title: National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England.
abstract: BACKGROUND
  Epidemiological and biomedical evidence link adverse childhood experiences (ACEs) with health-harming behaviors and the development of non-communicable disease in adults. Investment in interventions to improve early life experiences requires empirical evidence on levels of childhood adversity and the proportion of HHBs potentially avoided should such adversity be addressed.
  
  
  METHODS
  A nationally representative survey of English residents aged 18 to 69 (n = 3,885) was undertaken during the period April to July 2013. Individuals were categorized according to the number of ACEs experienced. Modeling identified the proportions of HHBs (early sexual initiation, unintended teenage pregnancy, smoking, binge drinking, drug use, violence victimization, violence perpetration, incarceration, poor diet, low levels of physical exercise) independently associated with ACEs at national population levels.
  
  
  RESULTS
  Almost half (47%) of individuals experienced at least one of the nine ACEs. Prevalence of childhood sexual, physical, and verbal abuse was 6.3%, 14.8%, and 18.2% respectively (population-adjusted). After correcting for sociodemographics, ACE counts predicted all HHBs, e.g. (0 versus 4+ ACEs, adjusted odds ratios (95% confidence intervals)): smoking 3.29 (2.54 to 4.27); violence perpetration 7.71 (4.90 to 12.14); unintended teenage pregnancy 5.86 (3.93 to 8.74). Modeling suggested that 11.9% of binge drinking, 13.6% of poor diet, 22.7% of smoking, 52.0% of violence perpetration, 58.7% of heroin/crack cocaine use, and 37.6% of unintended teenage pregnancy prevalence nationally could be attributed to ACEs.
  
  
  CONCLUSIONS
  Stable and protective childhoods are critical factors in the development of resilience to health-harming behaviors in England. Interventions to reduce ACEs are available and sustainable, with nurturing childhoods supporting the adoption of health-benefiting behaviors and ultimately the provision of positive childhood environments for future generations.
authors.affiliation: Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK. m.a.bellis@ljmu.ac.uk.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.forename: Karen
authors.initials: K
authors.lastname: Hughes
authors.forename: Nicola
authors.initials: N
authors.lastname: Leckenby
authors.forename: Clare
authors.initials: C
authors.lastname: Perkins
authors.forename: Helen
authors.initials: H
authors.lastname: Lowey
mesh_terms: D000293:Adolescent; D000328:Adult; D063425:Binge Drinking / Q000150:complications; D003075:Coitus; D019548:Crime Victims; D004032:Diet / Q000009:adverse effects; D004739:England; D005006:Ethnicity; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D015995:Prevalence; D055500:Resilience, Psychological; D057185:Sedentary Behavior; D012907:Smoking / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000150:complications; D014754:Violence; D055815:Young Adult