title: Adverse Childhood Experiences, the Medical Home, and Child Well-Being.
abstract: OBJECTIVE
  To examine the relationship between adverse childhood experiences (ACE), access to a medical home and a global measure of well-being among children ages 6-17 using the 2011-2012 National Survey of Children's Health.
  
  
  METHODS
  Multivariate linear regressions assessed the associations between each adverse experience and an index of child well-being with and without the impact of other events. The number of ACE was summed for each respondent and the analyses were repeated with the cumulative score as a continuous variable. The cumulative model was repeated with the addition of an interaction term between ACE score and medical home access. All analyses were conducted separately for children ages 6-11 and adolescents 12-17.
  
  
  RESULTS
  Over half (53 %) of US children ages 6-17 have experienced some adverse experience during childhood. Over a quarter (28 %) has experienced at least two adverse experiences, while 15 % have experienced three or more hardships. Results suggest that the accumulation of ACE reduces well-being in children. The associations remained significant after controlling for gender, race/ethnicity, age, parental education, special health condition, and medical home access. Medical home access was consistently associated with higher levels of child well-being and was a significant moderator of the relationship between the total ACE and child well-being among children ages 6-11. Children with ACE exposure and access to a medical home have higher levels of well-being than comparable children without access to a medical home.
  
  
  CONCLUSIONS
  Children exposed to adverse experiences have measurably lower levels of well-being, although younger children with access to a medical home are protected at increasing exposure.
authors.affiliation: Center for Family and Demographic Research, Bowling Green State University, 218 Williams Hall, Bowling Green, OH, 43403, USA. kellyba@bgsu.edu.
authors.forename: Kelly Stamper
authors.initials: KS
authors.lastname: Balistreri
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002669:Child Welfare; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys / Q000379:methods; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D018802:Patient-Centered Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D012307:Risk Factors; D064890:Social Determinants of Health; D014481:United States
keywords: Adverse childhood experiences (ACE); Child well-being; Medical home