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The ACE pyramid has five layers. The bottom layer represents “adverse childhood experiences”. Next is “social, emotional, and cognitive impairment”. Third is “adoption of health-risk behaviors”. Fourth is “disease, disability, and social problems,” and the top layer represents “early death”.  Spaces between layers represent scientific gaps about relationships between layers. A vertical arrow on the left of the pyramid represents the health impact of adverse childhood experiences from conception to death.

The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente's Health Appraisal Clinic in San Diego.

More than 17,000 Health Maintenance Organization (HMO) members undergoing a comprehensive physical examination chose to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. To date, more than 50 scientific articles have been published and more than100 conference and workshop presentations have been made.

The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life in the United States. Progress in preventing and recovering from the nation's worst health and social problems is likely to benefit from understanding that many of these problems arise as a consequence of adverse childhood experiences.

Learn About the ACE Study


The initial phase of the ACE Study was conducted at Kaiser Permanente from 1995 to 1997. More than 17,000 participants completed a standardized physical examination. No further participants will be enrolled, but we are tracking the medical status of the baseline participants.

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