{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:54:13Z","timestamp":1792799653082,"version":"4.5.0"},"reference-count":44,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2024,6,25]],"date-time":"2024-06-25T00:00:00Z","timestamp":1719273600000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,5,30]]},"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Although adverse childhood experiences (ACEs) are associated with poor health in adulthood, positive childhood experiences (PCEs) can reduce the risk of negative health outcomes. This study aimed to investigate whether PCEs in the community (CPCEs, ie, trusted adults other than parents, supportive friends, belongingness to school, or community traditions) would have an independent effect on better health outcomes and moderate the association between ACEs and adult illnesses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Data were gathered from a nationwide, cross-sectional internet survey conducted in Japan in 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>This study included 28\u2009617 Japanese adults aged 18\u201382 years (51.1% female; mean age=48.1 years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The associations among self-reported ACEs, CPCEs before the age of 18 years and current chronic diseases (eg, cancer and depression) were investigated using multivariable logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>CPCEs were associated with lower odds of adult diseases (such as stroke, chronic obstructive pulmonary disease (COPD), chronic pain, depression, suicidal ideation and severe psychological distress) after adjusting for ACEs. More CPCEs weakened the association between ACEs and adult diseases. Specifically, among those with ACEs, \u22653 CPCEs (vs 0\u20132 CPCEs) lowered the adjusted prevalence by \u226550% for stroke (2.4% to 1.2%), COPD (2.2% to 0.7%) and severe psychological distress (16.4% to 7.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CPCEs could reduce ACE-related risk of poor physical and mental health in later life. Early-life interventions that enhance PCEs in schools and\/or neighbourhoods are recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-082134","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T02:51:07Z","timestamp":1719370267000},"page":"e082134","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Promotive and protective effects of community-related positive childhood experiences on adult health outcomes in the context of adverse childhood experiences: a nationwide cross-sectional survey in Japan"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8882-5098","authenticated-orcid":false,"given":"Haruyo","family":"Mitani","sequence":"first","affiliation":[{"name":"Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6425-6844","authenticated-orcid":false,"given":"Naoki","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5319-9541","authenticated-orcid":false,"given":"Airi","family":"Amemiya","sequence":"additional","affiliation":[{"name":"Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-3125","authenticated-orcid":false,"given":"Takahiro","family":"Tabuchi","sequence":"additional","affiliation":[{"name":"Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan"},{"name":"Division of Epidemiology, School of Public Health, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,6,25]]},"reference":[{"key":"2025121515112224000_14.6.e082134.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(98)00017-8"},{"key":"2025121515112224000_14.6.e082134.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-005-0624-4"},{"key":"2025121515112224000_14.6.e082134.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(19)30145-8"},{"key":"2025121515112224000_14.6.e082134.4","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(17)30118-4"},{"key":"2025121515112224000_14.6.e082134.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001349","article-title":"The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis","volume":"9","author":"Norman","year":"2012","journal-title":"PLoS Med"},{"key":"2025121515112224000_14.6.e082134.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.chiabu.2019.104127","article-title":"Adverse childhood experiences and associated health outcomes: a systematic review and meta-analysis","volume":"97","author":"Petruccelli","year":"2019","journal-title":"Child Abuse Neglect"},{"key":"2025121515112224000_14.6.e082134.7","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2015.197"},{"key":"2025121515112224000_14.6.e082134.8","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-2663"},{"key":"2025121515112224000_14.6.e082134.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-017-1260-z","article-title":"Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming Behaviours and mental well-being","volume":"17","author":"Bellis","year":"2017","journal-title":"BMC Psychiatry"},{"key":"2025121515112224000_14.6.e082134.10","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s40653-018-0217-9","article-title":"Safe, stable, and nurtured: protective factors against poor physical and mental health outcomes following exposure to adverse childhood experiences (aces)","volume":"12","author":"Crouch","year":"2019","journal-title":"J Child Adolesc Trauma"},{"key":"2025121515112224000_14.6.e082134.