Originally posted on LinkedIn.
Science and medicine are rapidly catching up to the role that early adversity often plays in short- and long-term health. Researchers have been aware of ACEs—adverse childhood events—since a landmark 1998 study. But it’s taken some time to push the information publicly, and still more time to recognize that institutional and overt racism are ACEs too. Because parents can do little to prevent their children’s exposure to racism, it’s critically important to understand the role that positive parenting plays in blunting its effects. The good news is that parents can and do make a significant difference.
The original ACEs study, conducted by the Centers for Disease Control in partnership with Kaiser Permanente, is one of the largest studies of the links between early adversity and later health outcomes. It examined a group of 17,000 mostly Caucasian (75%), mostly college-educated (75% with at least some college) people. Researchers assessed how many ACEs each participant had suffered as a child under 18 years old. ACEs fall into three categories: abuse (emotional, physical, sexual); neglect (emotional and physical); and household dysfunction (mother treated violently; household substance abuse; household mental illness; parental separation or divorce; incarcerated household member).
The study established a strong link between early adversity and later negative health outcomes, finding that risks of suicide attempts, early pregnancy, substance abuse, depression, heart disease, cancer, and other conditions increased as exposure to ACEs increased, in a classic dose-response relationship. Nearly three-quarters of participants reported at least one ACE. Twenty-six percent of all participants had at least one ACE, 15.9% had two, 9.5% had three, and 12.5%—15.2% of the women and 9.2% of the men—had four or more, where four ACEs represents the threshold of greatly increased risk.
The original Kaiser study did not include racism and community violence in its inventory of ACEs. But recently, other researchers have. Prominent among them is Dr. Roy Wade, a Philadelphia pediatrician who has added “Expanded ACEs,” including racism, community violence, and other early adversity experienced outside the home, to “Conventional ACEs” in his study of the impacts of child trauma. The group of adults Dr. Wade studied was 45% white, 44% African American, 4% Latino, and 4% Asian; 55% had at least some college. Dr. Wade and his colleagues found that 14% of the participants they studied experienced only Expanded ACEs (and had a higher tendency to be male, non-white, divorced, and earning 150% of poverty level). Their trauma would have gone unnoticed in a traditional study, yet the effects were the same. An additional 49% of the participants had experienced at least one Conventional and at least one Expanded ACE. Counting all participants, 34.5% reported experiencing racism.
This is a public health crisis hiding in plain view. Durable, broad community solutions are desperately needed. But some of the interventions that really help children build resilience to and successfully tolerate these stressors are already in the parental toolbox. We know that a warm, loving, supportive relationship with an adult is tremendously helpful. Mindfulness meditation is too. The standard triad of diet, exercise, and sleep is a third tool. And parents can work with schools to ensure that the teachers and school system are trauma-informed.
Parents of white children—like me—absolutely have a role to play here. The findings of the ACEs study are probably too heavy for younger children. But all youth can be taught that racism is not only unjust, morally wrong, and wrongheaded generally, but it also hurts children and youth of color emotionally and physically. Racism can literally make children sick. Our children need to know this, because they bear responsibility to eradicate racism as a public health menace—just as their parents do.
This information gives us all more reasons to ground our practice in love. Health begins with hope. Let’s live it.
--Mary Kelly is a member of the Board of Directors of the Center for Youth Wellness, a pediatric clinic in San Francisco’s Bayview neighborhood that is dedicated to improving the health of children and youth affected by ACEs. All views expressed are her own.