The DOI matches its Crossref record, with a small difference in title or year; 93 of the 97 references it cites were found in a registry or an index; 1 of the 49 sources its claims cite were checked for support.
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
Open accessAbstract
Background The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. Methods A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. Results More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of…
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Claims the paper makes
49 Own result · 12 No full text of the sources · 12 Own interpretation · 10 Own method · 5 Not checked yet · 1 Partly supported · 1 Sources not found · 1 No basis given · accuracy not yet measured
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In the paper
“Longitudinal follow-up of adults whose childhood abuse was well documented has shown that their retrospective reports of childhood abuse are likely to under-estimate actual occurrence.47,48”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
What the sources say
- Partly supportedcites [47] Femina, 1990, Child abuse, Child Abuse Negl sourceExperimental — accuracy not yet measured
The Results report that eight adults with well-documented abuse in their adolescent records denied it at follow-up, and the Discussion says retrospective inaccuracies in this sample were in the direction of under-reporting. The paper limits that finding to a small sample of former delinquents and says its generalizability is uncertain; the claim does not retain that population qualifier. (LLM, conf=0.82)
- Not checked — no full text of the sourcecites [48] Williams, 1995, Recovered memories of abuse in women with documented child sexual victimization histories, J Traumatic Stress source
hedgedstates an association- Asserted: passes — The authors put it forward as true.
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- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“More than half of respondents reported at least one, and one-fourth reported Ն2 categories of childhood exposures.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“There was no statistically significant dose-response relationship for a history of stroke or diabetes.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Significance of Dose-Response Relationships
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“we found a strong, dose-response relationship between the number of childhood exposures and each of the 10 risk factors for the leading causes of death that we studied (P Ͻ .001).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Significance of Dose-Response Relationships
boostedstates an association- Asserted: passes — The authors put it forward as true.
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In the paper
“The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
hedgedstates an association- Asserted: passes — The authors put it forward as true.
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In the paper
“More than half of respondents reported at least one, and one-fourth reported Ն2 categories of childhood exposures.”
- Also stated in: § Adverse Childhood Exposures · plain
“More than half of respondents (52%) experienced Ն1 category of adverse childhood exposure; 6.2% reported Ն4 exposures.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
plain- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Adverse Childhood Exposures · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and a 1.4-to 1.6-fold increase in physical inactivity and severe obesity.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
plainstates an association- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.”
- Also stated in: § Relationships between Categories of Childhood Exposure · plain
“The relationship between single categories of exposure was significant for all comparisons (P Ͻ .001;chi-square).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
boostedstates an association- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Relationships between Categories of Childhood Exposure · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease.”
- Also stated in: § Discussion · plain
“Disease conditions including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease, as well as poor self-rated health also showed a graded relationship to the breadth of childhood exposures.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
plainstates an association- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We also found a significant (P Ͻ .05)dose-response relationship between the number of childhood exposures and the following disease conditions: ischemic heart disease, cancer, chronic bronchitis or emphysema, history of hepatitis or jaundice, skeletal fractures, and poor self-rated health.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Significance of Dose-Response Relationships
plainstates an association- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 16
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“a 2-to 4-fold increase in smoking, poor self-rated health, Ն50 sexual intercourse partners, and sexually transmitted disease;”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
plainstates an association- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, among persons with no childhood exposures, 56% had none of the 10 risk factors whereas only 14% of persons with Ն4 categories of childhood exposure had no risk factors.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Childhood Exposures and Clustering of Health Risk Factors
plainstates an association- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The most prevalent of the 7 categories of childhood exposure was substance abuse in the household (25.6%); the least prevalent exposure category was evidence of criminal behavior in the household (3.4%).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Adverse Childhood Exposures
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“By contrast, only 1% of persons with no childhood exposures had four or more risk factors, whereas 7% of persons with Ն4 childhood exposures had four or more risk factors (Table 6).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Childhood Exposures and Clustering of Health Risk Factors
plainstates an association- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Mental illness | | 18.8 |”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“| Ն65 | 2,610 | 60.0 | 24.5 | 8.9 | 4.2 | 2.4 |”
- Also stated in: § Discussion · plain
“| 19-34 | 807 | 35.4 | 25.4 | 17.2 | 11.0 | 10.9 |”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
plainstates an association- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Psychological | | 11.1 |”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Mother treated violently | | 12.5 |”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| 0 | 3,861 | 56 | 29 | 10 | 4 | 1 |”
- Also stated in: § Discussion · plain
“| Ն4 | 545 | 14 | 26 | 28 | 17 | 7 |”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
plainstates an association- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one. The quote only partly states this claim.
- Rests on an assumption: The number of categories of adverse childhood exposure is a valid cumulative measure of adversity.
- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Similarly, the odds ratios for skeletal fractures, hepatitis or jaundice, and poor self-rated health were 1.6, 2.3, and 2.2, respectively (Table 8).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Relationship between Childhood Exposures and Disease Conditions
plainstates an association- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“| Substance abuse | | 25.6 |”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The relationship between single categories of exposure was significant for all comparisons (P Ͻ .001;chi-square).For persons reporting any single category of exposure, the probability of exposure to any additional category ranged from 65%-93% (median: 80%); similarly, the probability of Ն2 additional exposures ranged from 40%-74% (median: 54.5%).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Relationships between Categories of Childhood Exposure
plainstates an association- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Because adverse childhood experiences are common and they have strong long-term associations with adult health risk behaviors, health status, and diseases, increased attention to primary, secondary, and tertiary prevention strategies is needed.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
boostedstates an association- Asserted: passes — The authors put it forward as true.
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In the paper
“Respondent (n ϭ 9,508) and nonrespondent (n ϭ 3,986) groups were similar in their percentages of women (53.7% and 51.0%, respectively) and in their mean years of education (14.0 years and 13.6 years, respectively).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Comparison of Respondents and Nonrespondents
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“After second mailings of the questionnaire to persons who did not respond to the first mailing, the response rate for the survey was 70.5% (9,508/13,494).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Survey Methods
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Respondents were slightly more likely to answer affirmatively than nonrespondents (6.1% vs. 5.4%, respectively).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Comparison of Respondents and Nonrespondents
plainstates an association- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Without measuring these household factors as well, long-term influence might be wrongly attributed solely to single types of abuse and the cumulative influence of multiple categories of adverse childhood experiences would not be assessed.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
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- Rests on an assumption: Conditions such as drug abuse, spousal violence, and criminal activity in the household may co-occur with specific forms of abuse that involve children.
