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The Most Important Public Health Study You’ve Never Heard
The ACE Study – the Centers for Disease Control’s Adverse Childhood Experiences Study – has been referred to an increasing number of times by the press over the past few years. Some have even gone so far as to say that everyone should know their ACE score, just as we all should know be aware of our weight, cholesterol levels, and blood pressure.
So what is the ACE Study and is knowing and understanding your ACE score really that important to your mental and physical health?
Origins of the ACE Study
In 1985, Dr. Vincent Felitti, chief of Kaiser Permanente’s Department of Preventive Medicine in San Diego, CA, couldn’t figure out why over half of the patients in his obesity clinic had dropped out each year for the past five years, especially since all the dropouts had been losing the weight they came to the program to lose.
Dr. Felitti’s desire to find an answer became a multi-decade mission involving the CDC and thousands of members of Kaiser’s San Diego care program. In the end, it revealed that adverse childhood experiences are extremely common – regardless of socio-economic status – and are linked to almost every major social problem and illness in the United States.
But 25 years ago, Dr. Felitti only knew his obesity clinic was losing patients that were seeing positive results from his program.
As he thoroughly reviewed the medical records of those who dropped out, the first surprise he came across was that not one in over 2,000 people gained weight steadily. They all gained 100, 200, even 300 + pounds rather abruptly. And, most of those that lost weight put it back on over a very short timeframe.
While interesting, this data shed no light on the answer to his question, so Dr. Felitti decided to conduct interviews with several hundred dropouts. To his astonishment, of the almost 300 people interviewed, the majority had experienced some form of childhood sexual abuse.
As surprising as this was, something more significant occurred when an overweight woman he was interviewing admitted to having put on the weight after being raped in her early 20s. She then looked down at her feet and said, “Overweight is overlooked, and that’s the way I need to be.”
Dr. Felitti was suddenly struck by the realization that, for many obese people, being overweight isn’t seen as being a problem. For them, eating is a solution, a fix, just as taking drugs provides drug users a “fix.”
Actually, eating can provide multiple solutions. It soothes their depression, anxiety, stress, and fear. And, for many, just being overweight often solves a problem, whether it’s making them “invisible” to the opposite sex, less likely to be physically assaulted, or lowering others’ expectations of them. For some people, eating provides both solutions.
The Growth of the ACE Study
Unfortunately, when Dr. Felitti presented the data from his initial study to professional organizations of psychiatrists, physicians, and pediatricians, he was met with a great deal of skepticism, if not outright rebuke.
Dr. Felitti determined to dramatically broaden the size of his study and decided that San Diego’s Kaiser Permanente was the perfect place. So, in 1995, 50,000 Kaiser members were asked to answer additional survey questions as part of their annual medical check-ups. In the first year, 17,241 Kaiser members agreed to answer the additional survey questions that were designed to increase the understanding of whether or not childhood events affect health later in life.
However, before adding questions to the medical evaluation that addressed childhood trauma, Dr. Robert Anda, an epidemiologist with the CDC, and Dr. Felitti devoted a year to reviewing all the available research on childhood trauma. This research, combined with the data from Dr. Felitti’s obesity clinic, determined that the questions would focus on eight major causes of childhood trauma:
- Physical abuse
- Emotional and verbal abuse
- Sexual abuse
- An alcoholic parent
- A parent suffering from mental illness
- Domestic violence
- A parent who’s incarcerated
- Parental loss suffered through separation, divorce, abandonment, or death
They also added physical and emotional neglect at a later date, bringing the total number of types of adverse childhood experiences, or ACEs, to 10.
The surveys started in 1995 and ran for two years. Even more importantly, participants of the study were followed up with regularly for 15 or more years after the initial study took place.
The Results of the ACE Study
The ACE Study was the first research study that evaluated the effects of numerous childhood traumas, as opposed to looking at the consequences of each one independently, and the results were nothing short of shocking:
- There’s a direct association between traumatic childhood experiences and chronic illness, addictive behaviors and other mental, emotional, physical, and social difficulties in adulthood.
