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Health Aff (Millwood). 2014 Dec;33(12):2106-15. doi: 10.1377/hlthaff.2014.0914.

Adverse childhood experiences: assessing the impact on health and school engagement and the mitigating role of resilience.

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Christina D. Bethell ( is director of the Child and Adolescent Health Measurement Initiative (CAHMI) and a professor of population, family, and reproductive health at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
Paul Newacheck is a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.
Eva Hawes is a research associate at CAHMI.
Neal Halfon is a professor of pediatrics at the Geffen School of Medicine; a professor of health policy and management at the Fielding School of Public Health; and a professor of public policy at the Luskin School of Public Affairs, all at the University of California, Los Angeles (UCLA), and is director of the UCLA Center for Healthier Children, Families, and Communities.


The ongoing longitudinal Adverse Childhood Experiences Study of adults has found significant associations between chronic conditions; quality of life and life expectancy in adulthood; and the trauma and stress associated with adverse childhood experiences, including physical or emotional abuse or neglect, deprivation, or exposure to violence. Less is known about the population-based epidemiology of adverse childhood experiences among US children. Using the 2011-12 National Survey of Children's Health, we assessed the prevalence of adverse childhood experiences and associations between them and factors affecting children's development and lifelong health. After we adjusted for confounding factors, we found lower rates of school engagement and higher rates of chronic disease among children with adverse childhood experiences. Our findings suggest that building resilience-defined in the survey as "staying calm and in control when faced with a challenge," for children ages 6-17-can ameliorate the negative impact of adverse childhood experiences. We found higher rates of school engagement among children with adverse childhood experiences who demonstrated resilience, as well as higher rates of resilience among children with such experiences who received care in a family-centered medical home. We recommend a coordinated effort to fill knowledge gaps and translate existing knowledge about adverse childhood experiences and resilience into national, state, and local policies, with a focus on addressing childhood trauma in health systems as they evolve during ongoing reform.


Children’s Health; Determinants Of Health; Epidemiology; Health Promotion/Disease Prevention; Health Reform

[Indexed for MEDLINE]

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