Dataset Information

Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial.

ABSTRACT:

Objective

In adolescents and young adults (AYAs) with cancer, we examined (1) the distribution and type of traumatic events (TEs) experienced prior to baseline assessment and (2) how a resilience intervention, Promoting Resilience in Stress Management (PRISM), impacted changes in patient-reported outcomes (PROs) for AYAs with and without TEs.

Methods

AYAs (12-25 years) within 1-10 weeks of diagnosis of new malignancy or ever diagnosed with advanced cancer were enrolled and randomly assigned to usual care (UC) with or without PRISM. To assess TEs, we screened medical records for traditionally defined adverse childhood experiences (ACEs) and medical traumatic events. Age-validated PROs assessed resilience, benefit-finding, hope, generic health-related quality of life (QoL), cancer-specific QoL, depression, and anxiety at enrollment and 6 months later. We calculated effect sizes (Cohen's d) for PRISM vs. UC effect on PRO score change at 6 months for 1+ TEs and 0 TE groups.

Results

Ninety-two AYAs enrolled and completed baseline surveys (44-UC, 48-PRISM; N = 74 at 6 months, 38-UC, 36-PRISM); 60% experienced 1+ TEs. PROs at baseline were similar across groups. PRISM's effect on score change was greater (Cohen's d ≥ 0.5) for the 1+ TE group on domains of benefit-finding and hope; and similar (d < 0.5) on domains of resilience, depression, anxiety, and both generic and cancer-specific QoL.

Conclusions

In AYAs with cancer, TEs occurred at similar rates as the general population. PRISM may be particularly helpful for improving benefit-finding and hope for those who have experienced TEs.

SUBMITTER: Scott SR

PROVIDER: S-EPMC8134517 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial.

Scott Samantha R SR O'Daffer Alison G AG Bradford Miranda C MC Fladeboe Kaitlyn K Lau Nancy N Steineck Angela A Taylor Mallory M Yi-Frazier Joyce P JP Rosenberg Abby R AR

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 20201120 7

<h4>Objective</h4>In adolescents and young adults (AYAs) with cancer, we examined (1) the distribution and type of traumatic events (TEs) experienced prior to baseline assessment and (2) how a resilience intervention, Promoting Resilience in Stress Management (PRISM), impacted changes in patient-reported outcomes (PROs) for AYAs with and without TEs.<h4>Methods</h4>AYAs (12-25 years) within 1-10 weeks of diagnosis of new malignancy or ever diagnosed with advanced cancer were enrolled and randoml ...[more]

PMID: 33219407

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Project description:BackgroundPreventing Adverse Childhood Experiences (ACEs) is a public health priority, and the perinatal period is a sensitive life stage when preventive interventions could be particularly effective. Protecting and buffering pregnant persons and infants from exposure to adversity can optimize children's development and health trajectories, reduce future morbidity and mortality, and even break intergenerational cycles of adversity, but no study has synthesized experimental evidence on effectiveness of interventions to address ACEs in the perinatal period.ObjectivesTo (1) identify perinatal ACE prevention interventions, tested in high quality randomized control trials, with a dyadic perspective examining outcomes for mother and child; (2) describe their (a) place on the public health prevention continuum and (b) incorporation of life course characteristics that aim to optimize life health trajectories; and (3) determine which interventions show evidence of effectiveness.MethodsWe undertook a scoping review, using a modified PRISMA-Sc approach, of articles published in English between January 2000 and November 2023 identified through Psych info and PubMed using search terms for a broad range of adversities, with additional capture of articles from relevant reference lists. Interventions were included if they targeted an identified ACEs exposure or risk; were tested in randomized controlled trials (RCTs); reported outcome measures for both mother and child and were initiated during pregnancy. Interventions were further analyzed using the public health prevention continuum and Life Course Intervention Research (LCIR) characteristics frameworks. A two-tailed t test was used to ascertain the association between LCIR characteristics, and the outcomes achieved.ResultsOf 2148 articles identified, 57 were in scope for detailed analysis, yielding 53 unique interventions. Overall, 42 (74%) reported some positive impact; 37 (65%) for mothers; 37 (65%) for the child, and 32 (56%) for both. Interventions with the strongest evidence based on study quality and reported outcomes were co-parenting programs designed to improve the quality and function of the co-parenting relationship, home visiting interventions, and integrative health interventions incorporating baby massage and/or yoga. Half of effective interventions were secondary prevention focused. The mean number of life course characteristics was significantly higher in the studies that reported a positive impact on the mother and/or child (p = 0.003).ConclusionsFew studies specifically addressed ACEs as a defined set of adversities, yet a range of perinatal interventions showed positive impacts on individual ACE risks or exposures. Intentional incorporation of life course characteristics and bundling of evidence-based components into comprehensive perinatal interventions hold promise for future ACEs prevention.

Project description:BackgroundAdverse childhood experiences (ACEs) increase the risk of poor health outcomes later in life. Psychosocial stressors may also have intergenerational health effects by which parental ACEs are associated with mental and physical health of children. Epigenetic programming may be one mechanism linking parental ACEs to child health. This study aimed to investigate epigenome-wide associations of maternal preconception ACEs with DNA methylation patterns of children. In the Center for the Health Assessment of Mothers and Children of Salinas study, cord blood DNA methylation was measured using the Illumina HumanMethylation450 BeadChip. Preconception ACEs, which occurred during the mothers' childhoods, were collected using a standard ACE questionnaire including 10 ACE indicators. Maternal ACE exposures were defined in this study as (1) the total number of ACEs; (2) the total number of ACEs categorized as 0, 1-3, and > 4; and (3) individual ACEs. Associations of ACE exposures with differential methylated positions, regions, and CpG modules determined using weighted gene co-expression network analysis were evaluated adjusting for covariates.ResultsData on maternal ACEs and cord blood DNA methylation were available for 196 mother/newborn pairs. One differential methylated position was associated with maternal experience of emotional abuse (cg05486260/FAM135B gene; q value < 0.05). Five differential methylated regions were significantly associated with the total number of ACEs, and 36 unique differential methylated regions were associated with individual ACEs (Šidák p value < 0.05). Fifteen CpG modules were significantly correlated with the total number of ACEs or individual ACEs, of which 8 remained significant in fully adjusted models (p value < 0.05). Significant modules were enriched for pathways related to neurological and immune development and function.ConclusionsMaternal ACEs prior to conception were associated with cord blood DNA methylation of offspring at birth. Although there was limited overlap between differential methylated regions and CpGs in modules associated with ACE exposures, statistically significant regions and networks were related to genes involved in neurological and immune function. Findings may provide insights to pathways linking psychosocial stressors to health. Further research is needed to understand the relationship between changes in DNA methylation and child health.

Dataset Information

Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial.

Objective

Methods

Results

Conclusions

Publications

Adverse childhood experiences (ACEs) and medically traumatic events (TEs) in adolescents and young adults (AYAs) with cancer: a report from the Promoting Resilience in Stress Management (PRISM) randomized controlled trial.

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