Q&A: Adverse Childhood Experiences and Toxic Stress

What do ACEs mean for long-term health?

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Not all Greater Chattanoogans have what they need to lead a healthy life. 

And not all members of our community can expect the same health outcomes in their lifetime. Much of what determines a person’s health occurs outside the doctor’s office. Unfortunately, factors like zipcode, socioeconomic standing and others -- called social determinants of health, which we’ll talk about more next month -- have an outsized impact on an individual’s or household’s health outcomes. At United Way of Greater Chattanooga, we fight for equal access to health for every member of our community. We believe that everyone deserves the opportunity to succeed, and that good health depends not just on access to quality medical care, but also the opportunity to live in an environment that is conducive to healthy living.


One of the ways we can understand an individual’s health outcomes, and address the related issues closer to the root, is through the ACEs framework. ACEs stands for Adverse Childhood Experiences. When we look at an individual’s early life in terms of ACEs, we see a correlation between the number of adverse experiences and negative health comes. Basically, the more ACEs a child accumulates, the more likely they are to experience poor health in a number of ways later in life. 



Adverse Childhood Experiences: a Q&A with an Expert 

This week, we sat down with Kristen Pavlik McCallie (Executive Director of the Children’s Advocacy Center and member of the Early Matters ACEs Workgroup) to learn more about ACEs and what they mean for our neighbors’ health -- as well as how an understanding of ACEs can be used for positive change. Read on to keep learning from Kristen.


Q: What does ACEs stand for? 

A: ACEs initially stood for the Adverse Childhood Experiences Study. This study was significant because it was the first time that there was a direct connection made between an individual’s childhood trauma and poor health outcomes as an adult. The ACEs study showed a significant correlation between experiencing multiple types of trauma and having health issues like high blood pressure, obesity and other health problems that come from using maladaptive behaviors (like smoking, using drugs, overeating) to cope. If a person experiences six types of ACEs early in life, their likelihood for early morbidly increases. (All stats are paraphrased from the Centers for Disease Control and Prevention).


Q: What kinds of experiences do ACEs refer to? 

A: ACEs contain a range of experiences that are both chronic and acute -- exposure to violence in the home, loss of a parent or caregiver, living in poverty or having a parent that may be coping with substance abuse or mental health issues.


Q: What sorts of factors put children at high risk for ACEs?

A: Kids are resilient. The way trauma (which can be the outcome of ACEs) affects each child is different. Lack of support is the biggest risk factor for kids. When we have an illness like the flu, we get a vaccine to prevent it from happening. With trauma, there is no vaccine we can give to reduce risk in the same way. Studies on chronic trauma and what drives resilience in a trauma victim state that even one relationship with a safe, stable, nurturing adult creates “a vaccination” against the poor health outcomes that ACEs can predict.


Q: How prevalent are ACEs among households in Greater Chattanooga?

The Children’s Advocacy Center sees between 500-800 children annually in Greater Chattanooga who have disclosed some type of severe abuse. We know that for every case reported there are between five and seven that go unreported. From this perspective, we know the risk of being a victim of violence within the home is high. Perpetrators of sexual abuse are known by the family 90% of the time. This ACE is prevalent and difficult to talk about, and like most ACEs there is no physical mark that can show and predict long-term chronic health problems. In terms of overall ACEs exposure in Tennessee, 13% of the general population identifies as having experienced at least one ACE, the most common being divorce in the home, followed by substance abuse exposure.


Q: What is considered 'toxic stress' and how does it relate to ACEs? 

Everyone experiences stress, and when circumstances provide support, that creates resilience despite the strain. Toxic stress is chronic stress with no support in place to provide relief. This type of stress can cause an individual’s brain chemistry to change in a way that has long-term impact on health and coping strategies.


Q: What impact do ACEs have on immediate and long-term health outcomes? What about on educational outcomes or other measurements of success? 

As mentioned above, ACEs can affect health in a lot of ways. If our health isn’t at 100%, it becomes difficult to do activities like attend school or work, or to focus in general. Individuals who identify as having between four and six ACEs have lower higher education graduation rates, and as they age their work attendance is often affected. Their healthcare costs are often greater as well, which can put them in financial strain.


Q: What are some ways of addressing ACEs and the associated health outcomes? 

Prevention is key for all types of ACEs. Providing children with education about safe adults, boundaries and strong communication skills can increase their self-advocacy. Having a relationship with a safe, stable adult can be transformative for an ACEs victim. Additionally, the Centers for Disease Control has done extensive research on violence prevention that indicates when you address one type of violence at the individual, relational or community level, you often address multiple types. For example, if you provide elementary school students with information on healthy relationships, this also plays a role in preventing teen dating violence and elder abuse. 



What can you do?

We can’t win the fight for health alone. Our neighbors need you to get involved. And now that you know more about ACEs and how it helps us understand who is at risk for poor health, you’re one step closer to joining the fight. Today, we ask that you share this article with someone who could benefit from learning about the ACEs framework. Encourage them to get involved -- this work is too difficult to do alone, but far too important not to do together.

Together, We Can

Building a strong community that takes care of everyone who lives here depends on your generous support.