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
50 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 · 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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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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- 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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A result the paper states — it cites no source for it, so there is none to check. 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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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
“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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“ACE types include physical, sexual, and psychological abuse and household dysfunction (e.g., living with criminality or domestic violence [DV]; Felitti et al., 1998).”
BackgroundCash outs during in-play sports betting: Who, why, and what it reveals
Sinclair, E. S.-L. L., Clark, L., Wohl, M. J. A., Keough, M. T., & Kim, H. S. A. (2024) · Addictive Behaviors · doi:10.1016/j.addbeh.2024.108008 · Cited by 11
Screening for symptoms of childhood traumatic stress in the primary care pediatric clinic
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Trauma as Cultural Capital: A Critical Feminist Theory of Trauma Discourse
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“Exposure to traumatic adverse childhood experiences (ACEs) is linked to a variety of negative effects into adulthood (Felitti et al. 1998).”
Dharma, C., Keyes, K. M., Rudolph, K. E., Shrader, C., Chen, Y., Schneider, J. A., & Duncan, D. T. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02168-6 · Cited by 10
“As there are many large datasets with BRFFS ACE measures beyond Black SMM [6, 7, 9], IRT can be done with these items on larger sample sizes of BRFFS data.”
MethodYang, R., Gu, Y., Cui, L., Li, X., Way, N., Yoshikawa, H., Chen, X., Okazaki, S., Zhang, G., Liang, Z., et al. (2024) · Developmental Science · doi:10.1111/desc.13522 · Cited by 11
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“The founding ACEs study identi fi ed several risk factors including physical, emotional and sexual abuse, neglect, and speci fi c household dysfunction including adulthood mental illness, domestic violence, divorce, having an incarcerated relative and substance misuse (Felitti et al., 1998).”
Public Health and Children’s Subjective Well-Being
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“Research has uncovered an association between adverse childhood experiences (ACEs) and a range of emotional, behavioural, and biological difficulties (Felitti et al. 1998), such as increased risk-taking, aggression and difficulties with relationships (Nelson et al. 2020).”
Childhood adversity and time to pregnancy in a preconception cohort
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“…version of the Medical Outcomes Study Social Support Scale [ 42, 43] Adverse childhood experiences Score on Adverse Childhood Experiences Questionnaire [ 44], which assesses for 10 types of childhood maltreatment (e.g., physical abuse, emotional neglect), occurring between birth and age 18 years.”
Development and Validation of a Trauma-Informed Care Communication Skills Assessment Tool
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“They are also associated with increased physical health risks and risk behaviours, as well as premature mortality (D. W. Brown et al., 2009; Felitti et al., 1998), and an overall reduced life expectancy (Pingley, 2017).”
BackgroundA scientometric review of the association between childhood trauma and sleep
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“Regarding childhood stressful events, participants completed the Adverse Childhood Experiences Questionnaire (ACEs; summed items for number of experiences) [54].”
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“The ACEQ is a self-report questionnaire used widely to assess the impact of adverse childhood experiences on health and well-being in adulthood (Felitti et al., 1998).”
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“Research in living populations indicates that individuals who experienced adverse events during growth and development, such as war or famine, often exhibited diminished height in adulthood, which is in turn associated with increased risks of mortality ( 74 – 76 ).”
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“…range of health outcomes, including cancer, cardiovascular diseases, diabetes, obesity, anxiety, depression, sleep disorders, and mental disorders (Felitti et al., 1998; Norman et al., 2012; Huang et al., 2015; Holman et al., 2016; Hughes et al., 2017; Bellis et al., 2019; Schroeder et al., 2021;…”
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“The scale covers seven dimensions of psychological abuse, physical abuse, exposure to sexual assault, substance abuse, mental illness, violent treatment of mother or stepmother and criminal behaviour in the family, with a total of 17 entries (Felitti et al. , 1998).”
Chandrasekar, R., Karamanos, A., Learoyd, A., & Khanolkar, A. R. (2024) · PLoS ONE · doi:10.1371/journal.pone.0312161 · Cited by 11
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“Although the original ACEs questionnaire focused on ten items related to abuse, neglect and family dysfunction (Felitti et al., 1998), researchers have also begun considering how additional challenges such as economic hardship, discrimination, and neighborhood violence impact development (e.g., C.…”
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“Therefore, assessing adverse childhood experiences seems relevant and can be done with the Adverse Childhood Experiences Questionnaire (ACE) [146].”
