Lifecourse Epi Lecture 8 Flashcards
Background: ACE Case Study
Background
Lack of data regarding the frequency and long-term consequences of childhood abuse
Most studies have examined only single types of abuse, and few have assessed the impact of more than one type of abuse
Need to assess the relationship between childhood abuse and household dysfunction and adult health risk behaviors, health status, and disease states
The Adverse Childhood Experiences (ACE) Study
What is the ACE study?
Examines the health and social effects of ACEs throughout the lifespan among 13,494 members of the Kaiser Health Plan in San Diego County
What do we mean by Adverse Childhood Experiences?
Childhood abuse and neglect
Growing up with domestic violence, substance abuse or mental illness in the home
Parental discord, crime
Methods: ACE Case Study
Retrospective study
Questionnaire about ACE completed by adults (n=13,494) receiving a standardized medical evaluation at Kaiser Permanente Health Appraisal Clinic in San Diego
Two waves of data collection
Exposures: abuse and household instability
Multivariate methods controlled for age, sex, race, and educational attainment
Adverse Childhood Experiences
Household dysfunction:
Substance abuse
Parental separation/divorce `
Mental illness
Violence against mother
Criminal behavior
Child Abuse:
Psychological
Physical
Sexual
Neglect:
Emotional
PhysicalMethods and Outcomes for ACE Case Study
Risk factors
Smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, drug abuse, parental drug abuse, high lifetime number of sexual partners, history of STI
Disease conditions
History of ischemic heart disease, any cancer, stroke, chronic bronchitis, emphysema, diabetes, hepatitis, skeletal fractures
Key Findings:
52% of respondents experienced at least one category of adverse childhood exposure (ACE)
Most common exposure: substance abuse (26%)
6.2% reported 4 or more exposures
Increase in prevalence and risk of specific outcomes as number of ACE increased
Smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, substance abuse, ≥50 sexual partners, history of STI
Strong relationship between number of ACE and number of health risk factors
Dose-response relationship between number of exposures and number of risk factors
Also between number of exposures and number of disease conditions
Importance of ACE Case Study
Presents evidence for the impact of childhood exposures on adult health risk behaviors and disease
Suggests a strong and cumulative relationship between ACE and adult health status
Highlights need for increased attention to primary, secondary, and tertiary prevention strategies
Adolescence
Multiple transformations occurring simultaneously
Biological growth
Development in multiple organ systems (i.e. brain, reproductive organs)
Increased receptivity to social influences
Initiation of multiple health-risk behaviors
Period of high vulnerability
Developmental Tasks of Adolescence
Physical physiological maturity (puberty)
Cognitive change/ brain maturation
Psychosocial maturity
Moral development
Sexual functioning
Family formation
Job force entrance
Early Adolescence
Body changes and self awareness Sense of being “center stage” Sense of invulnerability Mood swings Rejection of childhood things Other adult role models Same-sex friendships
Middle Adolescence
Physical development almost complete Becoming comfortable with a “new body” Independence-dependence conflicts Strong peer attachments Concern with appeal to sexual partners Experimentation/risk-taking Idealism, altruism, commitment to causes
Late Adolescence
Realization of vulnerability, limitations
Developing adult roles
Family formation
Society and employment
Independent in making decisions and actions
Established, realistic, self-identity
Extended “adolescence” in the developed world
Extended periods of education, later career establishment, women in work force, delayed childbearing
Context of Adolescent Development
Family (parents, siblings, others)
Peer group (friends, classmates)
School (academic, social, recreational)
Society (jobs, church, youth groups)
Adolescent Risk Behaviors
Smoking
80% of adult smokers initiate smoking before age 18
Almost none initiate after age 25
Early sexual initiation
58% of youth initiate sex before age 18
77% before age 20
90% before age 25
Health-risk behaviors show clustering and co-variation
i.e. smoking, substance abuse, aggression, early sexual activity
Adolescent risk behaviors result of complex combination of social, genetic and developmental factors
Propensity for risk taking, high sensation seeking, immature self-regulation
Being a risk taker may also have positive consequences
Adolescent Risk Behaviors: Lifecourse Perspective
Smoking and risky sexual behaviors (i.e. multiple partners) often persist into adulthood
Adolescent period of behavior initiation is fairly universal across nations and cultures
Adolescents who initiate sexual intercourse and smoking earlier than their peers also report more involvement in risk behaviors as young adults
Adult women reporting early initiation of smoking Due to the addictive qualities of tobacco, initiation of smoking often results in persistent use throughout adulthood
Use of alcohol and/or tobacco during adolescence may lead to use of other drugs (i.e. cocaine, opiates)
Potential mechanism: nicotine may “prime” the developing brain to later use of cocaine
also report greater sexual risk taking and more adverse reproductive health outcomes, as adults
Adolescence and Cancer Risk from a Lifecourse Perspective
Focusing on precursors is essential for primary prevention
Significant challenges in translating scientific information
Increasing anti-science political sphere
