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1.
Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health-related outcomes in later life. Less is known about the consequences of ACEs in early adulthood or among diverse samples. Therefore, we investigated the impacts of differential exposure to ACEs on an urban, minority sample of young adults. Health, mental health, and substance use outcomes were examined alone and in aggregate. Potential moderating effects of sex were also explored. Data were derived from the Chicago Longitudinal Study, a panel investigation of individuals who were born in 1979 or 1980. Main-effect analyses were conducted with multivariate logistic and OLS regression. Sex differences were explored with stratified analysis, followed by tests of interaction effects with the full sample. Results confirmed that there was a robust association between ACEs and poor outcomes in early adulthood. Greater levels of adversity were associated with poorer self-rated health and life satisfaction, as well as more frequent depressive symptoms, anxiety, tobacco use, alcohol use, and marijuana use. Cumulative adversity also was associated with cumulative effects across domains. For instance, compared to individuals without an ACE, individuals exposed to multiple ACEs were more likely to have three or more poor outcomes (OR range = 2.75–10.15) and four or more poor outcomes (OR range = 3.93–15.18). No significant differences between males and females were detected. Given that the consequences of ACEs in early adulthood may lead to later morbidity and mortality, increased investment in programs and policies that prevent ACEs and ameliorate their impacts is warranted. 相似文献
2.
BackgroundNumerous studies over the past two decades have found a link between adverse childhood experiences (ACEs) and worse adult health outcomes. Less well understood is how advantageous childhood experiences (counter-ACEs) may lead to better adult health, especially in the presence of adversity.ObjectiveTo examine how counter-ACEs and ACEs affect adult physical and mental health using Resiliency Theory as the theoretical framework.Participants and settingParticipants were Amazon mTurk users ages 19–57 years (N = 246; 42% female) who completed an online survey.MethodsWe conducted a series of regression analyses to examine how counter-ACEs and ACEs predicted adult health.ResultsCorresponding to the Compensatory Model of Resiliency Theory, higher counter-ACEs scores were associated with improved adult health and that counter-ACEs neutralized the negative impact of ACEs on adult health. Contrary to the Protective Factors Model, there was a stronger relationship between ACEs and worse adult health among those with above average counter-ACEs scores compared to those with below average counter-ACEs scores. Consistent with the Challenge Model, counter-ACEs had a reduced positive effect on adult health among those with four or more ACEs compared to those with fewer than four ACEs.ConclusionsOverall, the findings suggest that counter-ACEs protect against poor adult health and lead to better adult wellness. When ACEs scores are moderate, counter-ACEs largely neutralize the negative effects of ACEs on adult health. Ultimately, the results demonstrate that a public health approach to promoting positive childhood experiences may promote better lifelong health. 相似文献
3.
Adverse childhood experiences (ACEs) have been linked to negative health outcomes in adulthood, but little research has been done on the effect of ACEs on the health and well-being of adults in South Carolina (SC). This study analyzed a sample of 9744 respondents who participated in the 2014 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship among childhood experiences of physical, sexual, and emotional abuse, as well as witnessing household violence, on mental and physical health outcomes in adulthood among SC residents. Twenty-two percent of survey respondents reported poor general health (22.1%), and a smaller proportion reported high frequent mental distress in the past month (13.1%). Each category of childhood experiences was associated with an increase in the risk of poor general health. Individuals reporting three or more types of experiences were more likely to report poor health (aOR 2.89; 95% CI 2.86–2.92) than adults without such experiences. Respondents reporting three or more types of childhood adverse experiences were more likely to report frequent mental distress (aOR 3.29; 95% CI 3.26–3.33) compared to adults who did not report three or more types of adversity. Findings from the SC BRFSS highlight a connection between ACEs and negative health outcomes later in life. Given that results of this study also demonstrated that increased exposure to ACEs was associated with greater odds of negative health in adulthood, preventing adverse events such as experiencing abuse or witnessing domestic violence in childhood will have significant effects on later adult health. 相似文献
4.
