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Susan D. Hillis

Bio: Susan D. Hillis is an academic researcher from Centers for Disease Control and Prevention. The author has contributed to research in topics: Population & Poison control. The author has an hindex of 45, co-authored 109 publications receiving 8163 citations.


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TL;DR: Expanded population-based surveillance of violence against children is essential to target prevention and drive the urgent investment in action endorsed in the United Nations 2030 Sustainable Development Agenda.
Abstract: CONTEXT: Evidence confirms associations between childhood violence and major causes of mortality in adulthood. A synthesis of data on past-year prevalence of violence against children will help advance the United Nations’ call to end all violence against children. OBJECTIVES: Investigators systematically reviewed population-based surveys on the prevalence of past-year violence against children and synthesized the best available evidence to generate minimum regional and global estimates. DATA SOURCES: We searched Medline, PubMed, Global Health, NBASE, CINAHL, and the World Wide Web for reports of representative surveys estimating prevalences of violence against children. STUDY SELECTION: Two investigators independently assessed surveys against inclusion criteria and rated those included on indicators of quality. DATA EXTRACTION: Investigators extracted data on past-year prevalences of violent victimization by country, age group, and type (physical, sexual, emotional, or multiple types). We used a triangulation approach which synthesized data to generate minimum regional prevalences, derived from population-weighted averages of the country-specific prevalences. RESULTS: Thirty-eight reports provided quality data for 96 countries on past-year prevalences of violence against children. Base case estimates showed a minimum of 50% or more of children in Asia, Africa, and Northern America experienced past-year violence, and that globally over half of all children—1 billion children, ages 2–17 years—experienced such violence. LIMITATIONS: Due to variations in timing and types of violence reported, triangulation could only be used to generate minimum prevalence estimates. CONCLUSIONS: Expanded population-based surveillance of violence against children is essential to target prevention and drive the urgent investment in action endorsed in the United Nations 2030 Sustainable Development Agenda.

709 citations

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TL;DR: The relationship between ACEs and adolescent pregnancy is strong and graded and the negative psychosocial sequelae and fetal deaths commonly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se.
Abstract: Objectives. Few reports address the im- pact of cumulative exposure to childhood abuse and fam- ily dysfunction on teen pregnancy and consequences commonly attributed to teen pregnancy. Therefore, we examined whether adolescent pregnancy increased as types of adverse childhood experiences (ACE score) in- creased and whether ACEs or adolescent pregnancy was the principal source of elevated risk for long-term psy- chosocial consequences and fetal death. Design, Setting, and Participants. A retrospective co- hort study of 9159 women aged >18 years (mean 56 years) who attended a primary care clinic in San Diego, Cali- fornia in 1995-1997. Main Outcome Measure. Adolescent pregnancy, psy- chosocial consequences, and fetal death, compared by ACE score (emotional, physical, or sexual abuse; expo- sure to domestic violence, substance abusing, mentally ill, or criminal household member; or separated/divorced parent). Results. Sixty-six percent (n 6015) of women re- ported >1 ACE. Teen pregnancy occurred in 16%, 21%, 26%, 29%, 32%, 40%, 43%, and 53% of those with 0, 1, 2, 3, 4, 5, 6, and 7 to 8 ACEs. As the ACE score rose from zero to 1t o 2, 3t o 4, and>5, odds ratios for each adult consequence increased (family problems: 1.0, 1.5, 2.2, 3.3; financial problems: 1.0, 1.6, 2.3, 2.4; job problems: 1.0, 1.4, 2.3, 2.9; high stress: 1.0, 1.4, 1.9, 2.2; and uncontrollable anger: 1.0, 1.6, 2.8, 4.5, respectively). Adolescent preg- nancy was not associated with any of these adult out- comes in the absence of childhood adversity (ACEs: 0). The ACE score was associated with increased fetal death after first pregnancy (odds ratios for 0, 1-2, 3- 4, and 5- 8 ACEs: 1.0, 1.2, 1.4, and 1.8, respectively); teen pregnancy was not related to fetal death. Conclusions. The relationship between ACEs and ad- olescent pregnancy is strong and graded. Moreover, the negative psychosocial sequelae and fetal deaths com- monly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se. Pediatrics 2004;113:320 -327; adolescent pregnancy, child abuse, domestic violence, alcoholism, children of impaired parents, drug abuse.