Lynne‐Landsman, S. D., Fagan, A. A., Counts, T. M., Bryan, J. L., Kidd, J., & Fogarty, K. (2025) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2025.107325 · Cited by 15
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Understanding Trauma-Informed Care in Correctional Facilities: A Scoping Review
Gaber, J., Scallan, E., & Kouyoumdjian, F. G. (2025) · Journal of Correctional Health Care · doi:10.1089/jchc.24.07.0056 · Cited by 11
“Trauma can have adverse impacts throughout the life course, including wide-reaching impacts on mental and physical health (Felitti et al., 1998; Liu et al., 2017; SAMHSA ’ s Trauma and Justice Strategic Initiative Workgroup, 2014).”
Early Evidence on the Emotional Distress of Civilians, Including Evacuees, During a Recent Conflict
Peleg, O., & Gendelman, L. (2025) · International Journal of Psychology · doi:10.1002/ijop.70048 · Cited by 10
Transdiagnostic prevention in youth mental health, Part I: rationale, shared risk factors
Holt, D. J., Choi, K. W., DeTore, N. R., & Balogun‐Mwangi, O. (2025) · Neuropsychopharmacology · doi:10.1038/s41386-025-02233-w · Cited by 11
“For example, early epidemiological studies of childhood adversity, such as the well-known Adverse Childhood Experiences (ACE) study [62,] initially found graded relationships between ACEs and poor health outcomes, including ischemic heart disease.”
Posttraumatische Belastungsstörungen bei körperlichen Erkrankungen und medizinischen Eingriffen
Köllner, V. (2013) · Springer eBooks · doi:10.1007/978-3-642-35068-9_23 · Cited by 10
de Albuquerque, L. C., Santini, P. M., & D’Affonseca, S. M. (2014) · International journal of applied psychology · doi:10.5923/j.ijap.20140403.04 · Cited by 12
All they need is love? Helping children to recover from neglect and abuse
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Viewing psychopathology through a trauma lens
Bransford, C. L., & Blizard, R. A. (2016) · Social Work in Mental Health · doi:10.1080/15332985.2016.1173161 · Cited by 10
Depression and Pain in Heart Transplant Recipients
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Goodman, M. L., Raimer-Goodman, L. A., Chen, C. X., Grouls, A., Gitari, S., & Keiser, P. H. (2016) · Journal of Public Health · doi:10.1093/pubmed/fdw135 · Cited by 10
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The Role of Community Health Centers in Addressing Human Trafficking
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Mental health referrals and treatment in a sample of youth in foster care
Baker, A. J. L., Schneiderman, M., & Licandro, V. (2017) · Children and Youth Services Review · doi:10.1016/j.childyouth.2017.04.020 · Cited by 10
Watamura, S. E., & Roth, T. L. (2018) · Developmental Psychobiology · doi:10.1002/dev.21796 · Cited by 11
Logan‐Greene, P., Linn, B. K., Hartinger-Saunders, R. M., Nochajski, T. H., Wieczorek, W. F., & Rittner, B. A. (2019) · Journal of Community Psychology · doi:10.1002/jcop.22156 · Cited by 10
Pinto, R. J., Lamela, D. J. P. D. V., Simães, C., Levendosky, A. A., & Jongenelen, I. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01454-0 · Cited by 11
Kuper, J. L., & Turanovic, J. J. (2019) · Crime & Delinquency · doi:10.1177/0011128719850499 · Cited by 10
“Childhood physical abuse is therefore considered to be a trauma that can compromise one’s well-being over the life course (Felitti et al., 1998).”
BackgroundEvaluating the Cumulative Impact of Childhood Misfortune: A Structural Equation Modeling Approach
Mustillo, S., Li, M., & Ferraro, K. F. (2019) · Sociological Methods & Research · doi:10.1177/0049124119875957 · Cited by 11
“By contrast, some studies reveal that the sheer number of negative exposures, regardless of severity, harms adult health (Davis et al. 2014; Felitti et al. 1998; Finkelhor, Ormrod, and Turner 2007).”