Mary A. Sciaraffa Paula D. Zeanah Charles H. Zeanah 《Early Childhood Education Journal》2018,46(3):343-353
Brain development in the early years is especially susceptible to toxic stress caused by adverse childhood experiences (ACEs). According to epigenetics research, toxic stress has the capacity to physically change a child’s brain and be hardwired into the child’s biology via genes in the DNA. The compelling nature of the impact of early adversity on later health and development has generated interest in protection against the impact of early adversity. Research highlights three interrelated “core protective systems” associated with positive adaptation. Early childhood educators are in a unique position to play a role in early identification of ACEs and to contribute to the development of protective skills. Adults within the early childhood education community can assist in increasing physical health and mental well-being for children who have encountered ACEs. Safe and healthy environments that allow the child to play, explore, and maximize his/her capacities are examples of how individual protective factors can be enhanced. Early childhood educators can support the child’s protective system by building the child’s personal attributes associated with resiliency, such as self-efficacy and self-regulation. Early childhood educators can provide a secure relationship, which is especially critical for children who have experienced trauma because it can provide extra support in times of stress. Additionally, by working collaboratively with parents, early childhood educators provide an additional layer of protection for children who experience adversity. Lastly, at the community level, early childhood educators can bring awareness to the public and private sectors by informing others of ACEs effect on early brain development and the link to later outcomes on individuals and society. Society is positively impacted when ACEs are reduced and individuals are raised in thriving families and communities. 相似文献
5.
Although the association between adverse childhood experiences (ACEs) and adult mental health is becoming well established, less is known about the complex and multiple pathways through which ACEs exert their influence. Growing evidence suggests that adversity early in life conveys not only early impacts, but also augments risk of stress-related life course cascades that continue to undermine health. The present study aims to test pathways of stress proliferation and stress embodiment processes linking ACEs to mental health impairment in adulthood. Data are from the 2011 Behavioral Risk Factor Surveillance Survey, a representative sample of Washington State adults ages 18 and over (N = 14,001). Structural equation modeling allowed for testing of direct and indirect effects from ACEs though low income status, experiences of adversity in adulthood, and social support. The model demonstrated that adult low income, social support and adult adversity are in fact conduits through which ACEs exert their influence on mental health impairment in adulthood. Significant indirect pathways through these variables supported hypotheses that the effect of ACEs is carried through these variables. This is among the first models that demonstrates multiple stress-related life course pathways through which early life adversity compromises adult mental health. Discussion elaborates multiple service system opportunities for intervention in early and later life to interrupt direct and indirect pathways of ACE effects. 相似文献
6.
BackgroundAlthough adverse childhood experiences (ACEs) are relatively common among children, there is limited knowledge on the co-occurrence of such experiences.ObjectiveThe current study therefore investigates co-occurrence of childhood adversity in the Netherlands and whether specific clusters are more common among certain types of families.Participants and SettingRepresentative data from the Family Survey Dutch population 2018 (N = 3,128) are employed.MethodWe estimate Latent Class Analysis (LCA) models to investigate co-occurrence of ACEs. As ACEs we examine maltreatment, household dysfunction, demographic family events, as well as financial and chronic health problems. Gradual measures for maltreatment and financial problems are studied to make it possible to differentiate with regard to the severity of experiences.ResultsOur results show that four ACE clusters may be identified: ‘Low ACE’, ‘Moderate ACE: Household dysfunction’, ‘Moderate ACE: Maltreatment’ and ‘High ACE’. Regression analyses indicated that mother’s age at first childbirth and the number of siblings were related to experiencing childhood adversity. We found limited evidence for ACEs to be related to a family’s socioeconomic position.ConclusionThe found clusters of ACEs reflect severity of childhood adversity, but also the types of adversity a child experienced. For screening and prevention of childhood adversity as well as research on its consequences, it is relevant to acknowledge this co-occurrence of types and severity of adversity. 相似文献
7.
The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse. 相似文献
8.
