Assessing the interrelatedness of multiple types of adverse childhood experiences and odds for poor health in South Carolina adults

Adverse childhood experiences (ACEs) have been linked to negative health outcomes in adulthood, but little research has been done on the effect of ACEs on the health and well-being of adults in South Carolina (SC). This study analyzed a sample of 9744 respondents who participated in the 2014 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship among childhood experiences of physical, sexual, and emotional abuse, as well as witnessing household violence, on mental and physical health outcomes in adulthood among SC residents. Twenty-two percent of survey respondents reported poor general health (22.1%), and a smaller proportion reported high frequent mental distress in the past month (13.1%). Each category of childhood experiences was associated with an increase in the risk of poor general health. Individuals reporting three or more types of experiences were more likely to report poor health (aOR 2.89; 95% CI 2.86–2.92) than adults without such experiences. Respondents reporting three or more types of childhood adverse experiences were more likely to report frequent mental distress (aOR 3.29; 95% CI 3.26–3.33) compared to adults who did not report three or more types of adversity. Findings from the SC BRFSS highlight a connection between ACEs and negative health outcomes later in life. Given that results of this study also demonstrated that increased exposure to ACEs was associated with greater odds of negative health in adulthood, preventing adverse events such as experiencing abuse or witnessing domestic violence in childhood will have significant effects on later adult health.     

Childhood sexual abuse,risky sexual behaviors and adverse reproductive health outcomes among Chinese college students

BackgroundChildhood sexual abuse (CSA) is a serious public health problem worldwide.ObjectivesWe reported the prevalence of CSA and examined its association with risky sexual behaviors and adverse reproductive health outcomes among college students in China.Participants and settingParticipants were 17,966 college students from 130 colleges in Eastern, Central, and Western China, who completed the online questionnaire in January–August 2015.MethodsData were obtained from a cluster-random Internet-based survey. Multivariate logistic regression analyses were employed: risky sexual behaviors and adverse reproductive health outcomes were outcome variables, and various types of CSA were predictor variables, while adjusting for socio-demographic and lifestyle characteristics.ResultsThe overall prevalence of any type of CSA was 27.5%. Most perpetrators were friends/acquaintances (34.6%) or intimate partners (24.7%) of the victims. Respondents who reported penetrative CSA were strongly associated with regular unprotected sex (odds ratio (OR): 3.0, 95% confidence interval (CI): 2.2–4.0), early sexual debut (OR: 5.5, 95% CI: 3.3–9.1), having genital tract symptoms in the last 12 months (OR: 5.0, 95% CI: 4.1–6.0), unintended pregnancy (OR: 6.2, 95% CI: 4.2–9.0), and induced abortion (OR: 5.5, 95% CI: 3.7–8.2) (for boys, the survey asked about history of unintended pregnancy and induced abortion of their sexual partners). A dose-response relationship was found across non-contact, contact, and penetrative CSA.ConclusionsCSA experience may increase the likelihood of risky sexual behaviors and adverse reproductive health outcomes in victims’ early adulthood.     

Growing up with parental alcohol abuse: exposure to childhood abuse, neglect, and household dysfunction

OBJECTIVE: This study is a detailed examination of the association between parental alcohol abuse (mother only, father only, or both parents) and multiple forms of childhood abuse, neglect, and other household dysfunction, known as adverse childhood experiences (ACEs). METHOD: A questionnaire about ACEs including child abuse, neglect, household dysfunction, and exposure to parental alcohol abuse was completed by 8629 adult HMO members to retrospectively assess the relationship of growing up with parental alcohol abuse to 10 ACEs and multiple ACEs (ACE score). RESULTS: Compared to persons who grew up with no parental alcohol abuse, the adjusted odds ratio for each category of ACE was approximately 2 to 13 times higher if either the mother, father, or both parents abused alcohol (p < 0.05). For example, the likelihood of having a battered mother was increased 13-fold for men who grew up with both parents who abused alcohol (OR, 12.7; 95% CI: 8.4-19.1). For almost every ACE, those who grew up with both an alcohol-abusing mother and father had the highest likelihood of ACEs. The mean number of ACEs for persons with no parental alcohol abuse, father only, mother only, or both parents was 1.4, 2.6, 3.2, and 3.8, respectively (p < .001). CONCLUSION: Although the retrospective reporting of these experiences cannot establish a causal association with certainty, exposure to parental alcohol abuse is highly associated with experiencing adverse childhood experiences. Improved coordination of adult and pediatric health care along with related social and substance abuse services may lead to earlier recognition, treatment, and prevention of both adult alcohol abuse and adverse childhood experiences, reducing the negative sequelae of ACEs in adolescents and adults.     

