Aces as missing link to chronic disease care
In 2018, Bermuda was introduced to another meaning for “Aces”, one that did not have to do with playing cards, doing well on a test, or calling to your best friend.
During Family Centre’s 2018 Adverse Childhood Experiences Conference — or the “Aces Conference” — leaders and professionals in social services learned that Aces is the abbreviation for the growing field of research in adverse childhood experiences.
At the same time, Family Centre was also diligently working with the Bermuda Health Council to put together a national study on Aces, although the questions being asked would be similar to the original landmark studies in the United States. Collectively, both agencies knew that this research would need to be created in Bermuda, participated in by Bermudians, and be provided back to our community for the self-driven betterment of Bermuda.
The existing health profile of Bermuda also drove the need for Aces research. Combined, diseases of the circulatory system and neoplasms or cancers account for almost two thirds of deaths in Bermuda. Additionally, more than 95 per cent of the Bermudian population has at least one risk factor for a non-communicable disease such as obesity, excessive alcohol use, high cholesterol or physical inactivity.
Despite the focus being “childhood” events, Aces is often the missing link from behaviours or habits to chronic disease and risk seeking behaviour. The United States-based study found, for example, the majority of their obesity-clinic patients who would cycle between weight loss and weight regain also shared exposure to sexual abuse and violent physical abuse as children. Common types of adverse childhood events found in the first study were overall related to childhood neglect, abuse and household dysfunction, linked to conditions such as heart disease, anxiety, diabetes mellitus and strokes.
Although connections were made between many chronic diseases and the three major groups of Aces from that prior study, we knew the Bermudian-based study would need to also consider culture as integral to “growing up in Bermuda”. Through extensive research, comparison and validation, we added questions of racial experience, poverty and experiences related to road traffic accidents. Each of these additions were meant to capture the human impact found in between statistics; the effect on those who are the “10 per cent of Bermuda living below the poverty line” or the families rushing into the ER for “the No 1 cause of hospitalisations is accidents”.
The way the community shares in trauma, even when indirect, is also very fundamental to the “Bermudian way” — no study could be successful without this understanding.
As a result, we rolled out the scientifically rigorous, ethical, Bermuda-specific and Bermudian-based ACEs study. Initiated by Stephanie Guthman and Family Centre, then technically supported by Tara Hines and the Bermuda Health Council, the study evaluated Bermuda’s unique circumstances from more than 700 unique participants across the country.
The answers themselves are richly reflective of our collective “Bermuda experience”, and provide support for continuing to build on a Bermudian-based research capacity. To share this information with everyone in Bermuda, the study co-principal investigators, Ms Hines and Dr Guthman, prepared a detailed white paper of the process and initial results. Led by Family Centre, and supported by the Centennial Foundation, we are excited to announce the launch of that 2018-2020 Bermuda Adverse Childhood Experiences White Paper.
The publication is available on the Family Centre’s website offering the research findings and a resultant call to action. As a community, the effort to prevent further adverse childhood events for our children of today and the future is always the first suggestion.
The reality of Aces research is that every individual can benefit because our community feels the impact continuously. Medical practitioners and patients with chronic conditions can rely on the information captured in the Aces study to support improving health.
Over the next few months, we will be discussing the preliminary findings and possible next steps in the hope of driving positive change forward in our community. At a time when our lives are uniquely isolated and stressed in ways we may not have envisioned, this exciting opportunity to improve both the lives of children and adults cannot be understated.
Let us turn this year from awareness to action. Together!
• In addition to the publication, you can find an introductory video on the Bermuda ACEs study on Family Centre’s website at www.tfc.bm
• Tara Hines, MSPH, and Stephanie Guthman, PhD, are co-principal Investigators of the 2018-2020 Bermuda Adverse Childhood Experiences Study