PREVENTING ADVERSE CHILDHOOD EVENTS

BY ALISON MCGAUGHEY

Corinne 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 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.

Another component of a syndemic is that the underlying causal factors interact with each other. So, for example, a child who falls off of their bike, then gets exposed to a cold virus at the same time is not experiencing interacting causal factors. Instead, imagine a child who is a victim of abuse: suffering from that abuse leads to having a depressed immune system, which then leads them to being susceptible to infectious disease. So, the risk factors are not just parallel—they interact.

Adverse childhood experiences, which have health implications so early in life, are a component of many violence syndemics. Childhood adversity, for example, is an underlying element in many of the “diseases of despair”— substance use, alcohol use, and suicide. The work we do at the Injury Prevention Research Center is pushing the boundaries of how we can address some of the larger social determinants of these violence syndemics.

Corinne Peek-Asa

What sparked your interest in syndemics, and how do you see it being most useful in your areas of research?

The component of syndemics that most interests me has to do with cultural and social determinants. In other words, the nexus of adverse childhood experiences and substance use is concentrated in populations of people with limited access to health care, lower education levels, less access to resources, and fewer social connections.

From a public health standpoint, it’s important to address these connections to social inequity and poverty. And that can include changing the way we design our studies to think about these broader contexts. For example, we have done some studies in Romania showing that when the country joined the European Union, new roads were built in ways that did not accommodate pedestrians, especially those who had some physical limitations, like the elderly; they were having challenges getting across the road. It became clear that safety had not been a priority in decisions about transportation infrastructure.

So the syndemic framework is helpful in that it shows us we’re not going to solve the problem by installing lights, adding more stop signs or crosswalks, or having police do more patrols. We’re only going to solve the problem by building roads that accommodate all users, and by making health and safety a priority in transportation decisions. This approach, called “Health in All Policy,” is becoming a higher priority everywhere from the U.S. Department of Transportation to the World Bank.

What kinds of shifts in public health, or society at large, might be required to see more effective prevention or intervention?

We need to invest in early childhood injury intervention and prevention programs, and to think much more about health outcomes as a life trajectory. When we think about adverse childhood experiences and their ties to future substance use, we need to realize that a systems-oriented solution goes far beyond helping addicted people in rehab; a systemic approach will prevent the adverse childhood experiences. How do we as a society think about preventing child abuse? That’s a really hard question because it’s such a complex issue. Abuse is often intergenerational. It can be hard to detect. So, while we’re working on answers to this question, I want us to do our work thinking more in the big picture, focus on prevention, and how it can fit into these thorny societal issues.

This article originally was published in Iowa Now.