Adverse Childhood Experience Scores, more commonly known as ACE scores, have provided new insight into the effects of adverse events on longstanding health and chronic illnesses in adults. Evidence shows that individuals with history of ACEs have increased risk of developing multiple chronic illnesses with or without increased exposure to activities that are detrimental to health, i.e. tobacco, alcohol, or other drug use. Additionally, a history of ACEs significantly increases an individual’s likelihood of participating in behaviors that are detrimental to long-term health, including risky behaviors and resulting addiction issues. However, in most individuals with ACEs, their childhood experiences, or the extent of the experience, is not likely to be mentioned in casual conversation. By increasing knowledge on ACE scores and implementing scoring of all individuals possible, it would improve a physician’s ability to assess risk and health screening needs for a patient on a more individualized basis. The purpose of this study is to educate Bristol Family Medicine residents on the daily uses and clinical correlations provided by ACE scoring in an attempt to increase score documentation of future patients.We will begin by providing a short knowledge assessment about ACE scores to residents in the Bristol Family Medicine residency program. We will then give a detailed presentation on the usefulness and effectiveness of using ACE scores in clinical judgement and screening. Following the presentation, we will provide a similar knowledge assessment as well as a questionnaire to assess likelihood of residents to implement ACE scores in their current practice.

<p dir="ltr">Background—Adverse Childhood Experiences (ACEs) are events that occur before age 18, such as abuse and neglect, which are potentially traumatic. ACEs can lead to profound negative impacts on physical and psychological health and social relationships. Despite this, positive social connections can mitigate these effects. However, individuals with ACEs may struggle to form healthy relationships because of mistrust, leading to continued exposure to detrimental social environments. Additionally, ACE-exposed adults often internalize stigma.</p><p dir="ltr">Methods—Utilizing data spanning from 1995 to 2014, Chapter 2 examines 629 adults from the MIDUS II: Biomarker study. Employing counterfactual modeling, the study estimates the treatment effect of ACE exposure on well-being and employs weighted multilevel mixed models to analyze life course changes. Chapter 3 uses 1,243 respondents from the MIDUS II: Biomarker study, employing latent class analysis to identify social relationship patterns and assess their mediation between ACEs and the pursuit/enjoyment of new relationships. Chapter 4 uses experimental data from 493 respondents, employing vignette experiments to gauge perceptions of warmth and competence, with gender and happiness examined as moderators, and threat, status, four stigmatizing descriptions as mediators.</p><p dir="ltr">Results—ACE exposure is associated with increased chronic conditions, lower self-rated health, diminished psychological and social well-being. However, the strength of the treatment effects differs based on the type and number of ACE exposures. Latent Class Analysis of social relationships indicates four classes: healthy, ambivalent, kin-focused, and difficult, with higher ACEs linked to a decreased probability of being in the “healthy” class. ACEs also predict reduced enjoyment of interactions with new people, mediated 41% by the current social relationship class. ACE vignettes are perceived as less warm and competent, with happiness moderating some ACE-related perceptions. Status, “mentally ill”, and “damaged” emerged as strong mediators.</p><p dir="ltr">Conclusion—While ACE exposure is related to lower well-being, the rate of decline does not differ from non-ACE-exposed individuals across time. Those in strained relationships are less likely to enjoy new social interactions, potentially perpetuating ACE-related health consequences. Addressing interpersonal trust issues in ACE-exposed adults through social interventions may mitigate these effects. Additionally, there is stigma against each of the ten ACEs, and the medicalization of ACEs contributes to stigma.</p>