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State of Alaska

Health Indicator Report of Adverse Childhood Experiences: Sexual Abuse

Childhood sexual abuse is a major public health concern. Alaska has the highest rate of forcible rape in the nation^2^ and a rate of reported rape that is three times the national average.^3^ More than 9% of Alaska high school students have experienced sexual violence.^4^ The impacts of overwhelming stress on the brain caused by sexual abuse continue into adulthood and can have generational impacts. As Alaskans exposed to child abuse grow up, they may find negative ways to cope with their damaged stress responses. Adverse Childhood Experiences (ACEs) are potent risk factors for involvement in domestic violence, alcohol dependence, and suicide attempts. When Alaskans exposed to child abuse grow up and start families of their own, these behaviors can become ACEs for another generation.^5^ In one study, 80% of 21-year-olds who reported childhood abuse met the criteria for at least one psychological disorder.^6^ The Adverse Childhood Experiences (ACE) Study, a collaborative between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego, assessed associations between childhood maltreatment and later-life health and well-being. It is critical to understand how some of the worst health and social problems can arise as a consequence of adverse childhood experiences.^1^ Alaska takes on the burden of approximately $82 million in costs (e.g., health care costs, welfare costs, special education costs) each year due to nonfatal child maltreatment.^7^ Realizing these connections is likely to improve efforts towards prevention and recovery.[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016. 2. Alaska Department of Public Safety. Public safety frequently asked questions. [http://dps.alaska.gov/dpsfaq.aspx]. Accessed April 26, 2016. 3. Federal Bureau of Investigations . 2012 crime statistics. [http://www.fbi.gov/stats-services/crimestats]. Accessed April 26, 2016. 4. Alaska Department of Public Safety. Alaska Council on Domestic Violence and Sexual Assault. 2014 Alaska dashboard: key issues impacting domestic violence and sexual assault in Alaska. [http://dps.alaska.gov/Cdvsa/docs/DVSA_Dashboard_2014.pdf]. Published January 2014. Accessed April 26, 2016. 5. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/aceak/ Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 6. Silverman AB, Reinherz HZ, Giaconia RM. The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse & Neglect 1996;20(8):709-23. 7. Sidmore P. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Economic costs of adverse childhood experiences in Alaska. [http://dhss.alaska.gov/abada/aceak/ Documents/ACEsEconomicCosts-AK.pdf]. Accessed April 26, 2016. }}

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Interpretation Issues

The preamble to each of the Adverse Childhood Experiences (ACEs) question was: "I'd like to ask you some questions about events that happened during your childhood. This information will allow us to better understand problems that may occur early in life, and may help others in the future. This is a sensitive topic and some people may feel uncomfortable with these questions. At the end of this section, I will give you a phone number for an organization that can provide information and referral for these issues. Please keep in mind that you can ask me to skip any question you do not want to answer. All questions refer to the time period before you were 18 years of age. Now, looking back before you were 18 years of age ---" While the individual adverse childhood experience (ACE) an Alaska adult may have experienced is important, the strength of the research lies in the often multiple ACEs an individual has during childhood: "The ACE score, a total sum of the different categories of ACEs reported by participants, is used to assess cumulative childhood stress. Study findings repeatedly reveal a graded dose-response relationship between ACEs and negative health and well-being outcomes across the life course...Dose response describes the changes in an outcome (e.g., alcoholism) associated with differing levels of exposure (or doses) to a stressor (e.g., ACEs). A graded dose-response means that as the dose of the stressor increases the intensity of the outcome also increases."^1^ ACEs questions on sexual abuse were asked in 2013 through 2015.[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016.}}

Definition

Percentage of adults 18 years of age and older who responded "Once" or "More than once" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to any of the following questions: "How often did anyone at least 5 years older than you or an adult ever touch you sexually?"; "How often did anyone at least 5 years older than you or an adult try to make you touch them sexually?"; or "How often did anyone at least 5 years older than you or an adult force you to have sex?"

Numerator

Weighted number of adults (18+) who responded "Once" or "More than once" on the BRFSS to any of the following questions: "How often did anyone at least 5 years older than you or an adult ever touch you sexually?"; "How often did anyone at least 5 years older than you or an adult try to make you touch them sexually?"; or "How often did anyone at least 5 years older than you or an adult force you to have sex?"

