Adverse Childhood Experiences

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Adverse Childhood Experiences and their
Relationship to Adult Well-being, Disease,
and Death Turning gold into lead
A collaborative effort between Kaiser
Permanente and the Centers for Disease Control
ACMHA Policy Forum
Washington, DC December 5, 2012
Robert F. Anda, M.D. Vincent J. Felitti, M.D.
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ACE Study Design
Survey Wave 1 71 response (9,508/13,454)
n13,000 71 response
Mortality National Death Index Morbidity
Hospital Discharges Doctor Office Visits
Emergency Room Visits Pharmacy Costs
Present
vs.

All medical evaluations abstracted
Health Status
Survey Wave II n13,000
17,337 adults
All medical evaluations abstracted
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Empirically Selected Categories of Adverse
Childhood Experiences
Prevalence ()
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Adverse Childhood Experiences Score
Number of categories (not events) is summed
ACE Score Prevalence 0 33 1 25
2 15 3 10 4 6 5 or more
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• Two out of three adults experienced at least one
  category of ACE.
• If any one ACE is present, there is an 87 chance
  at least one other category of ACE is present,
  and a 50 chance of three or more.
• Women are 50 more likely than men to have an ACE
  Score gt5.

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Who would ever suspect without routinely asking
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Smoking to Self-Medicate
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Health Risks
Adverse Childhood Experiences vs. gt1 ppd Smoking
as an Adult

Plt .001
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Health Risks
Childhood Experiences vs. Adult Alcoholism
4
3
2
1
0
9
ACE Score vs. Intravenous Drug Use
Health Risks
plt0.001
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Well-being
Childhood Experiences Underlie Chronic Depression
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Death
Childhood Experiences Underlie Later Suicide
4
3
2
1
0
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Well-being
ACE Score and theRisk of Perpetrating Domestic
Violence__________________________________
15
Men
Women
10
Risk of Perpetration ()
5
0
0 1 2 3 4 gt5
0 1 2 3 4 gt5
ACE Score
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Turning Research into Practicea beginning

• Comprehensive biomedical evaluation provides a
  net 11 reduction in DOVs in the subsequent year.
• Comprehensive bio-psycho-social evaluation, which
  incorporates ACE Study findings, provides a 35
  reduction in DOVs in the subsequent year compared
  to the prior year. (125,000 patient sample)
• Imagine the possibilities!

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What Can We Do Today?

• Routinely seek a history of traumatic childhood
  experiences from all patients, inmates, and
  children in foster care.
• Acknowledge their reality by asking, How has
  this affected you later in life?
• Develop programs for primary prevention.

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Further Information

• www.acestudy.org
• http//www.cdc.gov/NCCDPHP/ACE
• Google Scholar (search Felitti or Anda or ACE
  Study)
• VJFMDSDCA_at_mac.com
• AVAHealth.org (Detailed DVD)
• www.ACEsTooHigh.com (useful blog on the
  subject)