Anew study published todayinBMC Medicine已经表明，童年的不利经历会对个人和社会产生严重的长期影响。利物浦约翰·摩尔大学（John Moores University）行为流行病学教授兼研究的合着者，客座博客作者Karen Hughes向我们介绍了他们的发现。

在过去的几十年中，人们对早期生活经历对人们的健康和行为的影响越来越多。简而言之，与遭受虐待，家庭冲突和其他童年压力源的孩子相比，在稳定，充满爱心环境中抚养的孩子往往更健康，寿命更长。

The mechanisms behind this trend are increasingly being understood; childhood stress impairs healthy social, emotional and academic development. It can cause adaptations in the brain that focus emotional and physical responses towards short term survival rather than long gain.

The不利的童年经历（ACE）研究in the USA has been instrumental in identifying the health-related impacts of childhood adversity and pushing forward research in this area. By asking patients about their childhood experiences and their health-related behaviors as adults, the study found that the more adverse experiences a person had suffered as a child, the greater their risks of a wide range of health-damaging behaviors and health conditions as adults. These range from substance abuse and risky sexual behavior through to mental ill-health, cancer and premature mortality.

Showing the burden that these childhood experiences place on population health creates a case for governments to invest in effective interventions to prevent them. Thus theWorld Health Organization和global health partners arepromoting researchinto the extent and impact of them around the world.

Studying the national impact

The aim of我们的研究是为了衡量不利的童年经历对英格兰与健康相关行为的影响。对这些经验的大多数研究都集中在特定的人群群体或地理区域，很少有人在全国范围内检查其影响。

在英格兰，人们对早期生活经历在树立生活中的道路和不断增加政策的重点关注早期干预方面的重要性越来越认识。然而，实际上，几乎了解多少人受到童年的不利经历的影响，或者他们如何影响与健康相关的行为。我们想发展这些知识，同时估计这些经历可能会对全国性危害行为的普遍性产生什么影响。

To do this,we conducted全国代表性的家庭调查，对整个英格兰的成年人。我们使用一份问卷调查了大约4,000名18-69岁的孩子，其中包括有关过去和当前与健康相关行为的一系列问题，以及美国疾病控制和预防中心开发的简短ACE工具。这衡量了18岁之前发生的九种不良童年经历：身体虐待，性虐待，口头虐待，暴露于家庭暴力，父母分离以及与患有酒精问题，使用药物的家庭成员生活，患有药物，患有精神病或被监禁。

By adjusting data to the demographics of the national population, we estimated that almost half (47.9%) of adults in England had had at least one adverse experience in childhood, and almost one in ten (9.0%) had had four or more.

We found that, with the exception of low physical exercise, these experiences were strongly related to all the health-harming behaviors we measured. These were: early sexual initiation (before age 16); having or causing an unintended teenage pregnancy (before age 18); eating low levels of fruit and vegetables; smoking; binge drinking; cannabis use; heroin or crack cocaine use; perpetrating violence; being a victim of violence; and being incarcerated.

与以前的工作一样，我们发现，随着人们报告的童年经历的数量，健康损害行为的流行和风险增加。例如，与没有报告的人相比，在有四种或更多不良经历的人中，吸烟的几率增加了三倍，参与暴力的几率（无论是受害者还是犯罪者）增加了七倍。

What is the potential impact of reducing adverse childhood experiences?

真正新颖的部分我们的研究它的估计是，如果没有这些经验，可以阻止多少人受到健康损害行为。

By quantifying the relationship between adverse childhood experiences and the development of health-harming behaviors we estimated the reduction in prevalence of each behavior that would be seen in the absence of these experiences and the numbers of individuals that this equated to across England.

For current levels of smoking, for example, we estimated that with no adverse experiences national prevalence would drop from 22.7% to 18.9%; a 16.5% reduction. In terms of numbers, this would equate to 1.3 million fewer adult smokers across England. For violence, we estimated that prevalence of past-year victimization would drop from 5.8% to 2.9%, a reduction of 50.6% and equivalent to just over a million victims of violence a year.

Our estimates may represent the very upper end of what is possible (i.e. removal of all adverse childhood experiences in a population) yet what they show is just how important preventing these experiences can be in tackling health risk behaviors; and therefore associated chronic health conditions.

通过将我们的发现转化为数字，我们将研究变成了不利的童年经历，成为对决策者和从业者有意义的事物。范围evidence-based programsare available that can prevent and address experiences such as child maltreatment and domestic violence, and systematic implementation of these programs within nations is likely to have major impacts in improving public health.