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamapediatrics.2019.3007","article-title":"Positive childhood experiences and adult mental and relational health in a statewide sample: associations across adverse childhood experiences levels","volume":"173","author":"Bethell","year":"2019","journal-title":"JAMA Pediatr"},{"key":"2025121515112224000_14.6.e082134.12","doi-asserted-by":"crossref","unstructured":"Masten AS , Cicchetti D . Resilience in development: progress and transformation. In: Cicchetti D , ed. Developmental Psychopathology, Risk, Resilience, and Intervention. John Wiley & Sons, Inc, 2016: 271\u2013333.","DOI":"10.1002\/9781119125556.devpsy406"},{"key":"2025121515112224000_14.6.e082134.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-024870","article-title":"What factors are associated with resilient outcomes in children exposed to social adversity? a systematic review","volume":"9","author":"Gartland","year":"2019","journal-title":"BMJ Open"},{"key":"2025121515112224000_14.6.e082134.14","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s10935-016-0455-2","article-title":"Identifying protective factors to promote health in American Indian and Alaska native adolescents: a literature review","volume":"38","author":"Henson","year":"2017","journal-title":"J Prim Prev"},{"key":"2025121515112224000_14.6.e082134.15","doi-asserted-by":"crossref","first-page":"e452","DOI":"10.1097\/DBP.0000000000001076","article-title":"Role of individual, family, and community resilience in moderating effects of adverse childhood experiences on mental health among children","volume":"43","author":"Okwori","year":"2022","journal-title":"J Dev Behav Pediatr"},{"key":"2025121515112224000_14.6.e082134.16","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/jan.14576","article-title":"Systematic review: effects of sustained nurse home visiting programs for disadvantaged mothers and children","volume":"77","author":"Molloy","year":"2021","journal-title":"J Adv Nurs"},{"key":"2025121515112224000_14.6.e082134.17","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s00127-022-02322-x","article-title":"School- and community-level protective factors for resilience among chronically maltreated children in Japan","volume":"58","author":"Isumi","year":"2023","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"2025121515112224000_14.6.e082134.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-024609","article-title":"Association between adverse childhood experiences and adult diseases in older adults: a comparative cross-sectional study in Japan and Finland","volume":"9","author":"Amemiya","year":"2019","journal-title":"BMJ Open"},{"key":"2025121515112224000_14.6.e082134.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2010.08.002"},{"key":"2025121515112224000_14.6.e082134.20","doi-asserted-by":"publisher","DOI":"10.1177\/1745691616646305"},{"key":"2025121515112224000_14.6.e082134.21","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1177\/15412040221131278","article-title":"How positive and negative childhood experiences interact with resiliency theory and the general theory of crime in juvenile Probationers","volume":"21","author":"Mueller","year":"2023","journal-title":"Youth Violence and Juvenile Justice"},{"key":"2025121515112224000_14.6.e082134.22","doi-asserted-by":"publisher","DOI":"10.1177\/1090198113493782"},{"key":"2025121515112224000_14.6.e082134.23","doi-asserted-by":"crossref","unstructured":"Oshri A , Duprey EK , Liu S , et al . Aces and resilience: methodological and conceptual issues. In: Asmundson GJG , Afifi TO , eds. Adverse Childhood Experiences: Using Evidence to Advance Research, Practice, Policy, and Prevention. Academic Press, 2020: 287\u2013306.","DOI":"10.1016\/B978-0-12-816065-7.00014-8"},{"key":"2025121515112224000_14.6.e082134.24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.chiabu.2017.09.022","article-title":"Positive childhood experiences predict less psychopathology and stress in pregnant women with childhood adversity: a pilot study of the benevolent childhood experiences (Bces) scale","volume":"78","author":"Narayan","year":"2018","journal-title":"Child Abuse Negl"},{"key":"2025121515112224000_14.6.e082134.25","doi-asserted-by":"crossref","first-page":"104089","DOI":"10.1016\/j.chiabu.2019.104089","article-title":"Aces and counter-aces: how positive and negative childhood experiences influence adult health","volume":"96","author":"Crandall","year":"2019","journal-title":"Child Abuse Negl"},{"key":"2025121515112224000_14.6.e082134.26","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-5699-8","article-title":"Adverse childhood experiences and sources of childhood resilience: a retrospective study of their combined relationships with child health and educational attendance","volume":"18","author":"Bellis","year":"2018","journal-title":"BMC Public Health"},{"key":"2025121515112224000_14.6.e082134.27","unstructured":"JACSIS study . The Japan COVID-19 and society Internet survey. 