Adverse Childhood Experiences: Public Health Implications

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ACEs cause poor health

Adverse childhood experiences cause poor health. Image by tat.

When epidemiologist Dr. Anda from the Center for Disease Control studied negative events in childhood and compared them to a variety of adult physical and mental health problems, he did not expect to discover an overwhelming dose-related effect. But that is what happened.

Family Health History and Health Appraisal Questionnaire

In 1995 and 1996, 17337 people enrolled in a health maintenance organization in San Diego answered simple questions designed to measure the amount of childhood trauma they experienced.

The questionnaire, named “the Family Health History and Health Appraisal questionnaire” is on the Center for Disease Control’s website.  The questionnaire uncovered an unexpected amount of trauma in a largely middle class, insured population.

Items measured included questions about parental drinking, divorce, imprisonment, depression, and mental health.  Both physical and emotional neglect were measured with questions such as whether or not “[y]our parents were too drunk or high to take care of the family”  or “[p]eople in your family called you things like ‘lazy’ or ‘ugly.‘”

It turns out that the more traumatic events children suffered, or ACEs, adverse childhood experiences, the more likely they were to develop a variety of physical and mental conditions.  The outcomes measured included depression, obesity, alcoholism and promiscuity.

Childhood Trauma Causes Poor Adult Health

In 2006, Dr. Anda and colleagues published a paper, “The Enduring Effects of Abuse and Related Adverse Experiences in Childhood: A Convergence of Evidence from Neurobiology and Epidemiology” documenting a “graded relationship of the ACE score to 18 different outcomes in multiple domains...”

Pressing the argument further, Anda et. al point out that the relationship between adverse childhood experiences and poor behavioral and physical health meets eight of nine criteria to be considered causal: The findings are strongly associated, the findings are consistent, the findings are “temporal in sequence” (one comes prior to the other), the findings demonstrate a biological gradient (dose response), there is “biological plausibility” (the impact of trauma on the brain can be understood biologically), the findings are coherent (do not conflict with other known outcomes), experimental evidence exists (from animal research on stress), and analogous evidence exists, such as evidence that smoking is related to poor mental health.

The ninth criteria to meet when considering if something is causal is that the finding should be specific.  By its nature, a study of childhood traumatic events is a meant to “represent cumulative stress,”  not a single measure.

Implications for Public Health and Cost Containment

Recapping his original findings at a conference for those interested in trauma and its impact, The Impact of Developmental Trauma: A Clinical, Public Health and Personal Perspective,  on May 23, 2014, in South Bend, Indiana, Dr. Ansa stated that he believes the relationship his research team discovered is causal.  ACEs cause bad health.

As a nation, our resources address poor physical health with medication and medical procedures, but this takes place long after childhood.  Anda’s research calls for early social intervention.  As Ansa proclaimed at the conference, “We come into this world largely unwired.”  And, “the key is interrupting the inter generational transmission of toxic stress.”

The research demonstrates a way to profoundly impact public health expenditures. Since, as Dr. Anda noted, “there are more people affected by ACEs than are not affected by ACEs” a majority of individuals would benefit from interrupting the cycle of passing stress to children.  Society as a whole will benefit by paying less for chronic health conditions caused when traumatized children grow up to be unhealthy adults.

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