The impact of drop-in centers on the health of street children in New Delhi,India: A cross-sectional study

Objectives(1) To determine whether street children who visit drop-in centers experience better physical and mental health, and engage in less substance use than street children who do not visit centers. (2) To determine whether the duration of attendance at a center has an impact on the above outcomes.MethodsWe conducted a cross-sectional study with 69 street children from two drop-in centers in New Delhi, India (attenders) and a comparison group of 65 street children who did not visit drop-in centers (non-attenders). We used pretested questionnaires to assess their physical health, substance use status and mental health.ResultsAttenders experienced fewer ill health outcomes, engaged in less substance use, and had better mental health outcomes than non-attenders (p < 0.01). For every month of attendance at a drop-in center, street children experienced 2.1% (95% CI 0% to 4.1%, p = 0.05) fewer ill health outcomes per month and used 4.6% (95% CI 1.3% to 8%, p = 0.01) fewer substances. Street children were also less likely to have been a current substance user than a never substance user for every additional month of attendance at a center (OR: 0.79, 95% CI: 0.66–0.96, p = 0.02). Duration of drop-in center attendance was not a significant factor in predicting mental health problems.ConclusionDrop-in centers may improve the physical health of street children and reduce their substance abuse. Rigorous longitudinal studies are needed to better determine if drop-in centers impact the health and substance use status of street children in LMICs.     

Adverse childhood experiences,mental health,and excessive alcohol use: Examination of race/ethnicity and sex differences

Responses from N = 60,598 interviews from the 2010 Behavioral Risk Factor Surveillance System (the 10 states and the District of Columbia that included the optional Adverse Childhood Experience (ACE) module) were used to test whether associations between childhood adversity and adult mental health and alcohol behaviors vary by race/ethnicity and sex. ACE items were categorized into two types – household challenges and child abuse. Outcomes were current depression, diagnosed depression, heavy drinking and binge drinking. Logistic regression models found ACEs significantly associated with depression and excessive alcohol use, but sex did not moderate any relationships. Race/ethnicity moderated the relationship between ACEs and heavy drinking. In stratified analyses, compared to those not exposed to ACEs, non-Hispanic blacks who experienced either type of ACE were about 3 times as likely to drink heavily; Non-Hispanic whites who experienced child abuse or both ACE types were 1.5–2 times as likely to drink heavily; and Hispanics who experienced household challenges or both ACE types were 1.2 and 11 times as likely to report heavy drinking. ACEs impact depression and excessive alcohol use similarly across men and women. With the exception of heavy drinking, ACEs appear to have the same association with excessive alcohol use across race/ethnicity. It may be prudent to further investigate why the relationship between ACEs and heavy drinking may differ by race/ethnicity such that prevention strategies can be developed or refined to effectively address the needs of all sub-groups.     

Adverse experiences in early childhood and their longitudinal impact on later behavioral problems of children living in poverty

BackgroundAdverse childhood experiences (ACEs) are an identified risk factor for the social and emotional development of children. What is less known is the long-term effects of ACEs when poverty and ACEs coincide.ObjectiveUsing longitudinal cohort-panel data, we examined whether exposure to ACEs by the age of three among poor children would longitudinally result in behavioral problems at ages three, five, nine, and 15, after controlling for mothers’ socioeconomic status and their children’s characteristics.Participants and settingWe used a subsample of 2750 children and their parents living in urban poverty from the Fragile Families and Child Wellbeing study.MethodsLogistic regression modeling was used to obtain adjusted odds ratios of ACE categories predicting behavioral problems after accounting for family socioeconomic position.ResultsOur findings indicate that experiencing ACEs in early childhood was significantly associated with later behavioral outcomes from childhood to adolescence. Exposure to multiple ACEs before the age of three was significantly associated with the top-risk behavior group at age five; the odd ratios were 2.0 (CI = 1.3–3.1) and 2.9 (CI = 1.8–4.6) for two ACEs and three or more ACEs, respectively. At both ages nine and 15, children experiencing two or more ACEs had 1.9 to 3.2 times higher odds to demonstrate more the top 10th percentile of behavioral problems. Among covariates, mothers’ race and education, and children’s gender and temperament were identified as significant factors to determine behavior problems.ConclusionsThe findings support policies and programs for families with children who have experienced economic disadvantages and early childhood adversity.     