Adverse childhood experiences (ACEs) are risk factors for interpersonal difficulties in adulthood, however the mechanism that underlies this association is unknown. The current study investigated the association of a wide range of ACEs with interpersonal difficulties in adulthood, and tested whether emotion dysregulation mediated the relationship between ACEs and interpersonal difficulties. Patients over the age of 18 were recruited from primary care clinics (N = 4006). Participants completed self-report questionnaires that assessed ACEs, emotion dysregulation, and interpersonal difficulties. Results indicated that, after controlling for a range of demographic variables, each type of ACE significantly predicted increased interpersonal difficulties and that cumulative ACEs predicted increased interpersonal difficulties, F(8, 3137) = 39.68, p < .001, R2 = 0.09. Further, emotion dysregulation mediated the association between ACEs and interpersonal difficulties, B = 0.79, SE = 0.09, 95% CI [0.64, 0.97]. These findings emphasize the role of childhood adversity on interpersonal functioning in adulthood, and highlight emotion dysregulation as a mechanism by which this association occurs. Results have the potential to inform preventative and treatment efforts to improve adaptive outcomes among individuals with a history of childhood adversity. 相似文献
9.
Research has demonstrated the negative impact of Adverse Childhood Experiences (ACEs) on long-term trajectories of mental and physical health. Yet existing literature on this topic is limited in its understanding of outcomes among youth samples, optimal measurement items and methods, and differences in adverse experiences across race/ethnicity. The current study used a person-centered approach to measure ACEs and their impact on youth health outcomes across three different racial/ethnic groups from a large national database. Patterns of exposure to adverse experiences among Black, Latinx, and White youth (N = 30,668, ages 12–17) were determined empirically using latent class analysis (LCA). Significant differences in class membership by demographic indicators (age, household income, sex) and concurrent health outcomes were identified. Different models emerged for Black (2 classes), Latinx (3 classes), and White youth (3 classes). Older and lower-income youth were more likely to have experienced adversities, but there were no differences in adversity likelihood by sex. Additionally, racial/ethnic minority youth were at greater risk of experiencing higher levels of adversity, poverty, and poor health when compared to their White counterparts. Rather than occuring in meaningful clusters, adverse experiences among youth reflected a cumulative risk model such that classes were defined by the overall intensity of adverse experiences (i.e., low, moderate, high). Findings provide greater knowledge regarding the relationship between ACEs and health and future research directions to inform more targeted and culturally-appropriate screening, prevention, and intervention programs. 相似文献
10.
Adverse childhood experiences (ACEs) are important public health concerns, with links to higher prevalence rates of both health-risk behaviors and physical health difficulties in adulthood. Research has demonstrated an association between early adversity and long-term health-risk behavior development. The current study assessed the role of emotion dysregulation and facets of impulsivity as potential mediators in the relation between ACEs and general health-risk behaviors, including alcohol-related consequences and risky sexual behavior. College students (N = 668) completed online questionnaires that assessed history of ACEs, emotion regulation difficulties, impulsivity under extreme affect, and current engagement in health-risk behaviors. Emotion dysregulation and impulsivity under extreme positive emotion, but not negative emotion, demonstrated a significant serial mediation between ACEs and alcohol-related consequences. Results also suggest that emotion dysregulation mediates the relation between early adversity and all three outcomes (i.e., overall engagement in maladaptive behavior, alcohol-related consequences, and risky sexual behavior). Impulsivity under positive or negative affect did not demonstrate a mediation effect on the three outcomes. Results of this study highlight the importance of assessing for emotion regulation skills when working with young adults with histories of adversity. 相似文献
11.
BackgroundAdverse childhood experiences (ACEs) are a potent risk factor. Despite these findings, studies have also recognized the importance of considering additional sources of genetic and environmental influence that cluster within families.ObjectiveTo properly control for latent sources of genetic and within-family environmental influences and isolate the association between ACEs and the following outcomes in adulthood: physical health, depressive symptoms, educational attainment, income attainment, alcohol problems, and antisocial behavior.Participants and SettingTwo independent samples of twins and siblings from the United States: the Midlife Development in the United States (MIDUS) study (N = 862) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 3112).MethodsSibling comparison models, which control for latent sources of genetic and within-family environmental influences, were estimated to examine whether differential exposure to ACEs was associated with the examined outcomes.ResultsFamilies that experienced more adversity also experienced more deleterious outcomes. However, siblings that experienced more adversity were no more likely to experience deleterious outcomes than their co-siblings. However, greater exposure to ACEs was associated with increases in depressive symptoms (Add Health). Additional models revealed that the similarity between siblings from the same family stemmed from latent sources of within-family environmental influences not captured by traditional ACEs measures.ConclusionsConsidering genetic influences and additional latent sources of within-family influences is crucial in isolating the effects of ACEs. Currently employed ACEs measures may not adequately capture the full range of impactful sources of family-level environmental influence. 相似文献
12.
