{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:48:05Z","timestamp":1790185685243,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although adverse childhood experiences (ACEs) have been linked to gastrointestinal (GI) conditions in children, it remains unclear which specific adversities confer greatest risk and how psychosocial or contextual factors modify these associations. This study identified ACEs most strongly associated with GI symptoms in US youth and evaluated emotional, behavioral, and environmental pathways that may affect these relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed nationally representative data from 73,055 US children and adolescents in the 2021\u20132023 National Survey of Children's Health. Least Absolute Shrinkage and Selection Operator regression identified ACEs most predictive of GI symptoms (primary outcome), with co\u2010occurring GI symptoms and chronic pain examined secondarily. Mediation and moderation analyses assessed psychosocial mechanisms and potential protective factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>GI symptoms were reported in 6% of children. Five ACEs were retained for the primary outcome; strongest associations were for household mental illness (adjusted odds ratio [aOR] 1.56; 95% confidence interval [CI] 1.44\u20131.70) and economic insecurity (aOR 1.38; 95% CI 1.26\u20131.50), followed by neighborhood violence (aOR 1.34; 95% CI 1.19\u20131.52) and racial discrimination (aOR 1.31; 95% CI 1.16\u20131.47). Emotional\/behavioral difficulties mediated 20%\u201335% of effects; food insecurity mediated 26% for economic insecurity. School and neighborhood safety and community support attenuated several ACE\u2013GI associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Household mental illness and economic insecurity were the strongest ACEs associated with GI symptoms in US youth. Emotional distress and perceived environmental safety mitigated these associations. Integrating psychosocial and contextual factors into evaluation of recurrent GI symptoms may improve care and identify targets for early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70385","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:01:57Z","timestamp":1773014517000},"page":"1162-1170","source":"Crossref","is-referenced-by-count":1,"title":["Adverse childhood experiences and gastrointestinal symptoms in US youth: Psychosocial pathways and protective contexts"],"prefix":"10.1002","volume":"82","author":[{"given":"Sierra L.","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Center for the Study of Traumatic Stress Uniformed Services University of the Health Sciences Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie M.","family":"Klapp","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Rady Children's Hospital San Diego San Diego California USA"},{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition University of California San Diego School of Medicine La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Shiels","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Kaiser Permanente Walnut Creek California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christin M.","family":"Ogle","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Center for the Study of Traumatic Stress Uniformed Services University of the Health Sciences Bethesda Maryland USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8538-2877","authenticated-orcid":false,"given":"Jeffrey B.","family":"Schwimmer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition University of California San Diego School of Medicine La Jolla California USA"},{"name":"Department of Gastroenterology Rady Children's Hospital San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2019.12.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2024-066633"},{"key":"e_1_2_7_4_1","volume-title":"Adverse Childhood Experiences (ACEs) Prevention Resource for Action: A Compilation of the Best Available Evidence","author":"Centers for Disease Control and 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