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EDITORIAL N MORE THAN 60 ARTICLES SINCE 1998, INTER- illness and is a likely predictor of long-term negative life nist Vincent Felitti, MD, pediatrician Robert events. Anda, MD, MS, and others have studied the re- The authors then posit that there are problems meth- lationship of childhood adversity and a variety odologically with the retrospective nature of the cur- 1,2 I of lifelong physical and emotional outcomes. rent ACEs, which also miss things we know are prob- Using a retrospective study design, they surveyed 17 337 lems associated with adult adversity, such as poor peer adult health maintenance organization members (aver- relationships, poor school performance, poverty, and un- age age, 57 years) about crucial events during child- employment. They then add additional variables to the hood and linked those events in a dose-response man- original ACEs to see what contributes more to psycho- ner with cardiovascular disease; cancer; AIDS, and other logical distress, choosing new items that have been sug- sexually transmitted diseases; unwanted, often-high- gested by relationships of child maltreatment with child- risk pregnancies; chronic obstructive pulmonary dis- hood stress in current research. These additional adverse ease; and a legacy of self-perpetuating child abuse. While experiences include having
JAMA Pediatrics – American Medical Association
Published: Jan 1, 2013
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