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Overview of the Adverse Childhood Experiences (ACE) Study Robert F. Anda, MD, MS ACE Study Co-Principal Investigator Co-Founder ACE Interface

www.ACEInterface.com

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The Adverse Childhood Experiences (ACE) Study Examines the health and social effects of ACEs throughout the lifespan among 17,421 members of the Kaiser Health Plan in San Diego County What do we mean by Adverse Childhood Experiences? -childhood abuse and neglect -growing up with domestic violence, substance abuse or mental illness in the home, parental discord, crime

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ACE Study Design Survey Wave I Follow-up (N=9,508) National Death Index (N = 17,421)

Mortality Morbidity Hospital

Discharge Outpatient Visits Survey Wave II room (N=8,667) visits

Emergency Pharmacy

Utilization

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Adverse Childhood Experiences Are Common Household dysfunction: Substance abuse Parental sep/divorce Mental illness Battered mother Criminal behavior Abuse: Psychological Physical Sexual Neglect: Emotional Physical

27% 23% 17% 13% 6% 11% 28% 21% 15% 10% Š 2013


Adverse Childhood Experiences Rarely Occur in Isolation… They come in groups.

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Domestic Violence and the Risk of Other ACEs...

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Prevalence of Childhood Abuse by Frequency of Witnessing Domestic 100 Violence Frequency of witnessing domestic violence Never Once,Twice Sometimes Often Very often

Percent (%)

80 60 40 20 0

Emotional

Physical

Childhood Abuse

Sexual Š 2013


ACEs tend to come in groups… Additional ACEs (%) 1 2 3 4 >5 If you had: A battered mother

95

82

64

48

52

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Adverse Childhood Experiences Score Complex Trauma--Trauma “Dose” Number of individual types of adverse childhood experiences were summed… ACE score 0 1 2 3 4 or more

Prevalence 33% 26% 16% 10% 16%

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ACE Score and Teen Sexual Behaviors Percent With Health Problem (%)

45 40

ACE Score 0

1

2

3

4 or more

35 30 25 20 15 10 5 0 Intercourse by Age 15

Teen Pregnancy

Teen Paternity

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Percent obese (%)

The ACE Score and the Prevalence of Severe Obesity (BMI >35)

ACE Score Š 2013


ACEs and Mental Health…

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Percent atempted (%)

The ACE Score and the Prevalence of Attempted Suicide

ACE Score Š 2013


The ACE Score and a Lifetime History of Depression Percent depressed (%)

70

Women

Men

60 50 40 30 20 10 0 0

1

2

3

>=4

ACE Score Š 2013


ACEs and Violent Victimization as an Adul

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ACE Score and the Risk of Being a Victim of Domestic Violence Men

Risk of Victimization (%)

15

Women

10

5

0 0 1 >5

2

3

4

ACE

0 1 >5 Score

2

3

4

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ACE Score and Drug Abuse

Percent With Health Problem (%)

14 ACE Score

12 0

1

2

3

4

>=5

10 8 6 4 2 0

Ever had a drug problem

Ever addicted to drugs

Ever injected drugs Š 2013


ACE Score and HIV Risks

Ever Injected Drugs

Had 50 or More Intercourse Partners

Ever Had an STD Š 2013


ACEs, Smoking, and Lung Disease 20

Percent With Health Problem (%)

18 16

ACE Score

0

1

2

3

4 or more

14 12 10 8 6 4 2 0

Early smoking initiation

Current smoking

COPD

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Percent (%)

The ACE Score and the Prevalence Ischemic Heart Disease

ACE Score © 2013


One Perspective on the Direct Health Care Costs of ACEs: The Burden of Prescription Drug Use

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Prescription Drugs in the United States (20 -nearly $180 billion spent -11% of total national health expenditures -more than four times the amount spent in 1990


Prescription rate (per 100 person-years)

ACE Score and Rates of Antidepressant Prescriptions

0

1

2

3

ACE Score

4

>=5


ACE Score and Rates of Prescribed Antidepressant Medications by Age, 19972004

ACE Score

ACE Score

ACE Score

18-44 yrs

45-64 yrs

65-89 yrs © 2013


Adverse Childhood Experiences as a Clinical and Public Health Issue ACEs: - are endemic - highly interrelated - have a cumulative stressor effect - effects are biologically plausible

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Adverse Childhood Experiences As a National Health Issue ACEs have a strong influence on: -adolescent health -reproductive health -smoking -alcohol abuse -illicit drug abuse -sexual behavior -mental health - risk of revictimization -stability of relationships, homelessness -performance in the workforce Š 2013


Adverse Childhood Experiences As a National Health Issue ACEs increase the risk of: -Heart disease - Chronic Lung disease - Liver disease - Suicide - Injuries -HIV and STDs - and other risks for the leading causes of death Š 2013


The Adverse Childhood Experiences (ACE) Study Summary of Findings: -Adverse Childhood Experiences (ACEs) are very common -ACEs are strong predictors of health risks and disease from adolescence to adulthood -This combination of findings makes ACEs one of the leading, if not the leading determinant

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Bridging The Chasm

Child health as it stands today

Breakthroughs in molecular genetics and biology: Mental illness Substance abuse Violence

Mass education about child development & parenting: Media Schools

Documenting the Improved recognition societal burden of and treatment of: child health as it Mental illness stands today Substance abuse Domestic violence Child abuse New directions in prevention and

Child health as it could be

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Bridging The Chasm

Child health as it stands today

Involving those who don’t yet realize that they are working on issues that represent the “downstream” wreckage of child abuse and neglect--and other adverse childhood experiences--in the effort to bridge the chasm.

Child health as it could be

Routine screening for trauma is needed

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Ace study congressional briefing anda