Overview of the ACE study - Delaware Courts · Overview of the Adverse Childhood Experiences (ACE)...
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Overview of the Adverse Childhood Experiences (ACE) Study Robert F. Anda, MD, MS Co-Principal Investigator www.acestudy.org
Transcript of Overview of the ACE study - Delaware Courts · Overview of the Adverse Childhood Experiences (ACE)...
Ove
rvie
w o
f the
Adv
erse
Chi
ldho
od
Exp
erie
nces
(A
CE
) S
tudy
Rob
ert F
. And
a, M
D, M
SC
o-P
rinci
pal I
nves
tigat
or
ww
w.a
cest
udy.
org
Ado
ptio
n of
H
ealth
-ris
k B
ehav
iors
Soc
ial,
Em
otio
nal,
&
Cog
nitiv
e Im
pairm
ent
Ear
lyD
eath
Adv
erse
Chi
ldho
od E
xper
ienc
es
Dea
th
Dis
ease
, Dis
abili
tyan
d S
ocia
l Pro
blem
s
Con
cept
ion
Sci
entif
icga
ps
The
Adv
erse
Chi
ldho
od E
xper
ienc
es (
AC
E)
Stu
dy
Exa
min
es th
e he
alth
and
soc
ial e
ffect
s of
AC
Es
thro
ugho
ut th
e lif
espa
n am
ong
17,4
21 m
embe
rsof
the
Kai
ser
Hea
lth P
lan
in S
an D
iego
Cou
nty
Wha
t do
we
mea
n by
Adv
erse
Chi
ldho
od E
xper
ienc
es?
-chi
ldho
od a
buse
and
neg
lect
-gro
win
g up
with
dom
estic
vio
lenc
e, s
ubst
ance
abus
e or
men
tal i
llnes
s in
the
hom
e, p
aren
tal
disc
ord,
crim
e
Follow
-up
AC
E S
tudy D
esig
n
Surv
ey W
ave I
M
ort
ality
(N=
9,5
08)
National D
eath
Index
Morb
idity
Hospital D
ischarg
e
Outp
atient
Vis
its
Surv
ey W
ave II
Em
erg
ency r
oom
(N
=8,6
67)
vis
its
Pharm
acy
Utilization
All
medic
al evalu
ations
abstr
acte
d f
rom
both
waves
(N =
17,4
21)
Adv
erse
Chi
ldho
od E
xper
ienc
es A
re C
omm
on
Sub
stan
ce a
buse
27%
Par
enta
l sep
/div
orce
23%
Men
tal i
llnes
s17
%B
atte
red
mot
her
13%
Crim
inal
beh
avio
r
6
%
Hou
seho
ld d
ysfu
nctio
n:
Abu
se:
Psy
chol
ogic
al
11%
Phy
sica
l28
%S
exua
l21
%
Neg
lect
:E
mot
iona
l
1
5%P
hysi
cal
1
0%
Adv
erse
Chi
ldho
od E
xper
ienc
es R
arel
y O
ccur
in Is
olat
ion…
The
y co
me
in
grou
ps.
Dom
estic
Vio
lenc
ean
d th
e R
isk
of O
ther
AC
Es
...