None of the sources cited for this claim have been checked yet.
In the paper
“We used questions from published surveys to construct the ACE Study questionnaire.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Questionnaire Design
What the sources say
- Not checked — no full text of the sourcecites [39] Straus, 1990 source
- Not checked — no full text of the sourcecites [40] Wyatt, 1985, The sexual abuse of Afro-American and White-American women in childhood, Child Abuse Negl source
- Not checked yetcites [41] National Center for Health Statistics. Exposure to alcoholism in the family: United States, 1988. Advance Data, No. 205. U.S. Department of Health and Human Services, Washington, DC; September 30, 1991.
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Respondents were older than nonrespondents (means 56.1 years and 49.3 years) and more likely to be white (83.9% vs. 75.3%)although the actual magnitude of the differences was small.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Comparison of Respondents and Nonrespondents
plainstates an association- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Studies of the long-term effects of childhood abuse have usually examined single types of abuse, particularly sexual abuse, and few have assessed the impact of more than one type of abuse.5,24 -28”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
What the sources say
- Not checked — no full text of the sourcecites [5] McCauley, 1997, Clinical characteristics of women with a history of childhood abuse, JAMA source
- Not checked — no full text of the sourcecites [24] Briere, 1988, Multivariate correlates of childhood psychological and physical maltreatment among university women, Child Abuse Negl source
- Not checked — no full text of the sourcecites [25] Briere, 1990, Differential adult symptomatology associated with three types of child abuse histories, Child Abuse Negl source
- Not checked — no full text of the sourcecites [26] Claussen, 1991, Physical and psychological maltreatment, Child Abuse Negl source
- Not checked — no full text of the sourcecites [27] Moeller, 1993, The combined effects of physical, sexual, and emotional abuse during childhood, Child Abuse Negl source
- Not checked — no full text of the sourcecites [28] Bryant, 1995, Suicidality in college women who were sexually and physically punished by parents, Violence Vict source
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Respondents and nonrespondents did not differ with regard to their self-rated health, smoking, other substance abuse, or the presence of common medical conditions such as a history of heart attack or stroke, chronic obstructive lung disease, hypertension, or diabetes, or with regard to marital status or current family, marital, or job-related problems (data not shown).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Comparison of Respondents and Nonrespondents
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“For example, the American Medical Association recommends screening of women for exposure to violence at every entrance to the health system; 66 however, such screening appears to be rare.67”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
What the sources say
- Not checked yetcites [66] 1992, American Medical Association Diagnostic and Treatment Guidelines on Domestic Violence, Arch Fam Med
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, there may be mediators of the relationship between childhood experiences and adult health status other than the risk factors we examined.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“High levels of exposure to adverse childhood experiences would expectedly produce anxiety, anger, and depression in children.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper may give no reason why it holds.
In the paper
“Although articles in the general medical literature are alerting the medical community to the fact that childhood abuse is common, 59 adolescent health care is often inadequate in terms of psychosocial assessment and anticipatory guidance.60”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
What the sources say
- Not checked — no full text of the sourcecites [60] Rixey, 1994, Family violence and the adolescent, Maryland Med J
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“For example, nicotine is recognized as having beneficial psychoactive effects in terms of regulating affect 49 and persons who are depressed are more likely to smoke.50,51”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
What the sources say
- Not checked — no full text of the sourcecites [49] Carmody, 1989, Affect regulation, nicotine addiction, and smoking cessation, J Psychoactive Drugs source
- Not checked — no full text of the sourcecites [50] Anda, 1990, Depression and the dynamics of smoking. A national perspective, JAMA source
- Not checked — no full text of the sourcecites [51] Glassman, 1990, Smoking, smoking cessation, and major depression, JAMA source
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“To the degree that behaviors such as smoking, alcohol, or drug use are found to be effective as coping devices, they would tend to be used chronically.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Many physicians may fear that discussions of sexual violence and other sensitive issues are too personal even for the doctor-patient relationship.65”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
What the sources say
- Not checked — no full text of the sourcecites [65] Sugg, 1992, Primary care physicians’ response to domestic violence. Opening Pandora’s box, JAMA source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“because it is strongly predictive of mortality.45”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > 3.4 Any category reported 52.1%
What the sources say
- Not checked — no full text of the sourcecites [45] Idler, 1990, Self-rated health and mortality in the NHANES I Epidemiologic Follow-up Study, Am J Pub Health source
boostedstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Second, some persons with health risk behaviors or diseases may have been either more, or less, likely to report adverse childhood experiences.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Moreover, these childhood exposures include emotionally sensitive topics such as family alcoholism 29,30 and sexual abuse.64”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
What the sources say
- Not checked — no full text of the sourcecites [29] Zeitlen, 1994, Children with alcohol misusing parents, Br Med Bull source
- Not checked — no full text of the sourcecites [30] Dore, 1995, Identifying substance abuse in maltreating families, Child Abuse Negl source
- Not checked yetcites [64] Tabachnick, 1997, Perceptions of child sexual abuse as a public health problem. Vermont, September 1995, Morb Mortal Wkly Rep
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Furthermore, disease conditions could be either over-or under-reported by patients when they complete the medical questionnaire.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The relationship between childhood experiences and adult health status is likely to be overlooked in medical practice because the time delay between exposure during childhood and recognition of health problems in adult medical practice is lengthy.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data about adverse childhood experiences are based on self-report, retrospective, and can only demonstrate associations between childhood exposures and health risk behaviors, health status, and diseases in adulthood.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, smoking, which is medically and socially viewed as a “problem” may, from the perspective of the user, represent an effective immediate solution that leads to chronic use.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Although articles in the general medical literature are alerting the medical community to the fact that childhood abuse is common, 59 adolescent health care is often inadequate in terms of psychosocial assessment and anticipatory guidance.60”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
What the sources say
- Not checked — no full text of the sourcecites [59] MacMillan, 1997, Prevalence of child physical and sexual abuse in the community. Results from the Ontario Health Supplement, JAMA source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Logistic regression analysis was employed to adjust for the potential confounding effects of age, sex, race, and educational attainment on the relationship between the number of childhood exposures and health problems.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Statistical Analysis
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper relies on this without support.
