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; 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 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