From the Archive: Research ArticleREPRINT OF: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study
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INTRODUCTION
Only recently have medical investigators in primary care settings begun to examine associations between childhood abuse and adult health risk behaviors and disease.1, 2, 3, 4, 5 These associations are important because it is now clear that the leading causes of morbidity and mortality in the United States6 are related to health behaviors and lifestyle factors; these factors have been called the “actual” causes of death.7 Insofar as abuse and other potentially damaging childhood experiences
Study Setting
The ACE Study is based at Kaiser Permanente's San Diego Health Appraisal Clinic. More than 45,000 adults undergo standardized examinations there each year, making this clinic one of the nation's largest free-standing medical evaluation centers. All enrollees in the Kaiser Health Plan in San Diego are advised through sales literature about the services (free for members) at the clinic; after enrollment, members are advised again of its availability through new-member literature. Most members
Adverse Childhood Exposures
The level of positive responses for the 17 questions included in the seven categories of childhood exposure ranged from 3.0% for a respondent's mother (or stepmother) having been threatened with or hurt by a gun or knife to 23.5% for having lived with a problem drinker or alcoholic (Table 1). The most prevalent of the 7 categories of childhood exposure was substance abuse in the household (25.6%); the least prevalent exposure category was evidence of criminal behavior in the household (3.4%).
DISCUSSION
We found a strong dose response 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. Disease conditions including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease, as well as poor self-rated health also showed a graded relationship to the breadth of childhood exposures. The findings suggest that the impact of these adverse
ACKNOWLEDGMENTS
We thank Naomi Howard for her dedication to the ACE Study. This research is supported by the Centers for Disease Control and Prevention via cooperative agreement TS-44-10/12 with the Association of Teachers of Preventive Medicine.
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This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245 -258. https://doi.org/10.1016/S0749-3797(98)00017-8. © 1998 American Journal of Preventive Medicine.