Prairie Doc Perspective Week of May 24th, 2026
“Adverse Childhood Experiences: From Public Health Crisis to Clinical Opportunity”
By Chrissie Young, MS
Since the landmark 1998 study conducted by the CDC and Kaiser Permanente, it has been understood that Adverse Childhood Experiences (ACEs), traumatic events occurring before age 18, have a profound and lasting impact on adult health. These experiences, ranging from abuse and neglect to household dysfunction like substance misuse or mental illness, are remarkably common. Approximately 62% of adults have experienced at least one ACE, and one in six report four or more.
The evidence for a dose-response relationship between ACEs and negative health outcomes is striking. Individuals with high ACE scores (four or more) face significantly increased risks for nine of the ten leading causes of death in the United States. This includes a 2.1-fold increased risk of heart disease, 2.3-fold for cancer, and 3.1-fold for chronic lower respiratory disease. The impact on behavioral health is even more acute, with high ACE scores associated with a 4.7-fold increase in depression, a 10.2-fold increase in substance dependence, and a staggering 37.5-fold increase in suicide attempts.
The biological mechanism driving these outcomes is the toxic stress response. When significant adversity is experienced without the buffering protection of safe, stable relationships, it leads to prolonged activation of the body’s stress response systems. This disruption to neuro-endocrine-immune-metabolic (NEIM) function, alters gene expression via epigenetic markers, and accelerates cellular aging through the shortening of telomeres.
However, the most critical takeaway for clinicians is that ACEs are not destiny. The brain and body remain malleable throughout the life course, and targeted interventions can improve outcomes even for adults with high ACE scores. A modern clinical response requires moving beyond isolated medical treatments toward a multidisciplinary "Network of Care" that leverages the expertise of Community Health Workers (CHWs).
CHWs are essential mitigating factors because they are uniquely positioned to solve for social determinants of health (SDOH). Because ACEs often co-occur with challenges like housing instability, food insecurity, and economic hardship, CHWs help patients secure these basic needs. By addressing these external stressors, CHWs effectively lower the "cumulative dose" of adversity the patient experiences, which is necessary for the body to return to a state of homeostasis. Furthermore, as culturally congruent navigators, they build the trust needed to coach patients in self-care and "stress-busting" strategies.
Robust evidence suggests that seven key evidence-based strategies can mitigate NEIM disruptions and enhance neuroplasticity:

1. Supportive Relationships: Buffering stress through strong emotional connections.
2. Quality Sleep: Improving immune regulation through healthy sleep habits.
3. Balanced Nutrition: Counteracting pro-inflammatory states with anti-inflammatory diets.
4. Regular Physical Activity: Promoting neurogenesis and metabolic health.
5. Mindfulness Practices: Reducing stress hormones and improving emotional regulation.
6. Access to Nature: Lowering blood pressure and calming the stress response.
7. Mental and Behavioral Healthcare: Trauma-informed therapies to reverse cellular "wear and tear".

Implementing trauma-informed care (TIC) allows providers to move the clinical inquiry from "What is wrong with you?" to "What happened to you?". By recognizing toxic stress as a treatable health condition and utilizing CHWs to address underlying social needs, we can offer genuine healing. In doing so, we not only improve individual adult outcomes but also interrupt the intergenerational transmission of adversity, providing a healthier foundation for the next generation
References:
Bhushan, D., Kotz, K., McCall, J., Wirtz, S., Gilgoff, R., Dube, S. R., Powers, C., Olson-Morgan, J., Galeste, M., Patterson, K., Harris, L., Mills, A., Bethell, C., & Burke Harris, N. (2020). Roadmap for resilience: The California Surgeon General's report on adverse childhood experiences, toxic stress, and health. Office of the California Surgeon General. https://doi.org/10.48019/PEAM8812
Centers for Disease Control and Prevention. (2021). About the CDC-Kaiser ACE study. https://www.cdc.gov/violenceprevention/aces/about.html
Dube, S. R., Fairweather, D., Pearson, W. S., Felitti, V. J., Anda, R. F., & Croft, J. B. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71(2), 243–250. https://doi.org/10.1097/PSY.0b013e3181907888
Felitti, V. J. (2002). The relation between adverse childhood experiences and adult health: Turning gold into lead. The Permanente Journal, 6(1), 44–47. https://doi.org/10.7812/TPP/02.994
Merrick, M. T., Ford, D. C., Ports, K. A., Guinn, A. S., Chen, J., Klevens, J., Metzler, M., Jones, C. M., Simon, T. R., Daniel, V. M., Ottley, P., & Mercy, J. A. (2019). Vital signs: Estimated proportion of adult health problems attributable to adverse childhood experiences and implications for prevention — 25 states, 2015–2017. MMWR. Morbidity and Mortality Weekly Report, 68(44), 999–1005. https://doi.org/10.15585/mmwr.mm6844e1
Schultz, K. (2018, September 18). We have to talk about childhood trauma and chronic illness. Healthline. https://www.healthline.com/health/chronic-illness/childhood-trauma-connected-chronic-illness
Tan, H., Zhou, H., Chen, J., Ren, H., Guo, Y., & Jiang, X. (2024). Association of early life adversity with cardiovascular disease and its potential mechanisms: A narrative review. Frontiers in Public Health, 12, Article 1341266. https://doi.org/10.3389/fpubh.2024.1341266
UCLA Health. (2021, November 23). Is there a link between childhood trauma and adult neurologic conditions? https://www.uclahealth.org/news/article/is-there-a-link-between-childhood-trauma-and-adult-neurologic-conditions


