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

Robert F. Anda, M.D.  Vincent J. Felitti, M.D.

                     U.S. Department of Justice

           Washington, DC    December 12, 2012 

1

ACE Study Design

Survey Wave 1

71% response (9,508/13,454)

  	n=13,000

 	71% response

Survey Wave II

     	n=13,000

All medical evaluations

abstracted

Present

Health Status

Mortality

  National Death Index

Morbidity

  Hospital Discharges

  Doctor Office Visits

  Emergency Room Visits

  Pharmacy Costs

All medical evaluations

abstracted

vs.

&

17,337 adults

Empirically Selected Categories of Adverse Childhood Experiences

Prevalence (%)

Abuse, by Category

    Psychological (by parents)					11%

    Physical (by parents)					28%

    Sexual (anyone)						22%

Major Neglect, by Category

    Emotional							15%

    Physical							10%

Household Dysfunction, by Category

     Alcoholism or drug use in home				27%

     Loss of biological parent <18                                            23%

     Depression or mental illness in home			17%

     Mother treated violently					13%

     Imprisoned household member				  5%

Who would ever suspect – without routinely asking

Here is a good example of what we’re talking about.  Superficially, this woman looks like she is doing fine, stressing the importance of routine inquiry of everyone.

Smoking to Self-Medicate

The Functionality of ‘dysfunctional’ behavior

And this looks like a hard-working man – and he is, but there is vastly more.  DESCRIBE CHILDHOOD HX and imprisonment for attempted murder.  He speaks of the psychoactive BENEFITS of nicotine that have been overlooked in the public health onslaught against smoking.  Why were these benefits needed when their future risk is so well known?   

Childhood Experiences vs. Adult Alcoholism

0

1

2

3

4+

Health Risks

ACE Score vs. Intravenous Drug Use

      p<0.001

Health Risks

One thing it means is that there is a PUBLIC HEALTH PARADOX wherein what we see as a public health PROBLEM is often also a SOLUTION for the person involved.  

Childhood Experiences Underlie Later Suicide

1

2

0

3

4+

Death

 .  With 6 or more categories of traumatic experience, the likelihood of subsequent suicide attempt is between 31-50 TIMES that of a person having no such traumatic experiences.  

ACE Score and theRisk of Perpetrating Domestic Violence__________________________________

Risk of Perpetration (%)

0

5

10

15

Women

Men

  0     1      2      3     4     >5

 0      1      2      3     4     >5

ACE Score

 Well-being

This is interesting because we found that adverse childhood experiences make men and women equally likely to be perpetrators of domestic violence.  We’re not used to thinking of that parity, but that’s only because children are the usual victims of women, and children are not In a position to make these experiences public.  Violence begets violence.  Remember the electrician.

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!

A history of traumatic experiences in childhood is primary to our most common medical, social, and public health problems.  We need to create an inexpensive and reliable system to identify all  cases, literally on a population-wide basis.  In other words, we need to identify mental health problems in their EARLIEST form before they progress to violence, addictions, biomedical disease, and premature death.

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.

Further Information

www.acestudy.org

http://www.cdc.gov/NCCDPHP/ACE

Google Scholar  (search: Felitti or Anda or ACE Study)

VJFMDSDCA@mac.com

AVAHealth.org              (Detailed DVD)

www.ACEsTooHigh.com        (useful  blog on the subject)

I shown you a skeletal outline of what we have found thus far in the 17 years of the ACE Study.  If you would like to know more, here are some sources