Evaluating the Impact of ACEs Screening and Behavioral-Social Support on Obstructive Lung Disease Health Outcomes - ABSTRACT The health and economic impacts of asthma and chronic obstructive pulmonary disease (COPD) in the United States are substantial and disproportionally burden marginalized and economically disadvantaged populations. Despite the existence of well-established guidelines for the treatment of asthma and COPD and preventative service recommendations, these glaring disparities highlight the need to better understand the upstream risk factors and psychosocial barriers associated with poor outcomes. One emerging risk factor is exposure to adverse childhood experiences (ACEs), which are stressful or traumatic experiences in childhood that are thought to have a long-term health effects. The association between ACEs and asthma prevalence in children and adults is well-established and there is evidence for a similar association with COPD in adults. In 2020, the Los Angeles Department of Health Services (LADHS) implemented ACEs screening, becoming one of the earliest and largest health system to adopt the practice across the state of California. With over 28,000 patients screened for ACEs, there is a unique opportunity to answer a critical gap in understanding the mechanism of action through which ACEs impact COPD and asthma. Exposure to ACEs creates complex social conditions which operate as risk factors for disease as well as interfere with an individual’s ability to access and adhere to guideline-concordant care and other preventative services. The fundamental aim of this proposal is to leverage data from the implementation of ACEs screening in LADHS to examine short- and long-term asthma and COPD- related health outcomes. Specifically, this proposal will 1) Examine the association between ACEs and asthma and COPD prevalence and morbidity in a racially and ethnically diverse population of children and adults 2) Examine the associations between ACEs and the delivery of guideline concordant care and preventative services for children and adults with asthma and COPD, with a particular focus on examining disparities based on race and language concordance, and 3) Evaluate the longitudinal impact of ACEs screening and linkage to socio- behavioral resources on healthcare utilization and delivery of guideline concordant care for patients with asthma and COPD. With 35,070 adult and pediatric ACEs initial and follow up screening encounters throughout LADHS, linked medical record data, chronic disease registries, closed-looped socio-behavioral referrals, medication prescription and filling data, and emergency services utilization records, the proposed study is well positioned to fill a critical gap in understanding the long-term impact of screening and addressing childhood adversities on asthma and COPD health outcomes. The results of which have the potential to change clinical practice and the allocation of resources within health systems to address disparities in respiratory health. Furthermore, this award will provide Dr. Adali Martinez with the necessary support to become an expert in implementation science and health disparities with a focus on addressing social and structural barriers to facilitate access to guideline concordant care and preventative services among those with chronic lung disease.
