Adverse childhood experiences and life opportunities: shifting the narrative
TL;DR: Compared to participants with no ACEs, those with higher ACE scores were more likely to report high school non-completion, unemployment, and living in a household below the federal poverty level, suggesting that preventing early adversity may impact health and life opportunities that reverberate across generations.
About: This article is published in Children and Youth Services Review.The article was published on 2017-01-01 and is currently open access. It has received 437 citations till now. The article focuses on the topics: Child abuse & Child neglect.
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TL;DR: In this paper, a systematic review and meta-analysis was conducted to identify the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life.
Abstract: Summary Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity ( I 2 of >75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales.
2,313 citations
TL;DR: This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date and highlights that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others.
Abstract: Importance Early adversity is associated with leading causes of adult morbidity and mortality and effects on life opportunities. Objective To provide an updated prevalence estimate of adverse childhood experiences (ACEs) in the United States using a large, diverse, and representative sample of adults in 23 states. Design, Setting, and Participants Data were collected through the Behavioral Risk Factor Surveillance System (BRFSS), an annual, nationally representative telephone survey on health-related behaviors, health conditions, and use of preventive services, from January 1, 2011, through December 31, 2014. Twenty-three states included the ACE assessment in their BRFSS. Respondents included 248 934 noninstitutionalized adults older than 18 years. Data were analyzed from March 15 to April 25, 2017. Main Outcomes and Measures The ACE module consists of 11 questions collapsed into the following 8 categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. Lifetime ACE prevalence estimates within each subdomain were calculated (range, 1.00-8.00, with higher scores indicating greater exposure) and stratified by sex, age group, race/ethnicity, annual household income, educational attainment, employment status, sexual orientation, and geographic region. Results Of the 214 157 respondents included in the sample (51.51% female), 61.55% had at least 1 and 24.64% reported 3 or more ACEs. Significantly higher ACE exposures were reported by participants who identified as black (mean score, 1.69; 95% CI, 1.62-1.76), Hispanic (mean score, 1.80; 95% CI, 1.70-1.91), or multiracial (mean score, 2.52; 95% CI, 2.36-2.67), those with less than a high school education (mean score, 1.97; 95% CI, 1.88-2.05), those with income of less than $15 000 per year (mean score, 2.16; 95% CI, 2.09-2.23), those who were unemployed (mean score, 2.30; 95% CI, 2.21-2.38) or unable to work (mean score, 2.33; 95% CI, 2.25-2.42), and those identifying as gay/lesbian (mean score 2.19; 95% CI, 1.95-2.43) or bisexual (mean score, 3.14; 95% CI, 2.82-3.46) compared with those identifying as white, those completing high school or more education, those in all other income brackets, those who were employed, and those identifying as straight, respectively. Emotional abuse was the most prevalent ACE (34.42%; 95% CI, 33.81%-35.03%), followed by parental separation or divorce (27.63%; 95% CI, 27.02%-28.24%) and household substance abuse (27.56%; 95% CI, 27.00%-28.14%). Conclusions and Relevance This report demonstrates the burden of ACEs among the US adult population using the largest and most diverse sample to date. These findings highlight that childhood adversity is common across sociodemographic characteristics, but some individuals are at higher risk of experiencing ACEs than others. Although identifying and treating ACE exposure is important, prioritizing primary prevention of ACEs is critical to improve health and life outcomes throughout the lifespan and across generations.
606 citations
TL;DR: A graded dose-response relationship between an expanded ACE score that includes being spanked as a child and the likelihood of moderate to heavy drinking, drug use, depressed affect, and suicide attempts in adulthood is indicated.
469 citations
TL;DR: Efforts that prevent adverse childhood experiences could also potentially prevent adult chronic conditions, depression, health risk behaviors, and negative socioeconomic outcomes.
Abstract: Introduction Adverse childhood experiences, such as violence victimization, substance misuse in the household, or witnessing intimate partner violence, have been linked to leading causes of adult morbidity and mortality. Therefore, reducing adverse childhood experiences is critical to avoiding multiple negative health and socioeconomic outcomes in adulthood. Methods Behavioral Risk Factor Surveillance System data were collected from 25 states that included state-added adverse childhood experience items during 2015-2017. Outcomes were self-reported status for coronary heart disease, stroke, asthma, chronic obstructive pulmonary disease, cancer (excluding skin cancer), kidney disease, diabetes, depression, overweight or obesity, current smoking, heavy drinking, less than high school completion, unemployment, and lack of health insurance. Logistic regression modeling adjusting for age group, race/ethnicity, and sex was used to calculate population attributable fractions representing the potential reduction in outcomes associated with preventing adverse childhood experiences. Results Nearly one in six adults in the study population (15.6%) reported four or more types of adverse childhood experiences. Adverse childhood experiences were significantly associated with poorer health outcomes, health risk behaviors, and socioeconomic challenges. Potential percentage reductions in the number of observed cases as indicated by population attributable fractions ranged from 1.7% for overweight or obesity to 23.9% for heavy drinking, 27.0% for chronic obstructive pulmonary disease, and 44.1% for depression. Conclusions and implications for public health practice Efforts that prevent adverse childhood experiences could also potentially prevent adult chronic conditions, depression, health risk behaviors, and negative socioeconomic outcomes. States can use comprehensive public health approaches derived from the best available evidence to prevent childhood adversity before it begins. By creating the conditions for healthy communities and focusing on primary prevention, it is possible to reduce risk for adverse childhood experiences while also mitigating consequences for those already affected by these experiences.
