Associated with range of negative outcomes.

Later lifestyle

Adverse childhood experiences increase probability of smoking in adulthood. Physical harm in Eastern European countries increases the probability of heavy drinking by about 3.4%, but not in other regions. Exposure to child neglect (little understanding) increases the probability of alcohol abuse by 2.7% in Nordic Countries but not other macro-regions. The experience of a poor relationship with parents is a strong predictor of alcohol abuse for the female subsample in Latin countries (2% higher).

While ACE does not appear to have a substantial effect on excess weight in any macro-region, childhood trauma (physical harm) appears to have a major impact on the likelihood of being obese later in life. Obesity has a more obvious impact on chronic illness than poverty, smoking or alcohol.

Trauma informed care

Recognising the impact of adverse experiences (“trauma”) on providing effective care.

Northwestern INFORMED toolkit suggests:

Work to establish trust and safety: Sit down. Demonstrate active listening. Use non-
threatening body language. Make sure the physical space feels safe and comfortable.

• Recognize the signs of re-traumatization (sudden anxiousness, restlessness, social isolation, physical expressions of such including fatigue, inability to control emotions) or emotional distress related to medical care.
• Acknowledge that trauma or difficult experiences impacts health care eg “Hospital can be hard for many people, especially if they have had difficult experiences in the past.”
• Ask open-ended questions, such as:
  o “Is there anything we should know to help make your time here more comfortable
  and make you feel safe?”
• If a patient discloses a trauma or difficult experiences, respond empathetically, for
  instance:
  o “Thank you for trusting me with this.”
  o “I can see how hurtful that must have been for you.”
• Navigate the emotions – normalize (“We would expect anyone in your shoes to respond this way after what you have been through”). Be present. “I would really like to understand more.” Respect – “you’ve really made the most of what you’ve been given”.
• Ask what could be done to support, while not being unrealistic. Check information can be shared and reassure around privacy. Get a team together!
• Empower – “what has helped you move forward in the past?” “Who has been there for you?”
• Monitor and feedback to team