Robert Sege

Children and youth with special healthcare needs (CYSHCN) face elevated risks of adverse childhood experiences while also having unique opportunities for positive childhood experiences (PCEs). Medical specialty camps can serve as protective environments promoting resilience and well-being in this population. We examined current literature to determine whether camp experiences align with the Healthy Outcomes from Positive Experience (HOPE) framework and function as PCEs for CYSHCN. A comprehensive literature search was conducted across PubMed, Google Scholar, and Elsevier databases using terms related to camps, positive childhood experiences, and childhood illness. Studies were systematically mapped onto the four HOPE framework categories and analyzed for qualities of effective PCE settings. Twenty-six studies demonstrated alignment between camp experiences and all four HOPE framework components: nurturing relationships, safe environments, social engagement opportunities, and social–emotional competency development. Four qualities of effective PCE settings emerged: being outdoors, engagement in meaningful activities, finding meaning in life, and experiencing “being away.” Research representing medical specialty camps demonstrates strong theoretical alignment with PCE frameworks, suggesting potential protective benefits against ACEs for CYSHCN. A conceptual model is proposed to guide future empirical research examining camps as facilitators of PCEs and their long-term health outcomes for this population.

Importance: Safe, stable, and nurturing childhood relationships and environments promote optimal child development. It is less understood how these experiences measurably affect individuals’ lifelong health and well-being into adulthood.Objective: To assess health and life opportunities and economic value associated with positive childhood experiences (PCEs) reported by adults.Design, Setting, and Participants: This cross-sectional study used Behavioral Risk Factor Surveillance Survey data from adults (≥18 years) from 4 states (Kansas [2020], Montana [2019], South Carolina [2020], and Wisconsin [2015]), analyzed from May 2023 to April 2024.Exposure: Seven PCEs (adult made you feel safe and protected, felt you belonged in high school, felt supported by friends, at least 2 adults that took an interest in you, felt your family stood by you, enjoyed community traditions, and felt able to talk to your family).Main Outcomes and Measures: Primary outcomes were PCE prevalence by count (1-2, 3-5, or 6-7 PCEs), adjusted prevalence ratios (aPRs) representing the association of PCEs with adult outcomes, and the estimated economic value of PCE-associated, averted morbidity and mortality for chronic health conditions and risk behaviors. Regression models of adult cohorts by PCE exposure and matched by demographic characteristics were used to assess associations of PCEs with current life opportunities (postsecondary education and income), health risk behaviors (moderate to heavy drinking and smoking), chronic health conditions (arthritis, asthma, cancer, chronic obstructive pulmonary disease [COPD], depression, diabetes, heart disease, kidney disease, overweight or obesity, and stroke), and overall physical and mental health. Prevented fractions for the population were used to calculate the reduced proportion of total disease-specific medical spending and healthy life-years savings associated with PCEs.Results: The sample size was 20 916 individuals (11 357 female [54.3%]; 4469 aged 55-64 years [21.4%]). Approximately one-half of adults (53.1%; 95% CI, 52.1-54.1) reported a high PCE score. A higher PCE score was associated with increased likelihood of attaining postsecondary education (1-2 PCEs: aPR, 1.23; 95% CI, 1.04-1.06; 3-5 PCEs: aPR 1.44; 95% CI, 1.23-1.67; 6-7 PCEs: aPR, 1.64; 95% CI, 1.42) and greater annual household income (1-2 PCEs: aPR, 1.33; 95% CI, 1.05-1.69; 3-5 PCEs: aPR, 1.74; 95% CI, 1.40-2.16; 6-7 PCEs: aPR, 2.17; 95% CI, 1.75-2.68), and lower likelihood of smoking (3-5 PCEs: aPR, 0.79; 95% CI, 0.70-0.89; 6-7 PCEs: aPR, 0.64; 95% CI, 0.57-0.72). Higher PCE scores were also associated with lower prevalence of most chronic conditions (any condition for those with 3-5 PCEs: aPR, 0.88; 95% CI, 0.83-0.93; any condition for those with 6-7 PCEs: aPR, 0.78; 95% CI, 0.74-0.83) including arthritis, asthma, cancer, COPD, depression, diabetes, heart disease, overweight or obesity, and poor general physical or mental health compared with having no PCEs. The estimated annual economic value of PCE-associated, reduced chronic disease in the 4 analyzed states was $215.9 billion ($3.1 billion in lower medical spending cost and $212.8 billion in additional healthy life-years) for respondents with PCE scores of 3 or more, which corresponded to an estimated $28 132 per adult per year, or $782 000 over their lifetimes.Conclusions and Relevance: This cross-sectional study quantified the importance of PCEs for lifelong health and well-being. The economic benefits associated with PCEs support consideration of strategies to promote these childhood experiences.

