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How Childhood Experiences Shape Our Nation's Health

Mar 12, 2015, 3:36 PM, Posted by Kristin Schubert

New findings strongly suggest that Americans are ready for new approaches to address early childhood trauma and stress. To do that in a big way, we need more than science—we need a movement.

I remember when I first learned about research showing that what happens to a person as a child impacts their health later in life. It was 2007, and I was pregnant with my first child. My boss and mentor, Jim Marks, brought the Adverse Childhood Experience’s (ACE) study to my attention. The Centers for Disease Control and Kaiser Permanente had surveyed 17,000 Kaiser members about their childhood experiences and compared the answers to those members’ medical records.

The ACE researchers found that the more trauma and stress you experienced as a child, the more likely you were to have cancer, heart disease, and diabetes as an adult. The more likely you were to suffer from chronic depression, be addicted to drugs and alcohol, or attempt suicide. And the more likely you were to drop out of school, be incarcerated, or chronically unemployed.

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Violence and the Media in 2014: Q&A with Lori Dorfman

Dec 18, 2014, 5:59 PM, Posted by Eric Antebi

Cease Fire A Chicago bumper sticker.

A culture of violence is the antithesis to a Culture of Health. As Risa Lavizzo-Mourey recently said in a speech to the American Public Health Association, “We will never be a healthy nation, if we continue to be a violent one.”

Violence is always in the news. But 2014 saw several high profile stories about violence dominating news cycles, including major stories about child abuse (Adrian Peterson), intimate partner violence (Ray Rice), sexual assault on college campus, and, of course, the deaths of Michael Brown and Eric Garner.

Because media coverage influences the social and political response to violence in America, I wanted to hear from Lori Dorfman, who directs the Berkeley Media Studies Group. She has spent decades monitoring how the media cover violence and other public health issues, helping public health advocates work with journalists, and helping journalists improve their coverage. The following is an excerpt of my interview with her.

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At the Crossroads of Risk and Resiliency: Averting High School Dropouts

Dec 8, 2014, 12:35 PM, Posted by Karen Johnson

Karen Johnson, PhD, RN, is a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and an assistant professor at the University of Texas at Austin School of Nursing. Her research focuses on vulnerable youth. The first RWJF Scholars Forum: Disparities, Resilience, and Building a Culture of Health was held last week. The conversation continues here on the RWJF Human Capital Blog.

Scholars Forum 2014 Logo

As Americans, we love stories about people who beat the odds and achieve success. We flock to movie theaters to watch inspiring tales—many times based on true stories—of resilient young people who have overcome unthinkable adversities (e.g., abuse, growing up in impoverished, high-crime neighborhoods) to grow into healthy and happy adults. Antwone Fisher, The Blind Side, Precious, and Lean On Me are just a few of my personal favorites that highlight the very real struggles faced by adolescents like those I have worked with as a public health nurse. My work with adolescent mothers and now as an adolescent health researcher has convinced me of the critical importance of focusing on promoting health and resilience among adolescents at-risk for school dropout.

Karen Johnson

How often do we as a society really sit down outside the movie theater or walls of academia and talk about why these young people are at risk for poor health and social outcomes in the first place, or what it would take to help them rise above adversity? If we look closely at the storylines of resilient youth, we will notice a number of similarities. Being resilient does not happen by chance: it takes personal resolve from the individual—something our American culture has long celebrated. And it takes a collective commitment from society to maintain conditions that empower young people to be resilient, and that is something that we as a society do not recognize or invest in nearly as often.  

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Population Sickness and Population Health: How Geographic Determinants Differ

Nov 19, 2014, 9:00 AM, Posted by Tamara G. Leech

Tamara G.J. Leech, PhD, is an associate professor in the Department of Social and Behavioral Sciences at the Indiana University Richard M. Fairbanks School of Public Health, and a former Robert Wood Johnson Foundation (RWJF) New Connections program grantee. She is principal investigator of a William T. Grant Scholar Award, “Pockets of Peace: Investigating Urban Neighborhoods Resilient to Adolescent Violence.”  

Tamara G. Leech

I am particularly excited about the American Public Health Association’s (APHA) Annual Meeting theme this year—Healthography! My research team has spent the past two years examining “cold spots” of urban youth violence. In other words, we have been analyzing areas where—regardless of the increased risk for violence—violence is not occurring or is rarely occurring. This is a departure from the dominant form of research on “hot spots” of violence, or any disease for that matter.  