Chrissie Young, MS, is the Director of the Center for the Prevention of Child Maltreatment at the University of South Dakota. She leads statewide efforts to strengthen child- and family-serving systems through training, technical assistance, prevention initiatives, and cross-sector collaboration. Her work focuses on building community and professional capacity to better recognize, respond to, and prevent child maltreatment and adverse childhood experiences. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on,YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).
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Prairie Doc Perspective Week of May 10th, 2026
“Pump Handles and Public Health”
By Jill Kruse, DO
Health care is often thought of as something that happens one patient at a time in a clinic or hospital. Public health takes a broader view and is focused on improving the health of entire populations. In 1854, a London physician helped stop a deadly cholera outbreak by removing a simple pump handle. That moment would become one of the earliest and most powerful examples of public health in action.  Back then no one understood how cholera spread. Many believed it was caused by “bad air” or mysterious environmental forces. They did not know that it was actually caused by a bacterium that was spread through contaminated water sources.  
Dr. John Snow noticed a pattern. In London’s Soho neighborhood, a cluster of cholera cases seemed concentrated around a single public water source, the Broad Street pump. When he mapped where people lived, most of the infections pointed back to that pump. Even those who lived farther away, but became ill reported getting their water from the same source. Meanwhile, workers at a nearby brewery, who drank beer instead of water, were largely spared. The brewing process, alcohol and acidity of the beer made it difficult for the cholera bacteria or other pathogens to survive. 
Armed with this evidence, Dr. Snow convinced local officials to remove the pump handle. This cut off public access to the contaminated water.  After this happened, the number of new infections quickly declined.  That simple act marked the beginning of modern public health; using data, observation, and intervention to stop disease at its source.
Today, public health has evolved from reacting to outbreaks to preventing illness before it starts. Public health professionals work behind the scenes to protect and improve the health of communities.  They do this through providing education, guiding policy, and conducting research. They are the unsung heroes of healthcare. When Public Health works well, it can be almost invisible or easy to ignore. However, when there is a breakdown in Public Health services, the results can be devastating to a community and the effects are obvious.  
Federal, state and local health departments prepare for emergencies, monitor for disease outbreaks, ensure food safety, and safeguard water quality. They also advocate for health screenings in underserved or high-risk populations. Public health officials work to reduce barriers to care and promote healthier lifestyles for everyone. They may not be removing pump handles anymore, but they are still working every day to protect our water, our food, and our communities. They are helping us all, as we say on the show, to stay healthy out there people.
Dr. Jill Kruse is a hospitalist at the Brookings Health System in Brookings, SD. She serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).

Prairie Doc Perspective Week of My 3rd, 2026
A Bump in the Crossroads of the Body 
By Andrew Ellsworth, MD


When was the last time you thought about your neck?


It’s easy to overlook, but your neck is a remarkably busy place. It houses the spinal cord, carrying signals between your brain and the rest of your body. It allows food to travel from your mouth to your stomach. It delivers blood to your brain. It contains muscles that support and move your head, along with your vocal cords, thyroid, and parathyroid glands.


In many ways, the neck is a crossroads of vital structures, and it can offer clues when something is not quite right elsewhere in the body.


Take a moment and gently feel your neck. Become familiar with what is normal for you. If you notice a lump or something that does not feel right, it’s worth paying attention.


Many neck lumps are not dangerous. Some are simply swollen lymph nodes reacting to an infection. A cold, flu, sinus infection, strep throat, dental issue, or even a skin infection can cause lymph nodes in the neck to enlarge. These typically improve over a couple of weeks as the body recovers.


However, as with any area of the body, if you feel a new lump or bump, consider an appointment with your provider to have it examined. 


As a general rule, if a neck lump persists beyond two to three weeks in an adult, it should be evaluated. In children, lymph nodes may remain enlarged a bit longer and still be harmless, but in adults, persistence deserves a closer look.


The feel of a lump can also provide clues. Lymph nodes from infection are often soft, movable, and a bit rubbery. In contrast, a hard, fixed, or rapidly growing lump is more concerning and should be checked promptly. Lumps that continue to enlarge or change over time also warrant evaluation.


Other symptoms also matter. Fever, unexplained weight loss, night sweats, or difficulty swallowing are important signals that should not be ignored. Swelling in multiple areas of the body may suggest a more widespread process, such as some infections or, less commonly, a cancer like lymphoma.


Another common finding is a thyroid nodule, located in the front of the neck. These are fairly common and usually benign, but they are often evaluated with ultrasound to better understand their size and appearance and to determine if follow-up is needed.


Some people experience a “globus sensation” which is the feeling of something stuck in the throat when nothing is actually there. This can be related to acid reflux, post-nasal drip, muscle tension, or even stress and anxiety. Once again, persistent symptoms should be checked out. 


The bottom line is simple: if you notice a lump or bump in your neck, do not ignore it. While many causes are minor and temporary, some require further attention. When in doubt, have it evaluated.
A quick check today can provide reassurance, or catch something early when it matters most.
Dr. Andrew Ellsworth is a Family Medicine Physician at Avera Medical Group Brookings in Brookings, SD. He serves as one of the Prairie Doc Volunteer Hosts during its 24th Season providing Health Education Based on Science, Built on Trust. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, YouTube, and Tik Tok. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB, YouTube and streaming on Facebook), 2 podcasts, and a Radio program (on SDPB, Sundays at 6am and 1pm).