Adverse childhood experiences and deleterious outcomes in adulthood: A consideration of the simultaneous role of genetic and environmental influences in two independent samples from the United States

BackgroundAdverse childhood experiences (ACEs) are a potent risk factor. Despite these findings, studies have also recognized the importance of considering additional sources of genetic and environmental influence that cluster within families.ObjectiveTo properly control for latent sources of genetic and within-family environmental influences and isolate the association between ACEs and the following outcomes in adulthood: physical health, depressive symptoms, educational attainment, income attainment, alcohol problems, and antisocial behavior.Participants and SettingTwo independent samples of twins and siblings from the United States: the Midlife Development in the United States (MIDUS) study (N = 862) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 3112).MethodsSibling comparison models, which control for latent sources of genetic and within-family environmental influences, were estimated to examine whether differential exposure to ACEs was associated with the examined outcomes.ResultsFamilies that experienced more adversity also experienced more deleterious outcomes. However, siblings that experienced more adversity were no more likely to experience deleterious outcomes than their co-siblings. However, greater exposure to ACEs was associated with increases in depressive symptoms (Add Health). Additional models revealed that the similarity between siblings from the same family stemmed from latent sources of within-family environmental influences not captured by traditional ACEs measures.ConclusionsConsidering genetic influences and additional latent sources of within-family influences is crucial in isolating the effects of ACEs. Currently employed ACEs measures may not adequately capture the full range of impactful sources of family-level environmental influence.     

Associations between childhood deaths and adverse childhood experiences: An audit of data from a child death overview panel

BackgroundDespite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality.MethodsThis study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012–2016) of cases from a CDOP in North West England were examined.ResultsOf 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72–86.59) times more likely (than those with 0 ACEs) to be classified as ‘avoidable and non-natural’ causes (e.g., injury, abuse, suicide; compared with ‘genetic and medical conditions’). Such children were also 3.44 (1.75–6.73) times more likely to have their deaths classified as ‘chronic and acute conditions’.ConclusionsThis study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from ‘chronic and acute conditions’ suggest that ACEs may be important factors in child deaths in addition to those classified as ‘avoidable and non-natural’. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses.     

Childhood abuse and community violence: Risk factors for youth violence

ObjectiveTo investigate the joint effect of child abuse and neglect (CAN) and community violence (CV) on adolescents with peers that commit youth violence (YV).MethodsThis is a school-based cross-sectional study of 699 students enrolled in four public and nine private schools in the municipality of Rio de Janeiro, Brazil. Participants were selected through a complex cluster sampling procedure. CAN was identified using the Childhood Trauma Questionnaire (CTQ). Exposure to CV was assessed by asking students if they have witnessed cases of lethal violence in the community. YV was measured indirectly through questions about having friends who have committed acts of crime. Multivariate logistic models were used to study the effects of emotional, physical, and sexual abuse and emotional and physical neglect in childhood on YV, controlled for confounders, according to different levels of CV.ResultsEmotional abuse OR = 3.32 (CI 95%: 1.79–6.17), sexual abuse OR = 2.33 (CI 95%: 1.20–4.54), and physical neglect OR = 1.81 (CI 95%: 1.02–3.20) increased the odds of YV in adolescents, whether cooccurring with CV or not. Physical abuse OR = 3.95 (CI 95%: 2.29 - 6.80) and emotional neglect OR = 2.93 (CI 95%: 1.83–4.72) are only risk factors for YV involvement when associated with CV.ConclusionsThese findings highlight the relevance of CAN and CV as risk factors for YV and the potential increase in adolescents’ vulnerability when exposed to both. Policies aiming at preventing and dealing with CAN are essential strategies to reduce YV, especially in areas with high levels of CV.     

