1 / 24

Adverse Childhood Experiences and their Relationship to

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. Creating Safe Environments

tola
Download Presentation

Adverse Childhood Experiences and their Relationship to

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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 Creating Safe Environments Phoenix, AZ. April 9, 2013 Robert F. Anda, M.D. Vincent J. Felitti, M.D.

  2. Origins of the ACE Study 51 weeks later 408 132 lbs What is the core diagnosis here? Which photo depicts the problem?

  3. Summary of the ACE Study • The ACE Study is a retrospective and prospective analysis in 17,337 middle-class adults of the effects of ten categories of adverse life experiences in childhood. • The very existence of these experiences was found to be quite unexpectedly high, though unrecognized because they are lost in time and protected by shame, by secrecy, and by social taboos against routinely exploring certain realms of human experience. • Their effect a half century later is powerfully and proportionately related to the number of categories of adverse life experiences in childhood, and thereby is a major determinant of well-being, health risks, mental illness, occupational performance, social malfunction, biomedical disease, and premature death.

  4. ACE Study Design Survey Wave 1 71% response (9,508/13,454) n=13,000 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 n=13,000 17,337 adults All medical evaluations abstracted

  5. Abuse, by Category Psychological (by parents) 11% Physical (by parents) 28% Sexual (anyone, but typically family) 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% Empirically Selected Categories of Adverse Childhood Experiences Prevalence (%)

  6. 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 11%* • Two out of threeadultsexperienced 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 >5.

  7. Smoking to Self-Medicate Is he describing dysfunctional behavior, or is it functional in realms of which we know nothing?

  8. A Public Health Paradox What are conventionally viewed as Public Health problems are often personal solutions to long-concealed adverse childhood experiences.

  9. The Hidden Threat of Weight Loss The unspoken benefits of Obesity

  10. Health Risks Adverse Childhood Experiences vs. >1 ppd Smoking as an Adult % P< .001

  11. Social function Childhood Experiences vs. Adult Alcoholism 4+ 3 2 1 0

  12. Health Risks ACE Score vs. Intravenous Drug Use p<0.001

  13. Molestation in Childhood Obesity runs in this family. So does speaking English. Familial obesity does not mean genetic.

  14. Well-being Childhood Experiences Underlie Chronic Depression

  15. Death Childhood Experiences Underlie Later Suicide 4+ 3 2 1 0

  16. Costs Childhood Experiences Underlie Later Prescription of Antidepressants approximately 50 years later 5 or more 4 Prescription rate per 100 person-years) 3 2 1 0 ACE Score

  17. Social malfunction: 25 ACE Score 0 1 2 3 4 or more 20 15 10 5 0 ACE Score and Indicators of Impaired Worker Performance Impaired Performance (%) Prevalence of Absenteeism Serious Serious ( > 2 days/month) Problems Financial Performing job Problems

  18. Biomedical disease ACEs Increase Likelihood of Heart Disease* Emotional abuse 1.7x • Physical abuse 1.5x • Sexual abuse 1.4x • Domestic violence 1.4x • Mental illness 1.4x • Substance abuse 1.3x • Household criminal 1.7x • Emotional neglect 1.3x • Physical neglect 1.4x • After correction for age, race, education, and conventional risk factors like smoking and * diabetes. Circulation , Sept 2004 .

  19. Newly Recognized Biomedical Relationships

  20. Well-being ChildhoodExperiences Underlie Rape 4+ 3 2 1 0

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

  22. Turning Research into Practicea beginning • Set up properly, and in high volume, comprehensive medical evaluation affordably can be provided to all patients at the outset of ongoing medical care. • Comprehensive biomedical evaluation provides a net 11% reduction in DOVs in the subsequent year. • Comprehensive biopsychosocial 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!

  23. Further Information www.acestudy.org http://www.cdc.gov/NCCDPHP/ACE/ Medline – PubMed (Felitti or Anda as author name) VJFMDSDCA@mac.com AVAHealth.org(Detailed DVD)

More Related