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 77-544-6911; eferran@capsonoma.org
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 Design Comprehensive Psycho-social Survey Over 17, Kaiser 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 7,97 17,337 Emotional Abuse 13.1 7.6 1.6 Physical Abuse 27 29.9 28.3 Sexual Abuse 24.7 16 2.7 Emotional Neglect 16.7 12.4 14.8 Physical Neglect 9.2 1.7 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 7,97 17,337 Emotional Abuse 13.1 7.6 1.6 Physical Abuse 27 29.9 28.3 Sexual Abuse 24.7 16 2.7 Emotional Neglect 16.7 12.4 14.8 Physical Neglect 9.2 1.7 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 34.5 38 36.1 1 24.5 27.9 26 2 15.5 16.4 15.9 3 1.3 8.6 9.5 4 or more 15.2 9.2 12.5
Adverse Childhood Experiences vs. Current Smoking % 2 18 16 14 12 1 8 6 4 2 1 2 3 4-5 ACE Score 6 or more
ACE Score vs. Smoking and COPD Percent With Problem 2 18 16 14 12 1 8 6 4 2 ACE Score: 1 2 3 4 or more Regular smoking by age 14 COPD
18 Childhood Experiences vs. Adult Alcoholism 16 14 4+ % Alcoholic 12 1 8 6 4 2 1 2 3 ACE Score
Childhood Experiences Underlie Chronic Depression % With a Lifetime History of Depression 8 7 6 5 4 3 2 1 1 2 3 >=4 ACE Score Women Men
25 Childhood Experiences Underlie Suicide 2 4+ % Attempting Suicide 15 1 5 1 2 3 ACE Score
Adverse Childhood Experiences vs. Likelihood of > 5 Sexual Partners 4 Adjusted Odds Ratio 3 2 1 1 2 3 ACE Score 4 or more
Adverse Childhood Experiences vs. History of STD 3 Adjusted Odds Ratio 2.5 2 1.5 1.5 1 2 3 ACE Score 4 or more
ACE Score vs.unintended Pregnancy or Elective Abortion 8 Unintended Pregnancy % have Unintended PG, or AB 7 6 5 4 3 2 1 Elective Abortion o m 1 2 3 4 r ore ACE Score
Childhood Experiences Underlie Rape 35 3 4+ 25 % Reporting Rape 2 15 1 1 2 3 5 ACE Score
12 ACE Score and Hallucinations Ever Hallucinated* (%) 1 8 6 4 2 1 2 3 4 5 6 >=7 ACE Score *Adjusted for age, sex, race, and education. Abused Alcohol or Drugs No Yes
ACE Score vs. Intravenous Drug Use 3.5 % Have Injected Drugs 3 2.5 2 1.5 1.5 o m 1 2 3 4 r ore ACE Score N = 8,22 p<.1
Premature mortality and excess morbidity are typically the result of a small number of common diseases. ACE = Parental Loss
Evidence from ACE Study Suggests: These chronic diseases in adults are determined decades earlier, by the experiences of childhood. Affective Response
The risk factors underlying these adult diseases are effective coping devices.
What is conventionally viewed as a problem is actually a solution to an unrecognized prior an unrecognized prior adversity.
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.
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
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
For more info. http://www.cdc.gov/ace/index.htm