ObjectiveThe purpose of this study was to estimate the prevalence of adverse childhood experiences (ACEs) among children in the United States and to examine the relationship between child and family characteristics and the likelihood of reported exposure to ACEs.MethodsData were drawn from the nationally representative 2016 National Survey of Children’s Health (NSCH). Parent-reported child ACE exposure was measured using counts of those reporting zero ACEs, one to three ACEs, and four or more ACEs.ResultsThe study sample included 45,287 children. The most prevalent types of ACE exposure experienced by children were economic hardship (22.5%) and parent or guardian divorce or separation (21.9%). Older children (34.7%), Non-Hispanic African American children (34.7%), children with special health care needs (SHCN; 36.3%), children living in poverty (37.2%), and children living in rural areas (30.5%) were more likely to be exposed to parental divorce or separation than their counterparts. Five cross-cutting factors emerged as important across outcomes: child’s age, family structure, poverty, type of health insurance, and SHCN status.ConclusionsWe found high prevalence rates of economic hardship on a national level. Our findings of higher prevalence among rural children further suggest the importance of the intersection of place and ACEs. Therefore, the geographic component of ACEs must be considered by policymakers. The identification of predictive factors related to high ACE exposure can inform early interventions at the national level. 相似文献
13.
BackgroundAdverse childhood experiences (ACEs) are an identified risk factor for the social and emotional development of children. What is less known is the long-term effects of ACEs when poverty and ACEs coincide.ObjectiveUsing longitudinal cohort-panel data, we examined whether exposure to ACEs by the age of three among poor children would longitudinally result in behavioral problems at ages three, five, nine, and 15, after controlling for mothers’ socioeconomic status and their children’s characteristics.Participants and settingWe used a subsample of 2750 children and their parents living in urban poverty from the Fragile Families and Child Wellbeing study.MethodsLogistic regression modeling was used to obtain adjusted odds ratios of ACE categories predicting behavioral problems after accounting for family socioeconomic position.ResultsOur findings indicate that experiencing ACEs in early childhood was significantly associated with later behavioral outcomes from childhood to adolescence. Exposure to multiple ACEs before the age of three was significantly associated with the top-risk behavior group at age five; the odd ratios were 2.0 (CI = 1.3–3.1) and 2.9 (CI = 1.8–4.6) for two ACEs and three or more ACEs, respectively. At both ages nine and 15, children experiencing two or more ACEs had 1.9 to 3.2 times higher odds to demonstrate more the top 10th percentile of behavioral problems. Among covariates, mothers’ race and education, and children’s gender and temperament were identified as significant factors to determine behavior problems.ConclusionsThe findings support policies and programs for families with children who have experienced economic disadvantages and early childhood adversity. 相似文献
14.
BackgroundAdverse childhood experience (ACE) and intimate partner violence (IPV) have sustained, deleterious effects on physical and mental health. Few studies have examined how to help Latina survivors of ACEs and/or IPV regain control of their health.ObjectiveTo inform interventions for this population, we examined whether mastery of stress and patient activation mediate the relationship between a history of ACE and/or IPV and mental and physical health.Participants and settingWe recruited 235 Latina women (M age = 29.6, SD = 5.75) from primary care clinics.MethodFor this cross-sectional study, we used linear regressions to examine the association between ACEs, history of IPV, and health, and the sobel’s test to determine whether patient activation and mastery of stress mediated the relationships between ACEs, IPV, and health.ResultsMost women reported at least one ACE (61.7%, n = 137) and 22.2% (n = 55) reported a history of IPV. Mastery of stress mediated the relationship between ACE and physical health (b= -3.16 p = .002) and mental health (b= -3.83, p < .001). Mastery of stress also mediated the relationship between history of IPV and physical health (b= -2.62, p = .008) and mental health (b= -2.74, p = .006). Patient activation was not associated with a history of trauma or mental health.ConclusionWhile past experiences of trauma cannot be changed, results from this study suggest that improving an individual’s mastery of stress may be a point of intervention for improving mental and physical health among survivors of ACEs and IPV. 相似文献
15.