Conditions such as drug abuse, spousal violence, and criminal activity in the household may co-occur with specific forms of abuse that involve children.
“Conditions such as drug abuse, spousal violence, and criminal activity in the household may co-occur with specific forms of abuse that involve children.”
The paper relies on this without support.
The number of categories of adverse childhood exposure is a valid cumulative measure of adversity.
“Number of categories of adverse childhood exposure and the adjusted odds of risk factors including current smoking, severe obesity, physical inactivity, depressed mood, and suicide attempt”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adverse childhood experiences (ACEs) were documented at baseline using the 10-item ACE Study questionnaire to measure childhood trauma, and were grouped as either “0–3” or “4+” due to the high rate of chronic health problems among individuals with scores of 4 or more 37.”
From Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study (2023) · cites this paper as [37]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Both exposure to IPV and parental separation or divorce are two adverse childhood experiences (ACEs) that are linked in a dose–response relationship to adverse health consequences through the lifespan (Felitti et al., 1998).”
From Post‐separation abuse: A concept analysis (2023) · cites this paper as Felitti et al., 1998
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“There is a strong, graded link between exposure to childhood adversity and risk of negative health, social, and emotional outcomes, including several major categories of chronic disease, lung cancer, various autoimmune diseases, depression and other mental illnesses, and high-risk behaviors (e.g., Felitti et al., 1998).”
From Malleability, plasticity, and individuality: How children learn and develop in context1 (2019) · cites this paper as Felitti et al., 1998
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“on average, the life span of individuals with six or more ACEs is 20 years shorter than that of those with zero ACEs (Felitti et al., 1998).”
From Malleability, plasticity, and individuality: How children learn and develop in context1 (2019) · cites this paper as Felitti et al., 1998
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“while adults with ELS/CT experience could be at increased risk of disease with potentially immune origin (36, 53).”
From Developmental Trajectories of Early Life Stress and Trauma: A Narrative Review on Neurobiological Aspects Beyond Stress System Dysregulation (2019) · cites this paper as [53]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In one study of more than 9,500 adults, for example, exposure to multiple forms of early life stress was associated with a 4.6-fold increase in risk of being depressed over the past year (Felitti et al., 1998).”
From From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. (2014) · cites this paper as Felitti et al., 1998
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Children enter foster care with a sum of adverse childhood experiences.55–57”
From Caregiving disruptions affect growth and pubertal development in early adolescence in institutionalized and fostered Romanian children: A randomized clinical trial (2018) · cites this paper as [55]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adverse childhood experiences, including growing up in a context of maternal substance use (74), predicts an earlier age of onset for alcohol (62, 75) and other drug use (76, 77), and increased odds for attempting suicide (78).”
From Mothering, Substance Use Disorders and Intergenerational Trauma Transmission: An Attachment-Based Perspective (2019) · cites this paper as [74]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Outcomes associated with early adversity include higher risk of type 2 diabetes, obesity, ischemic heart disease, cancers, depression, addictions, and premature mortality, as well as social outcomes including unemployment and lower educational attainment [1–8].”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Epidemiological studies have demonstrated that adverse childhood experiences, namely exposures such as neglect, abuse, caregiver mental illness, and family or community violence, predict poorer long-term outcomes across health and social domains.”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Interest in metabolic embedding of ELA stems from epidemiological [1, 69] and clinical [70] studies linking ELA to obesity, dyslipidemia, and type 2 diabetes, raising questions about possible causal pathways.”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adverse psychosocial exposures in early life, namely experiences such as child maltreatment, caregiver stress or depression, and domestic or community violence, have been associated in epidemiological studies with increased lifetime risk of adverse outcomes, including diabetes, heart disease, cancers, and psychiatric illnesses.”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In full, ELA-induced changes may mediate epidemiological links to key diseases, including, among others, obesity, dyslipidemia, type 2 diabetes, atherosclerosis, asthma, thromboembolic events (myocardial infarction, stroke), cancer onset and progression, as well as addictions, psychopathology, and adverse social outcomes [1–6, 18].”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [1]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“These frequencies are consistent with previous studies documenting elevated rates of childhood adversity among individuals with SUD [3, 5, 9].”
From The link of adverse childhood experiences and attachment to maladaptive personality traits in adults diagnosed with substance use disorder (2025) · cites this paper as [3]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adverse childhood experiences are associated with many negative adult health and health care utilisation outcomes, including cardiovascular illness, depression, suicide attempts, unhealthy substance use, obesity, lung disease, liver disease, cancer and medically unexplained symptoms such as pain or gastrointestinal problems[1–6].”
From Health care utilisation changes among Alaska Native adults after participation in an indigenous community programme to address adverse life experiences: a propensity score-matched analysis (2020) · cites this paper as [3]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Dose-response relationships between adverse childhood experiences (ACEs) and multiple risk factors have been documented among AIANs and non-AIANs [51,70].”
From Substance and Behavioral Addictions among American Indian and Alaska Native Populations (2022) · cites this paper as [70]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Rather, the overwhelming majority of studies14 have employed an empirical specification similar to that which has predominated in the literature on childhood adversity, i.e., a sum score of exposures.15–18”
From Co-occurring epidemics, syndemics, and population health (2017) · cites this paper as [17]
The cited source says what the claim attributes to it.
In the citing paper
“Much research associates CT with adverse physical and mental health outcomes (1,2)”
From Impact of Childhood Trauma on Executive Function in Adolescence—Mediating Functional Brain Networks and Prediction of High-Risk Drinking (2020) · cites this paper as [1]
The cited source says what the claim attributes to it.
In the citing paper
“Moreover, there is commonly a dose-response relationship between the number of types of adversity associated and the magnitude of the risk for depression.4-11”
From Early life adversity and the epigenetic programming of hypothalamic-pituitary-adrenal function (2014) · cites this paper as [4]
The cited source says what the claim attributes to it.
