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A Critique of the Adverse Childhood Experiences Framework in Epidemiology and Public Health: Uses and Misuses

Published online by Cambridge University Press:  03 April 2019

Michelle Kelly-Irving  and
Cyrille Delpierre
Michelle Kelly-Irving*
Affiliation:
Equity research team, LEASP, Inserm, Iferiss, Université Toulouse III Paul Sabatier, France E-mail: [email protected]
Cyrille Delpierre
Affiliation:
Equity research team, LEASP, Inserm, Iferiss, Université Toulouse III Paul Sabatier, France E-mail: [email protected]
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Abstract

Adverse childhood experiences (ACEs) have emerged as a major research theme. They make reference to an array of potentially harmful exposures occurring from birth to eighteen years of age and may be involved in the construction of health inequalities over the lifecourse. As with many simplified concepts, ACEs present limitations. They include diverse types of exposures, are often considered cumulatively, can be identified using prospective and retrospective approaches, and their multidimensional nature may lead to greater measurement error. From a public health perspective, ACEs are useful for describing the need to act upon complex social environments to prevent health inequalities at a population level. As the ACEs concept becomes popular in the context of policy interventions, concerns have emerged. As a probabilistic and population-level tool, it is not adapted to diagnose individual-level vulnerabilities, an approach which could ultimately exacerbate inequalities. Here, we present a critique of the ACEs framework, discussing its strengths and limits.

Keywords

Adverse childhood experienceshealth inequalitiesepidemiologypublic healthpolicy
Type
Themed Section: Adverse Childhood Experiences (ACES) – Implications and Challenges
Information
Social Policy and Society , Volume 18 , Issue 3 , July 2019 , pp. 445 - 456
Copyright
© Cambridge University Press 2019 

