A cross-cultural examination of adverse childhood experiences in low-and middle-income countries and their relation with adolescent educational aspirations.

BACKGROUND: Adverse Childhood Experiences (ACEs) are potentially traumatic events that occur before the age of 18. Researchers have examined the negative associations between adversity and adolescent and adult outcomes, such as education and physical health. However, research on ACEs, and their association with other outcomes in non-western contexts is sparse. OBJECTIVE: The present study aims to increase our understanding of the prevalence of ACEs - and their association with educational aspirations - in low- and middle-income country contexts. PARTICIPANTS AND SETTING: We utilize data from the Family Migration and Early Life Outcomes (FAMELO) project, a multi-site survey project that collected data from families in historically high-migration contexts. ACEs and educational aspirations were measured in children aged 11 to17 years in Mexico (n = 853), Mozambique (n = 651), and Nepal (n = 1180). METHODS: We use Poisson regressions to examine the prevalence of ACEs in multiple cultures, and then use multinomial logistic regressions to examine whether ACEs are associated with educational aspirations, as a practical application of the utility of the ACEs framework in cross-cultural contexts. RESULTS: Our results suggest that adolescents in Mozambique have a higher average number of ACEs (2.7) than adolescents in Mexico (1.4) and Nepal (1.3). Female adolescents reported fewer ACEs, while socioeconomic vulnerabilities (low-income and low parental education) were associated with higher exposure to ACEs, with differences by country. Lastly, ACEs were associated with lower educational aspirations in Mexico and Nepal. CONCLUSIONS: Our study attempted to heed the call of many scholars who have pushed for an expansion of research on ACEs in non-western, low- and middle-income country contexts.

Witches, Victims, and Villains: #MeToo and the Political Polarization of Sexual Violence.

#MeToo sought to combat sexual violence but evolved into a polarizing movement in the United States. Using a random sample of 5,153 tweets with #MeToo posted between 2017 and 2019 to explore the language and themes individuals use to polarize conversations around sexual violence, we find that MeToo supporters used rights-and-justice-focused language to advocate for survivors. In contrast, MeToo detractors employed legal and violent language to victimize the alleged perpetrators and villainize victims of sexual violence and their supporters. This demonstrates how "linguistic hijacking" unfolded online, with movement opponents co-opting key terms (like "victim") to undermine movement supporters' goals.

Early adverse childhood experiences and adolescent sleep outcomes.

BACKGROUND: Sleep is critical for physical, mental, and emotional health. This may be particularly true for adolescents experiencing rapid physiological changes. Relatively little is known about how adverse childhood experiences (ACEs) are implicated in adolescent experiences with sleep. OBJECTIVE: We use data (from the Future of Families and Child Wellbeing Study (FFCWS, n = 3444) to assess the relationship between early ACE exposure (by age 5) and various adolescent sleep outcomes. We anticipate that early ACEs will be associated with poor adolescent sleep outcomes. METHODS: FFCWS data includes survey responses from parents and/or primary caregivers and children at birth and approximately one, three, five, nine, and 15 years later. The FFCWS oversampled unmarried parents with low educational attainment, income, and from marginalized racial-ethnic groups. Models of sleep outcomes included ordinary least squares, Poisson, negative binomial, logistic, and order logistic regression, as appropriate. RESULTS: Despite a high number of ACEs, adolescent hours of sleep were consistent with published recommendations. Other measures of sleep indicated adolescents in the sample experience worse sleep on most other measures. ACE exposure was associated with difficulty falling asleep and staying asleep. More ACEs was also related with problematic sleep environments (i.e., place slept) and increased snoring. There was some evidence that ACEs were related to less sleep on weekends and increased social jet lag (different patterns of sleep between weekdays and weekends). CONCLUSIONS: Our findings suggest that ACEs could be important diagnostic data for clinicians in primary care and behavioral sleep medicine practice.

Early Adverse Childhood Experiences and Positive Functioning during Adolescence.

