Why were some people – indeed, some of the most successful at slimming down – more likely than others to drop out of a weight-loss program?
The question gnawed at Vincent Felitti, a physician in San Diego, as he looked for a pattern more than 25 years ago. As I described in my last post, Dr. Felitti eventually discovered that a large number of these patients had troubled childhoods — raising questions about if, how, and why psychological trauma in childhood could be connected with poor health later in life.
Felitti, then chief of preventive medicine at Kaiser Permanente, enlisted the help of Dr. Robert Anda — an internal/preventive medicine physician and epidemiologist with the Centers for Disease Control and Prevention — to develop a study and explore these questions in greater depth. The Adverse Childhood Experiences (ACE) Study was born.
Felitti and Anda recruited 17,337 adult members of Kaiser, the giant Health Maintenance Organization (HMO) based in California. The majority of those who participated in the study were white and middle class. Each underwent a physical examination and answered questions about things that might have happened to them through age 18. The questions spanned 10 categories:
Each category was worth one point. The highest possible adverse childhood experience (ACE) score was 10. (You can easily calculate your own ACE score here). Felitti and Anda then explored how ACE scores were associated with the health -- and health behaviors -- of their adult participants.
When the initial results appeared in 1998, they were astounded.
First was the sheer amount of childhood trauma — far more than the researchers had expected. Over 28% of the respondents reported being physically abused, 27% growing up with substance abuse in the household, and 25% of the women and 16% of the men being sexually abused. Of all the respondents, 15% reported four or more adverse childhood experiences (ACEs). Anda said tears streamed down his face when he first saw that data.
Second was the uncanny strength of the relationship between the number of ACEs and unhealthy behaviors and poor health outcomes. A person with an ACE score of 2 had significantly more health risk than a person with a score of 1, a person with an ACE score of 3 had significantly more health risk than the person with a score of 2, and so on all the way up to 10. The people with scores of 9 or 10 generally were in the poorest health.
Furthermore, the association did not exist just for a handful of specific health outcomes — it existed for many of the major risk factors of premature death in the United States.
So what could it be about childhood trauma and adversity that might make us do unhealthy things and put us at higher risk for poor health outcomes? And what are the implications of these findings?
These questions will be explored in my next post, on Monday.
This three-part ACE mini-series begins the exploration of a topic – trauma and health – that I will return to periodically. Upcoming posts will examine issues like urban violence, the “science of trauma,” and what people in Philadelphia are doing to address these issues.
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