title: Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010.
abstract: BACKGROUND
  Adverse childhood experiences (ACEs), including child abuse and family dysfunction, are linked to leading causes of adult morbidity and mortality. Most prior ACE studies were based on a nonrepresentative patient sample from one Southern California HMO.
  
  
  OBJECTIVE
  To determine if ACE exposure increases the risk of chronic disease and disability using a larger, more representative sample of adults than prior studies.
  
  
  METHODS
  Ten states and the District of Columbia included an optional ACE module in the 2010 Behavioral Risk Factor Surveillance Survey, a national cross-sectional, random-digit-dial telephone survey of adults. Analysis was conducted in November 2012. Respondents were asked about nine ACEs, including physical, sexual, and emotional abuse and household member mental illness, alcoholism, drug abuse, imprisonment, divorce, and intimate partner violence. An ACE score was calculated for each subject by summing the endorsed ACE items. After controlling for sociodemographic variables, weighted AORs were calculated for self-reported health conditions given exposure to zero, one to three, four to six, or seven to nine ACEs.
  
  
  RESULTS
  Compared to those who reported no ACE exposure, the adjusted odds of reporting myocardial infarction, asthma, fair/poor health, frequent mental distress, and disability were higher for those reporting one to three, four to six, or seven to nine ACEs. Odds of reporting coronary heart disease and stroke were higher for those who reported four to six and seven to nine ACEs; odds of diabetes were higher for those reporting one to three and four to six ACEs.
  
  
  CONCLUSIONS
  These findings underscore the importance of child maltreatment prevention as a means to mitigate adult morbidity and mortality.
authors.affiliation: Division of Violence Prevention. Electronic address: LGilbert@cdc.gov.
authors.forename: Leah K
authors.initials: LK
authors.lastname: Gilbert
authors.affiliation: Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Breiding
authors.affiliation: Division of Violence Prevention.
authors.forename: Melissa T
authors.initials: MT
authors.lastname: Merrick
authors.affiliation: Division of Birth Defects and Developmental Disabilities, National Center for Birth Defects and Developmental Disabilities.
authors.forename: William W
authors.initials: WW
authors.lastname: Thompson
authors.affiliation: Division of Violence Prevention.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Ford
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.
authors.forename: Satvinder S
authors.initials: SS
authors.lastname: Dhingra
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Sharyn E
authors.initials: SE
authors.lastname: Parks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D008603:Mental Health; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult