Dr. Roberta Waite: Replicating A Landmark Public Health Study

Replicating a landmark public health study, Dr. Roberta Waite has refocused it on an exceptionally appropriate population.

Dr. WaiteThe popular press has made risk factors associated with disease part of our common knowledge. Smoking carries the risk of lung disease and cancer. Obesity puts people at risk for a range of diseases ranging from diabetes to cardiovascular problems. Too much sun exposure can lead to skin cancer.

While all of these statements are true, it is also true that some aspects of disease can’t be explained in terms of the usual risk factors. We can all point to people who never smoked and had scant exposure to secondhand smoke, but nevertheless developed lung cancer. Clinicians cite many instances in which two apparently similar patients with cardiovascular disease have quite different outcomes: one dies at an early age while the other lives with the disease for years.

Researchers continue to search for possible explanations. A body of evidence has grown over the last decade suggesting that childhood events may be connected to physical, psychological and social problems later in life. The Adverse Childhood Experiences (ACE) Study, funded through the Centers for Disease Control and Kaiser Permanente, provided much of this evidence.

An important public health study conducted in the 1990s, ACE examined a multitude of connections between exposure to childhood adversity (such as physical or emotional trauma) and physical, psychological, social, and employment problems developing later in life. At 11th Street Family Health Services of Drexel University, Dr. Waite explains why she is conducting the first replication of the ACE study.

The inclusion of the 11th Street population is going to be significant because it helps determine who needs to be at the table in developing solutions.

“Given the high rates of morbidity and mortality among adults with certain diseases that we can’t attribute to classical risk factors associated with these illnesses,I think it’s imperative that we take a close look at the factors identified in ACE.” Funded by a grant from the Barra Foundation, Dr. Waite and her research team are collecting data using two surveys developed for the original ACE study: the Health Appraisal Questionnaire and the Family Health History. “We’re approaching all patients 18 years of age and older at the Health Center.”

“The original ACE study gathered data from a fairly broad demographic: people from all walks of life, living in the San Diego area. Our study is applying the same scrutiny to a population of inner city, low-income, mostly people of color— in which adverse experiences are known to be very common.” The researchers plan to include some 1000 patients in the study.

Entering data at a table in the 11th Street lobby, Reeva Gupta smiles as passing patients stop to read a sign soliciting study participants. “It takes 15 minutes to take the data,” she notes. “Sometimes as much as half an hour. It depends on the individual. “The survey addresses things people aren’t always eager to talk about, but you’d be surprised at how they’ll open up if you talk to them.”

Dr. Waite looks forward to using the ACE data in several ways. “The inclusion of the 11th Street population is going to be significant because it helps determine who needs to be at the table in developing solutions. “It will also help identify how patients with high ACE scores can benefit from the integrative transdisciplinary approach at 11th Street.”

Augmenting survey data, the research team will view patients’ medical records for medical diagnoses and to examine which services they have used at 11th Street. While many health systems can cite anecdotal data about trauma, outcomes from Dr. Waite’s research will provide much-needed evidence about the extent of the problem and inform healthcare providers about the resources needed to more appropriately treat these contributing factors related to many chronic illnesses. “ACE is part of the story,” concludes Dr. Waite. “If we’re going to develop effective interventions, we need to base them on empirical data.”