In the citing paper
“Similarly, the original ACE study [3] demonstrated that individuals exposed to multiple adverse experiences had a four- to twelve-fold increased risk for alcoholism, drug abuse, depression, and suicide attempts.”
From The link of adverse childhood experiences and attachment to maladaptive personality traits in adults diagnosed with substance use disorder (2025) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“Exposure to ELA is associated with a clustering of health risks, with increasing exposure related to an increasing number of HRBs.32”
From Early life adversity and health-risk behaviors: Proposed psychological and neural mechanisms (2018) · cites this paper as [32]
The cited source says what the claim attributes to it.
In the citing paper
“Such an approach facilitates the synthesis of complex evidence for application, and is supported by observed dose–response effects linking cumulative early adversity to later outcomes [1, 3, 5], and by the “allostatic load” paradigm exploring pathogenic effects of cumulative all-cause stress [15].”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [1]
The cited source says what the claim attributes to it.
In the citing paper
“Dose-response relationship between number of adversities and health and social effects are observed in large epidemiological studies”
From Biological embedding of childhood adversity: from physiological mechanisms to clinical implications (2017) · cites this paper as [1]
The cited source says what the claim attributes to it.
In the citing paper
“Adverse childhood experiences (ACEs) considerably increase the likelihood of mental illness, health risk behaviors, and chronic physical illnesses.”
From The link of adverse childhood experiences and attachment to maladaptive personality traits in adults diagnosed with substance use disorder (2025) · cites this paper as [3]
The cited source says what the claim attributes to it.
In the citing paper
“These findings are consistent with research that has supported the relationship between ACEs and further negative health consequences in the general population (Buckingham & Daniolos, 2013;Cicchetti & Handley, 2019;Felitti et al., 1998;Hughes et al., 2017).”
From Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review (2021) · cites this paper as Felitti et al., 1998
In the citing paper
“Also, adults who were abused as children have been shown to be at increased risk of disease with potential inflammatory origin (9, 10).”
From Childhood maltreatment predicts adult inflammation in a life-course study (2007) · cites this paper as [9]
In the citing paper
“Inflammation may be an important developmental mediator linking adverse experiences in early life to poor adult health.”
From Childhood maltreatment predicts adult inflammation in a life-course study (2007) · cites this paper as [9]
In the citing paper
“Given that the effect of stress often appears to be cumulative (2, 9, 19), we derived a cumulative exposure index for each child by counting the number of maltreatment experiences during the first decade of life (31);”
From Childhood maltreatment predicts adult inflammation in a life-course study (2007) · cites this paper as [9]
In the citing paper
“Childhood adversity has been repeatedly and robustly linked to physical and mental illness across the lifespan.”
From Developmental psychoneuroendocrine and psychoneuroimmune pathways from childhood adversity to disease (2017) · cites this paper as Felitti et al., 1998
In the citing paper
“The first study using the DAWBA-RAD section reported a very high RAD point-prevalence of 63.0% (96/153) in a sample of looked after youth in a variety of placement forms [29].”
From Mental disorders in foster children: a study of prevalence, comorbidity and risk factors (2013) · cites this paper as [29]
In the citing paper
“Compared to another study on RAD using DAWBA in high-risk foster youths [29], our estimate was quite moderate.”
From Mental disorders in foster children: a study of prevalence, comorbidity and risk factors (2013) · cites this paper as [29]
In the citing paper
“Victims of childhood physical or sexual abuse or parental neglect are at considerably greater risk for affective disorders.1-4”
From Early life adversity and the epigenetic programming of hypothalamic-pituitary-adrenal function (2014) · cites this paper as [4]
In the citing paper
“Epidemiological studies provide compelling support for the association between cumulative, adverse childhood experiences and the risk for depression.4,5”
From Early life adversity and the epigenetic programming of hypothalamic-pituitary-adrenal function (2014) · cites this paper as [4]
In the citing paper
“In humans, various forms of ELA are associated with illicit drug use later in life [21,22,23].”
From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [21]
In the citing paper
“In addition, there are established links between ELA and obesity [21,24], however, the exact mechanisms are not understood.”
From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [21]
In the citing paper
“Strong links between ACEs and the initiation of opioid use have been described (72, 73).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [72]
In the citing paper
“The Adverse Childhood Experiences (ACE) study from 1998 highlighted 5- to 10-fold increase in the risk of AUD and SUD following exposure to four or more ACEs in the first 18 years of life [112].”
From Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint (2020) · cites this paper as [112]
In the citing paper
“Indeed, ELA is associated with a greater likelihood of smoking cigarettes,32,43,44 abusing alcohol and drugs,32,45–47 eating a poor diet,48 and being obese.32,49”
From Early life adversity and health-risk behaviors: Proposed psychological and neural mechanisms (2018) · cites this paper as [32]
In the citing paper
“ELA has also been associated with physical inactivity, which likely also contributes to the link between ELA and obesity.32”
From Early life adversity and health-risk behaviors: Proposed psychological and neural mechanisms (2018) · cites this paper as [32]
In the citing paper
“Research has consistently found that care leavers are more likely to have experienced high levels of adverse childhood experience (ACEs) and are at significantly greater risk for negative outcomes (Felitti et al., 1998; Simkiss, 2019).”
From The relationship between spirituality and resilience and well-being: a study of 529 care leavers from 11 nations. (2023) · cites this paper as Felitti et al., 1998
In the citing paper
“The documented risks of having care experience are substantial and varied (Berlin et al., 2011; Felitti et al., 1998; Simkiss, 2019).”
From The relationship between spirituality and resilience and well-being: a study of 529 care leavers from 11 nations. (2023) · cites this paper as Felitti et al., 1998
In the citing paper
“Early life physical and sexual abuse carry with it a life-long burden of behavioral and pathophysiological problems (Felitti et al., 1998; Heim and Nemeroff, 2001).”
From Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators (2008) · cites this paper as Felitti et al., 1998
In the citing paper
“There are enormous individual differences in the response to stress, based upon the experience of the individual early in life and in adult life.”
