adverse childhood experiences and their relationship to adult well-being, disease, and...
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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. U.S. Department of Justice - PowerPoint PPT PresentationTRANSCRIPT
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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
Robert F. Anda, M.D. Vincent J. Felitti, M.D.
U.S. Department of Justice Washington, DC December 12, 2012
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ACE Study Design
Survey Wave 171% response (9,508/13,454) n=13,000 71% response
Survey Wave II n=13,000
All medical evaluationsabstracted
PresentHealth Status
Mortality National Death IndexMorbidity Hospital Discharges Doctor Office Visits Emergency Room Visits Pharmacy Costs
All medical evaluationsabstracted
vs. &
17,337 adults
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Empirically Selected Categories of Adverse Childhood Experiences
Abuse, by Category Psychological (by parents) 11% Physical (by parents) 28% Sexual (anyone) 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%
Prevalence (%)
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Who would ever suspect – without routinely asking
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Smoking to Self-Medicate
The Functionality of ‘dysfunctional’ behavior
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Childhood Experiences vs. Adult Alcoholism
0
1
23
4+
Health Risks
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ACE Score vs. Intravenous Drug Use
p<0.001p<0.001
Health Risks
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Childhood Experiences Underlie Later Suicide
1122
00
33
4+4+
Death
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ACE Score and theACE Score and theRisk of Risk of PerpetratingPerpetrating Domestic Domestic
ViolenceViolence__________________________________
Ris
k o f
Per
p etr
atio
n (%
)
0
5
10
15Women Men
0 1 2 3 4 >5 0 1 2 3 4 >5
ACE Score
Well-being
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Turning Research into Practicea beginning
• Comprehensive biomedical evaluation provides a net 11% reduction in DOVs in the subsequent year.
• Comprehensive bio-psycho-social 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!
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What Can We Do Today?• Routinely seek a history of traumatic childhood
experiences from allall patients, inmates, and children in foster care.
• Acknowledge their reality by asking, “How has this How has this affected you later in life?affected you later in life?””
• Develop programs for primary prevention.
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Further InformationFurther Informationwww.acestudy.org
http://www.cdc.gov/NCCDPHP/ACE
Google Scholar (search: Felitti or Anda or ACE Study)
AVAHealth.org (Detailed DVD)
www.ACEsTooHigh.com (useful blog on the subject)