301 citations
01 Jan 2018
TL;DR: A growing body of research has made it increasingly apparent that adverse childhood experiences (ACEs) are a critical public health issue as discussed by the authors, which can have negative, lasting effects on health and well-being in childhood or later in life.
Abstract: A growing body of research has made it increasingly apparent that adverse childhood experiences (ACEs) are a critical public health issue. ACEs are potentially traumatic experiences and events, ranging from abuse and neglect to living with an adult with a mental illness. They can have negative, lasting effects on health and well-being in childhood or later in life.1 However, more important than exposure to any specific event of this type is the accumulation of multiple adversities during childhood, which is associated with especially deleterious effects on development.2 There is growing interest in understanding the prevalence of these experiences across different communities in the United States, and how to prevent and respond to them. One mechanism responsible for these effects—toxic levels of stress— can be substantially buffered by a stable and supportive relationship with a caregiver.
162 citations
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TL;DR: Copyright (©) 1999–2012 R Foundation for Statistical Computing; permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and permission notice are preserved on all copies.
Abstract: Copyright (©) 1999–2012 R Foundation for Statistical Computing. Permission is granted to make and distribute verbatim copies of this manual provided the copyright notice and this permission notice are preserved on all copies. Permission is granted to copy and distribute modified versions of this manual under the conditions for verbatim copying, provided that the entire resulting derived work is distributed under the terms of a permission notice identical to this one. Permission is granted to copy and distribute translations of this manual into another language, under the above conditions for modified versions, except that this permission notice may be stated in a translation approved by the R Core Team.
272,030 citations
TL;DR: For example, this article found a strong relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
12,712 citations
TL;DR: An ecobiodevelopmental framework is presented that suggests that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood.
Abstract: in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our un- derstanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound impli- cations for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodeve- lopmental framework that illustrates how early experiences and envi- ronmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mech- anisms that link early adversity to later impairments in learning, be- havior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adultdiseasesshouldbeviewedasdevelopmentaldisordersthatbegin early in life and that persistent health disparities associated with pov- erty, discrimination, or maltreatment could be reduced by the allevi- ation of toxic stress in childhood. An ecobiodevelopmental framework alsounderscoresthe needfornewthinking aboutthe focus andbound- aries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically po- sitioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health. Pediatrics
3,248 citations
TL;DR: A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life as mentioned in this paper, and that these early experiences can affect adult health in 2 ways: cumulative damage over time or by the biological embedding of adversities during sensitive developmental periods.
Abstract: A scientific consensus is emerging that the origins of adult disease are often found among developmental and biological disruptions occurring during the early years of life. These early experiences can affect adult health in 2 ways—either by cumulative damage over time or by the biological embedding of adversities during sensitive developmental periods. In both cases, there can be a lag of many years, even decades, before early adverse experiences are expressed in the form of disease. From both basic research and policy perspectives, confronting the origins of disparities in physical and mental health early in life may produce greater effects than attempting to modify health-related behaviors or improve access to health care in adulthood.
2,065 citations
TL;DR: A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide throughout the life span, and alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship.
Abstract: ContextSuicide is a leading cause of death in the United States, but identifying
persons at risk is difficult. Thus, the US surgeon general has made suicide
prevention a national priority. An expanding body of research suggests that
childhood trauma and adverse experiences can lead to a variety of negative
health outcomes, including attempted suicide among adolescents and adults.ObjectiveTo examine the relationship between the risk of suicide attempts and
adverse childhood experiences and the number of such experiences (adverse
childhood experiences [ACE] score).Design, Setting, and ParticipantsA retrospective cohort study of 17 337 adult health maintenance
organization members (54% female; mean [SD] age, 57 [15.3] years) who attended
a primary care clinic in San Diego, Calif, within a 3-year period (1995-1997)
and completed a survey about childhood abuse and household dysfunction, suicide
attempts (including age at first attempt), and multiple other health-related
issues.Main Outcome MeasureSelf-reported suicide attempts, compared by number of adverse childhood
experiences, including emotional, physical, and sexual abuse; household substance
abuse, mental illness, and incarceration; and parental domestic violence,
separation, or divorce.ResultsThe lifetime prevalence of having at least 1 suicide attempt was 3.8%.
Adverse childhood experiences in any category increased the risk of attempted
suicide 2- to 5-fold. The ACE score had a strong, graded relationship to attempted
suicide during childhood/adolescence and adulthood (P<.001).
Compared with persons with no such experiences (prevalence of attempted suicide,
1.1%), the adjusted odds ratio of ever attempting suicide among persons with
7 or more experiences (35.2%) was 31.1 (95% confidence interval, 20.6-47.1).
Adjustment for illicit drug use, depressed affect, and self-reported alcoholism
reduced the strength of the relationship between the ACE score and suicide
attempts, suggesting partial mediation of the adverse childhood experience–suicide
attempt relationship by these factors. The population-attributable risk fractions
for 1 or more experiences were 67%, 64%, and 80% for lifetime, adult, and
childhood/adolescent suicide attempts, respectively.ConclusionsA powerful graded relationship exists between adverse childhood experiences
and risk of attempted suicide throughout the life span. Alcoholism, depressed
affect, and illicit drug use, which are strongly associated with such experiences,
appear to partially mediate this relationship. Because estimates of the attributable
risk fraction caused by these experiences were large, prevention of these
experiences and the treatment of persons affected by them may lead to progress
in suicide prevention.
2,019 citations