Preventing adverse childhood experiences (ACEs) can thwart some of the leading causes of death in adults, according to a study published Tuesday in the Centers for Disease Control and Prevention’s (CDCs) Vital Signs. These include heart disease, cancer, respiratory diseases, diabetes and suicide.
Such efforts are critical to addressing multiple public health and social challenges and to improving the lives of children, families and communities, the study noted.
CDC officials urged health care providers, states, communities and employers to help reduce ACEs, which also are associated with leading causes of poor socioeconomic outcomes in adulthood.
“It will take all of us working together to change environments and behaviors to stop ACEs from happening in the first place, and to lessen the harms for those who have experienced ACEs. There is a role for everyone: parents, families, neighborhoods, spiritual communities, business and government,” CDC Principal Deputy Director Anne Schuchat, M.D., said in a news briefing Tuesday.
According to the report:
- Females and several racial/ethnic minorities were at greater risk for having had four or more ACEs.
- Preventing ACEs could reduce the number of patients with coronary heart disease, the leading cause of death in the U.S., by up to 13%, a reduction of about 1.1 million cases for the 25 states analyzed in the study.
- Preventing ACEs could cut the number of adults who have depression by nearly 44%.
Data were collected from 144,017 respondents in 25 states who answered questions about ACEs in 2015-’17. Researchers looked at self-reported status for heart disease, stroke, asthma, chronic obstructive pulmonary disease, cancer, kidney disease, diabetes, depression, overweight/obesity, current smoking, heavy drinking, less than high school completion, unemployment and lack of health insurance.
Overall, 61% of adults noted at least one type of ACE, and 16% experienced four or more types. Those with the most ACEs had higher odds of having chronic health conditions for overweight or obesity than those reporting no exposure. In addition, the odds of depression, being a current smoker and socioeconomic challenges — including current unemployment — all were higher among adults with the most ACEs.
ACEs have been linked to increased risk for alcohol and substance use disorders, suicide, mental health conditions, heart disease, other chronic illnesses and health risk behaviors throughout life.
“The bottom line is this: Adverse childhood experiences produce toxic stress that can impact people all their lives. But ACEs are potentially preventable by creating safe, stable, nurturing relationships and environments for all children, families and communities,” Dr. Schuchat said.
Prevention strategies also are linked with higher academic achievement and reductions in suicidal behavior, arrest and incarceration rates and substance use in adolescence and adulthood.
Strategies to help reduce ACEs in families include promoting safe, stable, nurturing relationships and environments for children and families; emphasis on early prevention; and strengthening economic supports for families, such as earned income tax credits and family-friendly work policies. Other strategies involve ensuring a strong start for children such as through early childhood home visitation, high quality child care, preschool programs, and enhanced primary care services for screening, referral and support.
“Clinicians are busy and may or may not incorporate ACEs into their practice,” Dr. Schuchat said. “But we think it’s very important that they do — both pediatricians in terms of evaluating the children — and screening the parents as well, because we know that this is one of those issues that can (cross) generations…So we hope that clinicians will take the time to screen and refer. We also think that incorporating principles of trauma-informed care in that clinical encounter can be very helpful at the time of the event and then going forward.”
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