The Link between Asthma and Child Abuse


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Presentation to the WV Asthma Coalition

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  • More information about the Adverse Childhood Experiences Study (ACES) is available online at
  • Distribute Disclosure Job Aid Cards to participants (Tab 6).Process with them.
  • Refer to What Happens When You Make a Report Handout Tab 7. Prompt the participants to read the handout pages and mark their questions. Open the floor and respond to questions. Strive to maintain focus on reporting which is the purpose of this training vs. the complexities of CPS response.Note that the initial report will take longer than in the past, due to implementation of the SAMS (Safety Assessment & Management System) Model.
  • Refer to Protective Factors Handout.
  • The Link between Asthma and Child Abuse

    1. 1. The Link Between Child Abuse and Asthma WV Asthma Coalition Annual Retreat August 15, 2013 1
    2. 2. Connecting the Dots • Asthma appears to be a greater risk for children who have experienced traumatic and stressful events including child maltreatment. • Importance of screening for asthma among victims of childhood abuse, and awareness of the possibility of physical or sexual abuse among children with asthma. • Healthy lung development is key to preventing SUIDs and SIDS. 2
    3. 3. Child Abuse Increases Asthma Risks • The risk of developing asthma is doubled in children who have suffered physical or sexual abuse, new research in Puerto Rico shows. • Survey of 1,213 children and their chief caregivers found that nearly 40 percent had been diagnosed with asthma at some point. 3
    4. 4. 2008 Puerto Rico Study • Study found that victims of sexual or physical abuse were 2.52 times more likely to have asthma currently, and 2.35 times more likely to be taking asthma medications. • 4/rccm.200711-1629OC 4
    5. 5. Epigenetics • Follow-Up Study published this year linked Asthma In Puerto Rican Children and Exposure to Violence to Genetic Changes • ―Most asthma studies have focused on environmental factors such as air pollution. This is one of the first to look at the impact of stress on epigenetics, which can cause differences in gene expression.‖ 5
    6. 6. Boston University Study Linked Abuse in Childhood Linked to Adult Asthma in African-American Women • African-American women who reported suffering abuse before age 11 had a greater likelihood of adult-onset asthma compared to women whose childhood and adolescence were free of abuse, according to a new study from the Slone Epidemiology Center at the Boston University School of Public Health. 6
    7. 7. Boston University Study • The study followed 28,456 African-American women from 1995 to 2011. • Results indicate incidence of adult-onset asthma was more than 20% higher among women who had been abused during childhood. • Evidence was stronger for physical abuse than for sexual abuse. 7
    8. 8. Adverse Childhood Experiences: Lives Gone Up In Smoke Increased risk for: • Alcoholism • Depression • Domestic violence • Drug abuse • Heart disease • Liver disease • School Drop Out • Smoking • Asthma • Suicide attempts 8
    9. 9. The Adverse Childhood Experiences (ACE) Study • The largest study of its kind ever done to examine the health and social effects of adverse childhood experiences over the lifespan (18,000 participants)
    10. 10. The Adverse Childhood Experiences (ACE) Study Summary of Findings: • Adverse Childhood Experiences (ACEs) are very common • ACEs are strong predictors of later health risks and disease • This combination makes ACEs the leading determinant of the health and social well-being of our nation
    11. 11. Categories of Adverse Childhood Experiences (ACEs) • Recurrent physical abuse • Recurrent emotional abuse • Contact sexual abuse • An alcohol and/or drug abuser in the home • An incarcerated household member • Someone in home is chronically depressed, mentally ill, institutionalized, or suicidal • Mother is treated violently • One or no biological parents in home 11
    12. 12. Categories of Adverse Childhood Experiences Category Prevalence (%) Abuse, by Category Psychological (by parents) 11% Physical (by parents) 11% Sexual (anyone) 22% Household Dysfunction, by Category Substance Abuse 26% Mental Illness 19% Mother Treated Violently 13% Imprisoned Household Member 3%
    13. 13. Evidence from ACE Study Suggests: These chronic diseases in adults are determined decades earlier, by the experiences of childhood. Affective Response
    14. 14. Adverse Childhood Experiences vs. Current Smoking 0 2 4 6 8 10 12 14 16 18 20 0 1 2 3 4-5 6 or more ACE Score %
