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Cited by 160Child Abuse and TraumaChild Welfare and AdoptionSubstance Abuse Treatment and Outcomes

Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients

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Anda, Robert F, Brown, David W, Felitti, Vincent J, Dube, Shanta R, Giles, Wayne H·2008·BMC Public Health
DOI 10.1186/1471-2458-8-198PMC PMC2440750
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Abstract

BACKGROUND: Prescription drugs account for approximately 11% of national health expenditures. Prior research on adverse childhood experiences (ACEs), which include common forms of child maltreatment and related traumatic stressors, has linked them to numerous health problems. However, data about the relationship of these experiences to prescription drug use are scarce. METHOD: We used the ACE Score (an integer count of 8 different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. We prospectively assessed the relationship of the Score to prescription drug use in a cohort of 15,033 adult HMO patients (mean follow-up: 6.1 years) and assessed mediation of this relationship by documented ACE-related health and social problems. RESULTS: Nearly 1.2 million prescriptions were recorded; prescriptions rates increased in a graded fashion as the ACE Score increased (p for trend < 0.0001). Compared to persons with an ACE Score of 0, persons with a Score > or = 5 had rates increased by 40%; graded relationships were seen for all age groups (18-44, 45-64, and 65-89 years) (p for trend < 0.01). Graded relationships were observed for the risk of being in the upper decile of number of classes of drugs used; persons with scores of > or = 5 had this risk increased 2-fold. Adjustment for ACE-related health problems reduced the strength of the associations by more than 60%. CONCLUSION: ACEs substantially increase the number of prescriptions and classes of drugs used for as long as 7 or 8 decades after their occurrence. The increases in prescription drug use were largely mediated by documented ACE-related health and social problems.

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  • Extreme child abuse is the tip of an iceberg of parenting practices that harm children's short- and long-term welfare and lead to depression, academic failure, teenage pregnancy, obesity, substance abuse, and crime.

    “Extreme child abuse is the tip of an iceberg of parenting practices that harm not just the short-term but the long-term welfare of children, resulting in depression, academic failure, teenage pregnancy, obesity, substance abuse, and crime—generically called Adverse Childhood Experiences, made famous by the studies of middle-class persons enrolled in Kaiser Permanente (Anda, Brown, Felitti, Dube, &”

    From Evolving the future: Toward a science of intentional change (2014) · cites this paper as Anda, Brown, Felitti, Dube, & Giles, 2008

    The Background (Table 1; page not available) reports associations between adverse childhood experiences and depression, teen pregnancy, obesity, and alcohol or illicit drug use. The Methods define ACEs to include abuse and household dysfunction, and identify the participants as Kaiser Permanente members. The paper does not report academic failure or crime as outcomes, establish short-term harms, or show that the listed outcomes were caused by parenting practices. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Anda, R. F., Brown, D. W., Felitti, V. J., Dube, S. R., & Giles, W. H.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Kaiser Permanente (US)
Corresponding author
Anda, Robert F
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2008-06-04
Volume
8
Issue
1
Pages
198-198
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-8-198
PMC
PMC2440750
OpenAlex
W2057578301
Cited by
160
References
10
Citations by year
2026: 3 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 14 · 2021: 31 · 2020: 17 · 2019: 12 · 2018: 3 · 2017: 9 · 2016: 10 · 2015: 13 · 2014: 8 · 2013: 9 · 2012: 4
FWCI
5.21
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Centers for Disease Control and Prevention (TS-44-10/11)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
adverse childhood experiences, prescription drug use, ACE score, child abuse, traumatic stress, health care utilization, health disparities, health insurance beneficiaries
MeSH terms
Adult, Child, Drug Therapy, Drug Utilization, Follow-Up Studies, Health Maintenance Organizations, Humans, Drug Prescriptions, Cohort Studies, Adult Survivors of Child Abuse

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