The article by Felitti et al., looked at the impact of abuse and household dysfunction during childhood in relation to health risk behavior and disease in adulthood. Studies often focus on one type of abuse at a time, but this study looked at more than one type of abuse and this idea of cumulative influences. Adverse childhood experiences can include childhood emotional, physical, or sexual abuse, and household dysfunction. This study took place in in a primary care setting and aimed to describe the long term relationship of childhood experiences to important medical and public health problems. A questionnaire was mailed out and included questions about childhood abuse and exposure to forms of household dysfunction. All questions were introduced with the phrase,”while you were growing up during your first 18 years of life.”
Here is a breakdown of the questions to get a better sense of what was being asked:
- Psychological abuse 2Qs
- Physical abuse 2Qs
- Contact sexual abuse 4Qs
- Substances abuse in household 2Qs
- Mental illness in household 2Qs
- Violent treatment of mother or stepmom in household 4Qs
- Criminal behavior in household 1Qs
Possible number of exposures ranged from 0-7 unexposed to exposed to all categories
This study assessed the relationship between childhood exposures and disease conditions that are among the leading causes of mortality in the United States. The top 10 risk factors that contribute to the leading causes of morbidity and mortality in the United States included smoking, severe obesity,physical inactivity, depressed mood, suicide attempts, alcoholism, drug abuse, parental drug abuse, a high lifetime number of sexual partners, and history of having an STD. The study found that the most the most prevalent of the 7 categories of childhood exposure was substance abuse in the home (25.6%) and the least prevalent was criminal behavior at a 3.4%. More than half of the respondents (52%) experienced greater than 1 category of adverse childhood experiences. 6.2% reported greater than 4 exposures. Also the probability that persons who were exposed to any single category of exposure were also exposed to another category was statistically significant. The prevalence and risk increased for smoking, severe obesity, physical inactivity, depressed mood and suicide attempts as the number of childhood exposures increased. Therefore, this study suggested a strong relationship between the number of adverse childhood exposures and the number of health risk factors for leading causes of death in adults. High levels of exposure expectedly can produce anxiety, anger, and depression in children, which can lead to behaviors such as smoking, alcohol, or drug use for coping purposes. These cumulative incidences may affect attitudes and behaviors toward health and health care, sensitivity to internal sensations, or physiologic functioning in brain centers and neurotransmitter systems.
How can public health professionals address this issue?
When it comes to primary care prevention it is difficult, but home visitation programs can be a useful tool in creating a safe environment for raising a child and provide parents with the tools and resources they need to succeed. Secondary prevention is where awareness is needed. Bringing awareness about trauma informed care to our physicians training, so that they are able to identify and intervene with child and families who are at risk for these experiences. Increase communication between health services at all levels. Also we need to increase recognition of the occurrence of the behavioral coping devices that commonly are adopted to reduce the emotional impact of these experiences. Tertiary is difficult to address because of time delay from exposure, but I think that this group of individuals could benefit from therapy and also guidance on how to break the cycle for their own children. Further training and research are definitely needed to help public health and medical professionals understand how social, emotional, and medical problems are linked throughout the lifespan. I think we need to empower our community to acknowledge these types of childhood experiences and work to improve health promotion and disease prevention programming.
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
Felitti, Vincent J et al.