Analyze

"The report distills cutting-edge learnings from a variety of scientific disciplines in a way that seeks to be accessible to a broad array of readers. The scientific standards used to develop the report include systematic and targeted searches using electronic research and grey literature databases of English language articles, with preference given to systematic literature reviews, metaanalyses, and replicable findings in multiple, large-scale, and/or well-designed studies from reputable sources. Where possible, such well-supported evidence is presented and related methodologies are described. Where not available, supportive or promising evidence, emerging from fewer studies and/or studies with smaller or otherwise less representative samples, are presented instead. These instances are flagged as such, and are presented only when better quality evidence does not yet exist and because they still represent findings of emerging interest and relevance to the field.” (p. xvii)

“Advances in functional neuroimaging, developmental neurobiology, genomics, epigenomics, transcriptomics, proteomics, and metabolomics have begun to decode the complex mechanisms by which early adversity can become biologically embedded and influence life-course health and even the health of the next generation.” (p. 12)

“Project Cal-Well of the California Department of Education (CDE)1416 and the Healthy Environment and Response to Trauma in Schools (HEARTS) program of the University of California, San Francisco (UCSF),1417 are two case studies in California that are presented to provide a snapshot of how primary, secondary, and tertiary prevention of toxic have been translated into school settings.” (p. 196)

"Between 2005–2006 and 2017–2018, there was a 47% relative increase in the number of public schools nationwide with one or more security staff with the authority to arrest students.1411 When public schools increasingly rely on school resource officers to discipline students at school, school-based arrests go up.1412 Combating these systems using restorative justice techniques that emphasize redirection and de-escalation tactics, and prioritize time in the classroom, can minimize re-traumatization and mistrust and better support students’ long-term physical, social-emotional, and cognitive growth.1408-1410” (p. 195)

ACEs Aware Grants program: “Awarded 150 grants to 100 organizations across the state in three categories—Provider Training, Provider Engagement, and Communications—to expand the reach and impact of the ACEs Aware initiative” (vii)

“Historically, the national child welfare system has directed almost all its attention and resources to tertiary prevention efforts for children who have already experienced abuse and/or neglect (i.e., to prevent recurrence). In California, the Department of Social Services (CDSS) is the administrative agency that oversees the child welfare system. The Office of Child Abuse Prevention (OCAP) within CDSS has recently championed a more overt primary prevention focus (i.e., preventing abuse and neglect before they occur) by addressing the major drivers of child welfare involvement: poverty, unaddressed mental health challenges of caregivers, substance use, and a parental history of child abuse.1198 “ (p. 163)

“ACEs Connection—an information-exchange catalyst and social network community of practice in the worldwide ACEs and toxic stress movement—had been working in partnership with the EfC Initiative to identify and document ACEs-related activities (e.g., trainings or events) at the local level. In this effort, ACEs Connection developed a mapping tool for displaying ACEs and trauma-informed organizational activities geographically and by sector.1529 Three California counties (Fresno, San Diego, and Santa Barbara) have been piloting its use to help track their local ACEs-related work.” (p. 285)

“Resilience is the ability to withstand or recover from stressors, and results from a combination of intrinsic factors, extrinsic factors (like safe, stable, and nurturing relationships with family members and others), and predisposing biological susceptibility.42,98,99. Of note, while the term resilience is often considered in the mental health and behavioral domains, scientific advances in understanding of the impact of stress on neuro-endocrine-immune-metabolic and genetic regulatory health compel advancement of the definition of resilience to also include these domains as well.” (p. 18-19)

Primary prevention: “Public education campaigns to raise awareness of ACEs and toxic stress, and to arm the public with science-based solutions for reducing the impact of ACEs on children and adults, paired with policy strategies to support safe, stable, and nurturing relationships and environments; Access to high-quality mental and physical healthcare, including family-centered treatments; • Enabling opportunities for stress-buffering activities such as access to nature, mindfulness activities, physical activity, and sufficient and high-quality sleep; Providing high-quality early and ongoing learning opportunities, including for social-emotional learning, executive function skills, healthy relationship skills, and responding to challenges; Cross-sector and sector-specific training in trauma-informed tools, approaches, and strategies for all providers engaging with children and families; and public health surveillance and policy-oriented applications of population-level indicators of exposure to ACEs and impacts of toxic stress.” (p. xxx)

Secondary prevention: “There is a consensus of scientific evidence that early detection and early intervention improves outcomes related to toxic stress. 6-9,23,31,603,704” (p. xxx)

Tertiary prevention: “Tertiary prevention involves interventions beyond the clinical setting. This report outlines how each sector—healthcare, public health, social services, early childhood, education, and justice— can contribute to healing the harmful effects of ACEs and toxic stress. To truly achieve practice and population health transformation, coordinating a cross-sector network of highly effective and transformative referral and service options is imperative.” (xxxii)

“Public health efforts should target preventing or reducing environmental factors that worsen toxic stress physiology, such as exposure to lead and air pollution” (p. 155)