From Protective and damaging effects of stress mediators: central role of the brain (2006) · cites this paper as [41]
In the citing paper
“Early life physical and sexual abuse imposes a life- long burden of behavioral and pathophysiological problems.41,42”
From Protective and damaging effects of stress mediators: central role of the brain (2006) · cites this paper as [41]
In the citing paper
“Early-life events related to maternal care in animals, as well as parental care in humans, play a powerful role in later mental and physical health, as demonstrated by the adverse childhood experiences (ACE) studies”
From Neurobiological and Systemic Effects of Chronic Stress (2017) · cites this paper as [77]
In the citing paper
“ACE have a disproportionately powerful effect on life long trajectories of health and disease, 68 and poverty contributes in its own way as well as creating circumstances for ACE, 114 which, however, occurs across all levels of socioeconomic status (SES).”
From Neurobiological and Systemic Effects of Chronic Stress (2017) · cites this paper as [77]
In the citing paper
“Boarding schools as a form of cultural genocide and source of historical trauma have had a variety of negative health impacts on Native people, such as high suicide rates, post-traumatic stress disorder, and other illnesses such as heart disease and diabetes that are connected to trauma (Brave Heart et al. 2011;Duran 2019;Felitti et al. 1998).”
From Archaeology and Social Justice in Native America (2022) · cites this paper as Felitti et al. 1998
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
“We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P Ͻ .001).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Significance of Dose-Response Relationships
“There was no statistically significant dose-response relationship for a history of stroke or diabetes.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Exclusions from Analysis
“The mean age of the 8,506 persons included in this analysis was 56.1 years”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Exclusions from Analysis
“After these exclusions, 8,056 of the original 9,508 survey respondents (59.7% of the original sample of 13,494) remained and were included in the analysis.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Abstract
“a 1.4-to 1.6-fold increase in physical inactivity and severe obesity.”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
“| | 4 or more | 523 | 26.6 | 1.3 | ( 1.1-1.6) |”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Relationship between Childhood Exposures and Disease Conditions
“Similarly, the odds ratios for skeletal fractures, hepatitis or jaundice, and poor self-rated health were 1.6, 2.3, and 2.2, respectively (Table 8).”
§ Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study > Discussion
“| | 4 or more | 543 | 10.7 | 2.4 | (1.8-3.3) |”
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Samji, H., Long, D., Herring, J., Correia, R., & Maloney, J. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.106640 · Cited by 56
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Multiple traumas, postelection violence, and posttraumatic stress among impoverished Kenyan youth
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Civil Unrest in the Context of Chronic Community Violence: Impact on Maternal Depressive Symptoms
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Injury and Mortality Among Children Identified as at High Risk of Maltreatment
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Regional Prefrontal Resting-State Functional Connectivity in Posttraumatic Stress Disorder
Olson, E. A., Kaiser, R. H., Pizzagalli, D. A., Rauch, S. L., & Rosso, I. M. (2018) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2018.09.012 · Cited by 39
“The Adverse Childhood Experiences scale (51) is a 10-item self-report measure of childhood abuse, neglect, and stressful life experiences.”
Kowalski, M. A. (2018) · Youth Violence and Juvenile Justice · doi:10.1177/1541204018809836 · Cited by 36
Trauma-Informed Care: Essential Elements for Pediatric Health Care
Hornor, G., Davis, C., Sherfield, J., & Wilkinson, K. (2019) · Journal of Pediatric Health Care · doi:10.1016/j.pedhc.2018.09.009 · Cited by 39
O’Connor, S. G., Habre, R., Bastain, T. M., Toledo‐Corral, C. M., Gilliland, F. D., Eckel, S. P., Cabison, J., Naya, C. H., Farzan, S. F., Chu, D., et al. (2019) · BMC Public Health · doi:10.1186/s12889-019-6583-x · Cited by 36
“, corticosteroid, hormones, β-blockers), depression, [52] perceived stress, [37] stressful life events, [53] adverse childhood events, [54] pregnancy-related distress, [55] financial stress, [56] perceived neighborhood safety and social cohesion, [57] food insecurity, [58] sleep, acculturation, [59] pregnancy intended…”
Jones, C. W., Esteves, K. C., Gray, S. A. O., Clarke, T. N., Callerame, K., Theall, K. P., & Drury, S. S. (2019) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2019.03.022 · Cited by 39
“6 Maternal Adverse Childhood Experiences (ACE) Mothers reported on their Adverse Childhood Experiences at their prenatal study visit (Felitti et al., 1998).”
Health effects of family member incarceration in the United States: A meta-analysis and cost study
Provencher, A. J., & Conway, J. M. (2019) · Children and Youth Services Review · doi:10.1016/j.childyouth.2019.05.029 · Cited by 40
Mootz, J. J., Stark, L., Meyer, E., Asghar, K., Harker, A., Potts, A., Poulton, C., Marsh, M., Ritterbusch, A. E., & Bennouna, C. (2019) · Conflict and Health · doi:10.1186/s13031-019-0200-6 · Cited by 40
Adversity in childhood and young adulthood predicts young adult depression
Stern, K. R., & Thayer, Z. M. (2019) · International Journal of Public Health · doi:10.1007/s00038-019-01273-6 · Cited by 41
Sweeting, J. A., Garfin, D. R., Holman, E. A., & Silver, R. C. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2019.104048 · Cited by 45
“The seminal Adverse Childhood Experiences (ACE) study explored childhood abuse, childhood household dysfunction, and adulthood health outcomes, finding a graded, positive relationship between the number of categories of ACEs to which one was exposed and subsequent negative adulthood physical and mental health outcomes…”
BackgroundResultEarly adversity predicts adoptees’ enduring emotional and behavioral problems in childhood
Paine, A. L., Fahey, K. T., Anthony, R., & Shelton, K. H. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01553-0 · Cited by 50
“Given that children adopted from care in the UK have a high prevalence of ACEs [9] that impact on adult psychological and physical health [11, 13], our findings have relevance for prevention and intervention strategies by underscoring the need to protect children from accumulating ACEs in early childhood, and for effe…”
BackgroundHaardörfer, R., Windle, M. T., Fairman, R. T., & Berg, C. J. (2020) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106619 · Cited by 41
Hébert, M., Lapierre, A., MacIntosh, H. B., & Ménard, A. D. (2020) · Journal of Child Sexual Abuse · doi:10.1080/10538712.2020.1801936 · Cited by 58
Insomnia and Susceptibility to Depressive Symptoms and Fatigue in Diverse Breast Cancer Survivors
Haque, R., Hsu, J. Y., Avila, C. C., Olmstead, R., Carroll, J., & Irwin, M. R. (2020) · Journal of Women s Health · doi:10.1089/jwh.2019.8135 · Cited by 44
Teaching Trauma-Informed Care: A Symposium for Medical Students
Chokshi, B., Walsh, K., Dooley, D. G., Falusi, O. O., Deyton, L., & BEERS, L. S. (2020) · MedEdPORTAL · doi:10.15766/mep_2374-8265.11061 · Cited by 45
“In early discussion, we recognized that the content of the student reflections mapped to four of the six Accreditation Council for Graduate Medical Education (ACGME) domains of competence: (1) patient care and procedural skills,”
BackgroundMethodAdverse childhood experiences and children's development in early care and education programs
Lipscomb, S. T., Hatfield, B. E., Lewis, H., Goka‐Dubose, E., & Abshire, C. (2020) · Journal of Applied Developmental Psychology · doi:10.1016/j.appdev.2020.101218 · Cited by 51
Trauma Informed Ethics Consultation
Lanphier, E., & Anani, U. E. (2021) · The American Journal of Bioethics · doi:10.1080/15265161.2021.1887963 · Cited by 40
“ACEs include physical, emotional, and sexual trauma, as well as contextual events like growing up with a household member abusing substances, incarcerated, having a severe mental illness, or parents separating (Felitti et al. 1998).”
