How do Adverse Childhood Experiences (ACEs) Impact Health? Findings From the Centers for Disease Control and Prevention Vital Report
In the Dunn Lab, we spend a lot of our time trying to understand the effect of adverse childhood experiences (ACEs) on the health of individuals and populations, especially around mental health. Through our interdisciplinary research, we aim to discover how ACEs get “under the skin”. In other words, how they become incorporated into our biology – whether in our genes or possibly even our teeth – to impact mental health throughout the lifespan. Our long-term goal is to translate discoveries about the effect of ACEs into population-level preventative strategies, so we can prevent illnesses like depression before they even occur.
Because of our passion to understand ACEs, our lab was incredibly excited to see that the Centers for Disease Control and Prevention (CDC) published its first Vital Signs report on this topic. This publication is significant because these reports historically cover topics the CDC highlights as important public and global health threats. Previous topics have included HIV, tobacco use, and cancer screenings. The publication also provides information on what can be done to drive down incidence rates. In this post, we highlight some of the main findings from this report.
But before we do that, let’s first summarize what we even mean by ACEs.
Adverse Childhood Experiences, often referred to by the acronym of ACEs, generally refer to three broad types of adversities children or adolescents can experience: abuse, neglect, and household dysfunction. There are 10 types of childhood traumas measured by ACEs: five of which capture personal events (physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect) and five of which capture events relating to family members (e.g., living with a parent or other household member who has problems with alcohol, domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment).
These adverse experiences were first studied by the CDC and the Kaiser Center in 1995 in the critically important Kaiser ACE Study, which connected the experience of ACEs to later poor mental and physical health outcomes. Since the Kaiser study, ACEs have continued to be widely studied.
Who is affected by ACEs?
Experiencing ACEs is relatively common, with 61% of adults in the United States having experienced at least one ACE and 16% having experienced four or more. A majority of those who report having experienced at least one ACE often report more than one.
Furthermore, women and several racial/ethnic minority groups have been shown to be at a greater risk for experiencing four or more ACEs than their White and male counterparts. Specifically, 64% of black non-Hispanic children and 51% of Hispanic children were reported to have experienced at least one ACE compared to 40% of white non-Hispanic children and 23% of Asian non-Hispanic children.
The prevalence of ACE exposure also varies on a state level, with some states reporting higher rates of ACEs than the national average. For example, while children living in Maryland, Massachusetts, and Minnesota report fewer ACEs, children living in Arizona, Arkansas, Montana, New Mexico, and Ohio report rates of ACEs that are higher than the national average. Some suspect that the higher rates of childhood poverty in these states can be a contributing factor to higher ACE exposure.
What are the health implications of ACEs?
One of the most profound findings from ACEs research is that exposure to ACEs is consistently associated with overall poorer health outcomes across the lifetime, not just in childhood. For example, people who experience ACEs have a higher risk of experiencing poor mental health outcomes, such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance abuse. But ACE exposure also increases risk of physical health conditions, such as heart disease, cancer, bone fractures, chronic lung or liver diseases, diabetes, and stroke. ACEs have not only been linked to increased mental and physical health risks, but also social problems, adoption of risky behaviors, and even a shorter life expectancy. As shown by the ACEs pyramid, these childhood experiences have a significant impact on people’s health throughout their entire life, possibly initiating adverse life events that can result in early death.
How can we prevent ACEs?
The potential to prevent ACEs is a public health priority with far-reaching implications. The report highlighted several possibilities, and how different sectors can take a role in preventing ACEs.
Everyone can help raise awareness about ACEs. By reducing the stigma around seeking help with parenting or substance misuse, depression, and other conditions, people can feel more supported and empowered to get the treatment they need. Thus, we all have a role to play in changing societal norms to be more open and accepting. We can all also promote safe, stable, nurturing relationships and environments for children can thrive. We can do this through participating in public engagement campaigns and more open discussions such as by sharing information on social media, going to public events, and much more. Third, we can all recognize the challenges that families face and offer support and encouragement to reduce toxic stress. Lastly, we can all support community programs and policies that help to provide safe conditions for all, such as behavioral training programs and expanded affordable childcare.
States and communities can work to improve access to high-quality childcare and strengthen economic support for families. Access could be increased by expanding eligibility, activities offered, and involvement for families. Also, states and communities can work to address the financial hardships that often connect to ACEs and put families at risk of experiencing ACEs. Through strengthened household financial security, people have more of an opportunity to thrive. Lastly, these entities can work to create an environment that increases skills in managing emotions and conflict for families. This can be done through legislative approaches to reduce corporal punishment and increase healthy social-emotional learning.
Employers can support employees by implementing more family-friendly policies, such as flexible work schedules, paid maternity and paternity leave, and other means of support. Through these increased services and means of support, toxic stress that is connected to ACEs can be reduced and families can have more potential to thrive.
Healthcare providers can work to recognize risks for ACEs in children and history of ACEs in adults by enhancing primary care. By doing so, they can connect those at risk for ACEs and adverse health outcomes to effective support services such as substance abuse treatment, mental health counseling, and health providers. Furthermore, they can link families to resources to lessen parental stress and toxic family environments such as treatment to prevent problem behavior and parental training programs. By connecting families to these services early, the cycle of ACEs transmission can be reduced or broken.
What would preventing ACEs do for overall health?
Preventing ACEs would have a profound effect on both individual and population health. Researchers estimate that doing so could prevent up to an estimated 21 million cases of depression, 1.9 million cases of heart disease, and 2.5 million cases of overweight/obesity.
Imagine the ripple effects that would occur from these gains. Because depression, heart disease, and overweight/obesity are so common and often co-occur with other conditions, preventing them may also lead decreases in the incidence of chronic obstructive pulmonary disease, asthma, kidney disease, stroke, cancer, and diabetes. In terms of health risk behaviors, it could decrease current smoking and heavy drinking. Lastly, regarding socioeconomic challenges, it could lessen unemployment and increase educational and health insurance attainment.
By working to prevent ACEs, we are hopeful of the possibility to create a world with better health outcomes for all. Whether it’s spreading awareness, advocating for others in need, working to improve public policy, supporting community programs, or researching the effects of ACEs across the life course, we can all play a role in prevention efforts. Here at the Dunn Lab, these possibilities for improved population health drive our research and passion.