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Abstract
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BACKGROUND: Developmental trauma depending on several factors may lead to later adult health risks and is an increasing public health concern, especially in states with predominantly rural populations. Oklahoma remains one of the highest states in America of ACEs counts, therefore more refined research methods in quantifying ACEs are vital for ensuring proper statewide interventions.
OBJECTIVE: While datasets already exist at the state level measuring specific ACEs like divorce or child abuse, the state currently lacks a single source for specific ACEs that can incorporate regions to allow for the identification of counties where ACEs are especially high. This county identification will allow for assessing trends in adversity prevalence over time, to indicate where targeted interventions should be done and which counties experience amplified long-term consequences of high ACE rates. Thus, the model for the Oklahoma Adversity Surveillance Index System (OASIS) was born - a public health tool that would map ACEs at the county level and grade them by severity over time.
METHODS: County-level data for six ACEs (mental illness, divorce, neglect, child abuse, domestic violence, and substance use) were collected from the Oklahoma Department of Human Services, Oklahoma State Department of Health, and Oklahoma Community Mental Health Centers for the years 2010-2018. First, a Potential ACEs Score (PAS) was created by standardizing and summing county rates for each ACE. To examine the temporal change in the PAS, a bivariate regression analysis was conducted. Additionally, the ACEs Severity Index (ASI) was created as a standardized measure of ACEs severity across time. This included scoring counties based on severity for each ACE individually and summing the scores to generate an overall ASI for each county, capturing the severity of all ACEs included in the analysis.
RESULTS: Mental illness and substance use showed the highest rates at the state level.
RESULTS from the regression were significant (F = 5.269, P = 0.022) showing that county PAS showed an increase as a result of year. The results of the ASI scores ranged from 0 to 6, and four Oklahoma counties (Adair, McCurtain, Muskogee, and Pittsburg) received a score of 6.
CONCLUSIONS: OASIS involves the identification of counties where ACEs are most prevalent, allowing for the prioritization of interventions in these "hot spot" counties. In addition, regression analysis showed that ACEs are increasing in Oklahoma from the year 2010 to 2018. Future efforts should center on adding additional ACEs to the ASI and correlating adverse outcome rates (such as violence, medical disorder prevalence, etc.) at the county level with high ASI scores.
Language: en |