“While vulnerable communities experience greater stressors and are therefore at higher risk, it is important to recognize that ACEs happen in every sociodemographic group, and that they are often under-recognized in upper-income and non-minority groups; therefore, universal approaches are necessary.” (p. 171) 

“Exposure to ACEs can also set up transmission of health risks across generations by altering gene expression (epigenetics) in parents to be, which can affect the development and health of their children, and future generations to come.32,33 Intergenerational transmission of toxic stress physiology can also perpetuate and exacerbate socially rooted inequities in health, achievement, socioeconomic mobility, and mortality.16,29,35,36,60,62” (xviii)

“While there currently exist no widely agreed-upon clinical diagnostic criteria for toxic stress, a number of biomarkers associated with neuro-endocrine-immune-metabolic disruption are under investigation.332-334” (p. 30)

“More research is needed to precisely identify clinically useful biomarkers to diagnose and follow risk of toxic stress longitudinally, as well as more specific therapeutic targets.” (xviii)

“Policy- and systems-level efforts to prevent ACEs and toxic stress also depend on the awareness and engagement of the general public and governmental decision-makers. The “political will” to implement pro-child, pro-family policies and budgets is influenced by social norms about the status of children and the loci of responsibility for their well-being. The dominant public narrative about child abuse and neglect, for example, has been characterized by an individual focus on “bad” parents and government interference. Based on research findings, the FrameWorks Institute has created a social counter-narrative that can help engage the public in understanding early child development as it applies to child abuse and neglect prevention, understanding potential policy directions, and supporting solutions to pressing problems.” (p. 148)

“Lead is an example of a specific environmental exposure that interacts with the toxic stress response, in that the effects of lead exposure are more powerful in children who are experiencing toxic stress, and vice versa. Lead exposure disrupts a child’s ability to recover from early life stress. Both animal and human studies have identified toxic stress and lead as affecting shared neurobiological systems, including the hypothalamicpituitary-adrenal (HPA) axis, as well as the frontal cortex and hippocampus (parts of the mesocorticolimbic system). Exposure to lead in early life can result in potentially lifelong alterations in the HPA axis and accentuate physiologic responses to stress.169 Exposures to both lead and toxic stressors (like ACEs) together result in enhanced neurotoxicity.170 Exposure to lead also acts synergistically with stress during pregnancy and early childhood, and is associated with decreased IQ, increased incidence of attention-deficit/hyperactivity disorder (ADHD), antisocial behavior, preterm birth, lower birth weight, and juvenile justice involvement.” (p. 24)

“Exposure to ACEs and the associated dysregulation of the immune system involved in toxic stress can combine with breathing polluted air to exacerbate negative asthma-related outcomes.” (p. 27)

“As another example, in utero exposure to both stress and air pollution can increase oxidative stress, which may affect the development of the fetal lungs, including increasing airway inflammation and adverse simplification of the normally complex structure.235,236 In fact, an increased risk of asthma was found in children co-exposed in utero to fine particulate matter (PM2.5 ) and maternal stress (OR 1.15; 95% CI, 1.03-1.26) during the phase of lung development when many of the peripheral airways important in asthma develop (canalicular phase).” (p. 27)

BIOETHNOGRAPHY: “Thus, instead of combining objects of inquiry (biology and culture), I conceived of bioethnography as combining two different methods for knowing the world (Mol 2002, 153)—ethnographic observation and biochemical sampling—in order to ask and answer research questions that could not be addressed through either method alone. This methodological focus involves exploring how our data collection and analysis might be shaped if we suspended the nature/culture binary” (Roberts, 2021, p. 2)

“bioethnography asks, what if we created numbers otherwise, upending the cooked data that reinforces inequality? In fact, bioethnography can enable us to identify structural forces, such as NAFTA and the global health apparatus itself, that are part of the bodily processes that make ill health. In other words, while we know that all data is cooked, it matters how it’s cooked.” (Roberts, 2021, p. 5)

Roberts describes their ongoing bioethnographic collaboration with a team of exposure scientists who are working in environmental engineering and health. Though ethnography is not easily enumerated, Roberts emphasizes that integrating it with quantitative data is worthwhile and makes for “better numbers”. As an example, Roberts describes 3 bioethnographic projects on neighborhoods, water distribution, and employment and chemical exposures. These projects were part of a longitudinal birth-cohort study in Mexico City called Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT), created to understand the effects of early-life nutrition and exposure to toxicants (such as lead and phenols). Overtime, this project was expanded to include the study of new toxins (e.g. BPAS, mercury, and fluoride) and new health concerns (e.g. obesity, meopause, sleep).

Roberts’ focus on neighborhoods was produced from the ethnographic observation that neighborhood characteristics might influence exposure levels. Following this observation, Roberts’ and ELEMENT researchers sorted participants by neighborhood and identified significant differences in blood-lead levels. Additionally, Roberts applied previous ethnographic observation and scholarship to argue that high levels of toxicants like lead correlate with the capacity of neighborhoods to withstand other dangers, such as police violence. These findings prompted the development of two new bioethnographic project centered on water and the effect of neighborhood dynamics on health.