ROBERT SIEGEL, HOST:
We're launching a series today called What Shapes Health? We're exploring the social and environmental factors that affect our well-being. It's inspired in part by findings of a new poll released today by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. Here's one of the most notable results - a majority of adults believe abuse or neglect in childhood is an extremely important cause of problems with the person's health later in life. Back in the 1990s, two doctors explored the possibility of such a connection. As NPR's Laura Starecheski reports, what they found convinced them that American medicine was about to undergo a sea change, but that didn't happen.
LAURA STARECHESKI, BYLINE: In the 1980s, Dr. Vincent Felitti discovered something potentially revolutionary about the ripple effects of child sexual abuse. But he discovered it while trying to solve a very different health problem - helping severely obese people lose weight. Felitti had a new fasting treatment that worked really well at his Kaiser Permanente clinic in San Diego. The severely obese patients who stuck to it lost up to 300 pounds in a year.
VINCENT FELITTI: Oh, yeah. I mean, this is really quite extraordinary.
STARECHESKI: But then, some of the patients who lost the most weight quit the treatment and gained all the weight back faster than they'd lost it. Felitti couldn't figure out why, so he started asking. First, one person told him she'd been sexually abused as a kid. Then, another.
FELITTI: You know, I remember thinking, oh, my god. This is the second incest case I've seen in - then - 23 years of practice. And so I started routinely inquiring about childhood sexual abuse, and I was really floored.
STARECHESKI: Over half of the 300 or so patients said, yes, they too had been abused. Felitti wondered if he was uncovering a fundamental cause of obesity and all the health problems that go along with it. That possibility made him very curious. What if having a bad childhood could affect health in other ways? So Felitti got together with the Centers for Disease Control and Prevention and made a set of questions to study how childhood experiences might affect adult health.
CAROL REDDING: OK. So the first questions reads, (reading) did a parent or other adult in the household often or very often swear at you, insult you, put you down or...
STARECHESKI: That's Carol Redding, one of Dr. Felitti's patients. When she filled out the study questionnaire, Redding tallied up 10 different adverse childhood experiences.
REDDING: And if your answer is yes, you give yourself one point. So I gave myself one point.
STARECHESKI: There's a question about whether a parent was an alcoholic or used drugs.
REDDING: And that was a yes for me.
STARECHESKI: Mental illness in a parent, neglect, sexual abuse.
REDDING: All of these will be yeses for me.
STARECHESKI: Redding ended up with 10 yeses - 10 out of 10. A lot of people in the study had tough childhoods. Like Redding, most of them were highly educated, middle-aged white people in San Diego. Rob Anda is an epidemiologist. He was the one at the CDC who teamed up with Felitti on what they ended up calling the ACE study, ACE for adverse childhood experience.
ROB ANDA: I had no idea how much suffering there was hidden in the background of the lives of these people during their childhoods.
STARECHESKI: One in 10 people had grown up with domestic violence, 2 in 10 had been sexually abused, 3 in 10 had been physically abused.
ANDA: Just the sheer scale of the suffering, it was really disturbing to me. I actually remember being in my study and I wept.
STARECHESKI: And then Anda looked at what happened to all those people when they grew up.
ANDA: Very dramatic increases in pretty much every one of the major public health problems that we'd included in the study.
STARECHESKI: Cancer, addiction. Not everyone with a bad childhood developed a disease, of course. But according to the findings, four or more yeses to the ACE questions doubles your risk of heart disease. Women with five or more yeses are at least four times as likely to have depression.
REDDING: I had PTSD, certainly. I had the flashbacks, the depression.
STARECHESKI: That's Carol Redding, who had the 10-out-of-10 score.
REDDING: The anxiety - oh, my lord - anxiety. Like, if it were a tangible thing living in the house with me, I'd need another room just to house that.
STARECHESKI: Redding lives in a very tidy, peaceful, little house outside San Diego. The walls of her home office are lined with degrees and certificates. At 58, she's working on a Ph.D. From the outside, she's a total success. But inside - in her mind and her body - she has been battling her whole life.
REDDING: In adulthood, I had three bouts of cancer. I call it the trifecta (laughter).
STARECHESKI: She had a thyroid condition. She had high blood pressure as a 10-year-old from all the stress. The ACE study made her wonder if all of that - maybe even the cancer - might be connected to her childhood.
REDDING: All those confused, very scattered puzzle pieces of my life just locked together in one big, amazingly clear picture.
STARECHESKI: This newfound clarity meant so much to her that Redding started a newsletter about the ACE study. She later worked for the CDC publicizing it. And she did all that because one big question kept nagging at her. Why didn't more people know about this study?
ANDA: I thought that people would flock to this information...
STARECHESKI: Rob Anda, Felitti's partner at the CDC.
ANDA: ...And be knocking on our doors saying, tell us more. We want to use it. And the initial reaction was really silence.
STARECHESKI: In fact, it took a while to even get the study published. All the top medical journals at the time rejected the article.
ANDA: Because there was intense skepticism.
STARECHESKI: Which may have been warranted, according to Sarah Floud, an epidemiologist at Oxford University in England.
SARAH FLOUD: An association doesn't necessarily mean that one thing causes the other thing.
STARECHESKI: Floud says your ACE score is not a crystal ball that predicts health or illness. It's just one risk factor on top of lots of others - your genes, your diet, whether you drink or smoke, factors that the ACE study didn't measure perfectly. So if you're otherwise healthy - not a smoker or a drinker, not obese - can trauma in childhood alone cause diseases like cancer and heart disease? Sarah Floud is not convinced.
FLOUD: I don't think there's quite so much evidence for that. But that's not to say that it might not be true. It's just that that seems to be harder to prove.
STARECHESKI: Now, more than 15 years after the ACE study came out, scientists are trying to get a clearer picture of what these kinds of experiences do to the body and why the study results came out the way they did. Megan Gunnar has some ideas.
MEGAN GUNNAR: Well, you've reshaped the biology of the child.
STARECHESKI: Gunnar has been studying how children respond to stressful experiences for over 30 years. She says when we're small...
GUNNAR: ...We are being adapted to live in the kinds of environments we're born into.
STARECHESKI: Gunnar says adverse childhood experiences affect a kid's whole body - the brain and how they physically respond to stress, with hormones that affect their heart and lungs. And if you have traumatic experiences as a kid, your stress response system can almost get programmed to overreact. That affects all kinds of things in your body, but especially how your brain and your body work together.
GUNNAR: Experiences of neglect and abuse and stress actually impair the development of those circuits, so you are not as able to tell yourself not to eat the ice cream or smoke the cigarette or have that additional drink. You're less capable of regulating your own behavior.
STARECHESKI: Which means, she says, there are millions of children whose biology is being shaped by abuse and neglect. They're more likely to cope later by smoking, drinking, overeating. And they're more likely to grow up sicker. Laura Starecheski, NPR News.
SIEGEL: The full results of our poll are at npr.org. And while you're there, you can also find out your ACE score. This is NPR News.
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