By Chrissie Young, MS
Since the landmark 1998 study conducted by the CDC and Kaiser Permanente, it has been understood that Adverse Childhood Experiences (ACEs), traumatic events occurring before age 18, have a profound and lasting impact on adult health. These experiences, ranging from abuse and neglect to household dysfunction like substance misuse or mental illness, are remarkably common. Approximately 62% of adults have experienced at least one ACE, and one in six report four or more.
The evidence for a dose-response relationship between ACEs and negative health outcomes is striking. Individuals with high ACE scores (four or more) face significantly increased risks for nine of the ten leading causes of death in the United States. This includes a 2.1-fold increased risk of heart disease, 2.3-fold for cancer, and 3.1-fold for chronic lower respiratory disease. The impact on behavioral health is even more acute, with high ACE scores associated with a 4.7-fold increase in depression, a 10.2-fold increase in substance dependence, and a staggering 37.5-fold increase in suicide attempts.
The biological mechanism driving these outcomes is the toxic stress response. When significant adversity is experienced without the buffering protection of safe, stable relationships, it leads to prolonged activation of the body’s stress response systems. This disruption to neuro-endocrine-immune-metabolic (NEIM) function, alters gene expression via epigenetic markers, and accelerates cellular aging through the shortening of telomeres.
However, the most critical takeaway for clinicians is that ACEs are not destiny. The brain and body remain malleable throughout the life course, and targeted interventions can improve outcomes even for adults with high ACE scores. A modern clinical response requires moving beyond isolated medical treatments toward a multidisciplinary “Network of Care” that leverages the expertise of Community Health Workers (CHWs).
CHWs are essential mitigating factors because they are uniquely positioned to solve for social determinants of health (SDOH). Because ACEs often co-occur with challenges like housing instability, food insecurity, and economic hardship, CHWs help patients secure these basic needs. By addressing these external stressors, CHWs effectively lower the “cumulative dose” of adversity the patient experiences, which is necessary for the body to return to a state of homeostasis. Furthermore, as culturally congruent navigators, they build the trust needed to coach patients in self-care and “stress-busting” strategies.
Robust evidence suggests that seven key evidence-based strategies can mitigate NEIM disruptions and enhance neuroplasticity:
Supportive Relationships: Buffering stress through strong emotional connections.
Quality Sleep: Improving immune regulation through healthy sleep habits.
Balanced Nutrition: Counteracting pro-inflammatory states with anti-inflammatory diets.
Regular Physical Activity: Promoting neurogenesis and metabolic health.
Mindfulness Practices: Reducing stress hormones and improving emotional regulation.
Access to Nature: Lowering blood pressure and calming the stress response.
Mental and Behavioral Healthcare: Trauma-informed therapies to reverse cellular “wear and tear”.
Implementing trauma-informed care (TIC) allows providers to move the clinical inquiry from “What is wrong with you?” to “What happened to you?”. By recognizing toxic stress as a treatable health condition and utilizing CHWs to address underlying social needs, we can offer genuine healing. In doing so, we not only improve individual adult outcomes but also interrupt the intergenerational transmission of adversity, providing a healthier foundation for the next generation
References:
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Centers for Disease Control and Prevention. (2021). About the CDC-Kaiser ACE study. https://www.cdc.gov/violenceprevention/aces/about.html
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Tan, H., Zhou, H., Chen, J., Ren, H., Guo, Y., & Jiang, X. (2024). Association of early life adversity with cardiovascular disease and its potential mechanisms: A narrative review. Frontiers in Public Health, 12, Article 1341266. https://doi.org/10.3389/fpubh.2024.1341266
UCLA Health. (2021, November 23). Is there a link between childhood trauma and adult neurologic conditions? https://www.uclahealth.org/news/article/is-there-a-link-between-childhood-trauma-and-adult-neurologic-conditions
Chrissie Young, MS, is the Director of the Center for the Prevention of Child Maltreatment at the University of South Dakota. She leads statewide efforts to strengthen child- and family-serving systems through training, technical assistance, prevention initiatives, and cross-sector collaboration. Her work focuses on building community and professional capacity to better recognize, respond to, and prevent child maltreatment and adverse childhood experiences. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on,YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).