BackgroundResultIntimate Partner Violence: Identification and Response in Pediatric Health Care Settings
Randell, K. A., & Ragavan, M. I. (2019) · Clinical Pediatrics · doi:10.1177/0009922819879464 · Cited by 11
What Do Adults Think About Their Adverse Childhood Experiences (ACEs), and Does It Matter?
LaNoue, M. D., Cunningham, A., Kenny, L. C., Abatemarco, D. J., & Helitzer, D. (2020) · Community Mental Health Journal · doi:10.1007/s10597-020-00580-0 · Cited by 12
Okamura, K. H., Skriner, L. C., Becker‐Haimes, E. M., Adams, D. R., Becker, S. J., Kratz, H. E., Jackson, K., Berkowitz, S., Zinny, A., Cliggitt, L. P., et al. (2020) · Journal of Child and Family Studies · doi:10.1007/s10826-020-01708-2 · Cited by 11
Intersectional Pathways: The Role Victimization Plays in Women’s Offending and in Prisons
Lorenz, K., & Hayes, R. M. (2020) · Springer eBooks · doi:10.1007/978-3-030-46172-0_8 · Cited by 12
Holter, J. C., Marchionni, C., & Bhatt, B. (2020) · IntechOpen eBooks · doi:10.5772/intechopen.93520 · Cited by 10
“Fifty six percent of individuals that lack exposure to ACE possessed none of the high-risk behaviors that are linked to chronic disease, meanwhile merely 14% of individuals that encountered 4 or more ACEs possessed none of the high-risk behaviors [5].”
BackgroundCole, K. M., Wei, S.-M., Martinez, P. E., Nguyen, T., Gregory, M. D., Kippenhan, J. S., Kohn, P. D., Soldin, S. J., Nieman, L. K., Yanovski, J. A., et al. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2021.117970 · Cited by 14
Hollifield, M. A., Hsiao, A., Carrick, K., Munoz, A., Calloway, T., Cocozza, K., Smith, B., Smith, T. C., Jovanović, T., Norrholm, S. D., et al. (2021) · Trials · doi:10.1186/s13063-021-05394-3 · Cited by 10
Filipe, Â. M., Lloyd, S., & Larivée, A. (2021) · Frontiers in Sociology · doi:10.3389/fsoc.2021.635986 · Cited by 11
“Studies of ACEs are a part of an increasingly substantial and influential body of research on the role of early adversity on health and behavior, which emerged in the 1990s (Felitti et al., 1998) and was further developed in following decades (for a critical review, see Edwards et al.”
BackgroundLiu, M., Mini, F. N., Torres, C. G., Kwete, G. M., Boudreau, A. A., Hunter, M. L., Parra, M. Y., Lopez, W. D., Izen, A., Price, S. N., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.633285 · Cited by 10
Adverse childhood experiences and adult self-harm in a female forensic population
Holden, R., Stables, I., Brown, P., & Fotiadou, M. (2021) · BJPsych Bulletin · doi:10.1192/bjb.2021.34 · Cited by 10
Understanding and Treating C-PTSD
Franco, F. (2021) · Journal of Health Service Psychology · doi:10.1007/s42843-021-00038-1 · Cited by 12
Rahapsari, S. (2021) · Gadjah Mada Journal of Psychology (GamaJoP) · doi:10.22146/gamajop.64996 · Cited by 10
“The results of the study were quite surprising, adverse childhood experiences turned out to have a large impact on mental condition, health risks, disease, sexual behavior, disabilities, and health cost for survivors in the next ten years (Dube et al., 2005; Felitti et al., 1998).”
BackgroundResultGilroy, H. (2021) · Journal for Nurses in Professional Development · doi:10.1097/nnd.0000000000000761 · Cited by 10
“Moreover, this study revealed that the effects of this type of trauma could have lasting effects on physical and mental health as well as general functioning throughout the person’s lifetime, even many decades after the traumatic experience had occurred (Felitti et al., 1998).”