Numerous research studies have documented the significant influence of key types of positive childhood experiences (PCEs) on adult health and wellbeing, even in the presence of adverse childhood experiences (ACEs). Recent studies reveal that almost 87% of justice-impacted youth reported at least one ACE. Connecting youth to PCEs after trauma has occurred has been shown to disrupt the poor health trajectory associated with ACEs. Creating juvenile justice systems that prioritize equitable access to PCEs has the potential to change the life course of system-impacted youth. The HOPE (Healthy Outcomes from Positive Experiences) framework, a research-based, community-driven approach to improving access to the key types of PCEs youth need to thrive, presents a potentially powerful strategy for juvenile justice systems to transform care for system-impacted youth. This manuscript describes this proposed approach.

We report the results of a scoping review of the literature investigating associations between positive childhood experiences (PCEs) and selected health outcomes to identify which have the highest level of research activity based on the indexed academic literature. Yielded articles underwent title/abstract (Ti/Ab) and full text screening utilizing inclusion/exclusion criteria. The review was guided by PCE categories from the Healthy Outcomes from Positive Experiences framework: relationships, environment, engagement, and emotional growth. The initial search yielded 8,919 unduplicated articles, 759 were retained following Ti/Ab review and 220 articles were retained after full text screening describing 795 tested associations across 23 PCE types in ten outcome categories. The outcomes most commonly examined were substance misuse (305 tested associations across 93 studies), suicidal behaviors (195 tested associations across 56 studies), and depression (112 tested associations across 55 studies). Physical health outcomes were less common (14 tested associations across six studies). Of the PCE exposures, relationships represented 415 of tested associations, 236 with environment, and 114 with social engagement. A significant body of research demonstrated associations between PCEs and health outcomes. While further research is needed, available research suggests that public health efforts to promote PCEs may have impact across multiple domains.

This study evaluated the associations between positive and adverse experiences and environments in adolescence and health, education and employment outcomes in early adulthood. Data were extracted from the Longitudinal Studies of Australian Youth cohort that commenced in 2003. The items were conceptually mapped to Positive and Adverse Youth Experiences and environments (PYEs and AYEs) at 15, 16 and 17 years old and outcomes at 25 years old. The associations between PYEs, AYEs and general health, mental health, education and employment were examined, including testing whether PYEs mitigated the association between AYEs and outcomes. A higher number of AYEs was associated with poorer health, education, and employment outcomes. Conversely, a higher number of PYEs was correlated with positive outcomes. The participants with higher PYEs had significantly greater odds of better general and mental health outcomes, even after accounting for AYEs. This relationship was not observed for employment or education outcomes. Adolescence and the transition to adulthood are critical developmental stages. Reducing adverse experiences and environments and increasing positive ones during adolescence could enhance adult wellbeing.

This report describes the prevalence of positive childhood experiences among adults.