    15. 15. ACE Score vs. Smoking and COPD 0 2 4 6 8 10 12 14 16 18 20PercentWithProblem 0 1 2 3 4 or more ACE Score: Regular smoking by age 14 COPD
    16. 16. Implications • Research findings highlight importance of screening for asthma among victims of childhood abuse, and awareness of the possibility of physical or sexual abuse among children with asthma. 17
    17. 17. Childhood Asthma and Neglect • Extrinsic Asthma /Sensitivity to inhalent allergens – Dust mites – Animal dander – Cockroaches – Pollen – Mold • Intrinsic Asthma – Emotional Stress • Medical Neglect – Failure to maintain asthma medication • Smoking 18
    18. 18. What should you do when a parent or child discloses? 19
    19. 19. Disclosure What to do when a parent or child discloses? 1. Find a private place to talk with the person. 2. Reassure the person making the disclosure ("I believe you.‖) 3. Listen openly and calmly, with minimal interruptions. 4. Write down the facts and words as the person has stated them. (Exact words are important to investigators.) 5. Do not promise not to tell, but respect the person’s confidentiality by not telling others who don’t need to know. 6. Tell the truth. 7. Be specific. Let the child know what is going to happen. 8. Assess the child’s immediate safety. 9. Be supportive. Report the disclosure within 48 hrs to CPS.
    20. 20. Disclosure What NOT to Say When Someone Discloses To You 1. Don’t ask ―why‖ questions such as: • ―Why didn't you stop him or her?‖ • ―Why are you telling me this?‖ 2. Don't say "Are you sure?" 3. Don't ask "Are you telling the truth?" 4. Don't say "Let me know if it happens again." 5. Avoid leading questions ("Did your uncle touch you too? Was he wearing a blue jacket?‖)
    21. 21. How do you make a report? • You should contact CPS whenever you reasonably suspect a child has been abused or neglected or is subject to conditions where abuse or neglect is likely to occur. • CPS will accept your report and determine ―Is the child safe or does the child need protected?‖ 22
    22. 22. To Whom Do You Report? WV Child Abuse and Neglect Hotline 1-800-352-6513 24 hours a day - 7 days a week For serious physical abuse and sexual abuse, also contact the state police and local law enforcement. 23
    23. 23. Additional Implications • ACEs help explain why some patients, when faced with medical conditions that clearly indicate a smoker should stop smoking, continue to smoke anyway. 24
    24. 24. Nicotine as a Drug ―Nicotine has demonstrable psychoactive benefits in the regulation of affect; therefore, persons exposed to adverse childhood experiences may benefit from using nicotine to regulate their mood.‖ – Carmody TP. Affect Regulation, Nicotine Addiction, and Smoking Cessation. Psychoactive Drugs. 1989;24:111-122 25
    25. 25. The Importance of Trauma Informed Care • The sooner all modern health care practitioners include childhood trauma as part of their patients’ medical records— and take action to help their patients recover from such trauma—the sooner we are likely to see a healthier global population. • -- ACE Reporter, Vol. I, Issue 5, Summer 2007 26
    26. 26. Heredity or ACEs? Because ―heredity‖ is often blamed for health- related issues such as obesity and smoking, researchers considered whether or not a history of parental smoking and/or substance abuse influenced the smoker’s behavior. They found that the outcome was similar, regardless of familial history, and that smoking was therefore not likely linked to genetics or behavior modeling. --Adverse Childhood Experiences and Smoking During Adolescence and Adulthood, Anda, RF, Croft, JB (et al). 1999. 27
    27. 27. Heredity or ACEs? Smoking was ―strongly associated with adverse childhood experiences.‖ It is therefore likely that “primary prevention of adverse childhood experiences and improved treatment of exposed children could reduce smoking among both adolescents and adults.‖ --Adverse Childhood Experiences and Smoking During Adolescence and Adulthood, Anda, RF, Croft, JB (et al). 1999. 28
    28. 28. Responsibility to Prevent “No epidemic has ever been resolved by paying attention to the treatment of the affected individual.” -- George W. Albee, Ph.D. 29
    29. 29. Protective Factors That Prevent Child Abuse and Neglect • Knowledge of Parenting & Child Development • Parental Resilience • Social Connections • Social & Emotional Development of Children • Concrete Support in Times of Need
    30. 30. For More Information Contact: The TEAM for West Virginia Children 1-866-4KIDSWV 304-697-0340 Email: Twitter: @TEAM4WVChildren 31