1. The Relationship of Adverse Childhood Experiences to Adult Health Status Presentation to MCAH Committee December2, 2010 Edwin Ferran Director of Learning and Innovation Community Action Partnership of Sonoma County 707-544-6911; eferran@capsonoma.org

2. 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

3. ACE Study Design Comprehensive Psycho-social Survey Over 17,000 Kaiser patients Present Health Status Mortality & Morbidity Hospital Discharge Outpatient Visits Emergency Room Visits Pharmacy Utilization

4. What are “Adverse Childhood Experiences?” ACES Categories WomenMenTotal 9,3677,97017,337 Emotional Abuse 13.17.610.6 Physical Abuse 2729.928.3 Sexual Abuse 24.71620.7 Emotional Neglect 16.712.414.8 Physical Neglect 9.210.79.9 Mother Treated Violently 13.711.512.7 Household Substance Abuse 29.523.826.9 Household Mental Illness 23.314.819.4 Parental Separation or Divorce 24.521.823.3 Incarcerated Household Member 5.24.14.7

5. Prevalence ACES Categories WomenMenTotal 9,3677,97017,337 Emotional Abuse 13.17.610.6 Physical Abuse 2729.928.3 Sexual Abuse 24.71620.7 Emotional Neglect 16.712.414.8 Physical Neglect 9.210.79.9 Mother Treated Violently 13.711.512.7 Household Substance Abuse 29.523.826.9 Household Mental Illness 23.314.819.4 Parental Separation or Divorce 24.521.823.3 Incarcerated Household Member 5.24.14.7

6. Adverse Childhood Experiences Score Number of Adverse Childhood Experiences (ACE Score) WomenMenTotal 034.53836.1 124.527.926 215.516.415.9 310.38.69.5 4 or more15.29.212.5

7. Adverse Childhood Experiences vs. Current Smoking %

8. ACE Score vs. Smoking and COPD

9. Childhood Experiences vs. Adult Alcoholism 0 1 2 3 4+

10. Childhood Experiences Underlie Chronic Depression

11. Childhood Experiences Underlie Suicide 1 2 0 3 4+

12. Adverse Childhood Experiences vs. Likelihood of > 50 Sexual Partners

13. Adverse Childhood Experiences vs. History of STD

14. ACE Score vs.Unintended Pregnancy or Elective Abortion

15. Childhood Experiences Underlie Rape 0 1 2 3 4+

16. ACE Score Ever Hallucinated* (%) Abused Alcohol or Drugs *Adjusted for age, sex, race, and education. ACE Score and Hallucinations

17. ACE Score vs. Intravenous Drug Use N = 8,022 p<0.001

18. Premature mortality and excess morbidity are typically the result of a small number of common diseases. ACE = Parental Loss

19. Evidence from ACE Study Suggests: These chronic diseases in adults are determined decades earlier, by the experiences of childhood. Affective Response

21. The risk factors underlying these adult diseases are effective coping devices.

22. What is conventionally viewed as a problem is actually a solution to an unrecognized prior adversity.

23. Adverse Childhood Experiences determine the likelihood of the ten most common causes of death in the United States. Top 10 Risk Factors : smoking, severe obesity, physical inactivity, depression, suicide attempt, alcoholism, illicit drug use, injected drug use, 50+ sexual partners, h/o STD.

24. Adverse Childhood Experiences Social, Emotional, & Cognitive Impairment Adoption of Health-risk Behaviors Disease, Disability Early Death The Influence of Adverse Childhood Experiences Throughout Life Death Birth

25. Discussion questions….  What are the implications of this for addressing risk behaviors in adults?  What strategies can be employed to improve their health outcomes?  Acknowledge their reality by asking, “How has this affected you later in life?”  Parenting, parenting, parenting…

26. For more info….   http://www.cdc.gov/ace/index.htm