Perry et al. Respond

Abstract

We agree with Faulx et al. that the recognition and prevention of adverse childhood experiences (ACEs) should be part of public health efforts to prevent mental illness and chronic disease. The Centers for Disease Control and Prevention (CDC), in collaboration with Kaiser Permanente, has been studying the relationship between ACEs and adverse health outcomes in adulthood for more than a decade. These findings helped establish a strong evidence base supporting the association between ACEs and many chronic diseases and risk behaviors.1,2 The CDC's work on exploring the health impacts of ACEs incorporates both clinical and population-based assessments through surveillance in selected states.3 Addressing ACEs in the public health sector was beyond the scope of our editorial,4 the purpose of which was to encourage incorporation of mental illness prevention and mental health promotion into overall health promotion efforts. Evidence-based programs, such as the Nurse Family Partnership, the Early Start5 program, and the Triple P−Positive Parenting Program system,6 can be effective in preventing child abuse. Further trauma-focused cognitive behavioral therapy has also proven to be an effective clinical treatment to alleviate distress associated with ACEs.7 These approaches could potentially serve as models for public health interventions to prevent ACEs and thereby help prevent later adverse health outcomes, including mental illness. Although the CDC and Kaiser Permanente findings provided strong evidence of the negative effects of ACEs on adult health,1,2 population-wide data supporting this association are lacking. To identify the burden of ACEs in the general population, 12 states administered the ACE optional module on the Behavioral Risk Factor Surveillance System between 2008 and 2010. Initial results from the five states reporting data in 2009 confirm that ACEs are common and interrelated across all demographic groups, with 59% of respondents reporting at least one ACE and 8.7% reporting five or more.3 Such information can help states develop public health interventions to prevent and help reduce ACEs and their adverse health effects. Moving public health efforts in mental health and mental illness forward will require strategies that integrate both mental health promotion and mental illness prevention with broader chronic disease prevention efforts; these strategies include but are not limited to ACEs. This integrated approach will help to elucidate and address ACEs, mental health, and chronic diseases in the general population. Because it is estimated that by 2020 mental illness will be the second-leading contributor to the global disease burden, behind cardiovascular disease,8 public health entities must address mental health promotion and mental illness prevention. Therefore, we join the call for action to protect and promote the nation's mental health.