Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study
Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: The adverse childhood experiences study
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DOI：
10.1542/peds.111.3.564
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发表时间：
2003-03-01
期刊：
影响因子：
8
通讯作者：
Anda, RF
中科院分区：
文献类型：
--
作者：
Dube, SR;Felitti, VJ;Anda, RF
Objective.《2010年健康人》将非法药物使用确定为一项主要健康指标，因为它与多种有害健康后果有关，如性传播疾病、人体免疫缺陷病毒、病毒性肝炎以及青少年和成人中的许多社会问题。需要进一步了解童年时期的压力或创伤经历对药物滥用的开始和发展的影响。我们研究了非法药物使用和10类不良童年经历（ACE）和ACE总数（ACE评分）之间的关系。一项对8613名在加州初级保健诊所就诊的成年人进行的回顾性队列研究完成了一项关于儿童虐待、忽视和家庭功能障碍、非法药物使用和其他健康相关问题的调查。衡量的主要结果是自我报告的非法药物使用情况，包括在3个年龄段开始使用非法药物：小于或等于14岁、15至18岁或成年（大于或等于19岁）; 4个出生队列中每个队列的终生使用情况可追溯到1900年;药物使用问题;药物成瘾;和胃肠外药物使用。结果。每个ACE增加早期启动的可能性2- 4倍。ACE评分与所有3个年龄组的药物使用开始以及药物使用问题、药物成瘾和胃肠外药物使用有很强的分级关系。与ACE为0的人相比，ACE大于或等于5的人报告非法药物使用问题、非法药物成瘾和胃肠外药物使用的可能性高7- 10倍。这些非法药物使用问题中的每一个的归因于ACE的风险分数分别为56%，64%和67%。对于4个出生队列中的每一个，ACE评分与终生药物使用也有很强的分级关系。ACE评分与从青春期早期到成年的药物开始风险以及药物使用、药物成瘾和胃肠外使用问题有很强的分级关系。追溯到1900年，4个连续出生队列的ACE评分和开始使用药物之间的持续分级关系表明，不良童年经历的影响超越了世俗的变化，如药物的可获得性增加，对药物的社会态度，以及最近的大规模支出和公共宣传活动，以防止药物使用。由于ACE似乎占一半到三分之二的严重问题与药物使用，在实现国家目标的进展，减少药物使用将需要认真关注这些类型的共同的，紧张的，令人不安的童年经历的儿科实践。
Objective. Illicit drug use is identified in Healthy People 2010 as a leading health indicator because it is associated with multiple deleterious health outcomes, such as sexually transmitted diseases, human immunodeficiency virus, viral hepatitis, and numerous social problems among adolescents and adults. Improved understanding of the influence of stressful or traumatic childhood experiences on initiation and development of drug abuse is needed.Methods. We examined the relationship between illicit drug use and 10 categories of adverse childhood experiences (ACEs) and total number of ACEs (ACE score). A retrospective cohort study of 8613 adults who attended a primary care clinic in California completed a survey about childhood abuse, neglect, and household dysfunction; illicit drug use; and other health-related issues. The main outcomes measured were self-reported use of illicit drugs, including initiation during 3 age categories: less than or equal to14 years, 15 to 18 years, or as an adult (greater than or equal to19 years); lifetime use for each of 4 birth cohorts dating back to 1900; drug use problems; drug addiction; and parenteral drug use.Results. Each ACE increased the likelihood for early initiation 2- to 4-fold. The ACE score had a strong graded relationship to initiation of drug use in all 3 age categories as well as to drug use problems, drug addiction, and parenteral drug use. Compared with people with 0 ACEs, people with greater than or equal to5 ACEs were 7- to 10-fold more likely to report illicit drug use problems, addiction to illicit drugs, and parenteral drug use. The attributable risk fractions as a result of ACEs for each of these illicit drug use problems were 56%, 64%, and 67%, respectively. For each of the 4 birth cohorts examined, the ACE score also had a strong graded relationship to lifetime drug use.Conclusions. The ACE score had a strong graded relationship to the risk of drug initiation from early adolescence into adulthood and to problems with drug use, drug addiction, and parenteral use. The persistent graded relationship between the ACE score and initiation of drug use for 4 successive birth cohorts dating back to 1900 suggests that the effects of adverse childhood experiences transcend secular changes such as increased availability of drugs, social attitudes toward drugs, and recent massive expenditures and public information campaigns to prevent drug use. Because ACEs seem to account for one half to two third of serious problems with drug use, progress in meeting the national goals for reducing drug use will necessitate serious attention to these types of common, stressful, and disturbing childhood experiences by pediatric practice.