Preventing Adverse Childhood Events BY ALISON MCGAUGHEY
orinne Peek-Asa has devoted much of her research career to violence and injury prevention. She is an associate dean for research in the University of Iowa College of Public Health and professor in the Department of Occupational and Environmental Health. She also directs Iowa’s Injury Prevention Research Center (IPRC) and is an appointed member of the National Academy of Medicine’s Global Violence Prevention Forum. In May 2020, Peek-Asa was named an inaugural awardee of the new UI Distinguished Professorship program by the University of Iowa Office of the Provost. The program recognizes tenured scholars of national and international distinction who are having a significant positive impact within the state of Iowa and beyond through teaching, research, scholarship, and artistic creation. The Distinguished University Professor ranks highly among the honors bestowed by the UI on faculty members. In February 2020, Peek-Asa delivered the 37th annual UI Presidential Lecture, “Violence, Syndemics, and the Biology of Trauma.” She delved into these topics in a recent Q&A.
Why is childhood trauma so important to the research you focused on in your lecture? We’re learning about how trauma and violence in early childhood not only impact your development but can do so in a way that sets you up for many different health problems. So this leads to the question, if we can prevent extreme childhood adversity, traumatic stress, and abuse, can we show a lifelong trajectory of improved health? We need to 18 INSIGHT SPRING 2020
look at a lot of outcomes, and the framework that takes this approach is called a syndemic. Adverse childhood events, or ACEs, are traumatic experiences that impact brain development, causing a cascade of reactions that influence long-term health. These types of trauma can include emotional abuse and neglect, physical and sexual violence, household violence, substance abuse, mental illness, and even parental separation or divorce. Increasingly—all over the world, but especially in the U.S.— ACEs are being recognized for their damaging impact on brain development. This concept is recognized as the biology of trauma. In short, the brain will organize around the most common and intense experiences, turning them into a baseline, defining what is normal. We know that people with six or more ACEs have a life expectancy 20 years shorter than those with none.
How does a syndemic differ from an epidemic, and how does one unfold? Are we experiencing any syndemics in the U.S.? As we know, an epidemic is a health problem affecting a large number of people that has increased beyond what was anticipated. In addition to the current COVID-19 pandemic and opioid epidemic in our country, we’re also dealing with an epidemic of suicides and substance use. According to a report from the nonprofit Trust for America’s Health, this can actually be seen as a larger “epidemic of despair.” A syndemic is a cluster of related epidemics—synergistic epidemics— which are epidemics that have related causal factors and outcomes and involve larger social determinants.
