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A Study in Wellness

It has been over 20 years since a landmark study called “Adverse Childhood Experiences” was published in the American Journal of Preventative Medicine.1 Prior to 1998, researchers had demonstrated impacts of child abuse on adolescent and adult mental health, but no one knew whether these early experiences might impact physical health outcomes or whether other types of adverse childhood experiences might have similar negative consequences. The ACE study set out to answer these questions by collecting data on early childhood experiences from over 17,000 adults and expanding the definition of what ‘early adversity’ might include. The researchers examined long-term health impacts of child abuse and neglect, and they also looked at a variety of household dysfunctions including parental drug abuse, incarceration, mental illness, and domestic violence.

Findings from the study revealed that the more categories of adversity a person experienced as a child, the greater the likelihood was that they would experience a diverse array of health problems as adults including chronic disease, mental illness, addiction, cognitive challenges, and socio-emotional difficulties. Furthermore, the study showed that even among this population of relatively educated and financially secure individuals (study participants were medically insured by Kaiser Permanente and living in San Diego), experiences of early stress and trauma were considerably more common than anyone realized. This study has since spurred over two decades of investigations to figure out how and why early childhood stress and trauma have such pervasive impacts on lifelong health. The resulting body of research has profoundly changed how the medical community approaches health, disease, and the injurious effects of early stress and trauma.2,3

So, what have we learned? We now know that early life adversity alters the way brains develop. We know, for example, that when people have experienced early chronic stress and trauma, they process and regulate emotions differently,4,5 they make decisions and assess risks differently6-8, they think differently about the future,9 and they have different responses to stressful situations.9,10 We know that these changes in brain development almost certainly increase the likelihood people will engage in poor health behaviors like substance use or making poor nutritional choices.9, 11, 12  It is also likely that these brain alterations make it harder for people to change their behaviors, even when they know the long-term consequences. We know that poor health behaviors and chronic disease tend to cluster together15, 16, especially within marginalized and underserved populations. People living in poverty, those experiencing discrimination, and those struggling with behavioral health conditions are especially vulnerable when it comes to experiencing the burdens of tobacco use, managing stress, and maintaining healthy sleep, nutrition, and physical activity. And we know that health risks are passed down within families17, creating an intergenerational cycle of poor health and disease.

But here is what we also know. We know that when people are supported, they can change behaviors in ways that improve their health and the health of their families. We know that when it comes to health risk clusters, interventions that target multiple health risk behaviors can be effective across multiple domains.18, 19 And we know that interventions that focus on family systems, rather than on single individuals, can be particularly powerful.20

In response to these pressing challenges and opportunities, BHWP is excited to introduce our RAISE Families for Health Program. The program is designed to provide administrators, healthcare providers, and peer specialists the necessary knowledge and skills to help parents and caregivers envision a healthy lifestyle for their families and achieve their personal wellness goals through participation in our RAISE Families for Health group curriculum. This innovative program provides training on strategies for coping with stress, maintaining tobacco-free families, healthy sleep, healthy eating, and physical activity as well as ways to promote positive behavior change through motivational engagement and behavior change strategies. We invite you to learn more about our RAISE Families for Health Program [link to program overview].

  1. Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. Am J Prev Med, 14:245-258.
  2. Garner, A. S., Shonkoff, J. P., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., … & Committee on Early Childhood, Adoption, and Dependent Care. (2012). Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics129(1), e224-e231.
  3. Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., … & Committee on Early Childhood, Adoption, and Dependent Care. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics129(1), e232-e246.
  4. Heleniak, C., Jenness, J.L., Vander Stoep, A., et al. (2016). Childhood maltreatment exposure and disruptions in emotion regulation: a transdiagnostic pathway to adolescent internalizing and externalizing psychopathology. Cognit Ther Res, 40:394-415.
  5. Mclaughlin, K.A., Lambert, H.K. (2017). Child trauma exposure and psychopathology: mechanisms of risk and resilience. Curr Opin Psychol, 14:29-34.
  6. Arnsten, A.F.T. (2015). Stress weakens prefrontal networks: molecular insults to higher cognition. Nat Neurosci, 18:1376-1385.
  7. Ross, L.T., Hill, E.M. (2002). Childhood unpredictability, schemas for unpredictability, and risk taking. Soc Behav Pers, 30:43.
  8. Bechara, A., Damasio, H. (2002). Decision-making and addiction (part I): impaired activation of somatic states in substance dependent individuals when pondering decisions with negative future consequences. Neuropsychologia, 40:1675-1689.
  9. Lovallo, W.R. (2013). Early life adversity reduced stress reactivity and enhances impulsive behavior: implications for health behaviors. Int J Psychophysiol, 90:8-16.
  10. Ellis, B.J., Del Giudice, M. (2019). Developmental adaptation to stress: an evolutionary perspective. Annu Rev Psychol, 70:111-139.
  11. Richardson, G.B. (2012). Immediate survival focus: synthesizing life history theory and dual process models to explain substance use. Evol Psychol, 10:731-749.
  12. Duffy, K.A., McLaughlin, K.A., Green, P.A. (2018). Early life adversity and health-risk behaviors: proposed psychological and neural mechanisms. Ann NY Acad Sci, 1428:151-169.
  13. Lovallo, W.R. (2013). Early life adversity reduced stress reactivity and enhances impulsive behavior: implications for health behaviors. Int J Psychophysiol, 90:8-16.
  14. Ellis, B.J., Del Giudice, M. (2019). Developmental adaptation to stress: an evolutionary perspective. Annu Rev Psychol, 70:111-139.
  15. Chiolero, A., V. Wietlisbach, C. Ruffieux, et al. (2006). Clustering of risk behaviors with cigarette consumption: a population-based survey. Med., 4, 348–353.
  16. Leventhal, A.M., J. Huh & G.F. Dunton. (2014). Clustering of modifiable biobehavioral risk factors for chronic disease in US adults: a latent class analysis. Public Health, 134, 331–338.
  17. Ware JJ, Munafo MR. (2015). Genetics of smoking behaviour. Curr Top Behav Neurosci., 23,19-36.
  18. Albarracin D, Wilson K, Chan MS, Durantini M, Sanchez F. (2017). Action and Inaction in Multi-Behavior Recommendations: A Meta-Analysis of Lifestyle Interventions. Health Psychol Rev. 1-57.
  19. An LC, Demers MR, Kirch MA, Considine-Dunn S, Nair V, Dasgupta K, Narisetty N, Resnicow K, Ahluwalia J. (2013). A randomized trial of an avatar-hosted multiple behavior change intervention for young adult smokers. J Natl Cancer Inst Monogr., 47, 209-215.
  20. Prado G, Cordova D, Huang S, Estrada Y, Rosen A, Bacio GA, Leon Jimenez G, Pantin H, Brown CH, Velazquez MR, Villamar J, Freitas D, Tapia MI, McCollister K. (2012). The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: main effects and interaction effects by parental stress and social support. Drug Alcohol Depend., 125, Suppl 1:S18-25.

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