Presenter Profile
Dina Burstein, MD, MPH
The HOPE National Resource Center
Center for Community-Engaged Medicine
Institute for Clinical Research and Health Policy Studies
Tufts Medicine
dina.burstein@tuftsmedicine.org
(401) 787-1316
Dina Burstein, MD, MPH, FAAP is the Healthy Outcomes for Positive Experiences (HOPE) Project Director at the Center for Community-Engaged Medicine. Dr. Burstein is an experienced physician, healthcare project designer, and leader with over twenty years of success in scientific research, grant writing, analysis, training, and clinical practice. Previously, Dr. Burstein was an Assistant Professor of Emergency Medicine at the Warren Alpert Medical School of Brown University, directing injury prevention focused community outreach programming and community based research projects, as well as teaching and mentoring undergraduate, graduate, and medical students. Her aim is to enhance the well-being of individuals and the community by presenting and promoting programs while leveraging proficiency in research, care management, injury prevention and clinical effectiveness. She is a graduate of Tufts University and holds an MD and MPH from the University of Massachusetts Medical School.
Presentations
A Scoping Review of Adverse and Positive Childhood Experiences
Dina Burstein, MD, MPH
Robert Sege, MD, PhD
Joachim Hero, PhD
Children’s brain growth and cognitive development is influenced by adverse and positive experiences. The original adverse childhood experiences (ACEs) study was published more than two decades ago, therefore there is a need to update the original formulation. This study was undertaken to explore the evidence for categories of ACEs not included in the original study, and for positive childhood experiences (PCEs) that promote optimal development and mitigate the adverse outcomes associated with ACEs. We report the results of a scoping review of the literature on original ACEs, possible expanded ACEs (ExACEs), PCEs and their effects on health outcomes. This scoping review describes the available literature with the goal of identifying gaps and preparing for systematic literature reviews.
We conducted a systematic scoping review according to PRISMA standards: bibliographic review across multiple databases, screening of titles and abstracts to eliminate irrelevant articles, full text screening to identify relevant articles, data abstraction, analysis and reporting. Scoping reviews do not include an assessment of data quality. This study included only English language reports of studies conducted in the United States that reported associations between exposures and outcomes published in 2014 or later. Studies of people from other countries and prevalence studies were excluded.
Over 23,000 articles were screened; 4,048 original ACEs, 6,617 ExACEs, and 8,919 PCEs. Only systematic reviews were considered for the original ACEs. Nineteen studies were included, and these reported 33 associations with abuse, 11 with family factors, and 7 with neglect. Few studies looked at physical health outcomes. Fifty-one original reports related to ExACEs were included. Exposures included bullying, discrimination, exposure to violence, and harsh parenting. Mental health outcomes were most commonly reported for ACEs and ExACEs.
A total of 220 original articles concerning PCEs were included. Analytic categories were based on the HOPE (Healthy Outcomes from Positive Experience) framework, categorized as relating to environment, relationships, and social engagement. The largest volume of literature related to caregiver relationships, school environment, and opportunities for community and spiritual engagement. Much of the data was derived from a small number of surveys. PCEs were inconsistently defined.
Since 2014, many studies published in peer-reviewed journal articles have examined the roles of adverse experiences, beyond the original ACEs, and positive childhood experience. Relatively few studies investigated associations between childhood experiences and physical health outcomes. Further systematic reviews are needed to better understand the health effects of the original ACEs, to explore the inclusion of discrimination, harsh parenting, and violence exposure as ExACEs, and PCEs on their own and co-occurring with ACEs.
1. Understanding of the quantity and focus of literature investigating health effects of original ACEs, ExACEs and PCEs.
2. Identify gaps in current body of research.
3. Identify potential ExACEs.