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 ;

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

What are “Adverse Childhood Experiences?” ACES Categories WomenMenTotal 9,3677,97017,337 Emotional Abuse Physical Abuse Sexual Abuse Emotional Neglect Physical Neglect Mother Treated Violently Household Substance Abuse Household Mental Illness Parental Separation or Divorce Incarcerated Household Member

Prevalence ACES Categories WomenMenTotal 9,3677,97017,337 Emotional Abuse Physical Abuse Sexual Abuse Emotional Neglect Physical Neglect Mother Treated Violently Household Substance Abuse Household Mental Illness Parental Separation or Divorce Incarcerated Household Member

Adverse Childhood Experiences Score Number of Adverse Childhood Experiences (ACE Score) WomenMenTotal or more

Adverse Childhood Experiences vs. Current Smoking %

ACE Score vs. Smoking and COPD

Childhood Experiences vs. Adult Alcoholism

Childhood Experiences Underlie Chronic Depression

Childhood Experiences Underlie Suicide

Adverse Childhood Experiences vs. Likelihood of > 50 Sexual Partners

Adverse Childhood Experiences vs. History of STD

ACE Score vs.Unintended Pregnancy or Elective Abortion

Childhood Experiences Underlie Rape

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

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

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

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

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

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

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.

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

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…

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