Chris Bowling
32 statements · 1 topic · summaries given as host listed separately
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The ten adverse childhood experiences (ACEs) are: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, mother treated violently, household substance abuse, household mental illness, parental separation/divorce, and incarcerated household member.
clinical ·
Pediatric Obesity
Even when controlling for behavioral factors (obesity, smoking, substance abuse), children exposed to ACEs still had higher rates of diabetes, heart disease, stroke, and cancer.
epidemiological ·
Pediatric Obesity
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Chris's statements about Pediatric Obesity 32 statements
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Social Determinants of Health: Pediatric Obesity 2017
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Age-standardized mortality rates show clustering of respiratory disease deaths in eastern Kentucky and southern West Virginia coal-mining areas.
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Cardiovascular disease mortality is very high in the Mississippi Delta region (Arkansas, Tennessee, Mississippi, Louisiana border) and in Appalachia.
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Eastern Kentucky and southern West Virginia are the epicenter of the current heroin outbreak, with staggering rates.
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The heroin epidemic in the Ohio River Valley resulted from a distribution network encountering a population primed by the prescription drug epidemic.
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Cancer mortality rates are very high in the Mississippi Delta and Appalachia, possibly tied to chronic respiratory illness.
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Areas with high mortality from multiple diseases (respiratory, cardiovascular, cancer, infections) have a distribution similar to areas affected by pediatric obesity.
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Common infections (pneumonia, diarrhea) show geographic clustering tied to socioeconomic status, similar to obesity and oral health.
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The ACEs (adverse childhood experiences) study was developed in 1997 by Felitti and Anda in San Diego, starting as a dropout study from an obesity treatment program.
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Patients succeeding in the obesity program were dropping out at rates equal to those struggling, prompting investigation into other life factors.
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The ten adverse childhood experiences (ACEs) are: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, mother treated violently, household substance abuse, household mental illness, parental separation/divorce, and incarcerated household member.
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In families with ACEs, there are increases in smoking, substance abuse, obesity, diabetes, heart disease, stroke, and cancer.
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Even when controlling for behavioral factors (obesity, smoking, substance abuse), children exposed to ACEs still had higher rates of diabetes, heart disease, stroke, and cancer.
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Children exposed to ACEs had shortened life expectancy even when controlling for behavioral risk factors.
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In the ACEs study population, 67% of families reported at least one ACE, 40% had two or more, and 12.5% (1 in 8) had four or more.
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The effects of multiple ACEs are more than additive—they are almost multiplicative, with profound health impacts as the number of ACEs increases.
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Chronic activation of the fight-or-flight response—persistent elevation of epinephrine, cortisol, norepinephrine—has real physiologic consequences over a lifetime.
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Toxic stress affects the hypothalamic-pituitary-adrenal axis and other parts of the endocrine system.
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Overstimulation by norepinephrine, epinephrine, and cortisol may affect leptin resistance and insulin resistance in children with obesity.
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Toxic stress decreases the ability to fight off infection and changes immune modulation.
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Living in a stressful situation changes gene expression through epigenetic mechanisms—methylation and histone modification—that can result in adverse health outcomes.
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Epigenetic changes from toxic stress have profound impacts on development, aging, mental health, diabetes, and cancer.
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Social determinants of health can be used as proxy questions to screen for adverse childhood experiences and categorize families by risk.
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Barriers to ACEs screening in pediatric practice include provider concerns about parent pushback, time constraints, lack of resources to address identified problems, and poor reimbursement.
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Bowling's practice partners with Beech Acres Parenting Center, which provides an in-office parenting specialist to counsel families, connect them with resources, and teach behavioral techniques.
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The SEEK (Safe Environment for Every Kid) screening tool from the University of Maryland is used at 1-month, 9-month, 2-year, and 3-year well-child visits in Bowling's practice.
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Food insecurity is directly connected to adverse childhood experiences and is one of the more commonly answered questions on the SEEK questionnaire.
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Unstable or variable housing impacts the ability to maintain healthy food environments and to maintain contact with families in obesity care.
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The original ACEs study population was 70% white, 70% college-educated, and 100% insured, demonstrating that ACEs are not limited to low-income populations.
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In Bowling's suburban practice, 10–15% of the population screens positive for adverse childhood experiences on the SEEK tool at a single point in time.
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Nadine Burke Harris is a developmental specialist at UCLA who gave a 16-minute TEDMed talk on toxic stress and ACEs.
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Motivational interviewing skills are useful for asking ACEs screening questions in a non-threatening way and getting to the root of family issues.
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Summaries Chris gave as host · 4 summaries
Recaps of other experts' statements, not Chris's own clinical position.
Summaries Chris gave as host · Pediatric Obesity 4 summaries
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Social Determinants of Health: Pediatric Obesity 2017
Host summary
Chris Bowling summarizing the discussion: Doctor Bowling, that's great. Um, I'm more worried about my child getting shot when they walk out the door rather than them getting exercise to be at a healthy weight.
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Chris Bowling summarizing the discussion: You know, I just, I can't even imagine trying to screen for some of these things in the midst of all the other things I'm asked to do as a pediatrician.
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Chris Bowling summarizing the discussion: OK, I've uncovered that the mother is in an abusive relationship. Now, what do I do? I have no resources to deal with this.
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Chris Bowling summarizing the discussion: This is all well and good, but you have no idea what I'm dealing with at home.
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