American Public Health Association Meeting & Expo

For some, this approach has been puzzling. It’s not immediately obvious that the determinants of cold spots are not simply the opposite of the determinants of hot spots.  However, our evidence clearly suggests that the things that help to make a location healthy go well beyond the things that protect a location from high rates of illness.

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Addressing the Needs of Female Veterans Who Have Experienced Violence and Harassment

Nov 13, 2014, 1:00 PM, Posted by Angela Amar, Jacquelyn Campbell

Jacquelyn Campbell, PhD, RN, FAAN, is director of the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program and Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing.  Angela Amar, PhD, RN, FAAN, is an associate professor at the Nell Hodgson Woodruff School of Nursing at Emory University and an alumna of the RWJF Nurse Faculty Scholars program.

Jacquelyn Campbell Jacquelyn Campbell

As two scholars who have worked in research, practice and policy arenas around issues of gender-based violence for years, we honor our veterans this week by paying tribute to the Pentagon and the U.S. Department of Veterans Affairs (VA) for addressing intimate partner and sexual violence among active duty and returning military and their families, and urge continued system-wide involvement and innovative solutions.  

In our work, we’ve heard outrageous, painful stories. One female servicemember explained to Angela why she was ignoring the sexual harassment she experienced. She knew that hearing that she was inferior because she was a woman, being called “Kitty” instead of her name, and having the number 69 used in place of any relevant number was harassing. She knew it was wrong. But she had decided that she would not let it bother her. I can acknowledge that he is a jerk, but I can’t let that affect me.  

Angela Amar Angela Amar

I can’t let his behavior define me as a person. On some level this may seem like an accurate way of dealing with a problem person. However, sexual harassment isn’t just about one obnoxious person. Not telling the story doesn’t make the behavior go away. Rather, it sends the message that the behavior is acceptable and that sexist comments are a normal part of the lexicon of male/female interactions.

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Bringing Brain Science to the Front Lines of Care

Nov 4, 2014, 5:34 PM, Posted by Jane Isaacs Lowe, Martha Davis

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The brain is an exquisitely sensitive organ—so sensitive that, as recent advances in brain science show us, children who are exposed to violence, abuse, or extreme poverty can suffer the aftereffects well into adulthood. They are more likely to develop cancer or heart disease as they age, for example.

But how to translate these findings into practices and policies that can strengthen families and children? How do caregivers help traumatized children and their families cope with adversity? How can the science be applied to what teachers, doctors, social workers, and others on the front lines do every day? And how should the science affect whole systems, so that every person, at every level, can do their part to help children and families thrive?

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Childhood Trauma: A Public Health Problem that Requires a Robust Response

Jul 29, 2014, 9:00 AM, Posted by Cindy A. Crusto

Cindy A. Crusto, PhD, is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, an associate professor of psychology in psychiatry, Yale University School of Medicine, and a Public Voices Fellow with The OpEd Project.

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Were the findings really a surprise? The recent release of the report The Burden of Stress in America commissioned by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, highlights the major role that stress plays in the health and well-being of American adults. As a researcher who studies the impact of emotional or psychological trauma on children’s health, I immediately thought about the findings in the context of trauma and the associated stress in the lives of children. That trauma can include violence in the home, school, and community.

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Two decades of research has produced clear findings on this significant public health problem: Psychological trauma can have a powerful influence in the lives of children, and if not detected and addressed early, it can (and often does) have long-lasting physical and mental health effects into adulthood. Despite this strong evidence, I have encountered the sheer resistance of some advocates who work with or on behalf of vulnerable children to fully engage in this topic. Perhaps it’s because of the belief that this talk about trauma is a fad—a hot topic that will fade as soon as something “sexier” comes along.

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Supporting Families to Succeed

Jun 30, 2014, 9:31 AM, Posted by Jane Isaacs Lowe, Martha Davis

ACEs Billboard Version 2 Mobile

It has been more than 15 years since the Centers for Disease Control published the Adverse Childhood Experiences (ACES) study. What we learned from that study, and then subsequent research, is that sustained exposure to toxic stress and adverse childhood experiences—including abuse, neglect, neighborhood violence and chronic poverty—without the support of an engaged supportive parent or adult caretaker, can have serious extended effects on children’s subsequent development and success in life. This stress, without intervention, can lead to a lifetime of poorer health, including chronic diseases in adulthood, such as heart disease and diabetes.

