Showing papers by "Robert F. Anda published in 2010"

Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study

Abstract: Background: Strong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood. Methods: Baseline survey data on health behaviours, health status and exposure to adverse childhood experiences (ACEs) were collected from 17,337 adults during 1995-1997. ACEs included abuse (emotional, physical, sexual), witnessing domestic violence, parental separation or divorce, or growing up in a household where members with mentally ill, substance abusers, or sent to prison. We used the ACE score (an integer count of the 8 categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. Two methods of case ascertainment were used to identify incident lung cancer through 2005 follow-up: 1) hospital discharge records and 2) mortality records obtained from the National Death Index. Results: The ACE score showed a graded relationship to smoking behaviors. We identified 64 cases of lung cancer through hospital discharge records (age-standardized risk = 201 × 100,000 -1 population) and 111 cases of lung cancer through mortality records (age-standardized mortality rate = 31.1 × 100,000 -1 person-years). The ACE score also showed a graded relationship to the incidence of lung cancer for cases identified through hospital discharge (P = 0.0004), mortality (P = 0.025), and both methods combined (P = 0.001). Compared to persons without ACEs, the risk of lung cancer for those with ≥ 6 ACEs was increased approximately 3-fold (hospital records: RR = 3.18, 95%CI = 0.71-14.15; mortality records: RR = 3.55, 95%CI = 1.25-10.09; hospital or mortality records: RR = 2.70, 95%CI = 0.94-7.72). After a priori consideration of a causal pathway (i.e., ACEs ® smoking ® lung cancer), risk ratios were attenuated toward the null, although not completely. For lung cancer identified through hospital or mortality records, persons with ≥ 6 ACEs were roughly 13 years younger on average at presentation than those without ACEs. Conclusions: Adverse childhood experiences may be associated with an increased risk of lung cancer, particularly premature death from lung cancer. The increase in risk may only be partly explained by smoking suggesting other possible mechanisms by which ACEs may contribute to the occurrence of lung cancer.

Adverse childhood experiences reported by adults - five states, 2009.

Abstract: Adverse childhood experiences (ACEs) include verbal, physical, or sexual abuse, as well as family dysfunction (e.g., an incarcerated, mentally ill, or substance-abusing family member; domestic violence; or absence of a parent because of divorce or separation). ACEs have been linked to a range of adverse health outcomes in adulthood, including substance abuse, depression, cardiovascular disease, diabetes, cancer, and premature mortality. Furthermore, data collected from a large sample of health maintenance organization members indicated that a history of ACEs is common among adults and ACEs are themselves interrelated. To examine whether a history of ACEs was common in a randomly selected population, CDC analyzed information from 26,229 adults in five states using the 2009 ACE module of the Behavioral Risk Factor Surveillance System (BRFSS). This report describes the results of that analysis, which indicated that, overall, 59.4% of respondents reported having at least one ACE, and 8.7% reported five or more ACEs. The high prevalence of ACEs underscores the need for 1) additional efforts at the state and local level to reduce and prevent child maltreatment and associated family dysfunction and 2) further development and dissemination of trauma-focused services to treat stress-related health outcomes associated with ACEs.

Adverse childhood experiences and frequent headaches in adults.

Abstract: Background.- A variety of studies have linked childhood maltreatment to headaches, including migraines, and to headache severity. This study assesses the relationship of adverse childhood experiences (ACEs) to frequent headaches during adulthood. Methods.- We used data from the Adverse Childhood Experiences (ACE) study, which included 17,337 adult members of the Kaiser Health Plan in San Diego, CA who were undergoing a comprehensive preventive medical evaluation. The study assessed 8 ACEs including abuse (emotional, physical, sexual), witnessing domestic violence, growing up with mentally ill, substance abusing, or criminal household members, and parental separation or divorce. Our measure of headaches came from the medical review of systems using the question: "Are you troubled by frequent headaches?" We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a "dose-response" relationship of the ACE score to the prevalence and risk of frequent headaches. Results.- Each of the ACEs was associated with an increased prevalence and risk of frequent headaches. As the ACE score increased the prevalence and risk of frequent headaches increased in a "dose-response" fashion. The risk of frequent headaches increased more than 2-fold (odds ratio 2.1, 95% confidence interval 1.8-2.4) in persons with an ACE score ≥5, compared to persons with and ACE score of 0. The dose-response relationship of the ACE score to frequent headaches was seen for both men and women. Conclusions.- The number of ACEs showed a graded relationship to frequent headaches in adults. Future studies should examine general populations with headache, and carefully classify them. A better understanding of the link between ACEs and migraine may lead to new knowledge regarding pathophysiology and enhanced additional therapies for headache patients. Language: en

