Adverse Childhood Experiences Study

1
Adverse Childhood Experiences Study

• Long term health effects of childhood exposure to
  violence and other adverse events

2
The Study

• Kaiser Permanente, suburban San Diego
• Not a representative sample of the US
• Largely middle class
• Predominantly white (76)
• Average age 57
• Has health insurance (recruited through contact
  with the preventative medicine dept.)
• 17,421 adults surveyed

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Adverse Childhood Experiences

• 8 categories (3 abuse, 5 dysfunction)
• Abuse
• Recurrent physical abuse
• Recurrent emotional abuse
• Sexual abuse

4

• Household Dysfunction
• Growing up in a household where someone was in
  prison
• Where the mother was treated violently
• With an alcoholic or a drug user
• Where someone was chronically depressed, mentally
  ill, or suicidal
• Where at least one biological parent was lost to
  the patient during childhood regardless of why.

5
ACE Score

• Number of adverse childhood experiences of any
  kind (score of 1 to 8).
• Slightly more than half of respondents
  experienced one or more category of ACE.
• One in four were exposed to two categories of
  adverse experience, one in 16 were exposed to
  four categories.
• Given an exposure to one category, there is 80
  likelihood of exposure to another category.

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Effects on health behaviors
7
Effect on disease COPD
8
Insights into Addictions
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Emotional Health Outcomes
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Impact of ACE

• ACE are common, destructive, and have an effect
  that often lasts for a lifetime.
• They are the most important determinant of the
  health and well-being of our nation.
• Do you agree with Felitti?

11
Shift in Focus

• Our usual approach to many adult chronic
  diseases reminds one of the relationship of smoke
  to fire. For a person unfamiliar with fires, it
  would initially be tempting to treat the smoke
  because that is the most visible aspect of the
  problem. Fortunately, fire departments learned
  long ago to distinguish cause from effect else,
  they would carry fans rather than water hoses to
  their work.