BackgroundCelsi, L., Paleari, F. G., & Fincham, F. D. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.623646 · Cited by 43
“ACEs, defined as negative, stressful, and traumatic experiences during childhood and adolescence (Felitti et al., 1998), are undoubtedly some of the most studied risk factors for involvement in violent relationships.”
BackgroundScience, practice, and policy related to adverse childhood experiences: Framing the conversation.
Portwood, S. G., Lawler, M. J., & Roberts, M. C. (2021) · American Psychologist · doi:10.1037/amp0000809 · Cited by 39
Encyclopedia of Autism Spectrum Disorders
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A Scoping Review of Trauma-Informed Curricula for Primary Care Providers
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“19 This framework breaks down trauma into five categories: (1) patient-centered communication and care, (2) understanding the health effects of trauma, (3) interprofessional collaboration, (4) understanding your own history and reactions, and (5) screening.”
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Childhood Misfortune and Adult Health
Schafer, M. H., & Ferraro, K. F. (2012) · Journal of Aging and Health · doi:10.1177/0898264312464884 · Cited by 41
The Link Between Perinatal Glucocorticoids Exposure and Psychiatric Disorders
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Is Premenstrual Dysphoric Disorder Really a Disorder?
Browne, T. K. (2014) · Journal of Bioethical Inquiry · doi:10.1007/s11673-014-9567-7 · Cited by 47
Andersen, S. L., & Navalta, C. P. (2011) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2011.02376.x · Cited by 40
Halfon, N., Inkelas, M., & Hochstein, M. (2000) · Milbank Quarterly · doi:10.1111/1468-0009.00180 · Cited by 42
Reported child sexual abuse in Bahrain: 2000-2009
Al-Mahroos, F., & Al-Amer, E. (2011) · Annals of Saudi Medicine · doi:10.4103/0256-4947.83218 · Cited by 39
Marital Conflict Trajectories and Associations With Children's Disruptive Behavior
Madigan, S. L., Plamondon, A., & Jenkins, J. M. (2016) · Journal of Marriage and the Family · doi:10.1111/jomf.12356 · Cited by 37
Associations between childhood intelligence (IQ), adult morbidity and mortality
Kilgour, A. H. M., Starr, J. M., & Whalley, L. J. (2009) · Maturitas · doi:10.1016/j.maturitas.2009.09.021 · Cited by 41
Larson, M. J., Miller, L., Becker, M. A., Richardson, E., Kämmerer, N., Thom, J. C., Gampel, J., & Savage, A. (2005) · The Journal of Behavioral Health Services & Research · doi:10.1007/bf02287262 · Cited by 39
Childhood stress and birth timing among African American women: cortisol as biological mediator
Gillespie, S. L., Christian, L. M., Alston, A. D., & Salsberry, P. J. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.06.009 · Cited by 38
The detrimental influence of racial discrimination on child health in the United States
Anderson, A. T., Luartz, L., Heard-Garris, N., Widaman, K., & Chung, P. J. (2020) · Journal of the National Medical Association · doi:10.1016/j.jnma.2020.04.012 · Cited by 38
“The original ACEs study authors considered ACEs upstream risk factors for problems like depression, which then increased the likelihood of the physical health problems under study.(22,23) Further investigation is needed to establish causality, but the growing evidence base supports the contribution of racial discrimin…”
BackgroundOosterman, M., Schuengel, C., Forrer, M. L., & De Moor, M. H. M. (2019) · Development and Psychopathology · doi:10.1017/s0954579418001591 · Cited by 38
“All categories of ACEs were assessed and scored according to the criteria described by Felitti et al. (1998).”
BackgroundMethodInfluentialMedina, N. T., Canaval, G. E., Dávila, D. C. B., & Humphreys, J. C. (2011) · Investigación y Educación en Enfermería · doi:10.17533/udea.iee.9977 · Cited by 38
Shenk, C. E., Noll, J. G., Griffin, A. M., Allen, E. K., Lee, S. E., Lewkovich, K. L., & Allen, B. (2016) · Child Maltreatment · doi:10.1177/1077559516669253 · Cited by 39
Choi, K., Kim, D., Jang, E. Y., Bae, H., & Kim, S. H. (2016) · Yonsei Medical Journal · doi:10.3349/ymj.2017.58.1.226 · Cited by 39
Ross, L., & Arsenault, S. M. (2017) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x17734798 · Cited by 38
Avilés-Santa, L. M., Heintzman, J., Lindberg, N. M., Guerrero-Preston, R. E., Ramos, K. S., Abraído-Lanza, A. L., Bull, J. C., Falcón, A., McBurnie, M. A., Moy, E. M., et al. (2017) · BMC Proceedings · doi:10.1186/s12919-017-0079-4 · Cited by 41
Lesbian, Gay, Bisexual, Transgender, and Queer Youth and Social Justice
Jones, S. W., Sood, A. B., Bearss, N., & Clauss‐Ehlers, C. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108551830.009 · Cited by 38
Kahn, R. E., Jackson, K., Keiser, K. L., Ambroziak, G., & Levenson, J. S. (2020) · Sexual Abuse · doi:10.1177/1079063220970031 · Cited by 44
“…abuse, depression, suicide attempts, and problematic sexual behavior (e.g., promiscuity, sexually transmitted diseases) in addition to detrimental effects on brain development (Anda et al., 2010; Anda et al., 2006; Cicchetti, 2013; Dube et al., 2003; Felitti et al., 1998; Teicher et al., 2003).”
