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Adverse Childhood Experiences (ACEs)

One of the largest, most comprehensive landmark studies of the effects of childhood trauma on adulthood disease was in the work of Dr. Vincent Felitti from Kaiser Permanente and Dr. Robert Anda from the Center for Disease Control (CDC). The research started with the groundbreaking Adverse Childhood Experiences (ACEs) Study back in the 1990s. It ushered in a more mainstream understanding of the impact of childhood trauma on lifelong health, now with the understanding of how compounded adult trauma makes the outcomes even more complex. The initial study population, consisted of all insured, college-educated, middle class and mostly Caucasian subjects and 63.9% of the participants had experienced at least one ACE category and 12.5% had experienced four or more ACE categories. The research showed that in this patient population, a history of child sexual abuse was also common (Felitti, 1993).

The ACE study conveyed that the patients reporting greater numbers of ACEs had increased risk for smoking, severe obesity, physical inactivity, depressed mood, and suicide attempts (Felitti, 1993). In addition, there was a dose–response relationship between the number of ACEs and health conditions such as ischemic heart disease, cancer, chronic bronchitis/emphysema, liver disease, skeletal fractures, and poor overall self-rated health.  In other words, the higher the ACE score, the stronger the risk of having many of these health conditions including the potential for a 20-year earlier death.  Although, women from Tribal communities were not part of the initial study, the social determinants of health (SDOH) including the effects of historical and current day racism, bias, discrimination, stereotyping, substance use and violence, indicates that what Native people have been subjected to far surpasses the scope of the challenges of the average White, insured, middle class, and college-educated communities. In fact, the overall burden of trauma in both urban and rural Tribal communities is felt to have been equated with conflict-ridden developing countries (Miller, et al., 2007). The following links will provide further details on the ACEs research and the impact on physical and mental health.

AZ Adverse Childhood Experience Consortium

Video - Supporting Patients in Pregnancy: ACEs and Maternal Health (Expires 12/2/2021)


Video’s (Supporting Slide Deck)


American Indians and Alaska Natives must be included in research on adverse childhood experiences

The Science of ACEs and Toxic Stress

Overcoming Adverse Childhood Experiences

Adverse Childhood Experiences in Arizona

Number Story

Hope Heals


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