Denominator

Weighted number of adults (18+) who responded to the sexual abuse questions on the BRFSS, excluding those with missing or "Refused" responses. Those who responded "Don't know/Not sure" are defined as a negative response for that ACE category.

How Are We Doing?

In 2013-2015 combined, 13.7% of Alaska adults reported having experienced some form of childhood sexual abuse. Alaska Native adults at 17.4% had statistically higher prevalence than all Alaska adults. The 10.6% of Alaska Native adults reporting having been made to have sex by an individual five years older or an adult before they were 18 years old is significantly higher than the 6.2% experienced by the general Alaska adult population. Females reported significantly higher prevalence with 20.1% having been sexually abused, while 7.7% of males reported having been sexually abused. Those adults who were divorced or separated reported significantly higher prevalence of sexual abuse while children at 20.8% than those who were married (13.0%) or never married (10.6%). Employment status was also associated with prevalence of childhood sexual abuse: 13.1% of employed adults but those unable to work reported significantly higher prevalence at 30.9%. Those adults earning $75,000 or more reported significantly lower prevalence of childhood sexual abuse than those earning less than $25,000. This pattern continues with those with middle/high incomes reporting significantly lower prevalence of sexual abuse than those who are poor or near poor. Rates of sexual abuse during childhood from the BRFSS are initially presented for all Alaskans and Alaska Native people for the combined 3-year period from 2013-2015. Subsequent analyses were conducted for demographic subpopulations (i.e., sex, age, race/ethnicity, ethnicity, marital status, education, employment status, income, and poverty status). Crosstabulations were also conducted for 3-year averages by body mass index, current smoking, sexual orientation, and disability. Significant differences were evident in all 4 contrasts. Rates of sexual abuse during childhood by regions of Alaska are presented for all Alaskans and Alaska Native people for the 3-year average of surveys conducted between 2013-2015: 1) 7 Alaska Public Health Regions, 2) 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, 3) 10 behavioral health assessment regions based upon aggregations of 20,000 population, 4) 29 boroughs and census areas, and 5) 12 tribal health organization regions.

How Do We Compare With the U.S.?

There are no national statistics on ACEs available; however, in 2009 the CDC released a study comparing ACEs data from five states (i.e., Arkansas, Louisiana, Tennessee, New Mexico, Washington) that used the BRFSS ACEs module. When compared to the five states, Alaska reported the highest in rates of adults who had experienced childhood sexual abuse.^8^ Compared to data from adults from the 10 states (i.e., Hawaii, Maine, Nebraska, Nevada, Ohio, Pennsylvania, Utah, Vermont, Washington, and Wisconsin) that implemented the ACEs module in 2010, the rate of Alaska adults reporting experiencing childhood sexual abuse was lower.^1^[[br]] [[br]] ---- {{class .SmallerFont 1. U.S. Centers for Disease Control and Prevention (CDC). Adverse Childhood Experiences (ACE) Study. [http://www.cdc.gov/violenceprevention/acestudy/index.html]. Updated April 1, 2016. Accessed April 26, 2016. 8. U.S. Centers for Disease Control and Prevention (CDC). Adverse childhood experiences reported by adults - five states, 2009. MMWR 2010;59(49):1609-13. [https://www.cdc.gov/mmwr/pdf/wk/mm5949.pdf] Accessed October 31, 2017. }}

What Is Being Done?

