Robert F. Anda

Susan D Hillis, PhD, MS; Robert F Anda, MD, MS; Shanta R Dube, PhD, MPH; Vincent J Felitti, MD, FACP; Polly A Marchbanks, PhD; Maurizio Macaluso, MD, DrPH; James S Marks, MD, MPH Fall 2010 - Volume 14 Number 3 Abstract Background: Few reports ha

Strong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood.

To assess the association between adverse childhood experiences (ACEs), including childhood abuse and neglect, and serious household dysfunction, and premature death of a family member. Because ACEs increase the risk for many of the leading causes of death in adults and tend to be familial and intergenerational, we hypothesized that persons who report having more ACEs would be more likely to have family members at risk of premature death.

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.

Background. The relationship between boyhood exposure to physical abuse, sexual abuse, or to a battered mother and subsequent risk of impregnating a teenage girl has not previously been examined. Methods. In a retrospective cohort study set in a primary care clinic for adult members of a large health maintenance organization, questionnaire responses from 4127 men were analyzed. Respondents provided the age of the youngest female whom they had impregnated, their own ages at the time, and information regarding childhood exposure to physical or sexual abuse and battered mothers. We calculated the prevalence and adjusted odds ratio (OR) for having impregnated a teenage girl according to these 3 adverse childhood experiences, regardless of the male9s age at the time of impregnation. Using logistic regression, ORs were adjusted for the male9s age at time of survey, race, and education. Results. Nineteen percent of the men reported that they had ever impregnated a teenage girl. During childhood, 32% of respondents had been physically abused, 15% sexually abused, and 11% had battered mothers. Compared with respondents reporting no abuse, frequent physical abuse or battering of mothers increased the risk of involvement in teen pregnancy by 70% (OR: 1.7; 95% confidence interval [CI]: 1.2–2.5) and 140% (OR: 2.4; 95% CI: 1.1–5.0), respectively. Sexual abuse as a boy at age 10 years or younger increased the risk of impregnating a teenage girl by 80% (OR: 1.8; 95% CI: 1.3–2.4); sexual abuse with violence increased the risk by 110% (OR: 2.1; 95% CI: 1.2–3.4). We found a dose–response relationship between the number of types of exposures and the risk of impregnating a teenage girl; men who reported all 3 types of exposures were more than twice as likely to have been involved than those with no exposures (OR: 2.2; 95% CI: 1.4–3.5). Conclusions. Boyhood exposure to physical or sexual abuse or to a battered mother is associated with an increased risk of involvement in a teen pregnancy—during both adolescence and adulthood. Because these exposures are common and interrelated, boys and adult men who have had these experiences should be identified via routine screening by pediatricians and other health care providers and counseled about sexual practices and contraception. Such efforts may prevent teen pregnancy and the intergenerational transmission of child abuse and domestic violence.

Despite the recent availability of new classes of heart failure medications, little is known about national patterns in the actual physician utilization of these drugs. In the National Ambulatory Medical Care Survey, 2912 US physicians reported on 16,968 office visits in 1991-1992 with patients aged > or = 65 years. National estimates were obtained from weighted results that accounted for the complex sampling design. An estimated 8.3 million (2.6%) office visits with older adults involved heart failure. This included 9.3% of visits to cardiologists, 4.3% to internists, 3.5% to general and family physicians, and 0.6% to other physicians. The most frequently prescribed medications during visits with these patients were diuretics (69%), digitalis compounds (46%), angiotensin-converting enzyme inhibitors (30%), and nitrates (19%). Internists and general and family physicians prescribed angiotensin-converting enzyme inhibitors, digitalis compounds, and loop diuretics for patients with heart failure less often than did cardiologists. These are the first national surveillance estimates of physician practices in the management of heart failure. These data were collected during the same period in which heart failure clinical trial results were initially published, and they provide a baseline for monitoring the influence of recent clinical practice guidelines and professional education on changes in the management of heart failure by primary care physicians.