BackgroundMuñoz, R. T., Pharris, A. B., & Hellman, C. M. (2021) · Journal of Family Violence · doi:10.1007/s10896-021-00282-5 · Cited by 15
Intergenerational Trauma: Assessment in Biological Mothers and Preschool Children
Walden, E. D., Hamilton, J. C., Harrington, E. M., Lopez, S., Magrassi, A. O., Mauricci, M., Trevino, S. D., Giuliani, N. R., & McIntyre, L. L. (2021) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-021-00397-3 · Cited by 13
Burke, J., Fitzhenry, M., Houghton, S., & Fortune, D. G. (2021) · Children and Youth Services Review · doi:10.1016/j.childyouth.2021.106223 · Cited by 11
Spinelli, T., Bruckner, E., & Kisiel, C. (2021) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2021.105367 · Cited by 10
“When considering rates of childhood trauma among adolescents not involved in child welfare, rates of trauma among this sample are much higher (Felitti et al., 1998).”
InfluentialEkbäck, E., Granåsen, G., Svärling, R., Blomqvist, I., & Henje, E. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.674583 · Cited by 11
Moreno, A. J., Byers, K. D., Monahan, E. K., Robinson, J. L., & McCrae, J. S. (2021) · Children and Youth Services Review · doi:10.1016/j.childyouth.2021.106280 · Cited by 10
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Evaluation of an ACE-informed whole-school project development
Sparling, E., Woods, K., & Ford, A. (2022) · Educational Psychology in Practice · doi:10.1080/02667363.2021.2016373 · Cited by 10
“…and five categories that affect children through exposure to environmental stressors such as living with household members who are substance abusers or have mental health problems, or witnessing domestic violence, or caregiver’s abandonment or divorce (Bellis et al., 2015; Felitti et al., 1998).”
BackgroundAdverse Childhood Experiences: Past, Present, and Future
Hamai, T. A., & Felitti, V. J. (2021) · Springer eBooks · doi:10.1007/978-3-319-89999-2_305 · Cited by 14
Self-citationWood, L., McGiffert, M., Fusco, R. A., & Kulkarni, S. J. (2022) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-021-00809-1 · Cited by 11
Psychological well-being in midlife following early childhood intervention
Mondi, C. F., & Reynolds, A. J. (2022) · Development and Psychopathology · doi:10.1017/s0954579421001528 · Cited by 10
“Participants completed a measure resembling the ACE checklist from the Kaiser Permanente ACE Study during the age 22–24 survey (Felitti et al., 1998).”
MethodRyding, R., Scales, M. J., Brittingham, R., & Holz, D. (2022) · Disability and health journal · doi:10.1016/j.dhjo.2022.101287 · Cited by 12
Polyvictimization and Psychiatric Sequelae Associated with Female Genital Mutilation/Cutting (FGM/C)
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Bunting, L., McCartan, C. J., Davidson, G., Grant, A., Mulholland, C. C., Schubotz, D., McBride, O., Murphy, J., Nolan, E., & Shevlin, M. E. (2022) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2022.105568 · Cited by 10
Stout, M. E., Tsotsoros, C. E., & Hawkins, M. A. W. (2022) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-022-00442-9 · Cited by 11
“ACEs, by definition, represent a history of unmet physical, emotional, and safety needs, and loneliness, by definition, is unmet social needs (Felitti et al., 1998; Peplau & Perlman, 1979).”
BackgroundMethodARCCH Model of Resilience: A Flexible Multisystemic Resilience Framework
Wojciak, A. S., Powers, J., Chan, A. C. Y., Pleggenkuhle, A. L., & Hooper, L. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19073920 · Cited by 11
The Legacy of Troubled Childhoods: Adverse Childhood Experiences, Sleep, and Delinquency
Tomlinson, T. A., Mears, D., Stults, B. J., Meldrum, R. C., Turanovic, J., & Young, J. T. N. (2022) · Crime & Delinquency · doi:10.1177/00111287221083961 · Cited by 9
“Thus, a seven-item variety measure (α = .76) is employed in the primary analysis.3 This index is similar to one used by Felitti et al. (1998).”
BackgroundMethodInfluentialValidation of the Assessment of Parent and Child Adversity (APCA) in Mothers and Young Children
King, L. S., Humphreys, K. L., Shaw, G. M., Stevenson, D. K., & Gotlib, I. H. (2022) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2022.2042696 · Cited by 12
“There is extensive evidence that exposure to adversity during early life contributes to health difficulties across the lifespan and fosters social inequality in health outcomes (Felitti et al., 1998; Green et al., 2010; Umberson et al., 2014).”