The Protective Effect of Family Strengths in Childhood against Adolescent Pregnancy and Its Long-Term Psychosocial Consequences.

Abstract: Background: Few reports have addressed associations between family strengths during childhood and adolescent pregnancy and its consequences. We examined relationships among a number of childhood family strengths and adolescent pregnancy, risk behavior, and psychosocial consequences after adolescent pregnancy. Methods: Our retrospective cohort of 4648 women older than 18 years (mean age, 56 years) received primary care in San Diego, CA. Outcomes included adolescent pregnancy and psychosocial consequences compared with number of the following childhood family strengths: family closeness, support, loyalty, protection, love, importance, and responsiveness to health needs. Results: Of the cohort, 3082 participants (66%) reported 6 or 7 categories of childhood family strengths. Teen pregnancy occurred in 39%, 33%, 30%, 25%, 24%, 21%, and 19% of those with 0 or 1, 2, 3, 4, 5, 6, and 7 childhood family strengths, respectively (p for trend < 0.00001). When childhood abuse and household dysfunction were present, adjusted odds ratios (ORs) for adolescent pregnancy demonstrated an increasingly protective effect as numbers of childhood family strengths increased from 0 or 1 to 2 or 3, 4 or 5, and 6 or 7 (1.0 to 0.80), (1.0 to 0.80, 0.60, and 0.54, respectively). These findings were partly explained by progressive delays in initiation of sexual activity as the number of childhood family strengths increased. Adjusted ORs for psychosocial problem occurring decades later decreased as the number of childhood family strengths increased from 0 or 1 to 2 or 3, 4 or 5, and 6 or 7 (job problems, 1.0, 0.8, 0.6, 0.4; family problems, 1.0, 1.1, 0.7, 0.6; financial problems, 1.0, 0.9, 0.9, 0.6; high stress, 1.0, 1.1, 0.9, 0.8; uncontrollable anger, 1.0, 0.7, 0.7, 0.4). Conclusions: Childhood family strengths are strongly protective against adolescent pregnancy, early initiation of sexual activity, and long-term psychosocial consequences.

Adverse Childhood Experiences and Frequent Headaches

Abstract: Background.—A variety of studies have linked childhood maltreatment to headaches, including migraines, and to headache severity. This study assesses the relationship of adverse childhood experiences (ACEs) to frequent headaches during adulthood. Methods.—We used data from the Adverse Childhood Experiences (ACE) study, which included 17,337 adult members of the Kaiser Health Plan in San Diego, CA who were undergoing a comprehensive preventive medical evaluation. The study assessed 8 ACEs including abuse (emotional, physical, sexual), witnessing domestic violence, growing up with mentally ill, substance abusing, or criminal household members, and parental separation or divorce. Our measure of headaches came from the medical review of systems using the question: “Are you troubled by frequent headaches?” We used the number of ACEs (ACE score) as a measure of cumulative childhood stress and hypothesized a “dose–response” relationship of the ACE score to the prevalence and risk of frequent headaches. Results.—Each of the ACEs was associated with an increased prevalence and risk of frequent headaches. As the ACE score increased the prevalence and risk of frequent headaches increased in a “dose–response” fashion. The risk of frequent headaches increased more than 2-fold (odds ratio 2.1, 95% confidence interval 1.8-2.4) in persons with an ACE score 5, compared to persons with and ACE score of 0. The dose–response relationship of the ACE score to frequent headaches was seen for both men and women. Conclusions.—The number of ACEs showed a graded relationship to frequent headaches in adults. Future studies should examine general populations with headache, and carefully classify them. A better understanding of the link between ACEs and migraine may lead to new knowledge regarding pathophysiology and enhanced additional therapies for headache patients.