BackgroundExtensive research has documented the association between adverse childhood experiences (ACEs) and poor outcomes later in life, as well as the high prevalence of ACEs in the American population. Studies consistently find that over half of American adults have experienced at least one ACE. Despite this, research on the long-term impacts of ACEs is challenging due to the complex nature of adversity.ObjectiveOur study aimed to define underlying constructs of adversity, and explore how they changed throughout childhood, in a low-income population.Participants and SettingWe fielded a survey to Medicaid-enrolled adults in the Portland, OR metropolitan area.MethodsOur survey captured different experiences in childhood, including relationships and support, educational challenges, housing and employment stability, neighborhood environment, discrimination, abuse, neglect, and household dysfunction; questions were asked for 6–12 and 13–18 years of age. We then used factor analysis to identify underlying constructs of adversity in the two age ranges.ResultsWe identified two factors - Inadequate Emotional Support and Instability – in each age range. Inadequate Emotional Support remained consistent in both time periods while the Instability factor changed, expanding from household-centric experiences in childhood to a wider variety of experiences in adolescence. Additionally, a number of variables did not load on either factor in either age range.ConclusionsThese results underscore the importance of expanding how we think about instability specifically, and childhood adversity in general. 相似文献
16.
The aims of this study were to identify latent classes of adverse childhood experiences (ACEs) in a large sample of college students (N = 8997), investigate the relations between ACEs classes and life functioning, and compare results using latent class analysis to analyses using cumulative risk scores. Nine types of ACEs were assessed (three types of child abuse and six types of household dysfunction). Outcomes were self-report measures of mental health, physical health, alcohol consequences, and academic performance. Latent class analysis (LCA) results indicated that four classes fit the data best across random halves of the sample and were labeled High ACEs, Moderate Risk of Non-Violent Household Dysfunction, Emotional and Physical Child Abuse, and Low ACEs. Comparing across latent classes, the largest differences in outcomes were between the High ACEs and Low ACEs classes. There were no differences in outcomes between the Moderate Risk of Non-Violent Household Dysfunction and Emotional and Physical Child Abuse classes. The largest between-class differences were found for mental health and the smallest differences were found for academic performance. Comparing results using LCA latent classes and cumulative ACEs scores, the differences between the High and Low ACEs latent classes were similar to the differences between those with zero ACEs and those with 5 or more ACEs. Both approaches also accounted for roughly equivalent amounts of variance in all outcomes. Thus, latent class and cumulative risk analyses provided similar results with regard to predicting outcomes of interest among college students. 相似文献
17.
Adverse childhood experiences (ACEs), such as childhood abuse, neglect, and household dysfunction, have been identified as salient risk factors for adult depression. However, not all individuals who experience ACEs go on to develop depression. The extent to which resilience- or the ability to demonstrate stable levels of functioning despite adversity- may act as a buffer against depression among individuals with a history of ACEs has not been adequately examined. To address the associations between ACEs, depression, and resilience, 4006 adult participants were recruited from primary care clinics. Participants completed self-report questionnaires including: the Adverse Childhood Experiences Questionnaire, a retrospective measure of childhood adversity; the Patient Health Questionnaire-9, a measure of the presence and severity of the major symptoms of depression; and the Connor Davidson Resilience Scale, a measure of psychological resilience. Results from regression analyses indicated that, while controlling for a range of demographic variables, both ACEs and resilience independently predicted symptoms of depression, F(9, 3040) = 184.81, R2 = 0.354. Further, resilience moderated the association between ACEs and depression, F(10, 3039) = 174.36, p < 0.001, R2 = 0.365. Specifically, the association between ACEs and depression was stronger among individuals with low resilience relative to those with high resilience. This research provides important information regarding the relationships among ACEs, resilience, and depression. Results have the potential to inform the development of treatments aimed to reduce symptoms of depression among primary care patients with a history of childhood adversity. 相似文献
18.
