ABSTRACT
Studies are increasingly exposing relationships between childhood trauma and the emergence of health damaging behaviours and poor health and social outcomes in adulthood. [1-3] The first large-scale adverse childhood experiences (ACE) study in the USA began to quantify the impacts of ACEs on health and behaviour throughout the life course. [4] This and subsequent studies have identified a set of ACEs including: growing up in a household with someone who is depressed, mentally ill, a substance abuser or has been incarcerated in the criminal justice system; exposure to child maltreatment or domestic violence and losing a parent through divorce, separation or death. [4,5] Exposure to such ACEs has been associated with
poor health outcomes including substance use, mental ill-health, obesity, heart disease and cancer, as well as unemployment and continued involvement in violence. [4,6,7] Importantly, the impact of ACEs appears to be cumulative, with risks of poor outcomes increasing with the number of ACEs suffered. [4,8,9]
The relationships between ACEs and pressures on health and social systems [e.g. from non-communicable diseases (NCDs)] should be a critical element in informing health policy and strategic investment. [10,11] That ACEs appear linked to important outcomes for other public services (e.g. criminal justice, education) means an understanding of ACEs should inform work across government departments. However, such intelligence is rare outside the USA, even in high-income countries. [11] Thus, global public health efforts are focusing on developing and implementing standardized methodologies for measuring the impact of ACEs across populations. [11] As Europe increasingly embraces a social determinants approach to health, [12] understanding relationships between deprivation, ACEs and adult outcomes becomes paramount. [13 – 16]
We present fi ndings from a general population ACE study in a relatively deprived and culturally diverse part of the UK. The study was designed to examine associations between ACEs and poor health and social outcomes over the life course. Controlling for demographics and deprivation, we explore the strength of ACEs as predictors of poor behaviour, health, criminal justice and educational outcomes, and discuss the implications for health policy.
