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"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)

LCHE produces its own weekly radio show, Today's Health Topics, hosted by Ms. Alma Stewart-Allen. The show features various interrelated health topics relevant to Louisiana.

LCHE's initiatives have also been covered by regional and local news outlets like BR Proud and the Louisiana Illuminator. Notable articles include the following:

Canicosa, J. C. “‘We All Deserve to Keep Our Children’: Grieving Grandmother Calls Attention to State’s High Infant, Maternal Mortality Rates.” Louisiana Illuminator. April 15, 2021.

Mipro, Rachel. “Louisiana Activists Still Questioning Why Office for Women’s Health Wasn’t Created.” Louisiana Illuminator. October 7, 2021.

#LA40by2030 Campaign 

The 2020 America’s Health Rankings ranks Louisiana 50th in the United States. In response, LCHE has developed the LA40by2030 campaign to improve health outcomes and quality of life for children and families across the state. The goal of the campaign is to improve the state’s national ranking to 40th by the year 2030. LCHE recognizes that improving Louisiana’s health ranking by 2030 will require the participation of government officials, public healthcare professionals, and the general public. LCHE is inviting stakeholders to develop a health equity database and action platform and contribute to achieving #LA40by2030.

Annual Health Summit

LCHE leads an annual health summit with the goal of improving health in Louisiana through the lens of health equity and determinants of health. The summit is designed to engage a diverse array of stakeholders in better understanding rapdily changing conditions of health with the goal of informing policy and building partnerships for community health improvements. This goal of the summit is to inspire action on the state, regional and local levels, and to facilitate progress towards LA40by2030.

The 2023 health summit will focus on population heath, and women and children's health. The summit is also aligned with the Louisiana Department of Health (LDH) state health improvement priorities: behavioral health, chronic disease, community safety, and maternal and child health.

Louisiana Resources and Educational Assessments for Children’s Health (LA REACH)

LA REACH is a pilot program to develop a holistic approach to improving school environments for teachers and students by decreasing instances of student disciplinary actions, violence, alternative school placement, increasing graduation rates, grade point averages, and standardized test scores. The program goals are to address the lack of awareness and resources for mental health, provide trauma-informed training to school personnel, and build stronger home and school relationships. The program strategy is to provide a safe and conducive environment for learning.

Office of Women's Health and Community Health (OHWHCH)

In 2022, LCHE’s organization and activism led to the creation of the first Louisiana office focused on women’s health. The Office of Women’s Health and Community Health (OWHCH) was established under a bill passed by the Louisiana Legislature on June 18, 2022. The office exists to improve women’s health outcomes and act as a coordinating agency and resources center for women’s health data and strategies. 

The Wade Institute for Youth Equity

The Wade Institute for Youth Equity is a year-round program dedicated to pursuing youth equity in key quality indicators, and promoting community safety in communities across Louisiana. For more than a decade, the Louisiana Center for Health Equity has devised and implemented a holistic public health approach to adolescent health. This includes, but is not limited to, youth violence prevention, positive youth development, healthy living including sexual risk avoidance, and mental health wellness. The Institute aims to create a well-rounded and equipped student for positive decision making.