Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK

Adverse childhood experiences (ACEs) are stressful experiences during childhood such as child maltreatment and exposure to household difficulties including domestic violence, substance abuse, mental illness and family members being in prison. This study analysed data collected from 1,880 adult residents across Wales. It found that those who reported multiple ACEs in their childhood were significantly more likely to perceive they would be unable to cope financially during the cost-of-living crisis, independent of factors including household income level, employment status and residential deprivation.

Authors: Karen Hughes, Mark Bellis+ 4 more
, Katie Cresswell, Rebecca Hill, Kat Ford, Joanne C. Hopkins

Adverse childhood experiences and engagement with healthcare services: Findings from a survey of adults in Wales and England

Adverse childhood experiences (ACEs) are associated with poorer health outcomes yet their association with healthcare engagement remains relatively underexplored, particularly within the UK. This report presents the findings of an online survey with adults resident in Wales and England, developed to explore the association between ACEs and healthcare engagement, including comfort in the use of healthcare services.

Authors: Kat Ford, Karen Hughes+ 3 more
, Katie Cresswell, Rebekah Amos, Mark Bellis

Keeping warm at home during winter in Wales: Differences in heating behaviours, coping strategies, and wellbeing from 2022 to 2023

People’s homes can have a significant impact on their health and well-being. This includes the ability to keep warm at home during winter. This report describes the findings of a national household survey of residents in Wales aged 18 years and over between January to March 2022 (wave one) and repeated between January to March 2023 (wave two). The findings use a sample of 507 participants who completed both survey waves.

Authors: Kat Ford, Nicholas Carella+ 5 more
, Rebecca Hill, Hayley Janssen, Lauren Heywood, Daniella Griffiths, Sumina Azam

The Commercial Determinants of Violence: Identifying Opportunities for Violence Prevention through a Public Health-Based Framework Analysis

This paper uses a conceptual framework for the commercial determinants of health to map the potential commercial determinants of violence. It examines commercial practices directly linked with violence (e.g., firearms) and those that indirectly impact violence through the design and promotion of products; employment practices; and impacts on environment, poverty, and local resources. The paper aims to apply the framework to consider its utility for identifying risk and protective factors for violence, existing good practices, challenges, and opportunities for violence prevention.

Authors: Mark Bellis, Sally McManus+ 3 more
, Karen Hughes, Olumide Adisa, Kat Ford

Cold indoor temperatures and their association with health and well-being: a systematic literature review

Evidence suggests that indoor temperatures <18°C are associated with negative health effects. This study aimed to identify, appraise and update evidence on the association between cold temperatures (i.e. <18°C) within homes (i.e. dwellings) and health and well-being outcomes. Significant gaps in the current evidence base are identified, including research on the impacts of cold indoor temperatures on mental health and well-being, studies involving young children, and the long-term health effects of cold indoor temperatures.

Authors: Hayley Janssen, Kat Ford+ 5 more
, Ben Gascoyne, Rebecca Hill, Manon Roberts, Mark Bellis, Sumina Azam

The rising cost of living and health and wellbeing in Wales: a national survey

Households across Wales and worldwide are experiencing an increase in the cost of living. Since late 2021, price rises for basic items such as food and energy have outstripped increases in average wages and welfare payments, leading to a fall in real disposable incomes. As a result, increasing pressure on household budgets is making it harder for people to afford the basics and is often referred to as a ‘cost of living crisis’. This report presents the findings of a survey developed to understand how the cost of living crisis is affecting health and wellbeing among the Welsh public; their approaches and decision-making relating to rising living costs; and their awareness of and access to financial support and schemes.

Authors: Rebecca Hill, Karen Hughes+ 3 more
, Katie Cresswell, Kat Ford, Mark Bellis

Measuring changes in adult health and well-being during the COVID-19 pandemic and their relationship with adverse childhood experiences and current social assets: a cross-sectional survey

Adverse childhood experiences (ACEs) can impact mental and physical health, leaving people with less resilience to health challenges across the life-course. This study examines whether individuals’ levels and changes in levels of mental health, physical health and sleep quality reported across the first year of the COVID-19 pandemic are associated with ACEs and moderated by social assets such as having trusted family and friends.

Authors: Mark Bellis, Karen Hughes+ 2 more
, Kat Ford, Helen Lowey

Comparing relationships between single types of adverse childhood experiences and health related outcomes across the life course: a combined primary data study of eight surveys

Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms.

Authors: Mark Bellis, Karen Hughes+ 2 more
, Katie Cresswell, Kat Ford

Cold homes and their association with health and well-being: a systematic literature review

As part of a wider project to determine whether current indoor temperature standards for households in Wales are optimal for people’s comfort, health, and well-being, this review aims to identify and appraise the current evidence on the association between cold homes and health and well-being.