Although current policies discourage the use of corporal punishment (CP), its use is still widespread in the US. The objective of this study was to assess the proportion of parents who used CP during the pandemic and identify related risk and protective factors. We analyzed results of a nationwide cross-sectional internet panel survey of 9000 US caregivers who responded in three waves from November 2020 to July 2021. One in six respondents reported having spanked their child in the past week. Spanking was associated with intimate partner violence and the use of multiple discipline strategies and not significantly associated with region or racial self-identification. Parents who spanked sought out more kinds of support, suggesting an opportunity to reduce spanking through more effective parenting resources. Additionally, these results suggest that parents who report using CP may be at risk for concurrent domestic violence.

Objective: Families in the United States experienced tremendous disruptions during the COVID-19 pandemic. This study evaluated the relationship of parental stress during the pandemic with interruptions in availability of services (childcare, after-school activities, and medical appointments) for children. Methods: We analyzed data from 2 waves of the Measuring the Impact of Violence Against Children and Women During a Pandemic survey ¹ to develop a multivariable logistic regression model of the association between caregivers' stress and pandemic-related disruptions in children's lives. Caregivers' past experiences of childhood abuse, recommended stress-relieving activities, and responses to the statement “helping my child(ren) with their education, including remote schoolwork, has been very stressful and/or has resulted in increased tension at home” were included as covariates. Demographic and socioeconomic variables were examined as potential confounders. Results: In total, 3479 (73.3%) of 4659 respondents reported feeling stressed since the start of the pandemic. For every one-item increase in the number of COVID disruptions in children's lives, the odds of feeling stressed increased by 20% (OR 1.20: p value < 0.0001, 95% confidence interval [CI], 1.14–1.27). Compared with men, women had 60% higher odds of feeling stressed (odds ratio [OR] 1.60: p value < 0.0001, 95% CI, 1.32–1.93). The covariates listed earlier were all statistically significant. Conclusion: Pandemic-related disruptions in children's lives were significantly associated with caregiver stress. Women were more likely to feel stressed than men. Sex, education, marital status, and family income were also associated with parental stress. These results suggest that childcare continuity and parental support should be part of disaster planning.

Gender minority (GM) students are at high risk for substance use and depression. This study explores the role of protective factors in reducing rates of substance use and depression based on high school surveys. Univariate and multivariate analyses were conducted to evaluate the association between exposures and outcomes. Youth completed surveys in 2018 (n=16,288) and in 2021 (n=10,792). GM students reported exposure to protective factors less frequently than their cisgender peers: good financial status (88.6% v 96.5% v in 2018 and 95% v 97.8% in 2021), feeling a sense of school/community membership, (mean score 2.7 v 3.0 in 2018 and 2.6 v 3.0 in 2021) or having two or more caring adults in their life (61.5% v 79.7% v in 2018 and 64.2% v. 80.6% in 2021). GM youth experienced risk factors more often than their peers including bias-based bullying (mean score: 0.6 v 0.2 in 2018, 0.5 v. 0.2 in 2021); peer victimization (0.5 v. 0.2 in 2018, 0.3 v 0.1 in 2021), and homelessness/foster care exposure (32.8% v 10.8% in 2018 and 15.8% v. 6.6% in 2021). Several factors mitigated depression and substance use among GM students. GM youth experienced these protective factors less frequently than their peers.

Inadequate training in the interpersonal skills of conducting informed consent conversations has long been noted as a challenge for clinical research recruitment and retention. To address this critical gap, Tufts Clinical and Translational Science Institute developed regular trainings for clinical research coordinators and other research staff on the practical skills of communicating informed consent using community members as simulated patients for role-playing exercises. In this paper, we assess the reach and effectiveness of these trainings and describe the impact of employing community stakeholders as simulated patients. We found that by embedding community members in the trainings, clinical research coordinators get to hear diverse perspectives, experience a range of patient responses, and learn from the lived experience of the communities that research tries to serve. Utilizing community members as trainers also helps to dismantle traditional power dynamics by demonstrating the organization’s commitment to inclusiveness and community engagement. Based on these findings, we suggest that training on informed consent include more simulated consent exercises that feature interaction with community members who can provide real-time feedback to coordinators.