In 2012, the American Academy of Pediatrics published a policy statement calling on pediatricians to become leaders in an effort to decrease children’s exposure to toxic stress and to mitigate its negative effects. They acknowledged how much science had taught us about how our environment affects our “learning capacities, adaptive behaviors, lifelong physical and mental health, and adult productivity.” The statement was a significant shift in the conversation. It provided a biological framework and imperative for why we must do something about adverse childhood experiences now.

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Preventing Youth Violence May Cost Less Than You Think…

Apr 8, 2014, 9:42 AM, Posted by Adam L. Sharp

Adam L. Sharp, MD, MS is an emergency physician and recent University of Michigan Robert Wood Johnson Foundation Clinical Scholar (2011-2013). He works for Kaiser Permanente Southern California in the Research and Evaluation Department performing acute care health services and implementation research.

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Violence is a leading cause of death and injury in adolescents. Recent studies show effective interventions can prevent violent behavior in youth seen in the Emergency Department (ED). Adoption of this type of preventive care has not been broadly implemented in EDs, however, and cost concerns frequently create barriers to utilization of these types of best practices. Understanding the costs associated with preventive services will allow for wise stewardship over limited health care resources. In a recent publication in Pediatrics, "Cost Analysis of Youth Violence Prevention," colleagues and I predict that it costs just $17.06 to prevent an incident of youth violence.

The violence prevention intervention is a computer-assisted program using motivational interviewing techniques delivered by a trained social worker. The intervention takes about 30 minutes to perform and was evaluated within an urban ED for youth who screened positive for past year violence and alcohol abuse. The outcomes assessed were violence consequences (i.e., trouble at school because of fighting, family/friends suggested you stop fighting, arguments with family/friends because of fighting, felt cannot control fighting, trouble getting along with family/friends because of your fighting), peer victimization (i.e., hit or punched by someone, had a knife/gun used against them), and severe peer aggression (i.e., hit or punched someone, used a knife/gun against someone).

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Coming to the Rescue of Young Men of Color

Feb 27, 2014, 4:30 PM, Posted by Maisha Simmons

The Alameda County Public Health Department's EMS Corps program is supported by the Robert Wood Johnson Foundation.

When he was 17, Dexter Harris was good at two things: football and hustling. Although he went to school, he spent most of his time trying to earn money. He wasn’t thinking about his future. He was thinking about surviving the here and now.

Instead of finishing his senior year, Dexter found himself in a California juvenile facility. There, he met a mentor named Mike who told Dexter about a new program, EMS Corps, that offered far more than emergency medical training (EMT) classes. EMS Corps also provided tutoring, mentoring and leadership classes, and was looking for people from the community who were willing and ready to serve in the emergency services field.

After hearing about EMS Corps, something changed for Dexter. He weighed his options and saw that with EMS Corps he could actually have the chance for a different life. Dexter threw himself into studying, and eventually graduated first in his EMS Corps class. As a certified EMT, Dexter now has a career with Paramedics Plus and returns to the juvenile facility to teach other young people about being a First Responder.

Dexter Harris Dexter Harris

In every community there are young men like Dexter who have the potential to succeed.  But like most young people, they need help and support to bring out their best.

Today, I was honored to be present at the White House as President Obama helped to add more momentum to a growing movement to expand opportunity for young men of color. I was joined by leaders from both the public and private sector committing their intellect, creativity, passion and resources to continue to identify solutions for men and boys of color.

I was inspired by the continuing and new energy to ensure that every young man has the opportunity make healthy choices and has the tools to live a healthy life. That includes skills to succeed in school and work. EMS Corps is just one bright light among the many innovative and inspiring approaches that the Robert Wood Johnson Foundation has been proud to support as part of its effort to create a culture of health and opportunity for all young people.  This new national initiative announced at the White House brings a new chance to build upon this exciting and important work.

It’s not just EMS Corps. Look at our Forward Promise partners to see the richness of programs already lifting up young men. It’s not just the White House and our Foundation colleagues in this movement either. There are thousands of teachers, police chiefs, state and local legislators, judges, church leaders, and community based organizations from across the country that are taking steps to ensure that all young people in America, including our young men of color, have the opportunity to succeed. If our job is to build a culture of health for all young men, then those collective efforts are its vital building blocks.

As I arrived at the White House this afternoon, I couldn’t help but think of Dexter. And of all of the “Dexters” who will benefit from this unprecedented moment of commitment to hope, change, and opportunity for our sons, brothers, students and neighbors. I’m proud to be a part of the Robert Wood Johnson Foundation and of this larger movement. Together we can bring out the best in our young men. And they—in achieving their promise—can bring out the best in all of us.

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