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>> The categories included
in the ACE study do not represent all possible forms
of abuse, neglect, household challenges,
and other adversaries that children may experience.
Children can experience many other forms
of trauma including peer victimization, loss of a parent,
community violence, historical trauma, war,
poverty, and much more.
However, the categories included
in the ACE study provide a good snapshot of things
that occurred during childhood.
>> Well, the ACE study was groundbreaking, or pioneering
if you will, because no one had really tried to look
at what happened as children
and how it might have an affect later on into adulthood.
Most people had looked at maybe some
of the injuries especially physical abuse of children
and how that might have translated
into some very specific and oftentimes kind
of short-term kind of things.
But no one had really looked at, you know, an adult population
and seen that, you know, there are other kinds of diseases
and conditions that seem to be associated
with the adverse childhood experiences.
So the ACE study was fantastic in the sense
that it showed us those things
that now we could try to act on it.
So whether it was diabetes or tobacco use or things
like high blood pressure or things like mental illness.
All of those things were shown to be associated with the ACEs
that people had not known before.
And researchers had not known before.
>> Collecting ACE data is really important
for informing prevention.
For one thing it really helps us create awareness
about this problem.
It wasn't too many years ago
that people were totally unaware.
Violence was thought of as an injury problem alone.
Just something that caused physical injury.
People didn't understand that it also is a factor
that contributes to mental health problems,
infectious diseases, and chronic diseases.
The ACE data has allowed us to demonstrate that,
to allow us to make people aware of that.
And that is critically important.
The first thing you need in order
to create a public health response to a problem is
to have the pubic policy makers be aware of the nature
of the problem and it's full extent.
And the ACE data has been critical to accomplishing that.
>> As a part of the study, participants indicated which,
if any, ACEs they had experienced before they
turned 18.
Based on their responses each participant was assigned an ACE
score between zero and ten that was used to estimate the amount
of adversity the participant was exposed to as a child.
In addition to collecting data about their exposure to ACEs,
the study assessed participant's current health status
and health behaviors to identify connections
between childhood adversity and adult health and well being.
The study uncovered a strong relationship between exposure
to ACEs and numerous conditions that have a negative impact
on lifetime health and well being.
To date ACEs have been associated
with over 40 negative outcomes.
Findings from the ACE study led to the development
of a conceptual framework that helps explain the connections
between early adversities and negative outcomes.
As depicted in the ACE pyramid, early adversities can lead
to disrupted neural development, social, emotional,
and cognitive impairment and the adoption of high risk behaviors
that can lead to an increased risk for disease, disability,
social problems, and ultimately early death.
While an ACE score provides information
about a person's exposure to early adversity,
it does have its limitations.
The ACE score was developed as a research tool,
not as a diagnostic tool.
It was designed as a means to collect data
about exposure to ACEs.
Ace scores do not account for the severity or frequency
of adversities, nor do they account for age of onset
or a person's relationship to the perpetrator.
Despite these limitations the study provided a model
for data collection about ACEs
and demonstrated the value of these data.
Many states now collect ACE data
through the Behavioral Risk Factor Surveillance System,
BRFSS, an annual state-based telephone survey
that gathers information from adults
in the U.S. regarding their health conditions and behaviors.
These continued data collection efforts provide ongoing
and updated information about ACEs that inform prevention
and treatment initiatives.
>> I think it's important for us to take data and put it
into practice, if you will.
And so how can data help is in regards
to ACEs is not only knowing the extent of the problem and some
of the patterns of the problem, but then also making sure
that we get that information to those
that are the decision makers, those that are funding programs,
those who are actually administering programs
so that they can take that information
and actually put it into practice.
I think that's the primary reason that we want to collect
that information is so we can get it to the people who need
to know so that they can make the right decisions.
>> Another thing is actually taking that information
and getting it into the hands
of prevention program administrators and practitioners
so now that they know this information they can be able
to focus their programs on particular populations
that might be at risk.
So we're taking the ACEs, trying to expand where it's being used
and then not only take expanding where it's being used
but also expanding how it's being used
so that the right kind of people can make decisions about how
to focus on population.
>> The ACE data is used in many --
in increasingly more ways today.
First of all in public health we use it to show the proportion
of populations that are exposed to these adversities
and these risk factors.
And that's very important for us
to identify high-risk populations
and to target intervention strategies,
prevention strategies.
>> OK, let's review key points covered in this lesson.