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 Overview Regional and Local Data Medical Cost Burden and Health Care Utilization for IPV The Impact of IPV on Women’s Health IPV and Behavioral Health IPV and Family Planning, Birth Control Sabotage Pregnancy Pressure, and Unintended Pregnancy Linda Chamberlain, PhD MPH IPV and Sexually Transmitted Infections/HIV IPV and Perinatal Programs IPV, Breastfeeding, and Nutritional Supplement Programs IPV and Child and Adolescent Health ACE Study: Leading Determinants of Health IPV and Injury Prevention

Adverse Childhood Experiences (ACE) Study

Leading Determinants of Health

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• • • • One of the largest investigations ever done to examine the links between adverse childhood experiences and later life health Collaborative between the CDC and Kaiser Permanente Over 17,000 study participants Over 50 scientific publications www.cdc.gov/nccdphp/ACE

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Experiences that represent health or social problems of national importance. In this study, adverse childhood experiences included: – Witnessing a mother being battered – Having a parent who has a substance abuse problem, a history of mental illness, or criminal behavior Felitti et al, 1998

5 HOUSEHOLD EXPOSURES Alcohol abuse Mental illness Battered mother Drug abuse Criminal behavior CHILDHOOD ABUSE Psychological Physical Sexual

Felitti et al, 1998

% 23.5% 18.8% 12.5% 4.9% 3.4% % 11.0% 10.8% 22.0%

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• ACEs are very common and often cluster • ACEs are strong predictors of health behaviors in adolescence and adult life • This combination of findings makes ACEs one of the leading, if not

the leading

determinant of the health and social well being of our nation

• Ischemic heart disease • Cancer • Chronic lung disease • Autoimmune diseases • Skeletal fractures • Liver diseases • Premature death

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Anda et al, 2009; Dube et al, 2009; Felitti et al,1998

Persons with 2 or more ACEs were at for rheumatic diseases

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Dube et al, 2009

• Adults who experienced ACEs had significant and sustained losses in health related quality of life compared to adults without ACEs • These findings should be used in assessing cost-effectiveness of interventions to prevent ACEs Corso et al, 2008

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• ACEs substantially increase the number of prescriptions and classes of drugs used • The increases in prescription drug use among adults with ACEs are mediated by ACE-related health and social problems

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Anda et al, 2008

Persons with

four

or more ACEs had:

4-12 fold increased risk

for alcoholism, drug abuse, depression, and suicide attempts

2-4 fold increased risk

for smoking, poor self-rated health, having 50 or more sexual intercourse partners, and sexually transmitted diseases

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Felitti et al, 1998

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• There is a persistent grade relationship between ACE scores and initiation of alcohol use by age 14 • ACEs account for a 20% to 70% increased likelihood of alcohol use being initiated during mid adolescence (15-17 years) Dube et al, 2006

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• The number of ACEs increased dramatically for persons who saw their mothers being battered • As the frequency of witnessing violence increased, there was a positive, graded risk for: – – – Illicit drug use IV drug use Depression Dube et al, 2002