WINGATE — Children around the world have adverse experiences that can hinder their development and lead to problems down the road. But are the difficult experiences of children in low-to-middle-income countries different from those in higher-income countries, and, if so, are the outcomes later in life appreciably different?
That’s what Dr. Shanta Dube, director of Wingate University’s Master of Public Health program, and her colleagues from the National Institutes of Health and the Centers for Disease Control and Prevention set out to explore in a special issue of the international journal Child Abuse and Neglect being released next week.
Adverse childhood experiences are well studied, beginning with groundbreaking research by Kaiser and the CDC that Dube worked on in the 1990s. Most of the studies of ACEs, however, have been undertaken in higher-income countries and among adults.
For the special issue of Child Abuse and Neglect, Dube and her fellow guest editors, Dr. Leah Gilbert, of the NIH, and Dr. Francis Annor, of the CDC, solicited submissions from researchers working in low-to-middle-income countries, such as those in sub-Saharan Africa, Central and South America, and Asia. What the research from the special issue shows is that ACEs in these countries — even if some of the experiences and context differ — lead to similar health outcomes and that the outcomes begin in childhood and young adulthood.
“What we’ve seen is that ACEs contribute to similar negative health and behavioral outcomes among youth and young adults to what we’ve seen in studies conducted in developed nations among adults,” Dube says.
In developed countries, ACEs typically include abuse, neglect, and household exposures to growing up with mental illness, domestic abuse, criminality in the home, and parental separation or divorce. In developing countries, children experience much of the same problems but also often deal with greater instances of orphanhood, poor nutrition, food insecurity, unsafe housing, unstable home environments, unhygienic living conditions, and exposure to pathogens and environmental toxins, among other things.
The studies show that ACEs are common and manifest as broadly similar outcomes in developed and developing countries.
“When it comes to childhood development, we are trying to increase awareness of these exposures in different contextual environments,” Dube says. “In these studies, youth and young adults are at risk of HIV, mental illness, behavioral risk, suicidality — which is similar to what we have observed in developed nations studying ACEs among adults, as was the case with the original ACE Study.”
The editors spent a year and a half soliciting submissions, vetting them for relevance and scientific rigor, and then editing the chosen peer-reviewed studies. The result is a 16-paper issue.
Dube says that the special issue goes a long way toward filling in a research gap and raising awareness about ACEs and how they contribute to health outcomes in other contexts. It could also lead to substantial changes at a governmental level and to better health outcomes.
“Basically, the data are used by developing nations to inform programs and policies to help mitigate the outcomes and prevent future generations from experiencing ACEs,” Dube says.
Check the Child Abuse and Neglect website for more information about the special issue.
