The Relationship of Adverse Childhood Experiences to Adult Health Status

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Gwendoline Hood
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1 The Relationship of Adverse Childhood Experiences to Adult Health Status Presentation to MCAH Committee December2, 21 Edwin Ferran Director of Learning and Innovation Community Action Partnership of Sonoma County ;

2 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

3 ACE Study Design Comprehensive Psycho-social Survey Over 17, Kaiser patients Present Health Status Mortality & Morbidity Hospital Discharge Outpatient Visits Emergency Room Visits Pharmacy Utilization

4 What are Adverse Childhood Experiences? ACES Categories Women Men Total 9,367 7,97 17,337 Emotional Abuse Physical Abuse Sexual Abuse Emotional Neglect Physical Neglect Mother Treated Violently Household Substance Abuse Household Mental Illness Parental Separation or Divorce Incarcerated Household Member

5 Prevalence ACES Categories Women Men Total 9,367 7,97 17,337 Emotional Abuse Physical Abuse Sexual Abuse Emotional Neglect Physical Neglect Mother Treated Violently Household Substance Abuse Household Mental Illness Parental Separation or Divorce Incarcerated Household Member

6 Adverse Childhood Experiences Score Number of Adverse Childhood Experiences (ACE Score) Women Men Total or more

7 Adverse Childhood Experiences vs. Current Smoking % ACE Score 6 or more

8 ACE Score vs. Smoking and COPD Percent With Problem ACE Score: or more Regular smoking by age 14 COPD

9 18 Childhood Experiences vs. Adult Alcoholism % Alcoholic ACE Score

10 Childhood Experiences Underlie Chronic Depression % With a Lifetime History of Depression >=4 ACE Score Women Men

11 25 Childhood Experiences Underlie Suicide 2 4+ % Attempting Suicide ACE Score

12 Adverse Childhood Experiences vs. Likelihood of > 5 Sexual Partners 4 Adjusted Odds Ratio ACE Score 4 or more

13 Adverse Childhood Experiences vs. History of STD 3 Adjusted Odds Ratio ACE Score 4 or more

14 ACE Score vs.unintended Pregnancy or Elective Abortion 8 Unintended Pregnancy % have Unintended PG, or AB Elective Abortion o m r ore ACE Score

15 Childhood Experiences Underlie Rape % Reporting Rape ACE Score

16 12 ACE Score and Hallucinations Ever Hallucinated* (%) >=7 ACE Score *Adjusted for age, sex, race, and education. Abused Alcohol or Drugs No Yes

17 ACE Score vs. Intravenous Drug Use 3.5 % Have Injected Drugs o m r ore ACE Score N = 8,22 p<.1

18 Premature mortality and excess morbidity are typically the result of a small number of common diseases. ACE = Parental Loss

19 Evidence from ACE Study Suggests: These chronic diseases in adults are determined decades earlier, by the experiences of childhood. Affective Response

21 The risk factors underlying these adult diseases are effective coping devices.

22 What is conventionally viewed as a problem is actually a solution to an unrecognized prior an unrecognized prior adversity.

23 Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States. Top 1 Risk Factors: smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 5+ sexual partners, h/o STD.

24 Death Early Death Disease, Disability Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experiences Birth The Influence of Adverse Childhood Experiences Throughout Life

25 Discussion questions. What are the implications of this for addressing risk behaviors in adults? What strategies can be employed to improve their health outcomes? Acknowledge their reality by asking, How has this affected you later in life? Parenting, parenting, parenting

26 For more info.

Adverse Childhood Experiences and their Relationship to Adult Well-being and Disease :

Adverse Childhood Experiences and their Relationship to Adult Well-being and Disease : Turning gold into lead A collaborative effort between Kaiser Permanente and the Centers for Disease Control Loma Linda