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A majority of Americans believe adverse events during childhood can have a harmful effect on their health as adults. That was one of the major findings in NPR's latest poll with the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. And we've been exploring this idea in our series, What Shapes Health? Today, NPR's Laura Starecheski takes us to two Philadelphia clinics. They're trying to intervene at an early age to prevent health problems like heart disease, diabetes, depression and addiction.
LAURA STARECHESKI, BYLINE: At the Cobbs Creek Clinic in West Philly, pediatrician Roy Wade uses the tools every doctor uses when he does an exam - blood pressure cuffs, a stethoscope and, of course, tongue depressors.
ROY WADE: Can I look into your mouth really quickly? Can you go ah for me?
STARECHESKI: He also uses questions to get at something not too many doctors try to measure - adversity.
WADE: If you only have five minutes with the kid, what would be the five most relevant questions that you would need to ask in order to assess the kid's adversity? You don't have time to ask 20 questions or 10 questions.
STARECHESKI: Dr. Wade is designing a simple screening tool - a short list of questions that would give every young patient here an adversity score. It'll include abuse and neglect - things pediatricians look for already - and also poverty, discrimination, bullying. Wade wants to take action because research has shown that the stress of a tough childhood can raise your risk for later disease, mental illness and addiction. He knows he's got a special chance to head off those bad outcomes early, so if he sees a kid with a high adversity score...
WADE: ...That's not going to be a kid who I say, you know, come back to me in a year. That's going to be a kid who I say, come back to me in three months or two months. Let's see how you're doing. Let's check in.
STARECHESKI: Take 11-year-old Tavestsiar Fullard. When I met him, he was just about to start middle school, and he was really excited about one thing.
TAVESTSIAR FULLARD: In middle school the fifth grade is going on a camping trip.
STARECHESKI: Tavestsiar likes school now, but he didn't used to. Just a few years ago he was really struggling.
T. FULLARD: I was living with my mom, and I was in a shelter with my mom. And then I moved with my dad.
SYLVESTER FULLARD: He wouldn't talk. He didn't want to be around other kids.
STARECHESKI: Tavestsiar's dad, Sylvester, started taking care of him about five years ago, after his mom grabbed his face on a city bus one morning, leaving scratch marks with her nails. Child Protective Services intervened.
S. FULLARD: You know, if you just say something, he'd just, you know, go into, like, a little shell.
STARECHESKI: It's hard for him to talk about, but this information is really important for Tavestsiar's care because one of his health problems is severe obesity.
S. FULLARD: I felt, you know, like it was my fault that he added that weight, you know, because I started, you know, just giving him whatever he wanted to make him feel better after all the things he's been through. So I'm like, oh, maybe this will make you feel better. And then I look at his old clothes, and I could fit them. So I was like, OK then, you know, it's the time.
STARECHESKI: Time to get Tavestsiar signed up for a weight loss program at Children's Hospital.
And what were you worried about?
S. FULLARD: Losing him. Yeah, that's the main thing. I didn't want nothing to happen to him.
STARECHESKI: Being a father to Tavestsiar changed Sylvester's life. When he got the call to come take custody - an emergency phone call - no warning - he'd been an alcoholic for years.
S. FULLARD: Right when I got the phone call I was just getting ready to take a drink. So I put the alcohol down and went straight to pick him up. And I've been - I haven't drank since - since that day.
STARECHESKI: He also started eating better and going to the gym with Tavestsiar. It's these kinds of family dynamics that intrigue Dr. Wade. He thinks getting an adversity score from kids could give him a way to be a doctor to a whole family.
WADE: It's an easy conversation talking about things like smoking. Instead of looking at the parent, you say, well, you know, these are the impacts that could have on your kid. It helps you to address an array of different problems within the family.
STARECHESKI: So how early can you start? At 11, like with Tavestsiar - 5 or 6? Across town at the 11th Street Clinic in North Philly, they're determined to start even earlier than that, before a kid is even born.
UNIDENTIFIED WOMAN: I'm telling you, when I get the epidural, I'm only five centimeters. Like, that ain't nothing.
UNIDENTIFIED MAN: That's halfway there. That's something.
STARECHESKI: This is what a prenatal visit looks like at 11th Street. It happens with a group of other parents. It's a few hours long, with time for a physical exam and lots of discussion. Today, Aisha Walters, the family and child support coordinator who runs this group, is trying something new for the first time.
AISHA WALTERS: These surveys that you took - nobody was going to look at them or see them, but share, you know, things that...
So the questionnaire I gave each participant was the ACEs questionnaire.
STARECHESKI: This questionnaire is another way to measure adversity. ACE stands for adverse childhood experience. When you fill it out, you get an ACE score from 0 to 10, depending on how many of the experiences you had growing up - things like physical and sexual abuse, neglect, death of a parent.
WALTERS: The lowest score that I saw was three ACEs.
STARECHESKI: And all the scores fell between three and five. That's important because an ACE score of four is the threshold that's considered a high ACE score, where health risks really start to rise. But Walters wasn't surprised by the high scores of these parents-to-be because a few years ago, researchers asked about 800 11th Street patients for their ACE scores.
PATTY GERRITY: And 49 percent - I should say a whopping 49 percent - had four or more ACEs.
STARECHESKI: That's Patty Gerrity, the founder and director of this place.
GERRITY: We knew we were working with a very traumatized population, but we were sort of astounded at the numbers.
STARECHESKI: They were astounded because the landmark study on ACEs was done with mostly white, mostly middle-class people in San Diego back in the '90s. And back then, researchers were shocked that 1 in 10 people had a high ACE score. Compare that with 1 in 2 - half of the patients at 11th Street.
GERRITY: We can't go back and change it, but the patients can change.
STARECHESKI: A big part of that is working with parents before their kids are even born. The hope is that if the adults talk about their childhood in the prenatal group, it'll help break generational cycles of trauma and abuse.
GERRITY: And when they learn about it, they really - they don't want this to happen to their children.
STARECHESKI: I talked to one of the moms in the prenatal group about this. Ashley Brant was about eight months pregnant with her third child when I met her.
ASHLEY BRANT: I kind of have a feeling it's coming (laughter). It's coming soon.
STARECHESKI: Ashley told me her own childhood was tough. She doesn't remember ever living with her mom, who had a drug problem. Her dad was murdered, and she had her first kid when she was only 12 years old.
What do you want to do for your kids as a parent that maybe is different than how you grew up?
BRANT: Just to be able to give them a mom - to know what it feels like to have a mother 'cause I don't. And I guess just seeing them smile, having me around and relying on me so much - it was like I'm doing something good - positive.
STARECHESKI: Research shows that having a bond with a caring adult is one of the best ways kids can overcome adversity. So Ashley could give her kids more than a great childhood. She could also give them a better shot at being healthy when they're grown. Laura Starecheski, NPR News.
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