An Examination of the Cumulative Effect Model of Adverse Childhood Experiences: Are All ACEs Created Equal?

Document Type


Publication Date



Presentation: 7:35


Adverse childhood experiences have been linked to a wide variety of physical and mental/behavioral health outcomes later in life by many studies since a major research effort by Dr. Vincent Felitti in 1998. The majority of this research has used a cumulative model of the ACEs of participants, or what is known as an ACE score, and has linked a higher ACE score to an increased likelihood of negative health outcomes later in life. Other predictive models involving health conditions such as the LACE hospital readmission model and Charlson Comorbidity Index weight different factors of their models in the predictive assessments. The purpose of this Capstone project is to demonstrate that the cumulative ACE model may require revision in its assumption that all ACEs contribute equally to an ACE score, and that different ACEs may contribute more or less significantly than others. To accomplish this goal, the Behavioral Risk Factor Surveillance System (BRFSS) data from 2009 to 2012 was coded in a way that allowed for binary logistic regressions to be performed on single, 2 combination, and 3 combinations compared to those with no ACEs to create odds ratios of having angina/coronary artery disease or a smoking habit later in life. These odds ratios were then grouped in frequencies to show that different combinations varied widely in their odds ratio compared to the generic ACE score. Further research into this is necessary, especially if specific weights are to be created in order to revise the model, but it helps demonstrate that the cumulative effects model may be incorrect in assuming that all ACEs contribute equally.