TheProtectiveEffectofFamilyStrengthsinChildhood againstAdolescentPregnanc yandItsLong-T erm PsychosocialConsequences

Abstract: Background:�Fewreportsha vead dressedas sociations� betweenfamilyst rengthsdu ringch ildhoodan dad oles- centpregnancyan dit sco nsequences.� Weex amined� relationshipsam onganu mberofch ildhoodfa mily� strengthsandad olescentpr egnancy,�ri skbe havior,�an d� psychosocialco nsequencesaf terad olescentpr egnancy. Methods:� Ourretrospectiveco hortof� 46 48� wo men� olderthan�18�ye ars�(m eanag e,�56�ye ars)�re ceivedpr imary� careinSanDi ego,�CA .�Ou tcomesin cludedad olescent� pregnancyan dps ychosocialco nsequencesco mpared� withnumberofth efo llowingch ildhoodfa milyst rengths:� familycloseness,�su pport,�lo yalty,�pr otection,�lo ve,�im- portance,�andre sponsivenesstohe althne eds. Results:�Ofthecohort,�3082�participants�(66%)�re- ported�6�or�7�categoriesofchildhoodfamilystrengths.� Teenpregnancyoc curredin� 39 %,� 33 %,� 30 %,� 25 %,� 24%,�21%,�and�19%�ofthosewith�0�or�1,�2,�3,�4,�5,� 6,�and�7�childhoodfamilystrengths,�respectiv ely�(pfor� trend�<�0.00001).�Wh ench ildhoodab usean dho usehold� dysfunctionwerepresent,� adjustedoddsratios� (ORs)� foradolescentpr egnancyde monstratedanin creasingly� protectiveeffectasnu mbersofch ildhoodfa milyst rengths� increasedfrom�0�or�1�to�2�or�3,�4�or�5,�an d�6�or�7�(1 .0�to� 0.80),�(1.0�to�0. 80,�0.60,�and�0.54,�respectiv ely).�These� findingswerepartlyexplainedbyprogressiv edelaysin� initiationofsexualactivityasthenumberofchildhood� familystrengthsincreased.�AdjustedORsforpsychoso- cialproblemoccurringdecadeslaterdecreasedasthe� numberofchildhoodfamilystrengthsincreasedfrom�0� or�1�to�2�or�3,�4�or�5,�and�6�or�7�(jobproblems,�1.0,�0.8,� 0.6,�0.4;�familyproblems,�1.0,�1.1,�0.7,�0.6;�financial � problems,�1.0,�0.9,�0.9,�0.6;�highstress,�1.0,�1.1,�0.9,� 0.8;�uncontrollableanger,�1.0,�0.7,�0.7,�0.4).

Risk Factors for Disease Risk Factors and Attributable Risk Calculations: Are There Mathematical Limits?

Abstract: The Adverse Childhood Experiences (ACE) Study, a collaborative effort between Kaiser Permanente (San Diego, CA) and the Centers for Disease Control and Prevention (Atlanta, GA), was designed to examine the long-term relationship between adverse childhood experiences (ACEs) and a variety of health behaviors and outcomes in adulthood [1]. ACEs include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The ACE Study, based on chronic disease prevention and control models, proposes that ACEs influence social, emotional, and cognitive impairments which in turn increase the probability of adopting health risk behaviors that have been documented to influence the subsequent development of disease, disability, social problems, and ultimately premature death. We use the ACE pyramid to depict this concept (see www.cdc.gov/nccdphp/ace/pyramid.htm).