Oklahoma's poor health rankings could be a result of how many bad things children experience and witness while growing up, according to emerging research.

Those negative experiences could range from how a divorce is handled to the extent a child suffers abuse. A connection is being made between the number of such childhood experiences and the physical health of adults.

Through January, the Oklahoma Institute for Child Advocacy will be releasing five briefs detailing the Adverse Childhood Experience Study with Oklahoma data included. The first two briefs were issued Tuesday.

"It's pretty overwhelming, and each issue merits attention," Executive Director Anne Roberts said. "Basically, bad things that children are around and experience are linked to future adult health issues.

"We've always known about the psychological stress. Now, there is a link to physical health such as heart disease and diabetes," she said.

"And this discusses not only what the child personally goes through, but the type of home environment a child is raised in."

The study -- an ongoing project of the Centers for Disease Control and Prevention and the Department of Preventive Medicine at Kaiser Permanente in San Diego -- has been tracking more than 17,000 middle-class people to determine how childhood experiences affect adult health.

"The study looks at the whole environment," Roberts said. "It is not just about children, but about the entire family. This is something we can relate to and do something about."

In December, Men's Health magazine ranked Tulsa 96th and Oklahoma City 92nd out of 100 cities in overall health, and the United Health Foundation ranked Oklahoma 44th in the nation for health status.

Last year, a CDC report put Oklahoma as the 13th-fattest state, and Self magazine ranks Tulsa 94th and Oklahoma City 98th out of 100 cities in health.

"Some of the diseases we have now are behavior-related," Roberts said. "We smoke too much, we eat too much, we don't exercise, and that is why we get sick. But there is a missing link. This can help explain why we smoke in the first place."

The first issue brief gives an overview of the California study and how each county ranks based on the formula used in that project.

According to the rankings, children in most of the counties in southeastern Oklahoma are more likely to experience adversity than those in other parts of the state. Tulsa County ranked 31st.

The study relies on 10 risk factors: emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, mother treated violently, household substance abuse, household mental illness, parental separation or divorce and incarcerated household member.

Almost three-quarters of the study's participants had experienced one or more of the factors. One in six experienced two factors, and one in eight people experienced four or more.

"It is surprising how frequent these issues are," Roberts said. "Adverse childhood experiences happen much more than we think. These are not disadvantaged or poor people. These are working, middle-class, fully functioning adults we can all relate to."

The study showed that people with four or more adverse factors were twice as likely to be smokers, 12 times more likely to have attempted suicide, seven times more likely to be an alcoholic and 10 times more likely to have injected illegal drugs.

Higher adverse factors also show a link to other behaviors, such as overeating and promiscuity.

The second issue brief details child mistreatment. Policy suggestions include creating new diagnostic tools for health professionals and investing in child-abuse prevention programs.

Because of how Oklahoma records abuse and neglect statistics, the issue brief lumps the five risk factors dealing with abuse and neglect into one report, Roberts said.

About one-third of Oklahoma's child abuse and neglect occurs in Tulsa or Oklahoma counties.

Counties considered the most problematic for child abuse and neglect are Adair, Woodward, Choctaw, Pushmataha, Atoka, Coal and Garvin.

The remaining issue briefs will spotlight domestic violence, mental health, substance abuse and absent parents.

The institute will released the annual Kids Count child well-being report Jan. 25. Dr. Vincent J. Felitti, founder of the California study, visited Tulsa on Jan. 26 to discuss the research.