235 - Development of a screener question bank for adverse childhood experiences and positive childhood experiences (ACEs/PCEs) that is culturally tailored for Latine youth in immigrant families.

Publication Number: 2226.235

Keith J. Martin, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Anusha Sarkar, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Andrea M. Gonzalez Bojorquez, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Andrea Flores Umanzor, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Eliana M.. Perrin, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Judith K. Bass, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Christina D. Bethell, Johns Hopkins Bloomberg School of Public Health, Portland, OR, United States; Cyd Eaton, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Sara Johnson, Johns Hopkins University School of Medicine, Baltimore, MD, United States

Background: Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) provide frameworks for understanding how early experiences impact long-term health. Latine youth in immigrant families experience immigration trauma (deportation, detention) and supportive relationships with family and peers. Latine ACEs/PCEs may differ from those of non-Latine youth and are rarely included in screeners. Patient Reported Outcomes Measurement Information System (PROMIS) qualitative question review has been used to develop ACE/PCE screening questions for pediatric populations but not for Latine youth in immigrant families.

Objective: To create and refine an ACE/PCE question bank for Latine youth in immigrant families seen in primary care to mitigate trauma and promote resilience.

Design/Methods: An ACE/PCE question bank was developed in four steps: First, potential questions were identified from six systematic reviews of ACE and PCE screeners. Second, we evaluated these questions for alignment with qualitative interview data of Latine youth and parents conducted by our team. Third, questions from systematic reviews were organized by qualitative study theme. Fourth, for cultural tailoring, we searched PubMed and Google Scholar for Latine ACE/PCE literature (2015-2025), examined literature at the level of qualitative code, and categorized literature/code comparisons as: (1) confirmation (agreement), (2) expansion (complementary), (3) new (no literature), and (4) N/A (inappropriate).

Results: From 152 ACE and 21 PCE screeners identified from systematic reviews, 78 ACE (51.3%) and 13 PCE (61.9%) screeners were included, yielding 1,344 ACE and 263 PCE unique questions. Primary exclusions: screeners not received despite requests (35.1% ACE, 50.0% PCE), screeners measuring impacts not occurrences (28.4% ACEs), and paid screeners (28.4% ACE, 25.0% PCE). Violence/victimization (16.1%) was most common ACE theme; family social support (31.2%) most common PCE theme. Literature-qualitative alignment showed 53.3% ACE and 52.9% PCE questions examined Latine youth/parent experiences. Latine ACE/PCE literature confirmed most youth/parent themes, with family social support and family stressor themes showing expansion beyond the existing literature.

Conclusion(s): We created an ACE/PCE question bank for Latine youth based on youth/parent-generated themes and systematic literature review. Most screeners were not designed for Latine populations. These findings represent a critical step toward developing culturally tailored screening to identify ACEs and PCEs that may place Latine youth at-risk for poor health outcomes.

Table 1: Adverse & positive childhood experience (ACE/PCE) screener and question bank from six recent systematic reviews of ACE/PCE screeners
1. Screeners were identified from six recent systematic reviews of ACE and PCE screeners: Rariden et al. (2021); Mishra et al. (2023); Loveday et al. (2022); Cibralic et al. (2022); Szacilo et al. (2025); Raghunathan et al. (2024)
2. One screener contained both ACE and PCE items: this was counted as both an ACE and PCE screener. In ACE calculations, PCE items were excluded as non-ACE questions. In PCE calculations, ACE items were excluded as non-PCE questions.
3. PCE mean and standard deviation calculation excluded one outlier that had 506 items.
4. Training recommendations were: (1) including a clinician on the administration team, (2) ensuring team familiarity with trauma-informed care, and (3) providing screener-specific training (e.g., such as review of a manual or online training module(s).
5. Proportions were calculated using total number of validated screeners for each column as the denominator (ACE n=62, PCE n=12).

Table 2: Adverse & positive childhood experience (ACE/PCE) questions identified from systematic reviews: Alignment with Latine youth and parent experiences and distribution by qualitative study theme. Table 2A: Alignment of ACE/PCE questions from systematic reviews with Latine youth/parent experiences - Did ACE/PCE questions from screeners in systematic reviews capture experiences that participants reported in qualitative interviews? Table 2B: ACE/PCE question distribution by qualitative study theme.
1. Sub-total was calculated using total questions in each column to which only one theme applied (ACE n=723, PCE n=210). Proportion was calculated using total questions for each column as denominator (ACE n=1344, PCE n=263).
2. Sub-total was calculated using total questions in each column to which multiple themes applied (ACE n=158, PCE n=3). Proportion was calculated using total questions for each column as denominator (ACE n=1344, PCE n=263).
3. Total was calculated using total questions in each column (ACE n=1344, PCE n=263).

Figure 1: Qualitative study integration with adverse & positive childhood experience (ACE/PCE) question bank (from systematic reviews) and Latine literature. Figure 1A. Theme coverage: Qualitative interviews vs. question bank (from systematic reviews). Figure 1B. Cultural tailoring process: Code-level analysis of qualitative study themes compared with Latine ACE/PCE literature by classification category.
1. Question Bank: Proportion of questions within each theme = number of questions in theme ÷ 1094 ACE and PCE questions (total questions not categorized as Non-ACE/PCE or General).
2. Youth Transcripts: Proportion of youth transcripts within each theme = number of youth transcripts in theme ÷ 12 total youth transcripts.
3. Parent Transcripts: Proportion of parent transcripts within each theme = number of parent transcripts in theme ÷ 14 total parent transcripts.