BackgroundResultInfluentialRacial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss
Shorter, J. M., Koelper, N., Sonalkar, S., Oquendo, M. A., Sammel, M. D., & Schreiber, C. A. (2020) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000004212 · Cited by 39
“001 Some grade school or high school 10 (6) 16 (13) High school diploma or high school equivalency certificate 30 (19) 59 (49) Some college or post–high school education 115 (74) 45 (38) Medical insurance ,.”
BackgroundUsing the VIA Classification to Advance a Psychological Science of Virtue
McGrath, R. E., & Brown, M. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.565953 · Cited by 37
Ethical issues in participatory arts methods for young people with adverse childhood experiences
Pavarini, G., Smith, L. M., Shaughnessy, N., Mankee‐Williams, A., Thirumalai, J. K., Russell, N., & Bhui, K. S. (2021) · Health Expectations · doi:10.1111/hex.13314 · Cited by 41
“Adverse childhood experiences (ACEs) are potentially traumatic events that can have negative lasting effects on health and well‐ being.(1) This includes direct experiences of neglect; physical, mental”
Childhood Poverty, Adverse Childhood Experiences, and Adult Health Outcomes
Lee, H., Slack, K. S., Berger, L. M., Mather, R. S., & Murray, R. K. (2021) · Health & Social Work · doi:10.1093/hsw/hlab018 · Cited by 37
Sandoval-Obando, E., Alcaide, M., Salazar-Muñoz, M., Peña-Troncoso, S., Hernández-Mosqueira, C., & Gimenez-Serrano, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010045 · Cited by 38
“Firstly, parents have a greater responsibility for the physical, psychological, and emotional development of their children [19].”
BackgroundSiciliano, R. E., Anderson, A. S., & Compas, B. E. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102125 · Cited by 48
Social Justice for Children and Young People
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Eik‐Nes, T. T., Tokatlian, A., Raman, J., Spirou, D., & Kvaløy, K. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.886148 · Cited by 48
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Shukla, S., Ezebuihe, J. A., & Steinert, J. (2023) · BMC Public Health · doi:10.1186/s12889-023-15054-7 · Cited by 55
Raney, J. H., Al-Shoaibi, A. A. A., Ganson, K. T., Testa, A. M., Jackson, D. B., Singh, G., Sajjad, O. M., & Nagata, J. M. (2023) · BMC Public Health · doi:10.1186/s12889-023-16111-x · Cited by 46
“has documented greater risk concentration at this threshold [25, 26].”
BackgroundIs Dissociation a Fundamental Component of ICD-11 Complex Posttraumatic Stress Disorder?
Hyland, P., Hamer, R., Fox, R. J., Vallières, F., Karatzias, T., Shevlin, M. E., & Cloître, M. (2023) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2023.2231928 · Cited by 39
“Questionnaire (ACE-Q; Felitti et al., 1998) measures exposure to ten events occurring before the age of 18.”
Qu, G., Shu, L., Liu, H., Ma, S., Han, T., Zhang, H., Huang, C., Wang, J., Yang, L., & Sun, Y. (2024) · Trauma Violence & Abuse · doi:10.1177/15248380241246758 · Cited by 40
“Since adverse childhood experiences (ACEs) were originally identified and screened in the past century (Felitti et al., 1998), ACEs have gradually been recognized and attracted widespread attention.”
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Judging the Child’s Best Interests
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Estimating Present and Future Damages Following Child Maltreatment
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Sexuality Issues and Gynecologic Care of Adolescents with Developmental Disabilities
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Surveillance and Screening for Social Determinants of Health
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Discrepant Patterns of Heavy Drinking, Marijuana Use, and Smoking and Intimate Partner Violence
Cunradi, C. B., Todd, M. W., & Mair, C. (2015) · Journal of Drug Education · doi:10.1177/0047237915608450 · Cited by 38
Examining the contemporaneous occurrence of bullying and teen dating violence victimization.
Debnam, K. J., Waasdorp, T. E., & Bradshaw, C. P. (2015) · School Psychology Quarterly · doi:10.1037/spq0000124 · Cited by 39
Cortisol awakening response among women exposed to intimate partner violence
Pinto, R. J., Correia‐Santos, P., Costa-Leite, J., Levendosky, A. A., & Jongenelen, I. (2016) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2016.08.024 · Cited by 42
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Universal Design for Underserved Populations: Person-Centered, Recovery-Oriented and Trauma Informed
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Applying a trauma-informed perspective to loss and change in the lives of older adults
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“, 1993), as well as indirect effects through mediating behaviors such as smoking and other substance use, sub-optimal nutrition and exercise activity and ongoing stress (Chung et al., 2010; Dube et al., 2002b; Felitti et al., 1998).”
BackgroundChildhood adversity and parent perceptions of child resilience
Heard‐Garris, N., Davis, M. M., Szilagyi, M. A., & Kan, K. (2018) · BMC Pediatrics · doi:10.1186/s12887-018-1170-3 · Cited by 48
“, witnessing domestic violence; and household members with mental illness, substance abuse, or incarceration histories) [1].”