Pre
vale
nce o
f C
hildhood A
buse b
y F
requency o
f W
itnessin
g D
om
estic V
iole
nce
Pre
vale
nce o
f C
hildhood A
buse b
y F
requency o
f W
itnessin
g D
om
estic V
iole
nce
Childhood A
buse
Em
otional
Physic
al
Sexual
0
20
40
60
80
100
Never
Once,T
wic
eSom
etim
es
Oft
en
Very
oft
en
Fre
quency o
f w
itnessin
g
dom
estic v
iole
nce
Percent (%)
AC
Es
tend
to c
ome
in g
roup
s…
Add
ition
al A
CE
s (%
)1
23
4>5
If y
ou
had
:A
bat
tere
d m
othe
r95
8264
4852
Adv
erse
Chi
ldho
od E
xper
ienc
es S
core
Com
plex
Tra
uma-
-Tra
uma
“Dos
e”N
umbe
r of
indi
vidu
al ty
pes
of a
dver
se
child
hood
exp
erie
nces
wer
e su
mm
ed…
AC
E s
core
Pre
vale
nce
033
%1
26%
216
%3
10%
4 or
mor
e16
%
AC
E S
core
and
Tee
n S
exua
l Beh
avio
rs
051015202530354045
Percent With Health Problem (%)
01
23
4 o
r m
ore
AC
E S
core
Inte
rcou
rse
by
Age
15
Tee
n P
regn
ancy
Tee
n P
ater
nity
The
AC
E S
core
and
the
Pre
vale
nce
of
Sev
ere
Obe
sity
(B
MI >
35)
02468101214
01
23
>=4
AC
E S
core
Percent obese (%)
AC
Es a
nd M
enta
l H
ealth…
The
AC
E S
core
and
the
Pre
vale
nce
of
Atte
mpt
ed S
uici
de
05101520
01
23
>=4
AC
E S
core
Percent atempted (%)
The
AC
E S
core
and
a L
ifetim
e H
isto
ry o
f D
epre
ssio
n
010203040506070
01
23
>=4
Wom
enM
en
AC
E S
core
Percent depressed (%)
AC
Es a
nd V
iole
nt
Vic
tim
ization a
s a
n A
dult…
AC
E S
core
and
the
Ris
k of
Bei
ng a
Vic
tim o
f Dom
estic
Vio
lenc
e
051015W
om
en
Men
0 1 2 3 4 >
50 1 2 3 4 >
5
Risk of Victimization (%)
AC
E S
core
Eve
r ad
dict
edto
dru
gs
AC
E S
core
and
Dru
g A
buse
02468101214
Percent With Health Problem (%)
01
23
4>
=5
AC
E S
core
Eve
r ha
d a
drug
pro
blem
Eve
r in
ject
eddr
ugs
AC
E S
core
and
HIV
Ris
ks
02468
10
12
14
16
18
20
Percent With Health Problem (%)
01
23
4 o
r m
ore
AC
E S
core
Eve
r In
ject
edD
rugs
Had
50
or M
ore
Inte
rcou
rse
Par
tner
sE
ver
Had
an
ST
D
02468101214161820
Percent With Health Problem (%)
01
23
4 or
mor
e
AC
E S
core
Ear
ly s
mok
ing
initi
atio
nC
urre
nt s
mok
ing
CO
PD
AC
Es,
Sm
okin
g, a
nd L
ung
Dis
ease
The
AC
E S
core
and
the
Pre
vale
nce
Isch
emic
H
eart
Dis
ease
0123456
01
23
>=4
AC
E S
core
Percent (%)
One P
ers
pective o
n t
he D
irect
Health
Care
Costs
of
AC
Es:
The B
urd
en o
f Pre
scription D
rug U
se
Pre
scription D
rugs in t
he U
nited S
tate
s (2003)
-nearly $
180 b
illion s
pent
-11%
of
tota
l national health e
xpenditure
s
-more
than f
our
tim
es t
he a
mount
spent
in 1
990
AC
E S
core
and
Rat
es o
f Ant
idep
ress
ant
Pre
scrip
tions
0
10
20
30
40
50
60
70
80
90
100
AC
E S
core
0
1
2
3
4
>=5
Prescription rate
(per 100 person-years)
AC
E S
core
and R
ate
s o
f P
rescribed
Antidepre
ssant
Medic
ations b
y A
ge,
1997-2
004
1Rel
ativ
e ra
tes
are
adju
sted
for
age
, sex
, rac
e/et
hnic
ity, a
nd e
duca
tion.
Adu
lts w
ith a
n A
CE
Sco
re o
f 0
are
the
refe
rent
.
