Pediatric ACEs and related life event screener (PEARLS) latent domains and child health in a safety-net primary care practice

Morgan Ye; Danielle Hessler; Derek Ford; Mindy Benson; Kadiatou Koita; Monica Bucci; Dayna Long; Nadine Burke Harris; Neeta Thakur

doi:10.1186/s12887-023-04163-2

Pediatric ACEs and related life event screener (PEARLS) latent domains and child health in a safety-net primary care practice

BMC Pediatr. 2023 Jul 17;23(1):367. doi: 10.1186/s12887-023-04163-2.

Authors

Morgan Ye¹, Danielle Hessler², Derek Ford³, Mindy Benson⁴, Kadiatou Koita⁵, Monica Bucci⁵, Dayna Long⁴, Nadine Burke Harris⁵, Neeta Thakur⁶

Affiliations

¹ San Francisco Departments of Medicine and Epidemiology and Biostatistics, University of California, 500 Parnassus Avenue, 94143-0841, San Francisco, CA, USA.
² San Francisco Department of Family and Community Medicine, University of California, 500 Parnassus Avenue, 94143, San Francisco, CA, USA.
³ Center for Psychological and Social Health, LLC, 2918 Westover Dr, Danville, VA, 24541, USA.
⁴ San Francisco Department of Pediatrics, University of California, 5220 Claremont Ave, Oakland, CA, 94609, USA.
⁵ Center for Youth Wellness, 3450 3rd St, 94124, San Francisco, CA, USA.
⁶ San Francisco Departments of Medicine and Epidemiology and Biostatistics, University of California, 500 Parnassus Avenue, 94143-0841, San Francisco, CA, USA. Neeta.Thakur@ucsf.edu.

Abstract

Background: Research examining the connections between individual adverse childhood experiences (ACEs) and how groupings of interrelated adversities are linked with subsequent health is scarce, limiting our understanding of risk during a period of rapid expansion of ACE screening in clinical practice. The study objective was to conduct a psychometric analysis to derive latent domains of ACEs and related life events and assess the association between each domain and health outcome.

Methods: Participants (3 months-11 years) were recruited from the University of California San Francisco Benioff's Children Hospital Oakland Primary Care Clinic. Children were screened with the Pediatric ACEs and Related Life Events Screener (PEARLS) (n = 340), which assessed 17 total ACEs and related life events, including forms of abuse, household challenges, and social risks. Domains were constructed using confirmatory factor analysis and associations between the three identified domains and 14 health outcomes were assessed using multivariable linear and logistic regression models.

Results: Three PEARLS domains were identified: Maltreatment (ω = 0.73, ɑ=0.87), Household Challenges (ω = 0.70, ɑ=0.82), and Social Context (ω = 0.55, ɑ=0.70). Measurement invariance was supported across both gender and screening format. All domains were associated with poorer general and behavioral health and stomachaches. Maltreatment and Social Context were additionally associated with eczema while only Social Context was associated with increased odds of reporting headaches and somatic symptoms.

Conclusion: In an underserved, urban west-coast pediatric population, the PEARLS found three adversity domains of Maltreatment, Household Challenges, and Social Context that all had an independent statistically significant association with poorer child health. The results provide a timely and more nuanced representation of risk that can inform clinical practice and policy using more targeted resources and interventions.

Keywords: ACEs; Adverse childhood experiences; Child abuse; Factor analysis; PEARLS.

Publication types

Research Support, Non-U.S. Gov't