P3.C056: Parent's perceptions of the impact of adversity on health: Data & Insights From F5CA’s Campaign

Background: Adverse Childhood Experiences (ACEs) refer to potentially traumatic events that occur in childhood. ACEs are commonly measured by 10 categories of adversities broken into three domains: child abuse (physical, emotional, sexual); neglect (physical, emotional); or household challenges (growing up in a household with incarceration, mental illness, substance use, parental separation/divorce, intimate partner violence). ACEs can cause a physiological reaction in children called toxic stress response (TSR), which is the body's response to lasting and serious stress. TSR can have a lifelong impact on health, education, relationship, and economic outcomes.

In California, 62.3% of adults have experienced ≥1 ACE and 16.3% have experienced 4 or more. Parents’ history of ACEs is associated with a host of negative child and parental outcomes such as reduced resilience, decreased social support, attachment difficulties, and increased parenting stress. Parental TSR can increase the risk for child maltreatment, neglect, and exposure to traumatic events, sometimes resulting in intergenerational transmission of ACEs. First 5 California sought to develop a campaign directed at parents and caregivers to educate them about the impacts of TSR on children.

Methods: To assess reactions to potential campaign messages, parents and caregivers of children 0-5 in California who have experienced ACEs themselves participated in 9 focus groups (N=42; (4 in Spanish, 5 in English) in July 2022. Eligible participants were California adults ages 18 and older who reported ≥1 ACE, fluency in Spanish or English, being the primary caregiver to a child ages 0-5, and experiencing low income. Focus groups assessed knowledge and awareness of F5CA and reactions to video storyboards about ACEs and their consequences.

Results: Most participants were biological parents (88%) and had >3 ACEs (71%). About half lived in urban areas (60%) and had a GED, high school diploma, or less (52%). The sample was racially and ethnically diverse: identifying as Hispanic/Latino/a (45%), White (24%), Black/African American (21%), Asian American/Pacific Islander (17%), or American Indian/Alaska Native (5%). Thematic analysis revealed several messaging elements that participants perceived were most likely to motivate them to learn more about TSR. Four themes were identified as motivational: Action steps provide hope; Emotional connection between parent and child; Recognize the urgency; Inclusivity of language and visuals. Additionally, messages that explained the future consequences of TSR on physical and mental health, especially when delivered by a “voice of authority” (e.g., doctor) were attention-grabbing and impactful.

Conclusion: Parents and caregivers want support, are actively trying to self-better, are naturally reflecting on their own childhoods, and want more information about the impact and prevention of TSR. Findings provide evidence for promising messaging approaches to educate parents and caregivers about TSR and informed the development of a statewide campaign.