BackgroundAndrews, T. (2022) · The Police Journal Theory Practice and Principles · doi:10.1177/0032258x221094494 · Cited by 10
Timing and Persistence of Material Hardship Among Children in the United States
Campbell, C., O’Brien, G., & Tumin, D. (2022) · Maternal and Child Health Journal · doi:10.1007/s10995-022-03448-9 · Cited by 17
Renkiewicz, G. K., & Hubble, M. W. (2022) · Air Medical Journal · doi:10.1016/j.amj.2022.04.002 · Cited by 10
Childhood embedded: childhood abuse and chronic physical health conditions over a 10-year period
Fitzgerald, M., & Notice, M. R. (2022) · Journal of Public Health · doi:10.1093/pubmed/fdac063 · Cited by 10
Stressful life events and trajectories of depression symptoms in a U.S. military cohort
Sampson, L., Cabral, H., Rosellini, A. J., Gradus, J. L., Cohen, G. H., Fink, D. S., King, A. P. J., Liberzon, I., & Galea, S. (2022) · Scientific Reports · doi:10.1038/s41598-022-14496-0 · Cited by 10
Chronic vulvar pain in gynecological outpatients
Teigen, P. K., Hagemann, C. T., Fors, E. A., Stauri, E., Hoffmann, R., & Schei, B. (2022) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2021-0223 · Cited by 10
Adverse Childhood Experiences and Patient-Reported Outcome Measures in Critically Ill Children
Rodenbough, A., Opolka, C., Wang, T., Gillespie, S. E., Ververis, M., Fitzpatrick, A. M., & Grunwell, J. R. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.923118 · Cited by 10
“REDCap is a secure, web-based software platform designed to support data capture for research studies, providing (1) an intuitive interface for validated data capture; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistica…”
BackgroundMethodResultInfluentialProblematic substance use and its associated factors among street youth in Bahir Dar city, Ethiopia
Shegaw, M., Fekadu, W., Beka, M., Menberu, M., Yohannes, K., Yimer, S., Seid, M., Necho, M., Demeke, S. M., & Anbesaw, T. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.930059 · Cited by 10
Toombs, E., Lund, J. I., Radford, A., Drebit, M., Bobinski, T., & Mushquash, C. J. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00883-1 · Cited by 13
“Roberta Anda, a co-principal investigator of the original ACE study (Felitti et al., 1998) and colleagues in 2020, emphasized that no arbitrary score should be used as a cut-point for clinical decision-making.”
InfluentialPresnell, J., Keesler, J. M., & Thomas‐Giyer, J. (2022) · Intellectual and developmental disabilities · doi:10.1352/1934-9556-60.5.351 · Cited by 12
Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children
Fyfe‐Johnson, A. L., Reid, M. M., Jiang, L., Chang, J. J., Huyser, K. R., Hiratsuka, V. Y., Johnson-Jennings, M., Conway, C., Goins, R. T., Sinclair, K., et al. (2022) · Childhood Obesity · doi:10.1089/chi.2022.0012 · Cited by 12
“27 Trauma and stress in childhood are known risk factors for overweight and obesity status, 28,29 particularly given the historical context of cultural op-pression, discrimination, and colonial displacement that AI/AN peoples have faced for generations.”
Volk, K. T., DeCandia, C. J., & Unick, G. J. (2022) · Child Indicators Research · doi:10.1007/s12187-022-09978-6 · Cited by 10
Widyorini, E., Roswita, M. Y., Primastuti, E., & Wijaya, D. A. (2022) · The Open Psychology Journal · doi:10.2174/18743501-v15-e2203280 · Cited by 15
McGowan, E. C., Oyeku, S. O., & Lim, S. W. (2022) · Academic Pediatrics · doi:10.1016/j.acap.2022.10.009 · Cited by 10
Moreland-Capuia, A. R., Dumornay, N. M., Mangus, A. R., Ravichandran, C. T., Greenfield, S. F., & Ressler, K. J. (2022) · Journal of Public Health · doi:10.1007/s10389-022-01765-5 · Cited by 10
“Exposure to traumatic events can have long-lasting consequences, both physical and mental (Drury et al. 2012; Copeland et al. 2007; Felitti et al. 1998).”
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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