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Using Childhood Adversity Data to Improve Adult Health

Posted By Anna Austin, Thursday, October 30, 2014
As a CDC/CSTE Applied Epidemiology fellow in the Injury and Violence Prevention branch at the North Carolina Division of Public Health, one project that has particularly developed my skills as an epidemiologist and public health professional relates to adverse childhood experiences (ACEs). ACEs are traumatic or stressful events experienced before age 18 and include eight categories of childhood abuse and household dysfunction, such as physical, sexual, and emotional abuse; adult substance abuse; and household domestic violence.

A growing body of evidence shows that these early experiences are common and can have long-lasting effects on mental and physical wellbeing. Findings from the original 1995-1997 ACE Study showed a strong, graded relationship between ACEs and several poor health outcomes in adulthood. As the number of ACEs a person experiences increase, what also increases are the risks of alcohol and drug abuse, obesity, suicidality, depression, intimate partner violence, heart disease, and a range of other poor health outcomes in adulthood. Data specific to ACEs among North Carolinians first became available in 2012 when questions about ACEs were included on the North Carolina Behavioral Risk Factor Surveillance System survey. My task was to analyze this data and create North Carolina’s first state report on the topic.

The findings from the state report mirror the findings of the original ACE study. ACEs were found to be common among North Carolinians: 58% reported at least one ACE and 22% reported three or more ACEs. Over a quarter of North Carolinians reported having grown up with an adult who was abusing alcohol or drugs, and one in 10 reported sexual abuse by an adult. In addition, ACEs were found to cluster among North Carolinians—if a person reported having experienced one ACE, it was highly likely that he/she had also experienced additional ACEs. Lastly, the results showed that the risk of smoking, binge drinking, and obesity as well as HIV-risk behaviors, poor physical and mental health, chronic obstructive pulmonary disease, cardiovascular disease, arthritis, depression, and disability in adulthood increased as the number of ACEs reported increased.

The finding that ACEs impact health outcomes in adulthood, long after the events have occurred, supports ACE prevention as an effective long-term strategy for population health and highlights the importance of a life-course perspective in such prevention efforts. The finding that ACEs impact a wide range of outcomes from social, emotional, and behavioral problems to chronic diseases presents an opportunity to foster collaboration among diverse stakeholders and suggests such collaboration will be important to successful ACE prevention. Increasing awareness of ACEs as a public health issue will be important in North Carolina for mobilization.

We are engaging stakeholders from across the state to support local prevention efforts. I presented the findings from the state report at the North Carolina Public Health Association Conference alongside colleagues from the Innovative Approaches Initiative in Buncombe County. This initiative is developing a toolkit and website to educate local primary care providers on ACEs, connect them to local resources, and provide referral options for affected children and families. I have also collaborated with Harry Herrick, a survey analyst at the North Carolina State Center for Health Statistics, to respond to requests for data regarding ACEs among special populations, such as current smokers and persons with disabilities. I am also currently working on a multi-state study of ACEs among persons who identify as gay, lesbian, and bisexual. Ideally, data from each of these studies will help inform programs and policies aimed at ACE prevention and the enhancement of current efforts. This project has proved invaluable to my experience as a fellow, and I am extremely grateful for the opportunities, support, and guidance my mentors and colleagues have provided throughout the process.

Anna Austin, MPH is the CDC/CSTE Applied Epidemiology Fellow at the North Carolina Division of Public Health. In addition to this project, Anna has linked prescription drug overdose data from multiple sources, served on the leadership team developing the 2015 North Carolina Suicide Prevention Plan, and written surveillance reports on motor vehicle crash-related injuries.
Would you like to host or be a CDC/CSTE Applied Epidemiology fellow? Find out how. To learn more about ACEs, take a look at the CDC Injury Prevention and Control page.

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Tags:  adverse childhood experiences  data  fellowship  member spotlight  substance abuse 

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Jeffrey Engel MD says...
Posted Friday, October 31, 2014
Thanks Anna. This is incredibly important work, and sadly, all too common in the general population. The dose-response (i.e. the more ACEs one experiences, the worse are the adult health outcomes) is striking.
Jeff
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