency; (4) PEM providers should approach the patient in a direct, sensitive, and nonjudgmental manner; and (5) changes to the ED environment may facilitate the conversation. Suggested wordings and tips from survivors were compiled. CONCLUSIONS: Trafficking survivors feel that the pediatric ED can be a place where they can be asked about trafficking, and that when done in private, it is not harmful or retraumatizing. Fear is a major barrier to disclosure in the pediatric ED setting, and PEM providers can mitigate this by emphasizing privacy and confidentiality and increasing agency by providing choices. PEM providers should be direct, sensitive, and nonjudgmental in their approach to discussing trafficking.