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References

Appleton, A. A., Holdsworth, E., Ryan, M. and Tracy, M. (2017) ‘Measuring childhood adversity in life course cardiovascular research: a systematic review’, Psychosomatic Medicine, 79, 4, 434–40.CrossRefGoogle ScholarPubMed
Barker, D. J. P. and Osmond, C. (1986) ‘Infant mortality, chidhood nutrition, and ischaemic heart disease in England and Wales’, The Lancet, 1, 1077–81.CrossRefGoogle Scholar
Brown, D. W., Anda, R. F., Felitti, V. J., Edwards, V. J., Malarcher, A. M., Croft, J. B. and Giles, W. H. (2010) ‘Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study’, BMC Public Health, 10, 20.CrossRefGoogle ScholarPubMed
Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J. and Anda, R. F. (2004) ‘Adverse childhood experiences and the risk of depressive disorders in adulthood’, Journal of Affective Disorders, 82, 2, 217–25.CrossRefGoogle ScholarPubMed
Clark, C., Caldwell, T., Power, C. and Stansfeld, S. A. (2010) ‘Does the influence of childhood adversity on psychopathology persist across the lifecourse? A 45-year prospective epidemiologic study’, Annals of Epidemiology, 20, 5, 385–94.CrossRefGoogle ScholarPubMed
Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., Poulton, R. and Caspi, A. (2009) ‘Adverse childhood experiences and adult risk factors for age-related disease depression, inflammation, and clustering of metabolic risk markers’, Archives of Pediatrics and Adolescent Medicine, 163, 12, 1135–43.CrossRefGoogle ScholarPubMed
Dong, M., Giles, W. H., Felitti, V. J., Dube, S. R., Williams, J. E., Chapman, D. P. and Anda, R. F. (2004) ‘Insights into causal pathways for ischemic heart disease: adverse childhood experiences study’, Circulation, 110, 13, 1761–6.CrossRefGoogle ScholarPubMed
Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F. and Giles, W. H. (2001) ‘Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study’, JAMA, 286, 24, 3089–96.CrossRefGoogle ScholarPubMed
Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H. and Anda, R. F. (2003) ‘The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900’, Preventive Medicine, 37, 3, 268–77.CrossRefGoogle ScholarPubMed
Engels, F. (1987) ‘The condition of the working class in England’, American Journal of Public Health, 93, 8, 171–84.Google Scholar
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P. and Marks, J. S. (1998) ‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study’, American Journal of Preventive Medicine, 14, 4, 245–58.CrossRefGoogle ScholarPubMed
Finkelhor, D. (2018) ‘Screening for adverse childhood experiences (ACEs): cautions and suggestions’, Child Abuse and Neglect, 85, 174–9.CrossRefGoogle ScholarPubMed
Francis, D., Diorio, J., Liu, D. and Meaney, M. J. (1999) ‘Nongenomic transmission across generations of maternal behavior and stress responses in the rat’, Science, 286, 5442, 1155–8.CrossRefGoogle ScholarPubMed
Hardt, J. and Rutter, M. (2004) ‘Validity of adult retrospective reports of adverse childhood experiences: review of the evidence’, Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 2, 260–73.CrossRefGoogle Scholar
Hartas, D. (2019) ‘Assessing the foundational studies on adverse childhood experiences’, Social Policy and Society, doi: 10.1017/S1474746419000034.CrossRefGoogle Scholar
Hill, A. B. (1965) ‘The environment and disease: association or causation?’, Proceedings of the Royal Society of Medicine, 58, 5, 295–300.Google ScholarPubMed
Holman, D. M., Ports, K. A., Buchanan, N. D., Hawkins, N. A., Merrick, M. T., Metzler, M. and Trivers, K. F. (2016) ‘The association between adverse childhood experiences and risk of cancer in adulthood: a systematic review of the literature’, Pediatrics, 138, Supplement 1, S81–91.CrossRefGoogle ScholarPubMed
Houtepen, L., Heron, J., Suderman, M., Tilling, K. and Howe, L. (2018) ‘Adverse childhood experiences in the children of the Avon Longitudinal Study of Parents and Children (ALSPAC) [version 1; referees: 1 approved]’, Wellcome Open Research, 3, 106.CrossRefGoogle Scholar
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L. and Dunne, M. P. (2017) ‘The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis’, The Lancet Public Health, 2, 8, e356–66.CrossRefGoogle ScholarPubMed
Kelly-Irving, M., Lepage, B., Dedieu, D., Bartley, M., Blane, D., Grosclaude, P., Lang, T. and Delpierre, C. (2013a) ‘Adverse childhood experiences and premature all-cause mortality’, European Journal of Epidemiology, 28, 9, 721–734.CrossRefGoogle ScholarPubMed
Kelly-Irving, M., Lepage, B., Dedieu, D., Lacey, R., Cable, N., Bartley, M., Blane, D., Grosclaude, P., Lang, T. and Delpierre, C. (2013b) ‘Childhood adversity as a risk for cancer: findings from the 1958 British birth cohort study’, BMC Public Health, 13, 1, 767.CrossRefGoogle ScholarPubMed
Krieger, N. (1994) ‘Epidemiology and the web of causation: has anyone seen the spider?’, Social Science and Medicine, 39, 7, 887–903.CrossRefGoogle ScholarPubMed
Kuh, D., Power, C., Blane, D. and Bartley, M. (1997) Social pathways between childhood and adult health, in Kuh, D. and Ben-Shlomo, Y. (eds.), A Life Course Approach to Chronic Disease Epidemiology, Oxford: Oxford University Press.Google Scholar
Liu, D., Diorio, J., Tannenbaum, B., Caldji, C., Francis, D., Freedman, A., Sharma, S., Pearson, D., Plotsky, P. M. and Meaney, M. J. (1997) ‘Maternal care, hippocampal glucocorticoid receptors, and hypothalamic-pituitary-adrenal responses to stress’, Science, 277, 5332, 1659–62.CrossRefGoogle ScholarPubMed
Lupien, S. J., McEwen, B. S., Gunnar, M. R. and Heim, C. (2009) ‘Effects of stress throughout the lifespan on the brain, behaviour and cognition’, Nature Reviews Neuroscience, 10, 6, 434–45.CrossRefGoogle ScholarPubMed
Lynch, J. W., Davey Smith, G., Kaplan, G. A. and House, J. S. (2000) ‘Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions’, British Medical Journal, 320, 1200–04.CrossRefGoogle ScholarPubMed
Marmot, M. and Wilkinson, R. G. (2001) ‘Psychosocial and material pathways in the relation between income and health: a response to Lynch et al.’, British Medical Journal, 322, 1233–36.CrossRefGoogle ScholarPubMed
Metzler, M., Merrick, M. T., Klevens, J., Ports, K. A. and Ford, D. C. (2017) ‘Adverse childhood experiences and life opportunities: shifting the narrative’, Children and Youth Services Review, 72, 141–9.CrossRefGoogle Scholar
Poulter, M. O., Du, L., Weaver, I. C. G., Palkovits, M., Faludi, G., Merali, Z., Szyf, M. and Anisman, H. (2008) ‘GABAA receptor promoter hypermethylation in suicide brain: implications for the involvement of epigenetic processes’, Biological Psychiatry, 64, 8, 645–52.CrossRefGoogle ScholarPubMed
Public Health Wales (2015) Welsh Adverse Childhood Experiences Study, Wales: Public Health Wales NHS Trust.Google Scholar
Ridout, K. K., Khan, M. and Ridout, S. J. (2018) ‘Adverse childhood experiences run deep: toxic early life stress, telomeres, and mitochondrial dna copy number, the biological markers of cumulative stress’, Bioessays, 40, 9, e1800077.CrossRefGoogle ScholarPubMed
Rutter, M. (1980) ‘The long-term effects of early experience’, Developmental Medicine and Child Neurology, 22, 6, 800–15.CrossRefGoogle ScholarPubMed
Shonkoff, J. P. and Philips, D. A. (2000) From Neurons to Neighborhoods: The Science of Early Childhood Development, Washington: National Academy Press.Google Scholar
Solis, C. B., Kelly-Irving, M., Fantin, R., Darnaudery, M., Torrisani, J., Lang, T. and Delpierre, C. (2015) ‘Adverse childhood experiences and physiological wear- and-tear in midlife: findings from the 1958 British birth cohort’, Proceedings of the National Academy of Sciences of the United States of America, 112, 7, E738–46.CrossRefGoogle Scholar
Susser, M. and Susser, E. (1996) ‘Choosing a future for epidemiology: I. Eras and paradigms’, American Journal of Public Health, 86, 5, 668–73.CrossRefGoogle ScholarPubMed
Townsend, P. and Davidson, N. (1982) Inequalities in Health: the Black Report, Middlesex: Penguin.Google Scholar