Adverse childhood experiences (ACEs) have been shown to have consequences for adolescent development, yet little is known about the association between ACEs and positive functioning. Positive functioning evaluates engagement, perseverance, optimism, connectedness, and happiness, which are intimately related to pro-social behavior. As skills associated with sociability in adolescence often carry on into adulthood, understanding the developmental origins in inequalities in pro-social behavior, as measured by positive functioning, is key to ensuring equitable life chances across the life course. Subsequently, the Fragile Families and Child Wellbeing Study (FFCWS; n = 3444) was used to examine how early exposure to cumulative ACEs, plus the timing and duration of those ACEs may be associated with positive functioning development in adolescence. The sample consisted of urban-born youth (49% female) with the mean age of 15. Racial/ethnic breakdown of the sample is 18% non-Hispanic White, 49% non-Hispanic Black, 25% Hispanic, and 8% "Other". Overall, estimates suggest that roughly 88% of these youth experienced at least one ACE by age five. The findings indicate that cumulation, timing, and duration of early ACEs are related to overall adolescent positive functioning and four out of the five domains (perseverance, optimism, connectedness, and happiness), even after controlling for more recent ACEs. This study highlights the critical impact of very early ACEs on youth positive functioning, which may confer further physical, mental, and social disadvantages into adulthood. Positive functioning can serve as a protective factor against some of the negative consequences of adversity, and ensuring that all families receive proper supports may limit the lifelong effects of adversity, and most importantly, prevent ACEs from occurring in the first place.

Quality Initiative to Reduce Failed Trial of Labor after Cesarean Using Calculated VBAC Success Likelihood.

OBJECTIVE: Vaginal birth after cesarean can reduce morbidity associated with multiple cesarean deliveries. Failed vaginal birth after cesarean is associated with increased maternal and neonatal morbidity. The Maternal-Fetal Medicine Units Vaginal Birth After Cesarean calculator is a validated tool to predict the likelihood of successful trial of labor after cesarean. Predicted likelihood < 60% has been associated with increased maternal and neonatal morbidity. We sought to determine if formal incorporation of calculated vaginal birth after cesarean likelihood into patient-centered counseling would reduce failed vaginal birth after cesarean. STUDY DESIGN: This is a quality improvement intervention at a single tertiary-care academic medical center, in which standardized patient counseling was implemented, facilitated by an electronic medical record template featuring patient-specific likelihood of vaginal birth after cesarean success. Term singleton pregnancies with history of one to two cesareans were included; those with contraindication to labor were excluded. Historical controls (January 2016-December 2018, n = 693) were compared with a postimplementation cohort (January 2019-April 2020, n = 328). Primary outcome was failed vaginal birth after cesarean. RESULTS: Fewer patients in the postintervention cohort had a history of an arrest disorder (PRE: 48%, 330/693 vs. POST: 40%, 130/326, p = 0.03); demographics were otherwise similar, including the proportion of patients with <60% likelihood of success (PRE: 39%, 267/693, vs. POST: 38%, 125/326). Following implementation, induction of labor in patients with a <60% likelihood of successful vaginal birth after cesarean decreased from 17% (45/267) to 5% (6/125, p < 0.01). The proportion of failed vaginal birth after cesarean decreased from 33% (107/329) to 22% (32/143, p = 0.04). Overall vaginal birth after cesarean rate did not change (PRE: 32%, 222/693, vs. POST: 34%, 111/326, p = 0.52). CONCLUSION: An intervention targeting provider counseling that included a validated vaginal birth after cesarean success likelihood was associated with decreased risk of failed trial of labor after cesarean without affecting overall vaginal birth after cesarean rate. KEY POINTS: · Labored cesarean increases maternal morbidity.. · Application of the Maternal-Fetal Medicine Units (MFMU) calculator to antenatal counseling decreased labored cesarean.. · Application of the MFMU calculator to antenatal counseling did not decrease overall vaginal birth after cesarean rate..

Early Adverse Childhood Experiences and Social Skills Among Youth in Fragile Families.

