What do cholesterol scores and ACE scores have in common?
- on July 18, 2011
For the answer, you'll have to read to the end. And the story behind this link between cholesterol scores and ACE scores begins with, of all things, our polls.
Our WellCommons polls are entirely unscientific — you can't tell if they're accurate or not — but we think they're kind of interesting.
If our polls can be believed, however, most of us in Lawrence and Douglas County watch 1-4 hours of television every day. We're not worried enough about the risk of brain cancer to stop using our cell phones. We're about evenly divided between being morning people and not no way ever never. We're also evenly divided between ordering fries or salad as a side dish. Most of us have seen a dentist in the last six months. (Perhaps that means that most of the people who voted have dental insurance?) But quite a few haven't seen a dentist in 5 years.
If our polls come anywhere close to reflecting the Lawrence-Douglas County community, they say we're a healthy bunch — most of us can do between 10 and 70 pushups! (And more than I expected can do 100 — must be the influence of Red Dog Days.) And a surprising 41 percent of people voting in this poll ate four or more servings of vegetables each day. Wow. Somehow I don't think that 41 percent of the 110,000 people living in Douglas County eat that many vegetables every day. Maybe they're counting french fries. Maybe we need to have a poll to ask if people believe that poll.
By far the poll that attracted the most votes was this one:
There were some other interesting results, too. A LOT of people said they were bullied in elementary school. That poll accompanied a post about the bullying prevention program at Prairie Park Elementary.
And quite a few people -- mostly women, no doubt -- have been victims of domestic violence:
That last one got me to thinking that it would be very interesting to run a series of polls based on the ACE Study -- the Adverse Childhood Experience Study at the U.S. Centers for Disease Control and Prevention. So, that's what we're doing, this week and next.
What's so special about the ACE Study? It shows a direct link between child trauma and diabetes, heart disease, lung cancer, and a host of other chronic illnesses that people get when they're adults. The higher a person's ACE score, the higher risk of chronic disease when they're an adult.
There are 10 types of trauma measured in the ACE Study. Five are personal -- physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to the family: a parent who's an alcoholic, a mother who's a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. Each type of trauma counts as one. So a person who's been physically abused, with one alcoholic parent, and a mother who was beaten up has an ACE score of three.
Of course, we know that there are other types of child trauma — a family member with a serious illness or major injury, death of a sibling, being bullied in school. Although the ACE Study didn't measure those, in the bigger picture, there's no doubt that they can have an effect on a child's long-term development. In other words, trauma is trauma, and it can damage the developing brain of a child.
The original ACE Study began in San Diego at Kaiser Permanente — a health maintenance organization with nearly 9 million members in the U.S. About 17,000 people participated. Researchers found that one out of four people had an ACE score of 3 or more; one out of six had an ACE score of 4 or more. With an ACE score of 4, smoking and lung disease are 390 percent more likely; sexually transmitted disease, 250 percent; depression, 460 percent; suicide, 1,220 percent more likely.
What was most surprising to me is that most of the 17,000 people who participated were overwhelmingly white, middle- and upper-middle class, college-educated, with jobs and great health insurance (they all belonged to Kaiser). Their average age was 57. If these people, with all of their support systems and resources, had such a difficult time, what about people who don't have resources?
The ACE Study is catching on — five states have done their own ACE Study. Washington State was the first, in 2009, and found similar results to the CDC research.
Last yeaer, Dr. Robert Anda, one of the co-founders of the ACE Study, and Dr. David Brown of the CDC did an analysis of Washington State's ACE survey: Adverse Childhood Experiences & Population Health in Washington: The Face of a Chronic Public Health Disaster. Here are a couple of paragraphs from his introduction:
Until very recently, this public health disaster has been hidden from view. Our society has treated the abuse, maltreatment, violence and chaotic experiences of our children as an oddity that is adequately dealt with by emergency response systems -- child protective services, criminal justice, foster care, and alternative schools -- to name a fiew. These services are needed and are worthy of support -- but they are a dressing on a greater wound.
Our society has bought into a set of misconceptions. Here are a few: ACEs are rare and they happen somewhere else. They are perpetrated by monsters. Some, or maybe most, children can escape unscathed, or if not, they can be rescued and healed by emergency response systems. Then these children vanish from view...and randomly reappear -- as if they are new entitities -- in all of your service systems later in childhood, adolescence, and adulthood as clients with behavioral, learning, social criminal, and chronic health problems.
The first step toward healing, says Anda, comes with understanding the problem. Calculations that he and Brown did in their analysis showed that if the causes of ACE were removed in Washington State, heart disease would decrease by 25 percent, cancer by 24 percent, asthma by 22 percent, smoking by 36 percent, HIV risk by 59 percent and divorce by 33 percent. That's a lot of emotional cost and economic cost that could be eliminated.
So, this is our first baby step — just to get the conversation rolling. There are 10 questions on the general ACE Study questionnaire, and for the next two weeks, we'll be putting one question out each day in a poll. We're publishing the first one today. Each day I'll take a look at some of the research — ACE, brain development, and epigenetic — to provide more information and context. I encourage you to take the simple ACE test for yourself. There's also a link to the full 200-question survey.
To end with the beginning: What do cholesterol scores and ACE scores have in common? A high cholesterol score is a simple way to understand that you've got a serious health issue that can lead to heart disease, and you need to exercise and eat less and better to lower the score. A high ACE score is a simple way to understand the link between your chronic illness and your childhood trauma. You can't undo the past to lower the score, but understanding it may put you on a better path to improving your health. And, just as important, by understanding the link between your own child trauma and chronic illness — or the link between a relative or friend's child trauma and chronic illness — you can be part of the solution to make sure your children, grandchildren and your community's children have low ACE scores.