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Objective: We examine role of ACEs and pathways to risk of opioid misuse among young adults. Participants and Methods: A cross-sectional survey of validated measures of ACEs, risk of opioid misuse, and health conditions with a sample of 1,402 students from a large public university followed by multivariate logistic regression and pathway analysis. Results: Majority (61%) of participants reported at least one ACE. A dose-response relationship between numbers of ACEs with risk for opioid misuse was present. Compared to participants with no ACEs, participants with [greater than or equal to]4 ACEs and 0-3 ACEs were 2.93 (95% CI: 1.95, 4.39; p < 0.001) and 1.96 (95% CI: 1.46, 2.65; p < 0.001) times more likely to be at risk for opioid misuse, respectively. Having at least one existing or past health condition significantly mediated the association. Conclusions: Our findings suggest need to include assessment of ACEs as a screening criterion for opioid prescription and administration among college-aged individuals.

Understanding excessive absenteeism is important to ameliorating the negative outcomes associated with the behavior. The present study examined behavioral reinforcement profiles of school refusal behavior: negative reinforcement (avoidance) and positive reinforcement (gaining parental attention or receiving tangible benefits from not attending school). School social workers obtained information on school refusal behavior for 99 upper-elementary and middle school students referred for attendance problems. Three profiles were identified: 17.2 percent missed school to avoid fear- or anxiety-producing situations, escape from adverse social or evaluative situations, or gain positive tangible rewards (multiple profile); 60.6 percent missed school to gain parental attention or receive tangible rewards (positive reinforcement); and 22.2 percent had no profile. All three groups significantly differed in mean scores for behavioral difficulties, with children in the multiple profile group having the highest level of behavioral problems and children in the no profile group having the lowest. Children in the multiple profile group had higher mean scores on frequency of victimization and total number of traumatic or stressful events than did those in the other groups. Although more studies are needed, these findings suggest that school refusal behavior assessments may serve as a tool to better understand the phenomena of school attendance problems.

Objective: To examine relationships between childhood autobiographical memory disturbance (CAMD) and adverse childhood experiences (ACEs) which are defined as common forms of child maltreatment and related traumatic stressors. Methods: We use the ACE score (an integer count of eight different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. In a cross sectional analysis we assess the relationship of the ACE score to the prevalence of CAMD in a sample of 9,460 relatively healthy adults evaluated for wellness care at a southern California health maintenance organization between August 1995 and March 1996. In addition, we examined possible secular influences by examining association among each of four birth cohorts. Logistic regression was used to obtain the adjusted relative odds of CAMD associated with increasing ACE score. Results: Overall, the age-standardized prevalence of CAMD was 18% (men: 15%; women: 19%). As the ACE score increased, the prevalence of CAMD increased in a graded fashion for both men and women (p for trend less than 0.0001). After adjustment for age, sex, race/ethnicity, and education, adults with an ACE score greater than or equal to 6 were 5.9 (95% CI, 4.4-7.9) times more likely to have CAMD compared to adults with an ACE score of 0. The prevalence of CAMD increased with each successive birth cohort, and graded relationships between the ACE score and CAMD were observed among each of the four birth cohorts though no statistical difference in the association was found across birth cohorts. Conclusions: The accumulation of ACEs across several domains is associated CAMD among men and women and in each of four birth cohorts. Further research is needed that describes the prevalence of CAMD in population-based samples and that examines whether impaired memory is a marker for persons neurobiologically affected by multiple forms of child maltreatment and related traumatic stressors.

This retrospective cohort study assessed the relationship of childhood sexual abuse (CSA) to other categories of adverse childhood experiences (ACEs), such as childhood abuse, neglect, and parental separation/divorce. Adults reporting CSA experienced a 1.6- to 3.4-fold greater likelihood of experience each category of ACE. The ACE score was also positively related to the severity, duration, and frequency of CSA. (Contains references.) (Author/DB)

A study involving 8,629 adults examined the association between parental alcohol abuse and child abuse, neglect, and other household dysfunction. Compared to households without alcohol abuse, the adjusted odds ratio for each category of adverse childhood experience was 2 to 13 times higher if parents abused alcohol. (Contains references.) (CR)

Objectives. We estimated smoking prevalence, frequency, intensity, and cessation attempts among US adults with selected diagnosed lifetime mental illnesses. Methods. We used data from the 2007 National Health Interview Survey on 23393 noninstitutionalized US adults to obtain age-adjusted estimates of smoking prevalence, frequency, intensity, and cessation attempts for adults screened as having serious psychological distress and persons self-reporting bipolar disorder, schizophrenia, attention deficit disorder or hyperactivity, dementia, or phobias or fears. Results. The age-adjusted smoking prevalence of adults with mental illness or serious psychological distress ranged from 34.3% (phobias or fears) to 59.1% (schizophrenia) compared with 18.3% of adults with no such illness. Smoking prevalence increased with the number of comorbid mental illnesses. Cessation attempts among persons with diagnosed mental illness or serious psychological distress were comparable to attempts among adults without mental illnesses or distress, however, lower quit ratios were observed among adults with these diagnoses, indicating lower success in quitting. Conclusions. The prevalence of current smoking was higher among persons with mental illnesses than among adults without mental illnesses. Our findings stress the need for prevention and cessation efforts targeting adults with mental illnesses. (Am J Public Health. 2010;100:2464-2472. doi: 10.2105/AJPH.2009.188136)

