Eunice Lee

Adverse childhood experiences (ACEs) are a public health concern in the United States. Using the 2019 National Survey of Children’s Health, this cross-sectional secondary analysis examined associations between cumulative ACEs (0, 1, 2, and 3 or more) and three health behaviors among children ages 6 to 17, including physical activity, recreational screen time, and sleep. Interaction models were also estimated by child sex and race/ethnicity (White non-Hispanic, Black non-Hispanic, and Hispanic) to assess whether these associations differed across groups. Nearly half of children experienced at least one ACE, and about one in eight experienced three or more. In adjusted models, higher numbers of ACEs were associated with a lower likelihood of meeting recreational screen time guidelines and sleep recommendations, while no statistically significant association was observed for meeting physical activity recommendations. Interaction analyses by child sex and race/ethnicity found no statistically significant differences in these associations across groups. These findings suggest that children with higher numbers of ACEs may be less likely to meet recommended sleep and recreational screen time guidelines, underscoring the potential value of trauma-informed strategies that strengthen sleep routines and healthy media practices.

Objective: The objective of this study is to identify socioecological predictors of child flourishing and family resilience status among U.S. school-aged children with a history of childhood adverse experiences (ACEs). Study design: This study is a secondary analysis of the 2024 National Survey of Children’s Health (NSCH), a cross-sectional and nationally representative survey of noninstitutionalized U.S. children. Parental reports of child flourishing and family resilience measures were used to create a categorical variable with four different types of resilience status: neither child flourishing nor family resilience, child flourishing only, family resilience only, and both child flourishing and family resilience. Multinomial logistic regression was performed to investigate multi-level factors predicting the child flourishing and family resilience status of children aged between 6 and 17 years (N = 13,571). Results: Among children with ACEs, 46.5% were classified as both child flourishing and family resilience; 33.3% were in the family resilience only group, 14.0% were in the neither child flourishing nor family resilience group, and 6.6% were in the child flourishing only group. School safety, supportive neighborhoods, and neighborhood amenities were positively associated with resilient status, whereas parenting stress and higher cumulative ACE exposure were negatively associated with the resilience status. Conclusions: Children and families can demonstrate resilience despite ACE exposure in the presence of supportive socioecological conditions. Efforts to promote healthy development among children with ACEs may benefit from multilevel prevention and intervention strategies that strengthen caregiving resources, reduce parenting stress, and improve school and neighborhood environments.

To explore the impact of social and relational adversity on access to key health services among US children with autism spectrum disorders (ASD), cross-sectional analyses of the 2016–2019 National Survey of Children’s Health assessed use of key health services by children with ASD, accounting for differences in demographic characteristics, medical needs, and experience of social and relational adversities. sUS children with ASD were more than twice as likely as peers without ASD to report two or more social adversities and more than three times as likely to report two or more relational adversities. In multivariable models, relational adversities were significantly associated with greater odds of medication use for ASD (OR 1.50, 95%CI:1.02, 2.17). Social adversities were neither associated with receipt of behavioral therapies nor prescription of medication to treat ASD. Screening for various forms of adversity among youth with ASD is of great importance; even one adverse experience may be enough to influence care of a child with ASD, with differences in effect according to the nature of the particular adversity. Further research should evaluate the role that childhood adversity plays in physical and mental health outcomes in ASD.

Purpose: While previous research underscores the important role that neighborhood contexts play for child and adolescent health and well-being, how these neighborhood contexts influence substance use initiation among adolescents from low-income and ethnic minority families has been understudied. Methods: This study is a secondary analysis of data from the Denver Child Study a retrospective survey that uses a natural experiment aimed at assessing neighborhood effects on developmental outcomes of Latinx and African American adolescents (N = 736). Cox cause-specific hazards models were estimated to test: (1) the effects of cumulative exposure to neighborhood social disorder, neighborhood violent and property crime rates, and neighborhood social capital during preadolescence (ages 8–11) on the likelihood of initiating alcohol, cigarette, and marijuana use during adolescence (ages 12–18), after controlling for youth, caregiver, and household factors; and (2) whether the effects of these cumulative neighborhood factors vary by Latinx and African American ethnicity. Results: 5.6% of adolescents in this study initiated cigarette use, 5.4% initiated alcohol use and 5.2% used marijuana for the first time during adolescence. The results indicate that exposure to neighborhood social disorder during preadolescence is a significant risk factor, especially for the initiation of cigarette use (HR = 1.36, 95% CI = 1.062–1.745, p = 0.015) particularly among Latinx adolescents (HR = 1.42, 95% CI = 1.031–1.966, p = 0.032). Conclusions: The findings suggest the need for further research on the relationship between exposure to neighborhood social disorder and adolescent substance use initiation in order to develop and implement community-based prevention and intervention programs to reduce substance use initiation and facilitate healthy adolescent development.

Healthy food retail (HFR) interventions are a recommended strategy to improve the dietary behaviors of low-income residents with limited access to healthy food; however, tools are needed to assess, tailor, and implement HFR plans to local contexts. The present study identifies factors influ­encing HFR implementation and presents findings related to identifying, operationalizing, and priori­tizing facilitators of and barriers to implementing HFR interventions within low-resource rural and urban contexts. Practitioners and community resi­dents, recruited from nine counties in Ohio, par­ticipated in semistructured interviews and focus groups. Grounded theory methodology was used to develop themes and indicators of readiness and capacity for successful HFR implementation. Con­sensus conference feedback from an expert panel prioritized themes and indicators based on their perceived relevance and importance for successful­ly implementing HFR interventions. Five themes were identified as influential factors: (1) corner store awareness and perception, (2) organizational and practitioner capacity, (3) community attitudes and perceptions, (4) logistical factors, and (5) net­works and relationships. Additionally, 18 indicators within the five themes were identified to further illustrate influential factors to HFR implementa­tion. The themes and indicators presented in this research have been synthesized into the PSE READI tool[1] (developed outside of this research). The PSE READI tool uniquely provides an oppor­tunity to assess, tailor, and implement HFR plans to the local contexts by considering the key themes and influential factors that emerged from this community-level, qualitative research. [1] The PSE READI website is https://PSEREADI.org

BACKGROUND: Farm‐to‐school interventions are recommended strategies to improve dietary behaviors among school‐aged children. Tools are needed to assess community readiness and capacity to optimize farm‐to‐school implementation. The objective of this study was to identify and prioritize factors to inform tailored farm‐to‐school implementation by practitioners working in diverse contexts.METHODS: Practitioners and community residents (N = 194) participated in semistructured interviews (N = 18) and focus groups (N = 23). Thematic analysis was conducted to identify themes and subthemes influencing farm‐to‐school implementation. The subthemes were operationalized into measureable indicators. The themes and their associated indicators were prioritized through a consensus conference with an expert panel (N = 18).RESULTS: The qualitative data analysis and consensus conference yielded 4 themes and 17 indicators associated with community readiness and capacity to implement farm‐to‐school. The themes represent school capacity, networks and relationships, organizational and practitioner capacity, and community resources and motivations.CONCLUSIONS: Findings highlight a range of indicators of community readiness and capacity needed to support farm‐to‐school implementation. Results offer guidance for tailoring intervention delivery based on levels of community, school, practitioner, and organizational readiness and capacity.