1. The Delaware ACE’s Story
Dana Thompson, MPH
Iman Sharif, MD, MPH
Aileen Fink, PhD

2. Adverse Childhood Experiences (ACEs)
Stressful or traumatic experiences that occur before the age of 18
Cumulative ACE exposure is related to health, social, and behavioral problems later on in life
obesity
chronic health conditions
premature death

3. Goals
Describe the intergenerational impact of ACEs exposure in Delaware.
Identify disparities in exposure to ACEs in Delaware.
Describe the relationship between child and parent ACEs exposure and the child’s ability to thrive in our communities.

4. Objectives
Determine the prevalence of ACEs exposure amongst children in Delaware
Test the hypotheses that:
Children of racial/ethnic minority background and children with disabilities have a greater exposure to ACEs
Children who live in a household with someone who has a mental illness are at higher risk of exposure to additional ACEs.
Children’s ability to function in the community is hindered by ACEs exposure, but improved by positive parental health and neighborhood supports.

5. Methods Secondary Data Analysis
National Survey of Children’s Health (NSCH)
National telephone survey conducted by National Center for Health Statistics
Includes topics on child’s health and well-being
physical, emotional, and behavioral child health indicators
child’s family context
child’s neighborhood environment
Study Population:
Delaware children, ages 0-17 years old (n=1,824)
Statistical Analysis:
Logistic Regression (adjusted for age, race, income)
SAS 9.3 (SAS Institute, Cary NC)

6. Measures- ACEs exposure

7. Measures Flourishing (Thriving) Indicators in children 0-5 years old
Child is affectionate and tender with parent
Child bounces back quickly when things don’t go his/her way
Child shows interest in learning new things
Child smiles and laughs a lot
Indicators in children 6-17 years old
Child finishes tasks and follows through with plans
Child stays calm and in control when faced with a challenge
Child shows interest and curiosity in learning new things

8. Predictors Secondary Predictors Primary Predictor Demographics
Number of ACEs (0-1 vs. 2 or more)
Secondary Predictors
Parental Factors
Overall Parental Health
Parental Stress
Neighborhood Factors
Support
Amenities
Safety
Risks (Detracting Elements)
Demographics
Age
Race/Ethnicity
Special Health Care Needs
Federal Poverty Level (FPL)

9. Results

10. Study Population (n=1824) 497 (27%) 1278 (70%) 1053 (58%) 275 (15%)
Total n(%)
Age (years)
0-5
497 (27%)
6-17
1278 (70%)
Race/Ethnicity
White, NH
1053 (58%)
Black, NH
275 (15%)
Hispanic
198 (11%)
Other
204 (11%)
% Federal Poverty Level (FPL)
Below 200% FPL
525 (29%)
At or above 200% FPL
1250 (68%)

11. Prevalence of ACEs

12. Racial Disparities

13. Disparities for children with disabilities

14. Results: Children who live with an adult with mental illness have a greater odds of exposure to other ACEs

16. Results: Factors that diminish a child’s ability to flourish
AOR (95% CI)
p-value
2 or more ACEs
0.65 (0.48 – 0.86)
0.003
Black, non-Hispanic
0.61 (0.44 – 0.84)
0.012
School-aged children
(6-17 years old)
0.27 (0.21 – 0.36)
<0.001

17. Results: factors that promote child’s flourishing
AOR (95% CI)
p-value
More neighborhood safety
1.72 (1.17 – 2.52)
0.005
Decreased parental stress
4.44 (2.90 – 6.81)
<0.001
Excellent parent health
1.68 (1.31 – 2.16)

18. Conclusions Exposure to ACEs has an intergenerational impact.
Disparities exist
Black children and children with special health care needs are at greater risk of ACEs exposure.
It only takes 2 adverse childhood experience to have a significant impact on a child’s ability to flourish
Parental well-being and neighborhood safety play an important role in determining whether children flourish.

19. Implications
A holistic approach is needed to identify at-risk families and communities
Integrated systems of trauma informed care are needed across sectors-
Health Care
Education
Public Health
Criminal Justice

20. Acknowledgments
Work supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM (PI: Binder-Macleod).  Additional generous support comes from the State of Delaware, the University of Delaware, Christiana Care Health System, Nemours, and the Medical University of South Carolina.