ABSTRACT
Adverse childhood experiences (ACEs) have been associated with a variety of negative behavioral and health outcomes in adulthood [1]. Specifically, exposure to ACEs-which are defined as incidents of household abuse or dysfunction during the first 18 years of life-has been linked to the use of illicit drugs [2], depression [3], psychotropic medication use [4], premature mortality [5], and the prevalence of ischemic heart disease (IHD) [6]. The latter finding was judged noteworthy enough for the authors to conclude that psychological factors, such as anger and depressed affect, appear to be more important than traditional risk factors, including smoking and physical inactivity, in mediating the relation of ACEs
to the risk of IHD [6]. Thus, ACEs are powerful events with long-lasting consequences
Furthermore, ACEs have been demonstrated to be highly interrelated to each other. Using data obtained from 8,629 members of a managed healthcare plan who completed a survey about exposure to ACEs, Dong et al. [7] found that the presence of one ACE signifi cantly increased the likelihood of reporting exposure to another ACE. These investigators concluded that the number of respondents observed with an elevated total number of ACEs (the ACE score) was much greater than would be expected given the assumptions of independence, thereby demonstrating that ACEs were statistically interrelated [7].