Adverse childhood experiences (ACEs) are associated with negative health and behavioral outcomes across the life course, yet little is known about the association between early ACEs and social skills among youth. As social skills are often shaped by home environments, and social skills developed in adolescence often persist into adulthood, understanding the processes that drive inequalities in developmental outcomes, such as social skills, is imperative. The present study used data from the Fragile Families and Child Wellbeing Study (FFCW; n = 3245) and ordinary least squares regression analyses to explore the associations between early ACEs by age 5 (i.e., cumulative, timing, duration) and youth social skills (components include: emotional maturity, communication skills, intentionality, and social competence). The weighted sample consisted of urban-born youth (44% female) with a mean age of 15. Racial/ethnic breakdown of the sample is 37% non-Hispanic White, 25% non-Hispanic Black, 28% Hispanic, and 10% 'Other'. Overall, estimates suggest that nearly 79% of these youth experienced at least one ACE by age 5. Furthermore, the results indicated that as the number of early ACEs increased, deficits in social skills also increased. Moreover, the timing of exposure to early ACEs (i.e., high early, intermittent, chronic high) decreased social skills. The findings underscore the unique and robust links between early ACEs and youth social skills, underlining the importance of ACE exposure in social skill development.

Early adverse childhood experiences and exclusionary discipline in high school.

The use of school suspension and expulsion is a widespread phenomenon in American schools (Wallace et al., 2009; Owens and McLanahan, 2020). Yet, much of what we know about these exclusionary practices provide little insight into the personal biographies of the students themselves-specifically their histories of childhood trauma. Using measures of adverse childhood experiences (ACEs), we examine the link between early ACEs (up to age 5) and school suspension/expulsion using the Fragile Families and Child Wellbeing Study (1998-2010) (FFCWS). We find that a child with a cumulative ACE score are almost four times more likely to have been suspended or expelled. Importantly, this negative link persists even when accounting for factors known to be associated with ACEs and school discipline. This work offers new theoretical insight into how we understand discipline in school contexts and suggests the importance of trauma-informed interventions in the American education system.

Gender Marginalization in Sports Participation through Advertising: The Case of Nike.

The sport sector functions as a site of health-promotion by encouraging and enabling individuals to invest in their health and giving them tools to do so. This investment is often initiated by, or altered by, role modeling, or seeing other individuals engaging in sport. This could include family or peers but could also include depictions of sport in popular media. Inclusive role-modeling could subsequently encourage more sport participation, thus expanding access to health benefits that arise from sport. However, stereotypical depictions of sports role models could make sports seem like a more exclusive space and discourage participation. We examine a case study of a prominent athletic brand and their advertising to examine the ways they expand or reify stereotypes of gender in sport. Through a qualitative content analysis of 131 commercials released by Nike in the past decade, we explore whether their stated goals of being a socially progressive company extend to genuinely diverse and inclusive portrayals of gender in their commercials. Our results indicate that Nike commercials continue to treat sports as a predominantly and stereotypically masculine realm, therefore marginalizing athletes who are female, who do not fit traditional gender binaries, or who do not display traditionally masculine qualities. We also find that the bulk of athletes portrayed by Nike are those who adhere to gender stereotypes. Despite their purported goal of encouraging individuals to participate in sports, Nike's promotion of gendered sport behaviors may be having an opposite effect for some consumers by discouraging sports participation for those who do not align with the gendered behavior Nike promotes. The stereotyped role modeling of the sport sector portrayed in a majority of Nike commercials could dissuade already marginalized individuals from participating in the health-promoting behaviors available through sport.

Privilege and Place: an exploratory study about healthcare bypass behavior.

