Prevalence and Impact of Adverse and Positive Childhood Experiences in Asian Americans
Creators: name: Chen, Wenyi
name: Hoppe, Emily
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Public Health
subject: Medicine and Health Sciences
subject: Nursing
subject: FOS: Health sciences
subject: adverse childhood experience; positive childhood experiences; Asian Americans; minority health; health disparity

description: BACKGROUND Adverse childhood experiences (ACEs) are potentially traumatic events such as abuse, neglect, and household dysfunction that occur in the first eighteen years of life (Felitti et al., 1998). Research has found robust dose-response relationships between ACEs and many negative physical and psychosocial health outcomes (Kessler et al., 2010; Petruccelli, et al., 2019). The deleterious effects of ACEs can also be transmitted across generations through mechanisms such as maternal mental health, parenting practices, epigenetics, and socio-economic disadvantage (Merrick, et al., 2020; Scorza et al., 2020; Herbell &amp; Bloom, 2020; Mersky, et al., 2021). However, not all individuals who are exposed to ACEs experience negative outcomes, in part because they may also be exposed to protective factors such as positive childhood experiences (PCEs) that can build resilience and buffer the negative effects of ACEs (Bethell, Jones, Gombojav, et al., 2019). Examining ACEs and PCEs jointly is important because it provides researchers with a more comprehensive understanding of the impact of ACEs and the interactions between ACEs and PCEs. It also allows researchers to better target the needs of people exposed to ACEs and develop effective prevention and intervention strategies and promote positive health and psychosocial outcomes. Although ACEs affect people from all communities, racially marginalized groups have higher prevalence rates of ACEs (Maguire-Jack et al., 2020). One study indicated that mean ACE scores are higher among Hispanics, non-Hispanic Blacks, and American Indians compared to non-Hispanic Whites and Asians (Mersky et al., 2021). Asian Americans comprise the fastest-growing racial minority group in the U.S., but few studies have reported ACE or PCE prevalence rates in Asian American populations (Bethell, Jones, Gombojav, et al., 2019; Crouch et al., 2019). Of those studies that have, Asian Americans appear to have the lowest prevalence of ACEs compared to other racial/ethnic groups (Bethell, Davis, Gombojav, et al., 2017). However, low ACE prevalence rates may mask substantial social, economic, and educational disparities across Asian Americans that could have effects on health. Most studies depict Asian Americans as a homogeneous sociocultural group, when in fact, Asian Americans represent over 20 different ethnic groups. Asian Americans often face model minority stereotyping and are viewed as the most prosperous and well-educated ethnic group in the U.S. (Shih, Chang, &amp; Chen, 2019). This false narrative of Asian Americans obscures the understanding of diversity among this population. An assessment of the current knowledge of ACEs and PCEs prevalence and impact is imperative for beginning to evaluate the scope and severity of these phenomena in Asian American populations. A preliminary search did not identify any types of reviews about ACEs or PCEs in Asian American populations. A scoping review is indicated due to the exploratory nature of this review, in light of the limited research evidence on the topic. The objective of this scoping review is to assess the available evidence about the prevalence and impact of ACEs and PCE in Asian American populations. REVIEW QUESTIONS 1. What is known about the prevalence of adverse childhood experiences (ACEs) in Asian American populations? 2. What is known about the prevalence of positive childhood experiences (PCEs) in Asian American populations? 3. What is known about the impact of ACEs on Asian Americans’ physical and mental health and psychosocial outcomes such as educational attainment, criminal justice involvement, and socioeconomic status? 4. What is known about the impact of PCEs on Asian Americans’ physical and mental health and psychosocial outcomes such as educational attainment, criminal justice involvement, and socioeconomic status? KEYWORDS Adverse childhood experiences; Asian-American; health disparities; positive childhood experiences ELIGIBILITY CRITERIA Participants Individuals self-identified as Asian Americans aged zero to end of life living in the U.S.. Based on U.S. Census definition, Asian-Americans are persons “having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent” (U.S. Census Bureau, n.d.). The review includes all Asian American populations regardless of immigration status. Concept This review seeks to assess the state of the science regarding the prevalence and impact of ACEs and PCEs in Asian American populations. Studies will be included if they used ACE or PCE measures that captured cumulative adverse events or protective factors. Studies that only examine one domain of adversity, such as maltreatment or separation from caregivers, will be excluded. Context This review will assess studies that examined ACEs and PCEs in Asian Americans, including as a sub-sample within a larger study. This review will include national and state-level samples, community samples, and clinical samples. Studies will not be excluded based upon setting. Types of Sources This scoping review will consider quantitative and qualitative studies reporting on the prevalence of ACEs or PCEs or on the impact of ACE or PCEs. This will include any experimental or quasi-experimental study designs and observational study designs. Gray literature, including dissertations, reports, and white papers, will be included. Systematic reviews and meta-analyses will be excluded. METHODS The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) scoping review guideline for scoping reviews (Peters, et al., 2020) and publicly available in the Open Science Framework (OSF). Search Strategy An initial search of PubMed, CINAHL, PsycINFO, and Web of Science was conducted to identify keywords, search terms, and to develop a full search strategy. The review will conduct searches in five databases including PubMed, Embase, CINAHL, PsycINFO, and Web of Science. Advanced search techniques such as Medical Subject Headings (MeSH), truncation, proximity searching, and phrase searching will be used to capture the concept of adverse and positive childhood experiences. Appendix 1 describes the complete strategy for each database. Study Selection Following the search, all identified citations will be exported from the search databases into Covidence, a web-based software platform for researchers to collaborate on primary screening and data selection for research review projects. Duplicated citations are deleted by Covidence automatically or manually by two reviewers if missed by Covidence. Two levels of screening for the study selection will be established. At the first level, two reviewers will independently review titles and abstracts of all publications obtained from the electronic databases search. Citations deemed relevant by both reviewers will be included in full text review. Discrepancies between reviewers will be resolved by discussion between reviewers to reach consensus. At the second level, the full text of each relevant citation will be assessed by two reviewers independently using established criteria to determine eligibility for inclusion. Reasons for exclusion of citations will be recorded and reported in the scoping review. Any discrepancies between the assessments of the two reviewers will be resolved through discussion and consensus, or with an additional reviewer if needed. The results of the search, screening, and inclusion process will be reported in full in the scoping review using a PRISMA-ScR flow diagram (Page, et al., 2021). Data Extraction Data will be extracted from included sources by two independent reviewers using a standardized and detailed Excel spreadsheet. The following variables will be abstracted: • Authors • Year of publication • Type of publication • Location and setting • Study design • Study aim • Participant characteristics (e.g., mean age, ethnicity, gender) • Sample size • Measurement tools used to measure ACEs/PCEs and outcome variables • Type/category of ACEs and/or PCEs measured • ACE and/or PCE prevalence • Results for outcomes of interest Any discrepancies between the extraction results of the two independent reviewers will be resolved through discussion or with an additional reviewer if necessary. Data Analysis and Presentation Studies will be divided into two broad categories for analysis: ACEs/PCEs prevalence estimates and impact of ACEs/PCEs. Quality of selected publications will be critiqued using the JBI appraisal tools. Details of selected publications including quality of the evidence will be summarized and synthesized in tables within the paper. A narrative summary will accompany the tabulated results and will describe how the results relate to the review objectives. Funding None Conflicts of Interest Neither Wenyi Chen nor Emily Hoppe have a conflict of interest in this project.