Adverse Childhood Experiences (ACEs) in Hertfordshire, Luton and ...

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May 2, 2016 - 0151 231 4454 | [email protected]uk | www.cph.org.uk | ISBN: xxxxxxx ...... is roughly one handful or a full piece of fruit such as an apple)?.

Adverse Childhood Experiences (ACEs) in Hertfordshire, Luton and Northamptonshire Ford K1, Butler N1, Hughes K1, Quigg Z1, Bellis M A2

May 2016 CPH, Faculty of Education, Health and Community, Liverpool John Moores University, Henry Cotton Campus, 15-21 Webster Street, Liverpool, L3 2ET 0151 231 4510 4454 | [email protected] [email protected] || www.cph.org.uk www.cph.org.uk || ISBN: ISBN: xxxxxxx 978-1-910725-63-4 (web) (web)

Adverse Childhood Experiences (ACEs) in Hertfordshire, Luton and Northamptonshire Katharine Ford1, Nadia Butler1, Karen Hughes1, Zara Quigg1, Mark A Bellis2 1

Centre for Public Health Faculty of Education, Health and Community Liverpool John Moores University Henry Cotton Building 15‐21 Webster Street Liverpool L3 2ET www.cph.org.uk 2

Public Health Wales Hadyn Ellis Building Maindy Road Cathays Cardiff CF24 4HQ

Contributorship Peter Barker3, David Conrad4, Kelly O’Neill5, Chandraa Bhattacharya6, Barbara Paterson6. 3

Northamptonshire County Council County Hall Northampton NN1 1ED

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Hertfordshire County Council County Hall Pegs Lane Hertford SG13 8DQ

Luton Borough Council Public Health 3rd Floor Town Hall Extension Upper George Street Luton LU1 2BQ Public Health England (PHE) East of England West Wing Victoria House Capital Park Fulbourn Cambridge CB21 5XB

Acknowledgements We are very grateful to the residents of Hertfordshire, Luton and Northamptonshire who kindly participated in the survey. We would like to thank BMG research for collecting the data. We would like to thank Ann Robins (UNICEF), Tammy Coles, Sian Evans and Stephen Yeung (PHE) for their contributions to the study and Staff at the Centre for Public Health including Ryan Paden, Charlotte Bigland and Ciara McGee for assistance with report proofing, and Laura Heeks for producing the report cover and infographics.

Table of contents Executive summary ................................................................................................................................. 1 1. Introduction ........................................................................................................................................ 3 2. Methodology ....................................................................................................................................... 6 3. Findings ............................................................................................................................................... 9 3.1. Prevalence of ACEs in the study area............................................................................................... 9 3.2. Relationship between ACEs and socio-demographics ................................................................... 11 3.3. Health-harming behaviours ........................................................................................................... 13 Tobacco smoking........................................................................................................................... 14 Using e-cigarettes (vaping) ........................................................................................................... 15 Smoking tobacco or using e-cigarettes ......................................................................................... 15 Alcohol use – binge drinking ......................................................................................................... 16 Alcohol use – high-risk drinking .................................................................................................... 17 Cannabis use ................................................................................................................................. 18 Heroin or crack cocaine use .......................................................................................................... 19 Violence victimisation ................................................................................................................... 20 Violence perpetration ................................................................................................................... 21 Incarceration ................................................................................................................................. 22 Poor diet........................................................................................................................................ 23 Unintended teenage pregnancy ................................................................................................... 24 Early sexual initiation .................................................................................................................... 25 Low physical exercise .................................................................................................................... 26 3.4. Health service utilisation................................................................................................................ 27 Regularly visiting a General Practitioner (GP) ............................................................................... 27 Visited an Accident and Emergency Department (ED) in the last 12 months .............................. 28 Stayed a night in hospital in the last 12 months ........................................................................... 28 Having not attended the dentist in the last 12 months ................................................................ 29 3.5. Health outcomes ............................................................................................................................ 30 Overweight and obese (BMI 25 or more) ..................................................................................... 30 Mental wellbeing .......................................................................................................................... 31 Life satisfaction ............................................................................................................................. 31 More than ten teeth removed ...................................................................................................... 32 More than ten fillings.................................................................................................................... 32 Diagnosed with a sexually transmitted infection (STI) ................................................................. 33 3.6. Associations between ACEs and chronic disease........................................................................... 34 i

Any disease ................................................................................................................................... 34 Individual diseases ........................................................................................................................ 36 3.7. Associations between ACEs and premature mortality .................................................................. 38 4.