The [http://hss.state.ak.us/ha2020/ Healthy Alaskans 2020] initiative developed strategies by content experts to reduce child maltreatment. Public health partners around the state are aligning work around these approaches adapted by Alaska's unique needs. Alaska strategies include: 1. Promote screening and monitoring for child abuse in primary care offices and public health clinics. 2. Use the [http://www.cssp.org/reform/strengtheningfamilies Strengthening Families Protective Factors] framework in family programs. 3. Expand home visiting programs. 4. Expand and strengthen quality early childhood programs. 5. Train providers and the public on brain development, adverse childhood experiences (ACEs), and resiliency.^9^ Alaska has many groups working on preventing childhood trauma and easing the effects of damage already done. Here are a few examples (as of early 2015): Statewide, teachers and public health nurses provide teens with information on healthy relationships and life skills. They have partnered with the Alaska departments of Health and Social Services and Education and Early Development, the [http://www.dps.alaska.gov/cdvsa/ Council on Domestic Violence and Sexual Assault], and the [http://www.andvsa.org/ Alaska Network on Domestic Violence and Sexual Assault] on an evidenced-based curriculum for the 7th-9th grade called [https://education.alaska.gov/tls/schoolhealth/fourth.html "the Fourth R for Healthy Relationships."] The Division of Public Health partnered with the Alaska Native Tribal Health Consortium and the [http://dhss.alaska.gov/dph/chronic/pages/injuryprevention/akfvpp/default.aspx Alaska Family Violence Prevention Project] to develop a teen safety card, a gender-neutral resource developed for Alaska teens with guidance from Alaska teens. The card provides information about healthy and unhealthy relationship characteristics, what consent looks and sounds like, and where to get help, if needed. Another safety card was designed specifically for women.^9^ The Division of Behavioral Health has promoted trauma-informed care for several years. Efforts include development of "Trauma 101" and "Trauma 201" curriculum for behavioral health providers, used around the state.[[br]] [[br]] ---- {{class .SmallerFont 9. Alaska Department of Health and Social Services. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed April 26, 2016. 10. Alaska Native Tribal Health Consortium. Getting together - teen relationship safety card. [http://www.anthctoday.org/epicenter/healthyfamilies/teenCard_111014.pdf]. Accessed April 26, 2016. }}

Evidence-based Practices

Recovering from trauma is a challenging process. Building resiliency and having a supportive adult in your life can help with recovery. Positive experiences - such as exposure to environments rich in a range of developmentally appropriate opportunities for social play and exploration - can compensate for and even reverse the negative consequences of stress. Efforts during childhood are essential because over time, some stress-induced detriments are increasingly resistant to reversal. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment approach shown to help children, adolescents, and their caregivers overcome trauma-related difficulties. It is designed to reduce negative emotional and behavioral responses following traumatic events. The treatment - based on learning and cognitive theories - addresses distorted beliefs and attributions related to the abuse and provides a supportive environment in which children are encouraged to talk about their traumatic experience. TF-CBT also helps parents who were not abusive to cope effectively with their own emotional distress and develop skills that support their children.^11^ ACEs are best addressed through a coordinated effort to implement prevention programs across multiple settings and populations. Research indicates the majority of health and social challenges are interconnected and often share the same root causes. The following steps need to be taken to address these root causes: 1. Support quality early childhood programs. 2. Ensure access to health care including behavioral health care. 3. Strengthen capacity for social emotional learning throughout Alaska's schools. 4. Maintain and expand prevention efforts that have been proven to be effective.^5^ The [http://www.cssp.org/ Center for the Study of Social Policy] spent two years researching and identifying five protective factors that prevent child abuse and neglect. These are: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence of children. Research studies support the common-sense notion that when these protective factors are well established in a family, the likelihood of child abuse and neglect diminishes. Research shows that these protective factors are also "promotive" factors that build family strengths and a family environment that promotes optimal child and youth development.^12^[[br]] [[br]] ---- {{class .SmallerFont 5. Alaska Department of Health and Social Services. Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. Investing in prevention: working together in early childhood for healthy Alaskan children, families, and communities 2015. [http://dhss.alaska.gov/abada/aceak/ Documents/State_Interagency_Prevention_2015.pdf]. Accessed April 26, 2016. 11. Child Welfare Information Gateway. Trauma-focused cognitive behavioral therapy for children affected by sexual abuse or trauma. [https://www.childwelfare.gov/pubPDFs/trauma.pdf]. Accessed April 26, 2016. 12. Alaska Department of Health and Social Services. Office of Children's Services. Strengthening families. [http://dhss.alaska.gov/ocs/Pages/families/default.aspx]. Accessed April 26, 2016. }}
Page Content Updated On 10/31/2017, Published on 10/31/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 20 November 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Tue, 31 Oct 2017 10:24:37 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Tue, 20 November 2018 16:57:01 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Tue, 31 Oct 2017 10:24:37 AKDT