Prevalence and correlates of physical abuse in Hong Kong Chinese adolescents: a population-based approach.

OBJECTIVE: The objectives were to estimate the prevalence and correlates of physical abuse-related outcomes in the family setting in Hong Kong's adolescent population. METHOD: A cross-sectional study design was used. A randomly selected sample of 3,355 secondary school students in Kwai Tsing District of Hong Kong was surveyed. The response rate was 98%. RESULTS: The prevalence rates of corporal punishment, being beaten by parents for no apparent reason, being beaten to injury by family members in the past 3 months and any one of the above three were 4.9% (95% CI, 4.2% to 5.6%), 2.0% (95% CI, 1.5% to 2.5%), 1.1% (95% CI, .98% to 1.2%) and 6.6% (95% CI, 5.7% to 7.5%), respectively. Students who had experienced the above physical abuse-related outcomes were at a significant disadvantage for a wide range of morbidity indicators, including self-perceived bad health, anxiety and stress, somatic illnesses (such as asthma and epigastric pain), injuries and accidents, and hospitalization. They were more likely to have poor familial relations and coping skills, and to take up habits which potentially put their health at risk, such as smoking, alcohol consumption, and fighting with others. CONCLUSIONS: Our prevalence estimates of physical abuse in the family setting for a student population in Hong Kong is an improvement over previous local estimates of physical abuse occurrence, which were mainly based on case notifications and clinical samples. The results also show that the abused adolescents are growing up in an environment filled with physical, psychological, and familial adversities.     

Prevalence of adverse childhood experiences (ACEs) among US children

ObjectiveThe purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs.MethodsData were drawn from the nationally representative 2016 National Survey of Children’s Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs.ResultsThe study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child’s age, family structure, poverty, type of health insurance, and SHCN status.ConclusionsWe found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level.     

Adverse childhood experiences (ACE) and adult attachment interview (AAI) in a non-clinical population

Adverse childhood experiences (ACE) tend to be interrelated rather than independently occurring. There is a graded effect associated with ACE exposure and pathology, with an increase when ACE exposure is four or more. This study examined a sample of active individuals (n = 129) to determine distribution patterns and relationships between ACEs, attachment classification, unresolved mourning (U), and disclosure difficulty. The results of this study demonstrated a strong relationship between increased ACEs and greater unresolved mourning. Specifically, the group differences for individuals who experienced no ACE (n = 42, 33%), those with 1–3 ACEs (n = 48, 37.8%), and those with ≥4 ACEs (n = 37, 29.1%) revealed a pattern in which increased group ACE exposure was associated with greater lack of resolution for past trauma/loss experiences, more adult traumatic events, and more difficulty disclosing past trauma. Despite ≥4 ACEs, 51.4% of highly exposed individuals were classified as secure in the Adult Attachment Interview. Resilience in this group may be related to a combination of attachment security, college education, and engagement in meaningful activities. Likewise, adversity may actually encourage the cultivation of more social support, goal efficacy, and planning behaviors; factors that augment resilience to adversity.     

Self-reported adverse childhood experiences and quality of life among children in the two last grades of Dutch elementary education

BackgroundAdverse Childhood Experiences (ACEs) may have a life-long impact on mental health and are related to physical disease, such as diabetes and cardiovascular diseases in adulthood. Research on ACEs suffers from recall bias when performed with adults.ObjectiveTo estimate the prevalence of ACEs and the interrelationships between ACEs as reported by children, and to determine the impact on their self-reported quality of life (QoL). Children’s opinions on the ACE-Questionnaire were also obtained.MethodA cross-sectional study was conducted with a child version of the ACE-Questionnaire. This questionnaire assesses parental separation or divorce, physical and emotional child abuse and neglect, sexual violence, domestic violence, household substance abuse, psychological issues or suicide, and incarceration of a household member. QoL was measured with the Kidscreen-10.Participants and settingThe questionnaire was completed by 644 children at a mean age of 11 years (range 9–13 years), in the two last grades of regular elementary schools, recruited throughout the Netherlands.ResultsData were weighted by ethnicity to obtain a representative sample of children in Dutch elementary education. Of all children, 45.3% had one or more out of ten ACEs. Child maltreatment was experienced by 26.4%. ACEs often co-occurred. A higher number of ACEs correlated with a lower mean level of QoL (p < 0.001). Mean QoL was 8.5 points lower (Cohen’s d = 0.8) in children who experienced child maltreatment. Children’s opinions on the questionnaire were positive in 82.4%.ConclusionPrevention of ACEs, professional training and trauma-focus in schools are urgently needed.     

ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health

BackgroundNumerous studies over the past two decades have found a link between adverse childhood experiences (ACEs) and worse adult health outcomes. Less well understood is how advantageous childhood experiences (counter-ACEs) may lead to better adult health, especially in the presence of adversity.ObjectiveTo examine how counter-ACEs and ACEs affect adult physical and mental health using Resiliency Theory as the theoretical framework.Participants and settingParticipants were Amazon mTurk users ages 19–57 years (N = 246; 42% female) who completed an online survey.MethodsWe conducted a series of regression analyses to examine how counter-ACEs and ACEs predicted adult health.ResultsCorresponding to the Compensatory Model of Resiliency Theory, higher counter-ACEs scores were associated with improved adult health and that counter-ACEs neutralized the negative impact of ACEs on adult health. Contrary to the Protective Factors Model, there was a stronger relationship between ACEs and worse adult health among those with above average counter-ACEs scores compared to those with below average counter-ACEs scores. Consistent with the Challenge Model, counter-ACEs had a reduced positive effect on adult health among those with four or more ACEs compared to those with fewer than four ACEs.ConclusionsOverall, the findings suggest that counter-ACEs protect against poor adult health and lead to better adult wellness. When ACEs scores are moderate, counter-ACEs largely neutralize the negative effects of ACEs on adult health. Ultimately, the results demonstrate that a public health approach to promoting positive childhood experiences may promote better lifelong health.     

Maternal adverse childhood experiences,attachment style,and mental health: Pathways of transmission to child behavior problems

BackgroundInvestigations have found mothers’ adverse childhood experiences (ACEs) confer an intergenerational risk to their children's outcomes. However, mechanisms underlying this transmission have only been partially explained by maternal mental health. Adult attachment insecurity has been shown to mediate the association of ACEs and mental health outcomes, yet an extension of this research to children's behavioral problems has not been examined.ObjectiveTo examine the cascade from maternal ACEs to risk for child behavioral problems at five years of age, via mothers’ attachment insecurity and mental health.Participants and settingParticipants in the current study were 1994 mother-child dyads from a prospective longitudinal cohort collected from January 2011 to October 2014.MethodsMothers retrospectively reported their ACEs when children were 36 months of age. When children were 60 months of age, mothers completed measures of their attachment style, depression and anxiety symptoms, and their children's behavior problems.ResultsPath analysis demonstrated maternal ACEs were associated with children's internalizing problems indirectly via maternal attachment avoidance, attachment anxiety, and depression symptoms, but not directly (β = .05, 95% CI [−.001, .10]). Maternal ACEs indirectly predicted children's externalizing problems via maternal attachment avoidance, attachment anxiety, and depression. A direct effect was also observed from maternal ACEs to child externalizing problems (β = .06, 95% CI [.01, .11]).ConclusionsMaternal ACEs influenced children's risk for poor behavioral outcomes via direct and indirect intermediary pathways. Addressing maternal insecure attachment style and depression symptoms as intervention targets for mothers with histories of ACEs may help to mitigate the intergenerational transmission of risk.     

Suicidality among young adults: Unique and cumulative roles of 14 different adverse childhood experiences