Summary ....................................................................................................................................... 39

Implications for practice ....................................................................................................................... 42 References ............................................................................................................................................ 47 Glossary ................................................................................................................................................. 49 Appendix 1 – Methodology................................................................................................................... 51 Appendix 2 – Data tables ...................................................................................................................... 57 Appendix 3 – Local authority infographics………………………………………………………………………………………..99

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Executive summary Adverse childhood experiences (ACEs) include a range of stressful events that children can be exposed to while growing up, including: physical, sexual or emotional childhood abuse; family breakdown; exposure to domestic violence; or living in a household affected by substance misuse, mental illness or where someone is incarcerated. A growing body of research has identified that individuals’ childhood experiences are fundamental in determining their future health and social prospects, with ACEs being one of the strongest predictors of poor health and social outcomes in adults. The impact of ACEs can vary across population groups which may make comparisons between different areas not applicable. Thus, identifying the ACE profile of different communities is a critical element in understanding and addressing the underlying causes of ill health. Tackling ACEs in Hertfordshire, Luton and Northamptonshire relies on identifying the size and scale of the problem, and ascertaining which part of the population are most at risk. Consequently, the Centre for Public Health at Liverpool John Moores University was commissioned by Hertfordshire County Council, Luton Borough Council and Northamptonshire County Council in collaboration with Public Health England, to undertake a study of ACEs and their impacts in the adult population. This consisted of a crosssectional survey of 5,454 adults, aged 18-69 years resident in Hertfordshire, Luton and Northamptonshire. Participants were asked about their current health behaviours and their exposure to ACEs using an internationally validated ACE questionnaire.

findings to population demographics, at least four in ten (44.4%) adults have experienced one or more ACEs and almost one in ten (9.1%) have suffered four or more (see infographic). The adjusted prevalence of individual ACEs ranges from 3.1% of residents reporting living with someone who was incarcerated, to 22.9% experiencing verbal abuse by a parent or adult in their home during their childhood. Further, exposure to ACEs has had a major impact on the development of health-harming behaviours (e.g. smoking and binge drinking), health service use (e.g. staying a night in hospital), health outcomes (such as being diagnosed with a sexually transmitted infection [STI] or chronic disease), and low mental wellbeing and life satisfaction. This study reveals that ACEs in Hertfordshire, Luton and Northamptonshire are associated with chronic ill health in later life such as the development of cancer, liver and digestive disease and ultimately premature death. Preventing ACEs would not only lessen the prevalence of health-harming behaviours and prevent unintended teenage pregnancy, but also prevent violent behaviour, thus helping to break the cycle of adversity that families can become trapped into. Findings indicate that appropriate policies and programmes need to be implemented both to prevent ACEs and to recognise and moderate their impacts in affected populations, consequently improving health across the whole life course for residents in Hertfordshire, Luton and Northamptonshire.

This study identified that a substantial proportion of the adult population in Hertfordshire, Luton and Northamptonshire suffered abuse, neglect or other household dysfunction during their childhood. Adjusting 1

How many adults have suffered each ACE? CHILD MALTREATMENT

Verbal abuse 23%

Physical abuse 14%

Sexual abuse 6%

CHILDHOOD HOUSEHOLD INCLUDED

Parental separation 18%

Domestic violence 16%

Mental illness 11%

Alcohol abuse 11%

Drug use 4%

Incarceration 3%

For every 100 adults 44 have suffered at least one ACE during their childhood and 9 have suffered 4 or more Figures based on population adjusted prevalence in adults aged 18-69 years

0 ACEs 56% 1 ACEs 18% 2-3 ACEs 17% 4+ ACEs 9%

Compared with people with no ACEs, those with 4+ ACEs are: 2 times more likely to currently binge drink or have a poor diet

3 times more likely to be a current smoker

4 times more likely to have had sex while under 16 years old or to have smoked cannabis

4 times more likely to have had or caused unintended teenage pregnancy

8 times more likely to have been a victim of violence in the last year or ever been incarcerated

10 times more likely to have been a perpetrator of violence in the last year

Preventing ACEs in future generations could reduce levels of:

Early sex by 36%

Unintended teen pregnancy by 44%

Heroin/crack use (lifetime) 54%

Incarceration (lifetime) 50%

(before age 16)

Smoking

Binge drinking

(current)

(current)

(lifetime)

by 25%

by 22%

by 45%

Violence victimisation (past year) 56%

Poor diet (current; 10) Roughly how many of your (remaining) teeth have fillings or crowns/caps? (this does not include veneers) (>10) You are now going to see some statements about feelings and thoughts. For each statement, please select the box that best describes your experience over the last 2 weeks. (SWEMWBS score; see Appendix 1) All things considered, how satisfied are you with your life on a scale of 1 to 10, where 1 is not at all satisfied and 10 is very satisfied? (scores

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