- Well over half of the study’s participants had experienced at least one type of adverse childhood experience. Of those, almost 90% had experienced at least two types, if not more. And, remember, a type is not an occurrence. For example, families in which one parent was an alcoholic were also more likely to experience verbal or physical abuse or domestic violence.
- The more ACEs one had, the higher the likelihood of mental, emotional, physical, and social difficulties in adulthood.
To understand the results of the study, it’s important to understand the scoring system it uses. Each type of adverse childhood experience counts as one point. If someone didn’t experience any of the events in the questionnaire, his or her ACE score was zero. If a participant was hit hundreds of times by his or her mother or father, but experienced no other types of trauma, the person was deemed to have an ACE score of one. If a person was subjected to verbal and sexual abuse at the hands of an alcoholic parent, his or her ACE score would be three.
While there is a marked trend linking those with any ACEs – even only one or two – to a greater risk of mental, emotional, and physical difficulties in adulthood, the risks increase dramatically with ACE scores of 4 and above.
People who experienced four types of ACEs had a 390% greater chance of having chronic bronchitis or emphysema and a 240% greater chance of hepatitis and/or acquiring an STD as compared to those with an ACE score of zero.
Those with ACE scores of four were also twice as likely to smoke, had seven times the chance of being alcoholic, 10 times the likelihood of using street drugs, and were 12 times more liable to have attempted suicide.
Direct links were also established between higher ACE scores and increases in violence, sexual promiscuity, cancer and other diseases, depression, and absences from work.
Perhaps even more startling, ACE scores of at least four occurred in one out of every six participants and one out of every nine reported an ACE score of five or greater. And the participants of the ACE study were average middle-aged, middle-class, college-educated Americans. In fact, as Kaiser members, it’s likely most had good jobs and healthcare. One can only imagine the numbers of people with high ACE scores being greater if the study included more people from lower socio-economic classes.
The significance of the ACE Study continues to grow as more research has shown how adverse childhood experiences release hormones like cortisol that, over time, can cause physical damage to a child’s brain while it’s still developing, providing a reason why children with an ACE score of four or higher are 32 times more likely to be diagnosed with behavior or learning disorders.
In short, children who are regularly exposed to trauma and stress experience the world as being filled with danger, the constant stress of which makes it exceedingly difficult for them to relax and focus on learning and developing healthy relationships.
In order to cope with feelings of frustration, guilt, and despair – whether they’re conscious or unconscious – it’s not uncommon for them to turn to tobacco, alcohol, street drugs, food, risky sexual behavior, and/or work and over-achievement as they grow older. And, all too often, these coping methods aren’t seen as problems but rather solutions to help them escape anxiety, fear, anger, depression, and shame.
While Dr. Felitti didn’t know it at the time, his research and the ACE Study that resulted from it would lead to a new meme that would spread far beyond his weight clinic in San Diego.
Unfortunately, both public and private health organizations have been slow to adopt the findings of the ACE Study and adapt their work to it. For those that have, the results of the new approach are nothing less than astounding: the most hopeless of lives turned around, parents speaking about “ACEs” and determined not to pass on their high ACEs to their children, and a significant reduction in costs of health care, social services and criminal justice.
The ACE Study not only provides insight and understanding about the lives of hundreds of millions of people around the world who use biochemical coping methods – such as alcohol, marijuana, food, sex, tobacco, violence, work, methamphetamines, thrill sports, etc. – to escape intense fear, anxiety, depression, anger, it shows that chaotic, stressful, abusive, and violent experiences in childhood are far from uncommon and these issues need to be dealt with if we want to create a society of healthier, happier, and better adjusted individuals.
What can you do? Spread the word and find out your own ACE score. To learn more, visit http://www.acestudy.org.
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