Authors: Hayley Janssen, Ben Gascoyne+ 4 more
, Kat Ford, Rebecca Hill, Manon Roberts, Sumina Azam

Associations between Adverse Childhood Experiences (ACEs) and Lifetime Experience of Car Crashes and Burns: A Cross-Sectional Study

Using a UK general population sample, this study has identified relationships between exposure to ACEs and lifetime experience of car crashes and burns; two major markers of unintentional injury. Findings highlight the need for effective interventions to prevent ACEs and reduce their impacts on health and well-being. A better understanding of the relationships between ACEs and unintentional injury, and the mechanisms that link childhood adversity to injury risks, can benefit the development of multifaceted approaches to injury prevention.

Authors: Kat Ford, Karen Hughes+ 3 more
, Katie Cresswell, Nel Griffith, Mark Bellis

Parental adverse childhood experiences and perpetration of child physical punishment in Wales

In 2022, Wales joined the growing number of countries to ban physical punishment of children in all settings. Using data collected a year prior to legislative change, this study explores relationships between Welsh parents’ exposure to ACEs whilst growing up and their use of physical punishment towards children.

Authors: Karen Hughes, Kat Ford+ 2 more
, Mark Bellis, Rebekah Amos

Adverse childhood experiences and their relationship with poor sexual health outcomes: results from four cross-sectional surveys

Improving understanding of risk factors for risky sexual behaviour is fundamental to achieve better population sexual health. This study explored associations between ACEs and poor sexual health outcomes in the UK. Findings highlight the need for effective interventions to prevent and ameliorate the lifelong effects of ACEs. Trauma-informed relationships and sex education, sexual health services, and antenatal/postnatal services, particularly for teenagers and young parents, could provide opportunities to prevent ACEs and support those affected.

Authors: Sara Wood, Kat Ford+ 4 more
, Hannah Madden, Catherine Sharp, Karen Hughes, Mark Bellis

The use of mobile phone applications to enhance personal safety from interpersonal violence – an overview of available smartphone applications in the United Kingdom

Interpersonal violence has devastating implications for individuals, families, and communities across the globe, placing a significant burden on health, justice, and social welfare systems. Smartphone technology may provide a platform for violence prevention interventions. This paper explores the evidence on the availability and user experience of UK smartphone applications aimed to prevent violence and improve personal safety. The findings have implications for the development of policy on applications to improve personal safety, especially given recent national policy (e.g. UK) discussions about their utility.

Authors: Kat Ford, Mark Bellis+ 3 more
, Natasha Judd, Nel Griffith, Karen Hughes

Adverse childhood experiences and COVID-19 in Bolton

This report seeks to explore, for the Bolton population, any association between ACE exposure and COVID-19 infection. It will also seek to identify if ACE exposure is associated with: trust in COVID-19 health information; attitudes towards, and compliance with COVID-19 restrictions (e.g. use of face coverings, social distancing); and attitudes towards COVID-19 vaccination. A better understanding of such relationships will help local services understand how they can encourage compliance with public health restrictions and vaccine uptake; information crucial for targeting health messaging and the management of threats to public health, including future pandemics.

Authors: Kat Ford, Karen Hughes+ 2 more
, Hayley Janssen, Mark Bellis

An evaluation of a short film promoting kindness in Wales during COVID-19 restrictions #TimeToBeKind

In response to successive COVID-19 restrictions in Wales, the Welsh ACE Support Hub launched the #TimeToBeKind campaign in March 2021. The campaign used a short film broadcast on national television and promoted on social media to encourage behaviour change for kindness. This manuscript evaluates the #TimeToBeKind campaign film. Findings strongly indicated that film can be an effective tool to promote behaviour change for kindness and that even films that provoke strong emotional reactions can be positively perceived and lead to behaviour change. The findings of the evaluation are relevant to how public health messaging can adapt and utilise online space to target individuals and promote behaviour change.

Authors: Kat Ford, Mark Bellis+ 2 more
, Rebecca Hill, Karen Hughes

Maternal adverse childhood experiences and their association with preterm birth: secondary analysis of data from universal health visiting

Being born before full gestation can have short-term and life-long health implications, yet it remains difficult to determine the risk of preterm birth among expectant mothers. Across different health settings, increasing attention is given to the health and behavioural consequences of adverse childhood experiences (ACEs) such as child abuse or neglect, or exposure to harmful household environments (e.g. in which caregivers abuse alcohol), and the potential value of understanding these hidden harms when supporting individuals and families. A large international evidence base describes the association between childhood adversity and early years outcomes for mothers and children. However, the relationship between maternal ACEs and preterm birth has received far less attention.