The degree to which child maltreatment interacts with other household adversities to exacerbate risk for poor adult socioeconomic outcomes is uncertain. Moreover, the effects of residential, school, and caregiver transitions during childhood on adult outcomes are not well understood. This study examined the relation between household adversity and transitions in childhood with adult income problems, education, and unemployment in individuals with or without a childhood maltreatment history. The potential protective role of positive relationship quality in buffering these risk relationships was also tested. Data were from the Lehigh Longitudinal Study (n = 457), where subjects were assessed at preschool, elementary, adolescent, and adult ages. Multiple group path analysis tested the relationships between childhood household adversity; residential, school, and caregiver transitions; and adult socioeconomic outcomes for each group. Caregiver relationship quality was included as a moderator, and gender as a covariate. Household adversity was negatively associated with education level and positively associated with income problems for non-maltreated children only. For both groups, residential transitions was negatively associated with education level and caregiver transitions was positively associated with unemployment problems. Relationship quality was positively associated with education level only for non-maltreated children. For children who did not experience maltreatment, reducing exposure to household adversity is an important goal for prevention. Reducing exposure to child maltreatment for all children remains an important public health priority. Results underscore the need for programs and policies that promote stable relationships and environments. 相似文献
19.
BackgroundDespite strong associations between adverse childhood experiences (ACEs) and poor health, few studies have examined the cumulative impact of ACEs on causes of childhood mortality.MethodsThis study explored if data routinely collected by child death overview panels (CDOPs) could be used to measure ACE exposure and examined associations between ACEs and child death categories. Data covering four years (2012–2016) of cases from a CDOP in North West England were examined.ResultsOf 489 cases, 20% were identified as having ≥4 ACEs. Deaths of children with ≥4 ACEs were 22.26 (5.72–86.59) times more likely (than those with 0 ACEs) to be classified as ‘avoidable and non-natural’ causes (e.g., injury, abuse, suicide; compared with ‘genetic and medical conditions’). Such children were also 3.44 (1.75–6.73) times more likely to have their deaths classified as ‘chronic and acute conditions’.ConclusionsThis study evidences that a history of ACEs can be compiled from CDOP records. Measurements of ACE prevalence in retrospective studies will miss individuals who died in childhood and may underestimate the impacts of ACEs on lifetime health. Strong associations between ACEs and deaths from ‘chronic and acute conditions’ suggest that ACEs may be important factors in child deaths in addition to those classified as ‘avoidable and non-natural’. Results add to an already compelling case for ACE prevention in the general population and families affected by child health problems. Broader use of routinely collected child death records could play an important role in improving multi-agency awareness of ACEs and their negative health and mortality risks as well in the development of ACE informed responses. 相似文献
20.
Currently, in the U.S. and worldwide, childhood trauma is a public health crisis. Childhood adversities, such as abuse, neglect, and related household stressors, are common, interrelated and contribute to multiple adverse social, behavioral and health outcomes throughout the lifespan. The present article provides further discussion regarding adverse childhood experiences (ACEs) screening in healthcare utilizing the etic and emic perspectives. Screening in the healthcare system leans toward the etic view: objective observations of symptoms, which may then lead to intervention delivery. Whereas the emic view provides the subjective perspective as experienced by participants of a system, culture, or common group. Finkelhor’s argument about cautions regarding widespread screening is relevant in the current allopathic healthcare system, which utilizes an etic perspective and where evidence-based ACEs interventions within a biomedical-centric model are lacking. Therefore, in healthcare settings, universal ACEs screening may serve the clinicians with a surveillance tool to inform and guide medical practice and policy as they relate to delivering trauma-informed care. The Public Health Code of Ethics and Basis for Action reminds us about the values approach for collecting and using data ethically to protect population health. Practitioners and researchers across the globe are beginning to take community-engaged action, with an emic view of all community members involved. 相似文献