title: Childhood Abuse, Household Dysfunction, and Indicators of Impaired Adult Worker Performance.
abstract: OBJECTIVE
  We examined the relation between eight types of adverse childhood experience (ACE) and three indicators of impaired worker performance (serious job problems, financial problems, and absenteeism).
  
  
  METHODS
  We analyzed data collected for the Adverse Childhood Experiences Study from 9633 currently employed adult members of the Kaiser Foundation Health Plan in San Diego.
  
  
  RESULTS
  Strong graded relations were found between the ACE Score (total number of ACE categories experienced) and each measure of impaired worker performance (p < .001). We found strong evidence that the relation between ACE Score and worker performance was mediated by interpersonal relationship problems, emotional distress, somatic symptoms, and substance abuse.
  
  
  CONCLUSIONS
  The long-term effects of adverse childhood experiences on the workforce impose major human and economic costs that are preventable. These costs merit attention from the business community in conjunction with specialists in occupational medicine and public health.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Anda
authors.forename: Vladimir I
authors.initials: VI
authors.lastname: Fleisher
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Felitti
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Edwards
authors.forename: Charles L
authors.initials: CL
authors.lastname: Whitfield
authors.forename: Shanta R
authors.initials: SR
authors.lastname: Dube
authors.forename: David F
authors.initials: DF
authors.lastname: Williamson