020406080100
120
140
01
23
45+
01
23
45+
01
23
45+
Rate per 100 P-Y
AC
E S
core
45-6
4 y
rs
AC
E S
core
18-4
4 y
rs
AC
E S
core
65-8
9 y
rs
Adv
erse
Chi
ldho
od E
xper
ienc
esas
a C
linic
al a
nd P
ublic
Hea
lth Is
sue
AC
Es:
-ar
e en
dem
ic-
high
ly in
terr
elat
ed-
have
a c
umul
ativ
e st
ress
or e
ffect
-ef
fect
s ar
e bi
olog
ical
ly p
laus
ible
Adv
erse
Chi
ldho
od E
xper
ienc
esA
s a
Nat
iona
l Hea
lth Is
sue
AC
Es
have
a s
tron
g in
fluen
ce o
n:-a
dole
scen
t hea
lth-r
epro
duct
ive
heal
th-s
mok
ing
-alc
ohol
abu
se-il
licit
drug
abu
se-s
exua
l beh
avio
r-m
enta
l hea
lth-
risk
of r
evic
timiz
atio
n-s
tabi
lity
of r
elat
ions
hips
, hom
eles
snes
s-p
erfo
rman
ce in
the
wor
kfor
ce
Adv
erse
Chi
ldho
od E
xper
ienc
esA
s a
Nat
iona
l Hea
lth Is
sue
AC
Es
incr
ease
the
risk
of:
-Hea
rt d
isea
se-
Chr
onic
Lun
g di
seas
e-
Live
r di
seas
e-
Sui
cide
-In
jurie
s-H
IV a
nd S
TD
s-
and
othe
r ris
ks fo
r th
e le
adin
gca
uses
of d
eath
The A
dvers
e C
hildhood E
xperiences
(AC
E) Stu
dy
Sum
mary
of
Fin
din
gs:
-Advers
e C
hildhood E
xperiences (
AC
Es)
are
very
com
mon
-AC
Es a
re s
trong p
redic
tors
of
health r
isks a
nd
dis
ease f
rom
adole
scence t
o a
dulthood
-This
com
bin
ation o
f findin
gs m
akes A
CEs o
ne
of
the leadin
g, if n
ot
the leadin
gdete
rmin
ant
of
the h
ealth a
nd s
ocia
l w
ell-b
ein
g o
f our
nation
Brid
ging
The
Cha
sm
Chi
ld
heal
thas
it
stan
dsto
day
Chi
ld
heal
thas
itco
uld
be
Bre
akth
roug
hsin
mol
ecul
ar g
enet
ics
and
biol
ogy
:M
enta
l illn
ess
Sub
stan
ce a
buse
Vio
lenc
e
Impr
oved
rec
ogni
tion
and
trea
tmen
t of
:M
enta
l illn
ess
Sub
stan
ce a
buse
Dom
estic
vio
lenc
eC
hild
abu
se
Mas
s ed
ucat
ion
abou
t chi
ld
deve
lopm
ent &
pare
ntin
g:
Med
iaS
choo
ls
Doc
umen
ting
the
soci
etal
bur
den
ofch
ild h
ealth
as
it st
ands
toda
y
New
dire
ctio
nsin
pre
vent
ion
and
trea
tmen
t
Brid
ging
The
Cha
sm
Chi
ld
heal
thas
it
stan
dsto
day
Chi
ld
heal
thas
itco
uld
be
Invo
lvin
g th
ose
who
don
’t ye
t rea
lize
that
they
are
wor
king
on
issu
es th
at
repr
esen
t the
“do
wns
trea
m”
wre
ckag
eof
chi
ld a
buse
and
neg
lect
--an
d ot
her
adve
rse
child
hood
exp
erie
nces
--in
the
effo
rt to
brid
ge th
e ch
asm
.
Rou
tine
scre
enin
g fo
r tr
aum
a is
nee
ded