BackgroundEvidence Review—Social Determinants of Health for Veterans
Duan‐Porter, W., Martinson, B. C., Greer, N. L., Taylor, B. C., Ullman, K. E., McKenzie, L. G., Rosebush, C. E., MacDonald, R. H., Falde, S., & Wilt, T. J. (2018) · Journal of General Internal Medicine · doi:10.1007/s11606-018-4566-8 · Cited by 38
Lewis, M. E., Hartwell, E. E., & Myhra, L. L. (2018) · American Journal of Community Psychology · doi:10.1002/ajcp.12288 · Cited by 37
The relation between adverse childhood experiences and moral injury in the Canadian Armed Forces
Battaglia, A. M., Protopopescu, A., Boyd, J. E., Lloyd, C., Jetly, R., O’Connor, C., Hood, H. K., Nazarov, A., Rhind, S. G., Lanius, R. A., et al. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1546084 · Cited by 49
“we hypothesized that exposure to ACEs, as measured by the Adverse Childhood Experiences Questionnaire (ACE-Q) (Felitti et al., 1998), would be associated”
BackgroundMethodInfluentialSwedo, E. A., Sumner, S. A., Hillis, S. D., et al. (2019) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6815a3 · Cited by 38
“Accurately quantifying and addressing perpetration of violence is a critical first step to reducing such violence, along with its associated consequences, such as transmission of human immunodeficiency virus (6,7).”
BackgroundTsuyuki, K., Al-Alusi, N. A., Campbell, J. C., Murry, D., Cimino, A. N., Servin, A. E., & Stockman, J. K. (2019) · PLoS ONE · doi:10.1371/journal.pone.0216279 · Cited by 39
DeQuattro, K., Trupin, L. S., Li, J., Katz, P., Murphy, L. B., Yelin, E. H., Rush, S., Lanata, C. M., Criswell, L. A., Dall’Era, M., et al. (2019) · Arthritis Care & Research · doi:10.1002/acr.23878 · Cited by 42
“organization (Kaiser Permanente) found that ACEs were common (15), with a dose response for number of ACEs and adult negative health outcomes (16).”
BackgroundBrenhouse, H. C., & Bath, K. G. (2019) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2019.100768 · Cited by 46
“For example, work in humans investigating adverse childhood experiences (ACE’s) have found that increased risk for negative health outcomes are associated with exposure to such variable as physical abuse, psychological abuse, sexual abuse, neglect, loss of a parent, drug abuse/exposure, invasive medical procedures, to…”
BackgroundMethodSex and age effects in past-year experiences of violence amongst adolescents in five countries
Stark, L., Seff, I., Hoover, A., Gordon, R., Ligiero, D., & Massetti, G. M. (2019) · PLoS ONE · doi:10.1371/journal.pone.0219073 · Cited by 38
Sanz, J., Maurizio, P. L., Snyder‐Mackler, N., Simons, N. D., Voyles, T., Kohn, J. N., Michopoulos, V., Wilson, M., Tung, J., & Barreiro, L. B. (2019) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1820846116 · Cited by 33
Historic Lynching and Corporal Punishment in Contemporary Southern Schools
Ward, G. K., Petersen, N., Kupchik, A., & Pratt, J. B. (2019) · Social Problems · doi:10.1093/socpro/spz044 · Cited by 38
Refugee and Asylum-Seeking Children: Interrupted Child Development and Unfulfilled Child Rights
Vaghri, Z., Tessier, Z., & Whalen, C. (2019) · Children · doi:10.3390/children6110120 · Cited by 38
Adverse Childhood Experiences and Trauma-Informed Care: An Online Module for Pediatricians
Schmitz, A. H., Light, S., Barry, C. O., et al. (2019) · MedEdPORTAL · doi:10.15766/mep_2374-8265.10851 · Cited by 38
Early Life Trauma Has Lifelong Consequences for Sleep And Behavior
Lewin, M. P., Lopachin, J., Delorme, J. E., Opendak, M. M., Sullivan, R. M., & Wilson, D. A. (2019) · Scientific Reports · doi:10.1038/s41598-019-53241-y · Cited by 39
Substance Use in Registered Nurses: “I Heard About a Nurse Who . . .”
Foli, K. J., Reddick, B., Zhang, L., & Krcelich, K. (2019) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390319886369 · Cited by 38
“Of note is the significant difference between the two subsamples on ACE scores (Felitti et al., 1998) with those contributing responses reporting higher ACEs (p < .01).”
BackgroundMethodResultInfluentialBurton, C. W., Williams, J. R., & Anderson, J. (2019) · Journal of Forensic Nursing · doi:10.1097/jfn.0000000000000263 · Cited by 41
“Given what is known about the long-term consequences of trauma during childhood (Brown et al., 2009; Felitti et al., 1998), incorporating didactic and clinical opportunities for students to address trauma and violence prevention is crucial.”
Background
Metadata
- Authors
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S.
- Affiliations
- Kaiser Permanente (US)
- Centers for Disease Control and Prevention (US)
- Emory University (US)
- University of Arizona (US)
- Corresponding author
- Felitti, Vincent J
- Venue
- American Journal of Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 1998-05
- Volume
- 14
- Issue
- 4
- Pages
- 245-258
- ISSN
- 0749-3797 (ISSN-L)
- OpenAlex
- W2116839388
- Cited by
- 18,943
- References
- 97
- Citations by year
- 2026: 1615 · 2025: 1790 · 2024: 1720 · 2023: 1711 · 2022: 1648 · 2021: 1720 · 2020: 1565 · 2019: 1232 · 2018: 963 · 2017: 825 · 2016: 666 · 2015: 573 · 2014: 446 · 2013: 413 · 2012: 340
- FWCI
- 57.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention (TS-44-10/12)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Health › Intimate Partner and Family Violence
- Social Sciences › Sociology and Political Science › Child Welfare and Adoption
- Keywords
- adverse childhood experiences, childhood abuse, household dysfunction, childhood emotional abuse, child physical abuse, child sexual abuse, alcoholism, drug abuse, depression, suicide attempts, smoking, sexually transmitted infections, obesity, physical inactivity, ischemic heart disease, cancer, chronic lung disease, liver disease, cumulative exposure, leading causes of death
- MeSH terms
- Adult, Aged, Aged, 80 and over, California, Cause of Death, Child, Child Abuse, Family, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Risk Factors, Social Problems, Violence, Health Behavior, Logistic Models, Child of Impaired Parents, Domestic Violence
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