Perspectives

From ACEs to ASHEs: Adverse Shared Historical Experiences and Their Impact on Health Outcomes

Authors: William Ventres, MD, MA, Erick Messias, MD, PhD

Abstract

Since the landmark 1998 Adverse Childhood Experiences (ACE) study,2 the concept of ACEs has entered the vocabulary of medical and public health practitioners. It has helped define numerous risk factors for a variety of health outcomes. ACEs are potentially traumatic events that occur in an individual’s childhood. Examples of ACEs include, but are not limited to, experiencing interpersonal violence, abuse, and neglect; witnessing violence in the home or surrounding community; and having a family member attempt or die by suicide.

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References

1. Faulkner W. Requiem for a Nun. New York: Random House; 1951:92.
 
2. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med 1998;14:245–258.
 
3. Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: a systematic review and meta-analysis. Child Abuse Negl 2019;97:104127.
 
4. Ventres W, Kravitz JD, Dharamsi S. PEARLS+: connecting social forces, social determinants, and health outcomes. Acad Med 2018;93:143.
 
5. World Health Organization. Social determinants of health. https://www.who. int/teams/social-determinants-of-health. Accessed April 4, 2021.
 
6. Mohatt NV, Thompson AB, Thai ND, et al. Historical trauma as public narrative: a conceptual review of how history impacts present-day health. Soc Sci Med 2014;106:128–136.
 
7. Dias BG, Maddox S, Klengel T, et al. Epigenetic mechanisms underlying learning and the inheritance of learned behaviors. Trends Neurosci 2015; 38:96–107.
 
8. Lehrner A, Yehuda R. Cultural trauma and epigenetic inheritance. Dev Psychopathol 2018;30:1763–1777.
 
9. Conching AKS, Thayer Z. Biological pathways for historical trauma to affect health: a conceptual model focusing on epigenetic modifications. Soc Sci Med 2019;230:74–82.
 
10. Goodman R, West-Olatunji C. Transgenerational trauma and resilience: improving mental health counseling for survivors of Hurricane Katrina. J Mental Health Couns 2008;30:121–136.
 
11. Hirschberger G. Collective trauma and the social construction of meaning. Front Psychol 2018;9:1441.
 
12. Jones DS. The persistence of American Indian health disparities. Am J Public Health 2006;96:2122–2134.
 
13. Gone JP, Hartmann WE, Pomerville A, et al. The impact of historical trauma on health outcomes for indigenous populations in the USA and Canada: a systematic review. Am Psychol 2019;74:20–35.
 
14. Thomas SB, Casper E. The burdens of race and history on black people’s health 400 years after Jamestown. Am J Public Health 2019;109:1346–1347.
 
15. DeGury J. Post Traumatic Slave Syndrome (PTSS): America’s Legacy of Enduring Injury and Healing. Milwaukie, OR: Uptone Press; 2005.
 
16. Nagata DK, Kim JHJ, Wu K. The Japanese American wartime incarceration: examining the scope of racial trauma. Am Psychol 2019;74:36–48.
 
17. Krieger N, Chen JT, Coull BA, et al. Jim Crow and premature mortality among the US Black and White population, 1960–2009: an age-periodcohort analysis. Epidemiology 2014;25:494–504.
 
18. Physicians for Human Rights. Not in my exam room: how U.S. immigration enforcement is obstructing medical care. https://phr.org/wp-content/uploads/ 2019/06/Not-in-my-Exam-Room_-PHR-Sanctuary-Hospitals-June-2019. pdf. Published June 2019. Accessed April 4, 2021.
 
19. Makwana N. Disaster and its impact on mental health: a narrative review. J Family Med Prim Care 2019;8:3090–3095.
 
20. Fortuna LR, Porche MV, Alegria M. Political violence, psychosocial trauma, and the context of mental health services use among immigrant Latinos in the United States. Ethn Health 2008;13:435–463.
 
21. Pinderhughes H, Davis R, Williams M. Adverse community experiences and resilience: a framework for addressing and preventing community trauma. https://www.preventioninstitute.org/publications/adverse-communityexperiences-and-resilience-framework-addressing-and-preventing. Published February 2016. Accessed April 4, 2021.
 
22. Alexander M. The New Jim Crow: Mass Incarceration in the Age of Colorblindness. New York: New Press; 2010.
 
23. Eades SJ. Reconciliation, social equity and indigenous health. Med J Aust 2000;172:468–469.
 
24. Andrasik M. Historical trauma and the health and wellbeing of communities of color. https://www.hvtn.org/en/community/community-compass/vol18- issue1/historical-trauma.html. Accessed April 4, 2021.
 
25. Kirmayer LJ, Gone JP, Moses J. Rethinking historical trauma. Transcult Psychiatry 2014;51:299–319.
 
26. Sotero M. A conceptual model of historical trauma: implications for public health research and practice. J Health Disparities Res Pract 2006;1:93–107.
 
27. Internet Encyclopedia of Philosophy. George Santayana (1863–1952). https:// iep.utm.edu/santayan. Accessed April 4, 2021.
 
28. Ford K, Hughes K, Hardcastle K, et al. The evidence base for routine enquiry into adverse childhood experiences: a scoping review. Child Abuse Negl 2019;91:131–146.
 
29. Gillespie RJ. Screening for adverse childhood experiences in pediatric primary care: pitfalls and possibilities. Pediatr Ann 2019;48:e257–e261.
 
30. Campbell TL. Screening for adverse childhood experiences (ACES) in primary care: a cautionary note. JAMA 2020;323:2379–2380.
 
31. Mehta J, Fine S. The why, what, where, and how of deeper learning in American secondary schools. Students at the Center: Deeper Learning Research Series. Boston: Jobs for the Future. https://www.jff.org/ resources/why-what-where-and-how-deeper-learning-american-secondaryschools. Published 2015. Accessed April 4, 2021.
 
32. Shen MJ, Peterson EB, Costas-Muñiz R, et al. The effects of race and racial concordance on patient-physician communication: a systematic review of the literature. J Racial Ethn Health Disparities 2018;5:117–140.
 
33. Ventres W, Haq C. Toward a cultural consciousness of self-in-relationship: from “us and them” to “we.” Fam Med 2014;46:691–695.
 
34. Ventres W, Dharamsi S, Ferrer R. From social determinants to social interdependency: theory, reflection, and engagement. Soc Med 2017;11: 84–89.
 
35. Krishnamurthy M. Political solidarity, justice, and public health. Public Health Ethics 2013;6:129–141.
 
36. Candib L. Working with suffering. Patient Educ Couns 2002;48:43–50.