Systematic Review of the Global Implementation of Adverse Childhood Experiences Surveys

• In Event: Poster Session 11
  In Poster Session: PS 11 Topic - Solicited Content: Global South

Abstract

Adverse childhood experiences (ACEs) are common globally and have been found to be associated with a myriad of negative behavioral and health outcomes. An understanding of how ACEs are measured and through what survey mechanisms is not well documented. The aims of the review were to 1) determine where ACE questionnaires have been implemented globally, 2) determine what versions of ACE questionnaires have been used and how those questionnaires have differed, 3) the types of settings the ACE questionnaires were used (clinical or community), and whether the ACE questionnaires were modified for implementation and if so what explanations were provided. The overall goal of the review was to provide comprehensive documentation of ACE instruments implemented globally to guide decision-making and further research on their validity and reliability.

The systematic review protocol was registered with PROSPERO, the international prospective registrar of systematic reviews, in November 2018. Peer reviewed and grey literature were searched for articles on adverse childhood experiences and articles from 1998 through November 2018 were included. Inclusion criteria were studies that administered a version of the ACE questionnaire on non-institutionalized adults 18 years and older. All study designs were included with the exposure of interest being self-reported ACEs. Studies that did not meet these criteria were excluded.

There were 6,928 publications retrieved from the initial search. A total of 712 studies, from 60 different countries were included and there were 87 different ACEs related surveys used. Over a third of the surveys were modified from their original versions. Majority of the articles included questions on physical/emotional abuse (93%), while sexual abuse questions were included in 89% of the articles. Household dysfunction questions were included in 75% of the articles and neglect questions were included in 67% of the articles. Thirty-two percent of these studies were conducted in clinical settings while 68% were conducted in community settings. The Childhood Trauma Questionnaire was most commonly used in clinical settings and the Centers for Disease Control and Prevention ACE questionnaire in community settings. The World Health Organization ACE-IQ includes a broader range of childhood traumas than other surveys and not only assesses physical, emotional, and sexual abuse and neglect but also includes items concerning peer victimization, observing community violence, and collective violence. No survey assessed childhood poverty which has been linked to negative adulthood outcomes.

The variety of surveys used to measure ACEs may make it difficult for researchers and practitioners to choose which survey is best for a given setting and to compare findings across different populations. A concern with the assessment tools that are utilized in various settings was cultural competence. Primary reasons for survey modification included adaptation for language and cultural settings. Assessment of individual study quality for the risk of bias is not of concern in this review because the methods employed within individual studies do not influence the review questions, which are to identify the ACE questionnaire and versions used in individual studies, the implementation setting and the reasons for modification of the instrument, if applicable.

Authors

• Glory Okwori, East Tennessee State University
  Presenting Author

• Megan Quinn, East Tennessee State University
  Non-Presenting Author

• Steven Stewart, East Tennessee State University
  Non-Presenting Author

• Linh Ha Hong, East Tennessee State University
  Non-Presenting Author

• Ifeoma Ozodiegwu, Northwestern University
  Non-Presenting Author