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The Relationship of Adverse ChildhoodExperiences to Adult Health Status
Presentation to MCAH Committee
December2, 2010
Edwin FerranDirector of Learning and InnovationCommunity Action Partnership of Sonoma County707-544-6911; [email protected]
The Adverse Childhood Experiences (ACE) Study
• One of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being
• Conducted by Kaiser Permanente and The Centers for
Disease Control
•Principal Investigators:Vincent J. Felitti, M.D.Robert F. Anda, M.D
ACE Study DesignACE Study Design
Comprehensive Psycho-social
Survey
Over 17,000Kaiser patients
Present
Health Status
Mortality &Morbidity Hospital Discharge Outpatient Visits Emergency Room Visits Pharmacy Utilization
What are “Adverse Childhood Experiences?”
ACES Categories Women Men Total
9,367 7,970 17,337
Emotional Abuse 13.1 7.6 10.6
Physical Abuse 27 29.9 28.3
Sexual Abuse 24.7 16 20.7
Emotional Neglect 16.7 12.4 14.8
Physical Neglect 9.2 10.7 9.9
Mother Treated Violently 13.7 11.5 12.7
Household Substance Abuse 29.5 23.8 26.9
Household Mental Illness 23.3 14.8 19.4
Parental Separation or Divorce 24.5 21.8 23.3
Incarcerated Household Member 5.2 4.1 4.7
Prevalence
ACES Categories Women Men Total
9,367 7,970 17,337
Emotional Abuse 13.1 7.6 10.6
Physical Abuse 27 29.9 28.3
Sexual Abuse 24.7 16 20.7
Emotional Neglect 16.7 12.4 14.8
Physical Neglect 9.2 10.7 9.9
Mother Treated Violently 13.7 11.5 12.7
Household Substance Abuse 29.5 23.8 26.9
Household Mental Illness 23.3 14.8 19.4
Parental Separation or Divorce 24.5 21.8 23.3
Incarcerated Household Member 5.2 4.1 4.7
Adverse Childhood Experiences Score
Number of Adverse Childhood Experiences (ACE Score)
Women Men Total
0 34.5 38 36.1
1 24.5 27.9 26
2 15.5 16.4 15.9
3 10.3 8.6 9.5
4 or more 15.2 9.2 12.5
Adverse Childhood Experiences vs. Current Smoking
0
2
4
6
8
10
12
14
16
18
20
0 1 2 3 4-5 6 or more
ACE Score
%
ACE Score vs. Smoking and COPD
0
2
4
6
8
10
12
14
16
18
20P
erc
en
t W
ith
Pro
ble
m 0 1 2 3 4 or more
ACE Score:
Regular smoking by age 14 COPD
Childhood Experiences vs. Adult Alcoholism
0
2
4
6
8
10
12
14
16
18%
Alc
oh
olic
ACE Score
0
1
23
4+
Childhood Experiences Underlie Chronic Depression
0
10
20
30
40
50
60
70
80
% W
ith
a L
ifet
ime
His
tory
of
Dep
ress
ion
0 1 2 3 >=4
ACE Score
WomenMen
Childhood Experiences Underlie Suicide
0
5
10
15
20
25%
Att
em
pti
ng
Su
icid
e
ACE Score
11
22
00
33
4+4+
Adverse Childhood Experiences vs.Likelihood of > 50 Sexual Partners
0
1
2
3
4
Ad
jus
ted
Od
ds
Ra
tio
0 1 2 3 4 or more
ACE Score
Adverse Childhood Experiences vs.History of STD
0
0.5
1
1.5
2
2.5
3
Ad
jus
ted
Od
ds
Ra
tio
0 1 2 3 4 or more
ACE Score
ACE Score vs.Unintended ACE Score vs.Unintended Pregnancy or Elective AbortionPregnancy or Elective Abortion
0
10
20
30
40
50
60
70
80
%
ha
ve
Un
inte
nd
ed
PG
, or
AB
0 1 2 3 4 or more
ACE Score
Unintended Pregnancy
Elective Abortion
Childhood Experiences Underlie RapeChildhood Experiences Underlie Rape
0
5
10
15
20
25
30
35%
Re
po
rtin
g R
ap
e
ACE Score
00
11
2233
4+4+
0
2
4
6
8
10
12
0 1 2 3 4 5 6 >=7
No
Yes
ACE Score
Ever
Hallu
cin
ate
d*
(%)
AbusedAlcohol
or Drugs
*Adjusted for age, sex, race, and education.
ACE Score and HallucinationsACE Score and Hallucinations
ACE Score vs. Intravenous Drug UseACE Score vs. Intravenous Drug Use
0
0.5
1
1.5
2
2.5
3
3.5
% H
av
e In
jec
ted
Dru
gs
0 1 2 3 4 or more
ACE Score
N = 8,022 p<0.001N = 8,022 p<0.001
Premature mortality and Premature mortality and excess morbidity are excess morbidity are typically the result of a small typically the result of a small number of number of common diseases.common diseases.
ACE = Parental Loss
Evidence from ACE Study Suggests:Evidence from ACE Study Suggests:These chronic diseases in These chronic diseases in adults are determined adults are determined decades earlier, by the decades earlier, by the experiences of childhood.experiences of childhood.
Affective Response
The risk factors The risk factors underlyingunderlying
these adult diseases these adult diseases areare
effective coping effective coping devices.devices.
What is conventionallyWhat is conventionallyviewed as a problem viewed as a problem
is actually a solution to is actually a solution to
an unrecognized prior an unrecognized prior adversity.adversity.
Adverse Childhood Experiences Adverse Childhood Experiences determine the likelihood of the determine the likelihood of the
ten most common causes of ten most common causes of death in the United States.death in the United States.
Top 10 Risk FactorsTop 10 Risk Factors: smoking, severe obesity, physical inactivity, : smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, h/o STD.50+ sexual partners, h/o STD.
Adverse Childhood ExperiencesAdverse Childhood Experiences
Social, Emotional, & Cognitive Impairment
Adoption ofHealth-risk Behaviors
Disease, Disability
EarlyEarlyDeathDeath
The Influence of AdverseChildhood Experiences Throughout Life
Death
Birth
Discussion questions….Discussion questions…. What are the implications of this for What are the implications of this for
addressing risk behaviors in adults?addressing risk behaviors in adults? What strategies can be employed to What strategies can be employed to
improve their health outcomes?improve their health outcomes? Acknowledge their reality by asking, Acknowledge their reality by asking, “How “How
has this affected you later in life?”has this affected you later in life?” Parenting, parenting, parenting…Parenting, parenting, parenting…
For more info….For more info….
http://www.cdc.gov/ace/index.htmhttp://www.cdc.gov/ace/index.htm