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Adult Health Problems Linked to Traumatic Childhood Experiences
Thursday, May 14, 1998
Many of the most common causes of death and disability in this country may be linked to adverse emotional experiences in childhood, according to a study published today in the American Journal of Preventive Medicine.
The Adverse Childhood Experiences (ACE) study, conducted by the Kaiser Permanente Medical Care Program in San Diego, the Centers for Disease Control and Prevention (CDC), Emory University in Atlanta, and the University of Arizona Health Sciences Center in Tucson, suggests that childhood abuse and household dysfunction lead to the development decades later of the chronic diseases that are the most common causes of death and disability in this country, including heart disease, cancer, chronic lung and liver disease, and injuries.
Categories of abuse and household dysfunction during childhood include psychological, physical, or sexual abuse; violence against the mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned.
"Abused children may use behaviors such as cigarette smoking, heavy alcohol use, overeating, promiscuity, and drug use as a way of coping with damaging experiences much earlier in life, "says a principal investigator of the study, Dr. Vincent Felitti, Chief of Preventive Medicine at Kaiser Permanente in San Diego.
Traditionally viewed as public health problems, these behaviors appear to be coping mechanisms for people who have had adverse childhood experiences, the study found. The authors suggest the behaviors may also reflect the effects of the adverse experiences on the developing brain chemistry -- effects that may lead to the adoption of the coping behaviors.
The ACE study was designed to assess the relationship between the childhood experiences and the current health status and health risk behaviors of 30,000 mainly middle-class adult members of Kaiser Permanente. To date, data have been collected from 19,000 cooperating adults. Additional results will be reported as more data are collected.
A strong relationship was seen between the number of adverse experiences and self-reports of cigarette smoking, obesity, physical inactivity, alcoholism, drug abuse, depression, suicide attempts, sexual promiscuity, and sexually transmitted diseases. Furthermore, persons who reported higher numbers of adverse childhood experiences were much more likely to have multiple health risk behaviors. Similarly, the more adverse childhood experiences reported, the more likely the person was to have heart disease, cancer, stroke, diabetes, skeletal fractures, liver disease, and poor self-rated health as an adult.
Abuse and other adverse childhood experiences, which the study suggests lead to adoption of health risk behaviors as coping devices, may be two of the basic causes that underlie health risks, illness, and death and could be identified by routine screening of all patients, says Dr. Robert Anda of CDC's National Center for Chronic Disease Prevention and Health Promotion and a lead researcher on the study.
Emory University principal investigator and pediatrician, Dr. Dale Nordenberg, emphasized that pediatric professionals must provide support as early as possible to safeguard and promote lifelong psychosocial and physical health. "This study will help pediatric health care professionals to appreciate that victims of abuse may experience long-term health effects and even years of life lost," he says.
Felitti suggests that adults who have had negative childhood experiences would benefit if they could talk about them with someone they trust.
People who have been abused as children are uncomfortable talking about their experiences, but that is exactly what they should start doing, says Felitti. If people share their emotionally painful past with a spouse or sibling or someone they trust, it can start the healing process."
Kaiser Permanente, CDC, and Emory University plan to continue their collaboration and to translate Kaiser Permanente's experience in family-based interventions into the development of programs that could serve as models for communities throughout the country.
Journal of Preventive Medicine is the official journal of the
American College of Preventive Medicine and the Association of
Teachers of Preventive Medicine. The journal is published by
Elsevier Science in New York. The ACE study will eventually be
available on the Internet via AJPM Online, which can be found at
http://www.elsevier.com/locate/ajpmonline. Basic information on the
journal is also available at http://www.elsevier.com/locate/amepre.
More information about CDC and its programs is available on its web
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