Presentation to the WV Asthma Coalition

1. The Link Between Child
Abuse and Asthma
WV Asthma Coalition
Annual Retreat
August 15, 2013
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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.
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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.
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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.
• http://www.atsjournals.org/doi/abs/10.116
4/rccm.200711-1629OC
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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.‖
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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.
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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.
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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
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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. 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. 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. 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%

14. Evidence from ACE Study
Suggests:
These chronic diseases in
adults are determined
decades earlier, by the
experiences of childhood.
Affective
Response

15. 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
%

16. 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

17. 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.
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18. 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
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19. What should you do when a
parent or child discloses?
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20. 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.

21. 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?‖)

22. 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?‖
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23. 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.
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24. 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.
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25. 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
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26. 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
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27. 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.
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28. 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.
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29. Responsibility to Prevent
“No epidemic has ever been resolved by
paying attention to the treatment of the
affected individual.”
-- George W. Albee, Ph.D.
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30. 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

31. For More Information Contact:
The TEAM for West Virginia Children
1-866-4KIDSWV
304-697-0340
Email: pcawv@teamwv.org
Twitter: @TEAM4WVChildren
http://slideshare.net/PCAWV
http://www.preventchildabusewv.org
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