The Ripple Effects of ACEs By Keenia Tappin, MD
“Adverse childhood experiences are the single greatest, unaddressed public health threat facing our nation today.” – Dr. Robert Block, former President of the American College of Pediatrics.
From 1995-1997, Dr. Felitti from Southern California Kaiser and Dr. Anda from the CDC conducted the landmark Adverse Childhood Experiences (ACE) Study. The study included ~17,000 Southern California Kaiser members who were 54% female, 46% male, 75% Caucasian, and 39% college educated. The study was designed to look for a correlation between exposure to abuse or family dysfunction during childhood and development of common deadly medical and public health problems in adulthood. The 10 ACEs included in the study were psychological, physical, and sexual abuse, emotional neglect, physical neglect, household substance abuse (alcohol or illicit drug use), mother treated violently, mental illness, depression in the household, parental separation or divorce, and having an incarcerated household member. The negative adult health outcomes assessed included: severe obesity, being a smoker, being an alcoholic, lack of physical activity, 2 or more weeks of depressed mood in a year, lifetime attempt at suicide, illicit drug use, ≥50 sexual intercourse partners, and history of sexually transmitted disease. Adult chronic diseases assessed included: ischemic heart disease, cancer, stroke, chronic bronchitis/ emphysema, diabetes, hepatitis, fair or poor self-rated health. This landmark study revealed two unexpected and pivotal facts about trauma during childhood. Firstly, ACEs are common. 36% of the participants had no ACEs, 26% had 1 ACE, 16% had 2 ACEs, 9.5% had 3 ACEs, and 12% had 4 or more ACEs. The top 3 ACEs were physical abuse (28%), household substance use (27%), and parental
28 CENTRAL VALLEY PHYSICIANS
separation or divorce (23%). Secondly, there is a graded dose-response relationship between number of ACEs and development of negative adult health outcomes. For instance, when participants with 0 ACEs were compared to those with 4 or more ACEs, the latter group was 2.2 times more likely to be a smoker, 7.4 times more likely to consider themselves an alcoholic, 10.3 times more likely to have illicit IV drug use, and 12.2 times more likely to have a prior suicide attempt. In terms of chronic disease, participants with 4 or more ACEs versus those with 0 ACEs were 2.2 times more likely to have ischemic heart disease, 2.4 times more likely to have a history of stroke, and 3.9 times more likely to have chronic bronchitis or emphysema. Once the results came in the next question became, how exactly are these ACEs linked to risky health behaviors and diseases in adulthood? Is it simply that people who experience trauma are more likely to cope in unhealthy ways or is it linked to changes in the brain and other organs that occur during development? The answer is, it may be a little bit of both. In terms of unhealthy coping mechanisms, smoking is a prime example. Nicotine has been shown to have positive mood regulation effects. Also, when used alone or with other substances such as alcohol, it can stimulate the dopamine reward pathway via increased dopaminergic neuronal firing. Individuals exposed to repetitive trauma may find solace in the short term positive effects of smoking or alcohol. Unfortunately, chronic smoking predisposes to emphysema, heart disease, and malignancy. Chronic alcohol use is a factor in developing cancer, hepatitis, and cognitive impairment. Looking at neurodevelopment, trauma can have Spring 2021
