Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.

Published on May 1, 1998in American Journal of Preventive Medicine4.435
· DOI :10.1016/S0749-3797(98)00017-8
Vincent J. Felitti57
Estimated H-index: 57
(KP: Kaiser Permanente),
Robert F. Anda69
Estimated H-index: 69
(CDC: Centers for Disease Control and Prevention)
+ 5 AuthorsJames S. Marks48
Estimated H-index: 48
(CDC: Centers for Disease Control and Prevention)
Results: More than half of respondents reported at least one, and one-fourth reported 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P , .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, 0 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. Conclusions: We found a strong graded 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. Medical Subject Headings (MeSH): child abuse, sexual, domestic violence, spouse abuse, children of impaired parents, substance abuse, alcoholism, smoking, obesity, physical activity, depression, suicide, sexual behavior, sexually transmitted diseases, chronic obstructive pulmonary disease, ischemic heart disease. (Am J Prev Med 1998;14:245‐258) © 1998 American Journal of Preventive Medicine
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