2021. Available: https:\/\/jacsis-study.jp\/"},{"key":"2025121515112224000_14.6.e082134.28","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/pcn.13464","article-title":"Impact of adverse childhood experience on physical and mental health: a life-course epidemiology perspective","volume":"76","author":"Fujiwara","year":"2022","journal-title":"Psychiatry Clin Neurosci"},{"key":"2025121515112224000_14.6.e082134.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013228","article-title":"Adverse childhood experiences (aces) and later-life depression: perceived social support as a potential protective factor","volume":"7","author":"Cheong","year":"2017","journal-title":"BMJ Open"},{"key":"2025121515112224000_14.6.e082134.30","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.257"},{"key":"2025121515112224000_14.6.e082134.31","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291702006074"},{"key":"2025121515112224000_14.6.e082134.32","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/mpr.310","article-title":"Screening for serious mental illness in the general population with the K6 screening scale: results from the WHO world mental health (WMH) survey initiative","volume":"19 Suppl 1","author":"Kessler","year":"2010","journal-title":"Int J Methods Psychiatr Res"},{"key":"2025121515112224000_14.6.e082134.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2016.10.021"},{"key":"2025121515112224000_14.6.e082134.34","doi-asserted-by":"crossref","DOI":"10.1080\/20008198.2021.1924953","article-title":"Associations of adverse and positive childhood experiences with adult physical and mental health and risk Behaviours in Slovenia","volume":"12","author":"Kuhar","year":"2021","journal-title":"Eur J Psychotraumatol"},{"key":"2025121515112224000_14.6.e082134.35","doi-asserted-by":"crossref","first-page":"81","DOI":"10.15195\/v6.a4","article-title":"Best practices for estimating, interpreting, and presenting Nonlinear interaction effects","volume":"6","author":"Mize","year":"2019","journal-title":"SocScience"},{"key":"2025121515112224000_14.6.e082134.36","unstructured":"Hair JF , Black B , Babin BJ , et al . Multivariate Data Analysis: Global Edition. 7th edn. Pearson Education, 2009."},{"key":"2025121515112224000_14.6.e082134.37","unstructured":"Aiken LS , West SG . Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage Publications, 1991."},{"key":"2025121515112224000_14.6.e082134.38","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1002\/jcop.20124","article-title":"A model for the influence of mentoring relationships on youth development","volume":"34","author":"Rhodes","year":"2006","journal-title":"J Commun Psychol"},{"key":"2025121515112224000_14.6.e082134.39","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/bjop.12135","article-title":"Best friends and better coping: facilitating psychological resilience through boys\u2019 and girls\u2019 closest friendships","volume":"107","author":"Graber","year":"2016","journal-title":"Br J Psychol"},{"key":"2025121515112224000_14.6.e082134.40","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1016\/j.acap.2017.03.007","article-title":"Responding to aces with HOPE: health outcomes from positive experiences","volume":"17","author":"Sege","year":"2017","journal-title":"Acad Pediatr"},{"key":"2025121515112224000_14.6.e082134.41","unstructured":"The National Resource Center at Tufts Medical Center . Tufts HOPE: Healthy Outcomes from Positive Experiences.2023. Available: https:\/\/positiveexperience.org\/"},{"key":"2025121515112224000_14.6.e082134.42","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1111\/ped.14205","article-title":"Compulsory educational mental health support system in Japan","volume":"62","author":"Nishio","year":"2020","journal-title":"Pediatr Int"},{"key":"2025121515112224000_14.6.e082134.43","first-page":"159","article-title":"Current issues of school social work in Japan: from the historical relations between school, social work, and counseling","volume":"5","author":"Kanazawa","year":"2009","journal-title":"Japanese J Soc Serv"},{"key":"2025121515112224000_14.6.e082134.44","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1177\/10105395221119416","article-title":"Social capital and the spread of children\u2019s cafeterias (Kodomo Shokudo) in Japan: an ecological analysis","volume":"34","author":"Murayama","year":"2022","journal-title":"Asia Pac J Public Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-082134","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T23:11:33Z","timestamp":1765840293000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-082134"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6]]},"references-count":44,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,25]]},"published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1136\/bmjopen-2023-082134"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-082134","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6]]}}}