Objective: Little information is available about the contribution of multiple adverse childhood experiences (ACEs) to the likelihood of reporting hallucinations. We used data from the ACE study to assess this relationship. Methods: We conducted a survey about childhood abuse and household dysfunction while growing up, with questions about health behaviors and outcomes in adulthood, which was completed by 17,337 adult HMO members in order to assess the independent relationship of 8 adverse childhood experiences and the total number of ACEs (ACE score) to experiencing hallucinations. We used logistic regression to assess the relationship of the ACE score to self-reported hallucinations. Results: We found a statistically significant and graded relationship between histories of childhood trauma and histories of hallucinations that was independent of a history of substance abuse. Compared to persons with 0 ACEs, those with 7 or more ACEs had a five-fold increase in the risk of reporting hallucinations. Conclusion: These findings suggest that a history of childhood trauma should be looked for among persons with a history of hallucinations. Keywords: Hallucinations; Childhood trauma; Child abuse; Adverse childhood experiences

Objective: Childhood abuse and other adverse childhood experiences (ACEs) have historically been studied individually, and relatively little is known about the co-occurrence of these events. The purpose of this study is to examine the degree to which ACEs co-occur as well as the nature of their co-occurrence. Method: We used data from 8,629 adult members of a health plan who completed a survey about 10 ACEs which included: childhood abuse (emotional, physical, and sexual), neglect (emotional and physical), witnessing domestic violence, parental marital discord, and living with substance abusing, mentally ill, or criminal household members. The bivariate relationship between each of these 10 ACEs was assessed, and multivariate linear regression models were used to describe the interrelatedness of ACEs after adjusting for demographic factors. Results: Two-thirds of participants reported at least one ACE; 81%--98% of respondents who had experienced one ACE reported at least one additional ACE (median: 87%). The presence of one ACE significantly increased the prevalence of having additional ACEs, elevating the adjusted odds by 2 to 17.7 times (median: 2.8). The observed number of respondents with high ACE scores was notably higher than the expected number under the assumption of independence of ACEs (p < .0001), confirming the statistical interrelatedness of ACEs. Conclusions: The study provides strong evidence that ACEs are interrelated rather than occurring independently. Therefore, collecting information about exposure to other ACEs is advisable for studies that focus on the consequences of a specific ACE. Assessment of multiple ACEs allows for the potential assessment of a graded relationship between these childhood exposures and health and social outcomes. Keywords: Child abuse; Child neglect; Household dysfunction; interrelationship

Objectives. Few reports address the impact of cumulative exposure to childhood abuse and family dysfunction on teen pregnancy and consequences commonly attributed to teen pregnancy. Therefore, we examined whether adolescent pregnancy increased as types of adverse childhood experiences (ACE score) increased and whether ACEs or adolescent pregnancy was the principal source of elevated risk for long-term psychosocial consequences and fetal death. Design, Setting, and Participants. A retrospective cohort study of 9159 women aged [greater than or equal to] 18 years (mean 56 years) who attended a primary care clinic in San Diego, California in 1995-1997. Main Outcome Measure. Adolescent pregnancy, psychosocial consequences, and fetal death, compared by ACE score (emotional, physical, or sexual abuse; exposure to domestic violence, substance abusing, mentally ill, or criminal household member; or separated/divorced parent). Results. Sixty-six percent (n = 6015) of women reported [greater than or equal to] 1 ACE. Teen pregnancy occurred in 16%, 21%, 26%, 29%, 32%, 40%, 43%, and 53% of those with 0, 1, 2, 3, 4, 5, 6, and 7 to 8 ACEs. As the ACE score rose from zero to 1 to 2, 3 to 4, and [greater than or equal to]5, odds ratios for each adult consequence increased (family problems: 1.0, 1.5, 2.2, 3.3; financial problems: 1.0, 1.6, 2.3, 2.4; job problems: 1.0, 1.4, 2.3, 2.9; high stress: 1.0, 1.4, 1.9, 2.2; and uncontrollable anger: 1.0, 1.6, 2.8, 4.5, respectively). Adolescent pregnancy was not associated with any of these adult outcomes in the absence of childhood adversity (ACEs: 0). The ACE score was associated with increased fetal death after first pregnancy (odds ratios for 0, 1-2, 3-4, and 5-8 ACEs: 1.0, 1.2, 1.4, and 1.8, respectively); teen pregnancy was not related to fetal death. Conclusions. The relationship between ACEs and adolescent pregnancy is strong and graded. Moreover, the negative psychosocial sequelae and fetal deaths commonly attributed to adolescent pregnancy seem to result from underlying ACEs rather than adolescent pregnancy per se. Pediatrics 2004;113:320-327; adolescent pregnancy, child abuse, domestic violence, alcoholism, children of impaired parents, drug abuse., Despite reductions in the rate of adolescent pregnancy and birthrates during the 1990s, adolescent pregnancy rates in the United States still exceed those of other developed countries by 2- to [...]

Objective. Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed. Methods. We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: [less than or equal to] 14 years, 15 to 18 years, or as an adult ([greater than or equal to] 19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use. Results. Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with [greater than or equal to] 5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use. Conclusions. The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice. Pediatrics 2003; 111:564-572; childhood abuse, domestic violence, drug use, substance abuse, parenteral drug use., ABBREVIATIONS. ACE, adverse childhood experience; CTS, Conflict Tactics Scale; CTQ, Childhood Trauma Questionnaire; SD, standard deviation; OR, odds ratio; CI, confidence interval; ARF, attributable risk fraction. Psychoactive substances have been [...]