AIM: Bypass, or utilizing healthcare outside of one's community rather than local health care, can have serious consequences on rural healthcare availability, quality, and outcomes. Previous studies of the likelihood of healthcare bypass used various individual and community characteristics. This study includes measures for individuals and communities, as well as place-based characteristics. The authors introduce the Social Vulnerability of Place Index (SoVI) - a well-established measure in disaster literature - into healthcare studies to further explain the impact of place on healthcare selection behavior. Additionally, with the use of open-ended questions, this study explains why people choose to bypass. By including each of these measures, this study provides a more nuanced and detailed understanding of how individual healthcare selection is affected by the privilege of the individual, community ties, place of residence, and primary motivator for bypass. METHODS: A systematic random sample of residents from 25 rural towns in the western US state of Utah were surveyed in 2017 in the Rural Utah Community Survey. After accounting for missing data, the total sample size was 1061. This study used logistic regression to better predict the likelihood of rural healthcare bypass behavior. Measures associated with community push factors (dissatisfaction with various local amenities), community pull factors (friends in community and length of residence), individual ability (demographics, self-reported health, and distance to a hospital), and SoVI, were added to the models to examine their impact on the likelihood of bypass. The SoVI was made using census data with variables that measure both social and place inequality. Each town in the study received a SoVI score and was then categorized as having low, mean, or high social vulnerability. Qualitative open-ended responses about healthcare selection were coded for explanations given for bypassing. RESULTS: The pooled model showed that bypass was more likely amongst residents who were dissatisfied with local health care and more likely for females. Breaking bypass down, according to SoVI, provides a more nuanced understanding of bypass. For people living in low socially vulnerable areas, privileges such as graduating college made them more likely to bypass. For high socially vulnerable areas, privilege did not help people bypass, but disadvantages such as aging made residents less likely to bypass. Thus, by introducing the SoVI into healthcare literature, this study can compare healthcare selection behaviors of residents in low vulnerable towns, average vulnerable towns, and highly vulnerable towns. Additionally, the analysis of open-ended responses showed patterns explaining why people bypass. CONCLUSION: Policymakers and public health workers can use the SoVI to better target their healthcare outreach. Reasons for bypass include quality, selection, consistency, cost of insurance, one-stop shop, and confidentiality. Rural clinics can help residents avoid the need to bypass by improving in these areas and thus gaining patients and minimizing the risk of closure. Healthcare policymakers should focus resources on high socially vulnerable places as well as underprivileged people in low socially vulnerable places.

Reproductive health care utilization among refugees in Jordan: Provisional support and domestic violence.

OBJECTIVES: Conflict and displacement are associated with poverty, disruption of services, loss of identity, reduced care for reproductive needs, and reduced provision of health care, among other things. This article uses the framework outlined by Obermeyer and Potter to test how refugee and native status influence utilization of reproductive health services and experience with domestic violence in a context of high refugee inhabitants and strong refugee-focused non-governmental organization presence. This article addresses the following: (1) coverage, source, and method of contraceptives; (2) variation in reproductive health experience by source of contraception; and finally, (3) factors determining variation in the utilization of reproductive health services and domestic violence experiences for individuals living in and out of refugee camps. METHODS: The data is the 2012 Jordan Demographic and Health Survey, and the method utilized is logistic regression. RESULTS: Findings suggest that refugee women serviced by the United Nations Relief and Works Agency have greater access to health-related resources (family planning and contraception), but they have weaker positions in the family as evidenced by domestic violence experiences. CONCLUSION: It is plausible that provisional resources are the easiest for an aid organization to provide, while the complications of identity loss and the loss of a sense of space pose a challenge for refugees and aid organizations.

Increasing health facility deliveries in Cambodia and its influence on child health.

BACKGROUND: A growing number of women in Cambodia are seeking support from health facilities during delivery, up from 8% in 2000 to 82% in 2014. This growth may be attributed to increased national level attention to incentivize hospital births and reduce potential barriers. This paper address three related questions regarding the impact of increased utilization of health care in Cambodia. First, did increasing health facility deliveries occur most among disadvantaged women? Second, as health facility utilization increased, did the benefit of delivery location on child health outcomes weaken? Finally, did socioeconomic disparities in child outcomes decline as a result of increased health facility deliveries? METHODS: Data is from the 2010 and 2014 Cambodian Demographic and health surveys. Regression models include logistic regression to predict utilization of a health facility, linear regression to predict child nutritional status and Cox regression to measure child survival. Propensity score matching was used to account for selectivity. RESULTS: Analysis shows that health facility delivery is associated with better nutritional status and survival and the effectiveness of a health center delivery remains with this rapidly increasing care. However, the largest increases in delivery at a health facility did not occur among less educated, less wealthy, and rural Cambodian women, and inequalities in child health outcomes remain. CONCLUSIONS: Cambodian women have participated in a rapid increase in health center deliveries and those health facility deliveries remain beneficial for future child outcomes. However, initiatives to increase care are not addressing inequity in access to care among disadvantaged women. Additionally, disparities in children's health outcomes remain, suggesting that health facility births are not sufficient in reducing disparities among children of disadvantaged mothers. Moving forward, current initiatives are rapidly increasing facility deliveries and maintaining their efficacy, but further efforts need to be placed on targeting disadvantaged women and their children.

