The Elephant in the Room 25 minutes.pdf · The Adverse Childhood Experiences (ACE) Study Examines...
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Adverse Childhood Experiences and Chronic Disease: The Elephant in the Room Robert Anda, MD, MS www.cdc.gov/ace www.acestudy.org
Transcript of The Elephant in the Room 25 minutes.pdf · The Adverse Childhood Experiences (ACE) Study Examines...
Adverse Childhood Experiences andChronic Disease:
The Elephant in the Room
Robert Anda, MD, MS
www.cdc.gov/ace
www.acestudy.org
The Walk toParadise Garden
W. Eugene Smith
Unpredictable PredictableSevere Moderate
Number of EpisodesChronicity*
ResilienceVulnerability
(Poly)geneticsEpigenetics Intrauterine
exposures*
Stress(adrenaline, cortisol)
The Adverse Childhood Experiences (ACE) Study
Examines the health and social effects of ACEsthroughout the lifespan among 17,421 membersof the Kaiser Health Plan in San Diego County
A Primary Care Setting…Educated…
Middle Class..Predominantly White…
Adverse Childhood Experiences Are Common
Substance abuse 27%Parental sep/divorce 23%Mental illness 17%Battered mother 13%Criminal behavior 6%
Household dysfunction:
Abuse:Psychological 11%Physical 28%Sexual 21%
Neglect:Emotional 15%Physical 10%
Adverse Childhood Experiences Rarely Occur in Isolation…
They come in groups.
ACEs tend to come in groups…
Additional ACEs (%)1 2 3 4 >5
If you had:A battered mother 95 82 64 48 52
Adverse Childhood Experiences ScoreBiologic Stress “Dose”
ACE Score Prevalence0 33%1 26%2 16%3 10%
4 or more 16%
0
2
4
6
8
10
12
14
16
18
20
Perc
ent W
ith H
ealth
Pro
blem
(%
) 0 1 2 3 4 or moreACE Score
Early smokinginitiation
Current smoking COPD
ACEs, Smoking, and Lung Disease
ACE Score and HIV Risks
0
2
4
6
8
10
12
14
16
18
20
Perc
ent W
ith H
ealth
Pro
blem
(%
)
0 1 2 3 4 or moreACE Score
Ever InjectedDrugs
Had 50 or MoreIntercourse Partners
Ever Had anSTD
The ACE Score…Alcohol Use and Abuse
0
5
10
15
20
25
30
35
40
0 1 2 3 4 or moreACE Score
Alcoholic Married anAlcoholic
Perc
ent w
ith a
lcoh
ol
rela
ted
prob
lem
A Focus on Mental Health…
The ACE Score and a Lifetime History of Depression
0
10
20
30
40
50
60
70
0 1 2 3 >=4
Women Men
ACE Score
Perc
ent
depr
esse
d (%
)
The ACE Score and the Prevalence of Attempted Suicide
0
5
10
15
20
0 1 2 3 >=4
ACE Score
Perc
ent
atem
pted
(%
)
Leading Causes of Death…
The ACE Score and the Prevalence of Coronary Heart Disease
0
1
2
3
4
5
6
0 1 2 3 >=4
ACE Score
Perc
ent
(%)
Adverse Childhood ExperiencesAs a National Health Issue
ACEs have a strong influence on:-adolescent health
-reproductive health-smoking
-alcohol abuse-illicit drug abuse-sexual behavior
-mental health- risk of revictimization
-stability of relationships-performance in the workforce
Adverse Childhood ExperiencesAs a National Health Issue
ACEs increase the risk of:-Early Death
-Heart disease-Lung cancer
- Chronic Lung disease- Liver disease
- Suicide- Injuries
-HIV and STDs-Autoimmune Disease
No data
Source: Behavioral Risk Factor Surveillance System, CDC.
2009
6 States
States With ACE Studiesin 2009
No data
Source: Behavioral Risk Factor Surveillance System, CDC.
20102009
13 States
States With ACE Studiesin 2009-2010
Source: Behavioral Risk Factor Surveillance System, CDC.
No data 20102009 2011
18 States
States With ACE Studiesin 2009-2011
Source: Behavioral Risk Factor Surveillance System, CDC.
No data 20102009 2011
19 States
States With ACE Studies2009-2012
2012
Beham, (Hans) Sebald (1500-1550): Hercules slaying the Hydra, 1545 from The Labours of Hercules (1542-1548).
The Walk toParadise Garden
W. Eugene Smith
“The Creation of Adam”Michelangelo 1508-1512
Treatment
Education Prevention
All must considerIntergenerational transmission
A Public Health Framework For Change
Limits of Understanding
by Paul Klee (1879-1940)
