COPH researchers report on adverse childhood experiences and adult quality of life

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Dr. Abraham A. Salinas-Miranda, visiting research scholar in the USF College of Public Health’s Department of Community and Family Health, has been published in the August issue of Health and Quality of Life Outcomes. The report is titled “Adverse childhood experiences and health-related quality of life in adulthood: revelations from a community needs assessment.”

Abraham Salinas Miranda, MD, PhD, MPH

Abraham Salinas Miranda, MD, PhD, MPH

Other contributors to the study include Dr. Jason Salemi and Lindsey King, alumna of the COPH, as well as Drs. Julie Baldwin and Hamisu Salihu, former COPH faculty members.

Utilizing a community-based participatory needs and assets assessment, researchers examined how adverse childhood experiences influence adult health-related quality of life in a low-income community in Tampa, Florida.

“It is well known that racial and ethnic minorities in the United States experience a multitude of health disparities compared to non-Hispanic whites,” Salihu said. “Previous research has also shown that exposure to adversity during childhood can also impact a person’s health well into adulthood. Thus, we were interested in further investigating the role and potential mechanisms by which adverse childhood experiences impact adults’ health-related quality of life.”

The researchers worked in partnership with community members and an advisory board from Central Hillsborough Healthy Start’s REACHUP Inc., a community agency providing resources to assist in healthcare equality for families, to collect data.

“This was different from other community-based needs assessments that are home-to-home,” Salinas said. “We felt that this approach of gathering persons in central locations that were identified by community advisory board members was an effective way to get the residents, because these community members know the area like the back of their hand.”

As a result of working with community members directly to collect the data, a total of 23 different locations, such as churches, schools and libraries were targeted.

Using the Life Course Perspective as guide, they designed a needs assessment survey that included the Centers for Disease Control Adverse Childhood Experiences Score questions and the Healthy Days Measures Instrument, as well as other validated social-behavioral questionnaires. The survey was implemented by trained community members using Android tablets and the data transmitted to USF via wireless internet.

The study confirmed associations between adverse childhood experiences and health related quality of life. Research results indicate that adverse childhood experiences impact stress and sleep disorders, which then affect overall health-related quality of life.

“In the literature, we already know that social demographics and neighborhood factors affect health-related quality of life, but that was not the purpose of the study,” Salinas-Miranda said. “We wanted to find out what happens if we controlled for those factors; how are adverse childhood experience associated with poor health-related quality of life? So, we tried to look at the behavioral factors that we collected as potential mechanisms and we found out that stress and sleep were statistically significant.”

When looking at the data collected from 201 residents in the central and east Tampa community, it was clear that sleep disorders and stress are correlated with adverse childhood experiences.

Adverse Childhood Experiences Salinas Salihu

“Adverse childhood experiences in the community are very important to know about because those experiences are manifesting themselves now in high levels of stress and sleep disorders, which in turn, are related to poor health related quality of life,” Salinas-Miranda said. “It affects physical health, mental health and social health. In order to reduce health disparities in racial minorities in socially disadvantaged neighborhoods, you need to pay attention to these factors because these factors affect the entire community.”

Salinas-Miranda hopes that the correlations found in this study will serve as catalyst for future research. He also noted that the top assets identified in the community were churches, schools, and other local agencies, which point to the importance of engaging the wider community into developing solutions that address health disparities.

“That’s the value of this study, now other researchers can look at this mediational analysis and start looking for the biological mechanisms and also the behavioral interventions that can be done to curtail the effects of this,” Salinas-Miranda said.

Salinas-Miranda also hopes this research will bring awareness to the light that in order to improve overall health-related quality of life, the issues that are creating adverse childhood experiences must be addressed.

“I suggest adopting a public health approach, at the community and family level. Instead of dealing with the problems as they appear, such as abuse, let’s prevent it,” Salinas-Miranda said.
“We need to mobilize the community, so they work in tandem trying to improve their efforts to reduce these adverse experiences.”

Because this particular study was based on a specific region within Hillsborough County, Salinas-Miranda said the data is particularly insightful.

“That’s the importance of community needs assessment, you’ll find out what those risk factors are for that community, not at the Florida level or Hillsborough level; you’ll understand social risk and social protection factors that are there and happening in a community,” he said. “You then map out the programs for the community and try to get the community leaders involved.”

Dr. Salinas-Miranda said this particular area of Hillsborough County was targeted because it was previously indicated as an area having a disproportionate number of infant mortalities, was ethnically diverse and was also home to residents of low income.

“This is one of a few empirical studies that has been conducted in a low SES population with an aim of providing an enhanced understanding of the risks and protective factors influencing health-related quality of life in a community setting,” Salihu said. “It yields pertinent results that can be utilized to inform interventions, programs and other public health efforts aimed at improving the health of racial and ethnic minorities across the life span.”

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Salinas-Miranda AA, Salemi JL, King LM, et al. Adverse childhood experiences and health-related quality of life in adulthood: revelations from a community needs assessment. Health and Quality of Life Outcomes. 2015; 13:123.

 

Story by Anna Mayor, USF College of Public Health

 

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