419 - Gun Violence Exposure/Adverse Childhood Experiences and Healthcare Utilization

Kiesha Fraser Doh, Children's Healthcare of Atlanta, Atlanta, GA, United States; Lilian Zapata, University of Washington School of Medicine, Seattle, WA, United States; Andrew Jergel, Emory University, Atlanta, GA, United States; Scott Gillespie, Emory University School of Medicine, Atlanta, GA, United States; Catherine Kreatsoulas, Harvard School of Public Health, Boston, MA, United States; Claudia R.. Morris, Emory University School of Medicine, Atlanta, GA, United States; Maneesha Agarwal, Emory University School of Medicine, Atlanta, GA, United States; Karli Okeson, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA, United States; Angela Boy, Children's Healthcare of Atlanta, Stephanie Blank Center, Atlanta, GA, United States; Melese Crozier, Emory University, Atlanta, GA, United States; Sofia Chaudhary, Emory University School of Medicine, Decatur, GA, United States; Eric W. Fleegler, MassGeneral Hospital for Children, Needham, MA, United States

Background: Gun violence exposure (GVE) can significantly impact children's health and healthcare utilization. Furthermore, adverse childhood experiences (ACEs) have been associated with increased healthcare utilization.

Objective: To investigate the association between GVE and ACEs on healthcare utilization among urban youth

Design/Methods: We utilized the Future of Families and Child Wellbeing Study, a longitudinal birth cohort surveying urban youth/guardians. Participants’ home and school addresses were geographically linked with firearm non-suicide fatality data from the Gun Violence Archive. The outcome variable “healthcare utilization” included accessing routine medical and dental care, or injury and illness visits, reported by parents of 15-year-old youth. Independent variables included the presence of GVE within 1 mile from home or school and the presence of 1 or more ACEs. The association between the GVE and ACE with healthcare utilization was estimated using multivariate logistic regression controlling for parent age, race, ethnicity, education level, poverty level, insurance status, and child’s sex.

Results: Among 2798 participants, 52.9% were male, 46.4% Black non-Hispanic, 26.4% Hispanic. During the previous 12 months prior to their interview parents reported that, 88.5% attended routine medical and 83.8% routine dental care, while 17.4% reported injury visits and 31.6% illness visits. 61.3% experienced GVE within 1 mile of their home or school. Those with any home GVE had decreased odds of illness-related visits aOR 0.77 (95%CI 0.64-0.94) and dental visits aOR 0.76 (95%CI 0.59—0.97) but no statistically significant impact on routine healthcare or injury-related visits. Youth with ACEs had increased odds of illness-related visits aOR 1.25 (95% CI 1.04-1.51) but no increased odds for injury, routine visits or dental visits (Table 1). The combined analysis of GVE/ACE noted decreased routine dental visit with exposure to GVE & ACE aOR 0.56 (95%CI 0.41-0.77) but no other statistically significant associations (Table 2).

Conclusion(s): Exposure to gun violence is associated with a decrease in illness and dental visits among urban youth while the presence of ACEs is associated with an increase in illness-related visits. Additionally, association with decreased dental care utilization in combination with ACE/GVE was noted. Although causality cannot be assessed these findings underscore the complex interplay between GVE and ACEs on youth healthcare utilization and highlight the need for future research to develop targeted interventions to mitigate the impacts of GVE and ACE on healthcare utilization.

Table 2
Combined association between gun violence exposure near home and adverse childhood event with healthcare utilization

Association between Gun Violence Exposure, Adverse Childhood Experiences and Healthcare Utilization