Background: Adverse childhood experience (ACE) scores have become a common approach for considering childhood adversities and are highly influential in public policy and clinical practice. Their use is also controversial. Other ways of measuring adversity -examining single adversities, or using theoretically or empirically driven methods -might have advantages over ACE scores. Methods: In this narrative review we critique the conceptualisation and measurement of ACEs in research, clinical practice, public health and public discourse. Results: The ACE score approach has the advantagesand limitationsof simplicity: its simplicity facilitates wide-ranging applications in public policy, public health and clinical settings but risks over-simplistic communication of risk/causality, determinism and stigma. The other common approachfocussing on single adversities -is also limited because adversities tend to co-occur. Researchers are using rapidly accruing datasets on ACEs to facilitate new theoretical and empirical approaches but this work is at an early stage, e.g. weighting ACEs and including severity, frequency, duration and timing. More research is needed to establish what should be included as an ACE, how individual ACEs should be weighted, how ACEs cluster, and the implications of these findings for clinical work and policy. New ways of conceptualising and measuring ACEs that incorporate this new knowledge, while maintaining some of the simplicity of the current ACE questionnaire, could be helpful for clinicians, practitioners, patients and the public. Conclusions: Although we welcome the current focus on ACEs, a more critical view of their conceptualisation, measurement, and application to practice settings is urgently needed. Researchers need to be clearer about their definitions of adversitywhat constitutes an adversity and what does not?Researchers should consider including additional ACEs other than the 10 frequently investigated ACEs from the Kaiser Permanente Study and justify these clearly.Researchers should explore the different ways in which ACEs tend to cluster cluster and, individually and together, predict outcomes Longitudinal studies are required, particularly those which are able to consider the co-occurrence, timing, frequency, duration and severity of ACEs, and which have high quality prospective ACEs data. Key practitioner messagesTwenty years of adverse childhood experiences (ACEs) research has shown a graded relationship between the number of adversities (ACE score) and health and other outcomes in many different populations, with important implications about the potential impact of ACEs in clinical practice, public policy and public health initiatives.
BackgroundTo analyse whether Adverse Childhood Experiences (ACE) are associated with an increased risk of cancer.MethodsThe National child development study (NCDS) is a prospective birth cohort study with data collected over 50 years. The NCDS included all live births during one week in 1958 (n = 18558) in Great Britain. Self-reported cancer incidence was based on 444 participants reporting having had cancer at some point and 5694 reporting never having cancer. ACE was measured using reports of: 1) child in care, 2) physical neglect, 3) child’s or family’s contact with the prison service, 4) parental separation due to divorce, death or other, 5) family experience of mental illness & 6) family experience of substance abuse. The resulting variable had three categories, no ACEs/ one ACE/ 2 + ACEs and was used to test for a relationship with cancer. Information on socioeconomic characteristics, pregnancy and birth were extracted as potential confounders. Information on adult health behaviours, socioeconomic environment, psychological state and age at first pregnancy were added to the models. Multivariate models were run using multiply-imputed data to account for missing data in the cohort.ResultsThe odds of having a cancer before 50 y among women increased twofold for those who had 2+ ACEs versus those with no ACEs, after adjusting for adult factors and early life confounders (OR: 2.1, 95% CI: 1.42-3.21, p < 0.001).ConclusionThese findings suggest that cancer risk may be influenced by exposure to stressful conditions and events early on in life. This is potentially important in furthering our understanding of cancer aetiology, and consequently in redirecting scientific research and developing appropriate prevention policies.
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