JMIR Publications

ABSTRACT

Background:

Developmental trauma depending on a number of factors may lead to later adult health risks and is an increasing public health concern especially in states with predominantly rural populations. Oklahoma remains one of the highest states in America of ACEs counts, therefore more refined research methods in quantifying ACEs are vital for ensuring proper statewide interventions.

Objective:

Create the methodology to assess ACE severity in Oklahoma at the county level by both quantity of ACE rates as well as severity over time.

Methods:

County-level data for six ACEs (mental illness, divorce, neglect, physical abuse, and substance use) were collected from Oklahoma Department of Human Services, Oklahoma State Department of Health, and Oklahoma Community Mental Health Centers for the years 2010-2018. First, an All ACEs Score (AAS) was created by standardizing and adding county rates for each ACE. Second, an Adversity Severity Index (ASI) was calculated through above-mean tabulation of county ACE rates compared to the state mean, over the years of study data. Data analysis was conducted in 2022.

Results:

Mental illness and substance use showed the highest rates at the state level. ASI scores ranged from 0 to 6, with four nonmetro counties (Adair, McCurtain, Muskogee, and Pittsburg) receiving a score of 6.

Conclusions:

OASIS involves identification of counties where ACEs are most prevalent, allowing for the prioritization of interventions in these “hot spot” counties. A further analysis of other upstream factors, including Social Determinants of Health, can be explored and examined for correlation. Future efforts will center on adding additional ACEs, improving data collection, adding adverse outcome rates (such as violence, medical disorder prevalence, etc), and validity testing.