620 citations

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TL;DR: This research presents a case study of parenting in a time of COVID-19, which aims to provide a guide for parents to consider their children's needs during this crucial period of transition.

595 citations

Journal ArticleDOI
TL;DR: Examination of recent trends in hysterectomy rates and indications in the United States found continued monitoring is needed to determine whether the observed trends persist and to evaluate impact on women's health.

581 citations

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TL;DR: An enhanced delivery identification method based on additional delivery-related codes was developed and the performance of the enhanced method with the V27 method in identifying estimates of deliveries as well as estimates of maternal morbidity was compared.
Abstract: Objectives The accuracy of maternal morbidity estimates from hospital discharge data may be influenced by incomplete identification of deliveries. In maternal/infant health studies, obstetric deliveries are often identified only by the maternal outcome of delivery code (International Classification of Diseases code = V27). We developed an enhanced delivery identification method based on additional delivery-related codes and compared the performance of the enhanced method with the V27 method in identifying estimates of deliveries as well as estimates of maternal morbidity. Methods The enhanced and standard V27 methods for identifying deliveries were applied to data from the 1998–2004 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationwide representative survey of U.S. hospitalizations. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression were used to examine predictors of deliveries not identified using the V27 method. Results The enhanced method identified 958,868 (3.4%) more deliveries than the 27,128,539 identified using the V27 code alone. Severe complications including major puerperal infections (OR = 3.1, 95% CI 2.8–3.4), hysterectomy (OR = 6.0, 95% CI 5.3–6.8), sepsis (OR = 11.9, 95% CI 10.3–13.6) and respiratory distress syndrome (OR = 16.6, 95% CI 14.4–19.2) were strongly associated with deliveries not identified by the V27 method. Nationwide prevalence rates of severe maternal complications were underestimated with the V27 method compared to the enhanced method, ranging from 9% underestimation for major puerperal infections to 40% underestimation for respiratory distress syndrome. Conclusion Deliveries with severe obstetric complications may be more likely to be missed using the V27 code. Researchers should be aware that selecting deliveries from hospital stay records by V27 codes alone may affect the accuracy of their findings.

396 citations


Cited by
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Journal ArticleDOI
TL;DR: For example, this article found a strong relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

12,712 citations

Journal ArticleDOI
TL;DR: The new STD treatment guidelines for gonorrhea, chlamydia, bacterial vaginosis, trichomonas, vulvovaginal candidiasis, pelvic inflammatory disease, genital warts, herpes simplex virus infection, syphilis, and scabies are reviewed.
Abstract: The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333.

4,563 citations

Journal ArticleDOI
TL;DR: The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.
Abstract: Childhood maltreatment has been linked to a variety of changes in brain structure and function and stress–responsive neurobiological systems. Epidemiological studies have documented the impact of childhood maltreatment on health and emotional well–being. After a brief review of the neurobiology of childhood trauma, we use the Adverse Childhood Experiences (ACE) Study as an epidemiological “case example” of the convergence between epidemiologic and neurobiological evidence of the effects of childhood trauma. The ACE Study included 17,337 adult HMO members and assessed 8 adverse childhood experiences (ACEs) including abuse, witnessing domestic violence, and serious household dysfunction. We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "doseresponse" relationship of the ACE score to 18 selected outcomes and to the total number of these outcomes (comorbidity). Based upon logistic regression analysis, the risk of every outcome in the affective, somatic, substance abuse, memory, sexual,and aggressionrelated domains increased in a graded fashion as the ACE score increased (P <0.001). The mean number of comorbid outcomes tripled across the range of the ACE score. The graded relationship of the ACE score to 18 different outcomes in multiple domains theoretically parallels the cumulative exposure of the developing brain to the stress response with resulting impairment in multiple brain structures and functions.

3,284 citations

Journal ArticleDOI
TL;DR: For example, this article found that exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences, which has longlasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour.

3,034 citations

Journal ArticleDOI
TL;DR: In this paper, a systematic review and meta-analysis was conducted to identify the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life.
Abstract: Summary Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity ( I 2 of >75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales.

2,313 citations