Resources

Abuse and other adversities in community-dwelling older adults in Wales: associations with health and well-being

This report presents findings from a national household survey of adults aged 60 years and over in Wales. The survey asked about a range of adverse experiences since the age of 60, including exposure to abuse, feeling lonely or socially isolated, struggling financially, being unable to access health or social care, and feeling overwhelmed by caregiving responsibilities. The report examines relationships between these five experiences and participants’ health and wellbeing, including self-rated bad health, alcohol and tobacco use, mental health, life satisfaction and ageism experience. It finds that abuse, feeling lonely or socially isolated and struggling financially in later life are independently associated with poorer health.

Childhood Poverty and ACEs

This study, published in the journal BMC Public Health, examined the role of adverse childhood experiences (ACEs) and childhood poverty in life course health and prosperity.

Using a sample of 5,330 adults from five local authorities in England, the study found that ACEs were significantly related to childhood poverty. Both ACEs and childhood poverty were associated with poorer life outcomes, including for self-rated health, chronic health conditions, mental well-being, employment and income.

The findings underscore the need for investment in interventions and policies to prevent intergenerational cycles of abuse and poverty.

Winter well-being: shared actions and impact

A new report by Public Health Wales brings together the latest evidence, behavioural insights and practical tools to support health and care colleagues and services in preparing for the winter months.

The report, Winter Well-being: Shared Actions and Impact, is designed to complement existing NHS and Welsh Government winter planning frameworks. It provides actionable guidance and checklists to help teams strengthen system resilience, maintain population health, and ease demand on services.

The report also highlights the importance of prevention, including protecting against winter viruses by getting vaccinated against flu, RSV and COVID-19, staying active, eating warm meals, checking in on neighbours, and taking vitamin D daily to stay healthy through the colder months.

Comparative relationships between physical and verbal abuse of children, life course mental well-being and trends in exposure: a multi-study secondary analysis of cross-sectional surveys in England and Wales

This study examined relationships between physical and verbal abuse in childhood and adult mental well-being. The study, published in the journal BMJ Open, used data from surveys conducted in Wales and England between 2012 and 2024. It found that childhood verbal abuse was associated with similar increases in risk of low mental well-being as childhood physical abuse. The study also measured trends in self-reported physical and verbal abuse across birth cohorts.

Trauma Exposure in Adulthood and Suicidal Experiences in Military Members and Veterans: A Systematic Review and Meta-analysis

Research has consistently shown a higher prevalence of mental health challenges and suicidal ideation and attempts among active-duty military personnel and veterans compared to the general population. Traumatic experiences in adulthood, particularly those encountered during military deployment, can significantly increase the risk of suicidal ideation and attempts. This systematic review and meta-analysis aimed to examine the relationship between trauma exposure in adulthood and suicidal experiences within military populations.

The findings indicate that both pre-service traumatic events and those experienced during employment are linked to a higher likelihood of suicidal ideation and attempts. The study underscores the critical need for targeted interventions to address trauma in military personnel.

Trauma and Adverse Childhood Experiences (TrACE)-informed training for English for Speakers of Other Languages (ESOL) practitioners in Wales: understanding current provision and gaps

The report explores trauma-informed training availability and needs of English for Speakers of Other Languages (ESOL) practitioners in Wales. ESOL learners come from diverse backgrounds, including refugees and asylum seekers who may have experienced complex trauma. It is essential that ESOL providers are trained to provide valuable support to these learners. The report presents findings from interviews with ESOL practitioners across Wales, exploring their training experiences and identifying additional training needs. The report’s recommendations focus on enhancing trauma-informed training availability and delivery in Wales. The report is designed for ESOL practitioners and policymakers interested in trauma-informed approaches to teaching.

Adverse childhood and school experiences: a retrospective cross-sectional study examining their associations with health-related behaviours and mental health

This study examined relationships between adverse childhood experiences (ACEs), school experiences and adult health outcomes in a sample of the Welsh adult general population. It found ACEs and negative school experiences (having been bullied and lower sense of school belonging) were independently associated with poorer adult mental health. Experiencing both ACEs and negative school experiences exacerbated risks of poorer mental health. The study indicates the protective role that schools may play in fostering resilience among children who experience adversity in home settings.

Cold homes in Wales: Is the satisfactory heating regime appropriate for health and well-being?

The report presents evidence that living in a colder home (at a temperature below 18°C) is linked with negative impacts on health and well-being, particularly for people who are older or who have health conditions or disabilities. The report also includes a set of recommendations on the satisfactory heating regime in Wales.

Exploring the intergenerational continuity of ACEs amongst a sample of Welsh male prisoners: A retrospective cross-sectional study

This study explored the intergenerational continuity of adverse childhood experiences (ACEs) in a male justice-involved population. 294 fathers aged 18-69 years in a Welsh prison completed a questionnaire exploring their exposure to ACEs. The questionnaire also measured the ACE exposure of each child they had fathered. The study found evidence for the intergenerational continuity of ACEs. Paternal ACE exposure was found to increase the risk of child ACE exposure, both to multiple ACEs and individual ACE types.

Associations between adverse childhood experiences and trust in health and other information from public services, professionals and wider sources: a national cross-sectional survey

Trust in health and other systems can affect uptake of public health advice and engagement with health services. Adverse childhood experiences (ACEs) increase individuals’ risks of ill health, thus understanding how ACEs affect trust in sources of health advice and other support is important to inform engagement with this vulnerable group. This study examined associations between ACEs and trust in health advice, other information and public services in a nationally representative sample of 1,880 adults in Wales.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis

Adverse childhood experiences (ACEs) are associated with increased health risks across the life course. This paper aims to estimate the annual health and financial burden of ACEs for 28 European countries.

Perceptions of a short animated film on adverse childhood experiences: a mixed methods evaluation

This paper evaluates a short animated film on adverse childhood experiences (ACEs) to explore viewer attitudes and sentiment towards the film including, for a subsample of professionals, associations between attitudes and personal experience of ACEs.