Elsevier

Preventive Medicine

Volume 37, Issue 3, September 2003, Pages 268-277
Preventive Medicine

Regular article
The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900

https://doi.org/10.1016/S0091-7435(03)00123-3Get rights and content

Abstract

Background

We examined the relationship of the number of adverse childhood experiences (ACE score) to six health problems among four successive birth cohorts dating back to 1900 to assess the strength and consistency of these relationships in face of secular influences the 20th century brought in changing health behaviors and conditions. We hypothesized that the ACE score/health problem relationship would be relatively “immune” to secular influences, in support of recent studies documenting the negative neurobiologic effects of childhood stressors on the developing brain.

Methods

A retrospective cohort study of 17,337 adult health maintenance organization (HMO) members who completed a survey about childhood abuse and household dysfunction, as well as their health. We used logistic regression to examine the relationships between ACE score and six health problems (depressed affect, suicide attempts, multiple sexual partners, sexually transmitted diseases, smoking, and alcoholism) across four successive birth cohorts: 1900–1931, 1932–1946, 1947–1961, and 1962–1978.

Results

The ACE score increased the risk for each health problem in a consistent, strong, and graded manner across four birth cohorts (P < 0.05). For each unit increase in the ACE score (range: 0–8), the adjusted odds ratios (ORs) for depressed affect, STDs, and multiple sexual partners were increased within a narrow range (ORs: 1.2–1.3 per unit increase) for each of the birth cohorts; the increase in risk for suicide attempts was stronger but also in a narrow range (ORs: 1.5–1.7).

Conclusions

Growing up with ACEs increased the risk of numerous health behaviors and outcomes for 20th century birth cohorts, suggesting that the effects of ACEs on the risk of various health problems are unaffected by social or secular changes. Research showing detrimental and lasting neurobiologic effects of child abuse on the developing brain provides a plausible explanation for the consistency and dose–response relationships found for each health problem across birth cohorts, despite changing secular influences.

Section snippets

Methods

The ACE Study is a collaboration between Kaiser Permanente's Health Appraisal Center (HAC) in San Diego, California, and the U.S. Centers for Disease Control and Prevention. The ACE Study was approved by the institutional review boards of Kaiser Permanente, Emory University, and the U.S. Department of Health and Human Services. Potential participants were sent letters that accompanied the ACE Study questionnaire informing them that their participation was voluntary and their answers would held

Characteristics of study population

The study population included 9367 women (54%) and 7970 men (46%). The mean age (standard deviation) was 56 (15.2) years. Seventy-five percent of participants were white, 39% were college graduates, 36% had some college education, and 18% were high school graduates. Only 7% had not graduated from high school.

Adverse childhood experiences

The prevalence of each individual ACE and of the ACE scores is shown in Table 1. Women were more likely than men to report ACEs, with exception of physical abuse (Table 1). Sixty-four

Discussion

The risk of depressed affect, suicide attempts, multiple sexual partners, sexually transmitted diseases, ever smoking cigarettes, and alcoholism increased in a graded manner as the ACE score increased in each of four successive birth cohorts from 1900 to 1978. Furthermore, the strength of these graded relationships did not differ substantially or in a statistically significant manner between successive birth cohorts. The difference in the overall prevalence for health behaviors observed in each

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