{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T11:39:22Z","timestamp":1774006762316,"version":"3.50.1"},"reference-count":43,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>With this study, we seek to understand the relationship between prebirth household challenges and the child\u2019s adverse childhood experiences (ACEs) score by age 3 in a statewide-representative birth cohort to inform primary prevention strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We used a longitudinally linked data set from the Alaska 2009\u20132011 Pregnancy Risk Assessment Monitoring System, its 3-year follow-up survey, and multiple administrative data sources. Using this linked data set, we predicted an expanded ACEs score by age 3 using maternal reported prebirth household challenges.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>The number of household challenges reported during the 12 months before or during pregnancy predicted ACEs score in a graded, dose-response manner. On average, reporting 4+ prebirth household challenges was associated with an ACEs score 4.1 times that of those reporting 0 challenges. Homelessness was associated with the greatest increase in ACEs score (relative rate ratio = 3.0). Prebirth household challenges that were independently associated with an elevated ACEs score in our final model included problems paying bills, someone close to the mother having a drinking and\/or drug problem, homelessness, mother or husband or partner being in jail, husband or partner losing job, separation or divorce, and being checked or treated for anxiety or depression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>The accumulation and certain prebirth household challenges are strongly associated with the accumulation of childhood ACEs. Addressing and reducing household challenges during the prebirth period may serve as a primary point of ACEs prevention. Many evidence-based, multidisciplinary intervention strategies can and should be implemented in the prebirth period to strengthen the household unit before the introduction of a new child.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2020-1303","type":"journal-article","created":{"date-parts":[[2020,10,23]],"date-time":"2020-10-23T12:25:49Z","timestamp":1603455949000},"source":"Crossref","is-referenced-by-count":6,"title":["Prebirth Household Challenges To Predict Adverse Childhood Experiences Score by Age 3"],"prefix":"10.1542","volume":"146","author":[{"given":"Danielle","family":"Rittman","sequence":"first","affiliation":[{"name":"Alaska Mental Health Board, Alaska Department of Health and Social Services, Juneau, Alaska;"},{"name":"Section of Women\u2019s, Children\u2019s, and Family Health, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Alaska; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared","family":"Parrish","sequence":"additional","affiliation":[{"name":"Section of Women\u2019s, Children\u2019s, and Family Health, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, Alaska; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Lanier","sequence":"additional","affiliation":[{"name":"School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2020,11,1]]},"reference":[{"issue":"4","key":"2021121012545458800_B1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","article-title":"Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. 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