Social inequality and children's health in Africa: a cross sectional study.

BACKGROUND: This study examines socioeconomic inequality in children's health and factors that moderate this inequality. Socioeconomic measures include household wealth, maternal education and urban/rural area of residence. Moderating factors include reproductive behavior, access to health care, time, economic development, health expenditures and foreign aid. METHODS: Data are taken from Demographic and Health Surveys conducted between 2003 and 2012 in 26 African countries. RESULTS: Birth spacing, skilled birth attendants, economic development and greater per capita health expenditures benefit the children of disadvantaged mothers, but the wealthy benefit more from the services of a skilled birth attendant and from higher per capita expenditure on health. CONCLUSION: Some health behavior and policy changes would reduce social inequality, but the wealthy benefit more than the poor from provision of health services.

Caregiver Decision-Making: Household Response to Child Illness in sub-Saharan Africa.

We draw upon a framework outlining household recognition and response to child illness proposed by Colvin and colleagues (2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multilevel analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increase the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.

Increasing maternal healthcare use in Rwanda: implications for child nutrition and survival.

Rwanda has made great progress in improving maternal utilization of health care through coordination of external aid and more efficient health policy. Using data from the 2005 and 2010 Rwandan Demographic and Health Surveys, we examine three related questions regarding the impact of expansion of health care in Rwanda. First, did the increased use of health center deliveries apply to women across varying levels of education, economic status, and area of residency? Second, did the benefits associated with being delivered at a health center diminish as utilization became more widespread? Finally, did inequality in child outcomes decline as a result of increased health care utilization? Propensity score matching was used to address the selectivity that arises when choosing to deliver at a hospital. In addition, the regression models include a linear model to predict child nutritional status and Cox regression to predict child survival. The analysis shows that the largest increases in delivery at a health center occur among less educated, less wealthy, and rural Rwandan women. In addition, delivery at a health center is associated with better nutritional status and survival and the benefit is not diminished following the dramatic increase in use of health centers. Finally, educational, economic and residential inequality in child survival and nutrition did not decline.

The role of Gliadel wafers in the treatment of high-grade gliomas.

Glioblastoma multiforme (GBM) is the most aggressive brain tumor. Standard treatment includes surgery, radiation and chemotherapy. Prognosis is dismal with an average survival of approximately 1 year. Gliadel wafers are one treatment option, working as a source for local chemotherapy delivery. Their use is controversial with questionable survival benefit and potential side effects. We reviewed the literature in an effort to clarify their role in the treatment of high-grade gliomas. A systematic PubMed search was performed using the keywords 'Gliadel', 'carmustine' or 'BCNU wafers' in newly diagnosed high-grade glioma patients. Treatment regimen, and median survival were analyzed. Adverse event ratio was calculated by computing the number of adverse events in a study per patient receiving carmustine wafers. Nineteen studies with 795 patients were included in our review. Survival was 8.7-22.6 months with a mean overall survival (OS) of 16.2 months (control survival is approximately 14 months with surgery and adjuvant chemoradiotherapy). Adverse event ratio using Gliadel wafersin control group. Complication rate was 42.7%. Gliadel wafers may marginally increase survival and local control in newly diagnosed GBM patients but are associated with a high complication rate; therefore, we do not recommend using Gliadel wafers in patients with GBM. Further research may be warranted once a safer alternative to Gliadel wafers has been introduced.