Authors: Katie Hardcastle, Kat Ford+ 1 more
, Mark Bellis

Associations between adverse childhood experiences, attitudes towards COVID-19 restrictions and vaccine hesitancy: a cross-sectional study

Childhood adversity has been shown to be linked to poorer mental well-being, with some studies suggesting it may lead to reduced trust in health and other public services. Research conducted with adults in Wales identified that vaccine hesitancy was three times higher among people who had experienced four or more types of childhood trauma than it was among those who hadn’t experienced any.

Authors: Mark Bellis, Karen Hughes+ 4 more
, Kat Ford, Hannah Madden, Freya Glendinning, Sara Wood

Adverse childhood experiences (ACEs) in Bolton: Impacts on health, wellbeing and resilience

There is substantial evidence identifying the detrimental impacts that adverse childhood experiences (ACEs) can have on individuals’ health, wellbeing and broader life opportunities. A number of studies in the UK have identified the prevalence and impacts of ACEs at a national level, yet few studies have been undertaken at a local level. Understanding how local populations are affected by ACEs can enable local authorities and partnerships to tailor their support services, targeting resources to the health needs of the populations they serve. This study was implemented by Public Health Wales and Bangor University on behalf of Bolton Council to understand the impact of ACEs on the health and wellbeing of adults in the Bolton Local Authority area. The study explores:
■ The prevalence of ACEs in Bolton Local Authority;
■ Relationships between ACEs and health and wellbeing;
■ Resilience factors that may offer protection against the harmful impacts of ACEs.

Authors: Kat Ford, Karen Hughes+ 1 more
, Mark Bellis

Adult support during childhood: a retrospective study of trusted adult relationships, sources of personal adult support and their association with childhood resilience resources

Adverse childhood experiences (ACEs) can affect health and well-being across the life course. Resilience is an individual characteristic that is known to help negate the effect of adversities and potentially transform toxic stress into tolerable stress. Having access to a trusted adult during childhood is critical to helping children build resiliency. This paper aims to understand the relationship between always having access to trusted adult support and childhood resilience resources, and examine which sources of personal adult support and the number of sources of adult support, best foster childhood resilience.

Authors: Kathryn Ashton, Alisha Davies+ 4 more
, Karen Hughes, Kat Ford, Andrew Cotter-Roberts, Mark Bellis

The annual costs of adverse childhood experiences (ACEs) in Wales

An infographic highlighting the annual costs of adverse childhood experiences (ACEs) in Wales. ACEs increase individuals’ risks of adopting health-harming behaviours and developing ill health. ACE survey data was used to calculate the proportion of key health risk behaviours and health conditions attributable to ACEs and estimate the associated annual costs to Wales.

Authors: Karen Hughes, Kat Ford+ 1 more
, Mark Bellis

Adverse childhood experiences: a retrospective study to understand their impact on mental illness, self-harm and suicide attempt in a male Welsh prison population

Prisoners are at increased risk of poor mental health and self-harming behaviours, with suicide being the leading cause of death in custody. Adverse childhood experiences (ACEs) such as child maltreatment are strong predictors of poor mental health and wellbeing yet despite high levels of ACEs in offender populations, relatively few studies have explored the relationships between ACEs and prisoners’ mental health and wellbeing.

Authors: Kat Ford, Mark Bellis+ 3 more
, Karen Hughes, Emma Barton, Annemarie Newbury

Inspiration from ACE Interrupters in Great Britain

Sharing the stories of individuals who have made a remarkable difference to those affected by Adverse Childhood Experiences (ACEs).

Authors: Katie Hardcastle, Mark Bellis+ 4 more
, Kat Ford, Katy Hetherington, Joanne C. Hopkins, Emma Clark

Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a meta-analysis

An increasing number of studies are identifying associations between adverse childhood experiences (ACEs) and ill health throughout the life course. We aimed to calculate the proportions of major risk factors for and causes of ill health that are attributable to one or multiple types of ACE and the associated financial costs.

Authors: Mark Bellis, Karen Hughes+ 4 more
, Kat Ford, Gabriela Ramos Rodriguez, Dineshi Sethi, Jonathon Passmore

Understanding the association between self-reported poor oral health and exposure to adverse childhood experiences: a retrospective study

Adverse childhood experiences, including physical, sexual or emotional abuse, can have detrimental impacts on child and adult health. However, little research has explored the impact that such early life experiences have on oral health. This study examines whether experiencing adverse childhood experiences before the age of 18 years is associated with self-reported poor dental health in later life.

Authors: Kat Ford, Paul Brocklehurst+ 3 more
, Karen Hughes, Catherine Sharp, Mark Bellis