BackgroundCollege students with suicidal ideation (SI) are at high risk of suicide. Adverse childhood experiences (ACEs) are important risk factors for suicidal behavior. Most research in this area has been restricted to 10 conventional ACEs and suggests negative long-term developmental effects from other common childhood adversities such as peer victimization, peer isolation/rejection, exposure to community violence, and low socioeconomic status.ObjectiveTo test the unique and cumulative associations of 14 different ACEs with SI among young adults.Participants and SettingParticipants were 989 college students from two universities in China’s provincial-leveled Hui Autonomous Region.MethodsAssociations between ACEs and SI were analyzed by logistic regression. A Chi-square trend test was used to examine the association between cumulative ACEs and SI.ResultsThe rates of suicidal ideation, plans, and attempts among the cohort were 11.9%, 3.7%, and 1.6%, respectively; 43.9% had experienced at least one ACE. The strongest predictor of SI in adulthood was peer isolation/rejection, followed by emotional neglect, then low socioeconomic status. There was a cumulative effect of ACEs and SI, whereby the greater the number of ACEs, the greater the likelihood of SI.ConclusionPeer isolation/rejection, emotional neglect, and low socioeconomic status were associated with increased risk of SI in adulthood. Two (peer isolation/rejection and low socioeconomic status) of the three factors that emerged from the analysis are not typically included in ACEs research. There was a cumulative effect of 14 kinds of ACEs on SI among young adults. Early recognition of risk factors is therefore important.     

Coerced and forced sexual initiation and its association with negative health outcomes among youth: Results from the Nigeria,Uganda, and Zambia Violence Against Children Surveys

IntroductionCoerced and forced sexual initiation (FSI) can have detrimental effects on children and youth. Understanding health outcomes that are associated with experiences of FSI is important for developing appropriate strategies for prevention and treatment of FSI and its consequences.MethodsThe Violence Against Children Surveys were conducted in Nigeria, Uganda, and Zambia in 2014 and 2015. We examined the prevalence of FSI and its consequences (sexual high-risk behaviors, violence experiences, mental health outcomes, and sexually transmitted infections (STI)) associated with FSI among youth aged 13–24 years in three countries in sub-Saharan Africa.ResultsOver one in ten youth aged 13–24 years who had ever had sex experienced FSI in Nigeria, Uganda, and Zambia. In multivariable logistic regression, FSI was significantly associated with infrequent condom use (OR = 1.4, 95%CI = 1.1–2.1), recent experiences of sexual violence (OR = 1.6, 95%CI: 1.1–2.3), physical violence (OR = 2.2, 95%CI: 1.6–3.0), and emotional violence (OR = 2.0, 95%CI: 1.3–2.9), moderate/serious mental distress (OR = 1.5, 95%CI: 1.1–2.0), hurting oneself (OR = 2.0, 95%CI: 1.3–3.1), and thoughts of suicide (OR = 1.5, 95%CI: 1.1–2.3), after controlling for demographic characteristics. FSI was not statistically associated with engaging in transactional sex, having multiple sex partners, or having a STI.ConclusionFSI is associated with infrequent condom use, recent experiences of violence and mental health outcomes among youth in sub-Saharan Africa, which may increase the risk for HIV and other consequences. Developing strategies for prevention is important for reducing the prevalence of FSI and its effects on children and youth.     

Incorporating radiology into medical gross anatomy: Does the use of cadaver CT scans improve students' academic performance in anatomy?

Radiological images show anatomical structures in multiple planes and may be effective for teaching anatomical spatial relationships, something that students often find difficult to master. This study tests the hypotheses that (1) the use of cadaveric computed tomography (CT) scans in the anatomy laboratory is positively associated with performance in the gross anatomy course and (2) dissection of the CT‐scanned cadaver is positively associated with performance on this course. One hundred and seventy‐nine first‐year medical students enrolled in gross anatomy at Boston University School of Medicine were provided with CT scans of four cadavers, and students were given the opportunity to choose whether or not to use these images. The hypotheses were tested using logistic regression analysis adjusting for student demographic characteristics. Students who used the CT scans were more likely to score greater than 90% as an average practical examination score (odds ratio OR 3.6; 95% CI 1.4, 9.2), final course grade (OR 2.6; 95% CI 1.01, 6.8), and on spatial anatomy examination questions (OR 2.4; 95% CI 1.03, 5.6) than were students who did not use the CT scans. There were no differences in performance between students who dissected the scanned cadavers and those who dissected a different cadaver. These results demonstrate that the use of CT scans in medical gross anatomy is predictive of performance in the course and on questions requiring knowledge of anatomical spatial relationships, but it is not necessary to scan the actual cadaver dissected by each student. Anat Sci Educ 3: 56–63, 2010. © 2010 American Association of Anatomists.