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de la Rosa R, Le A, Holm S, Ye M, Bush NR, Hessler D, Koita K, Bucci M, Long D, Thakur N. Associations Between Early-Life Adversity, Ambient Air Pollution, and Telomere Length in Children. Psychosom Med 2024; 86:422-430. [PMID: 38588482 PMCID: PMC11142884 DOI: 10.1097/psy.0000000000001276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Examine the independent associations and interaction between early-life adversity and residential ambient air pollution exposure on relative buccal telomere length (rBTL). METHODS Experiences of abuse, neglect, household challenges, and related life events were identified in a cross-sectional sample of children aged 1 to 11 years ( n = 197) using the 17-item Pediatric ACEs and Related Life Event Screener (PEARLS) tool. The PEARLS tool was analyzed both as a total score and across established domains (Maltreatment, Household Challenges, and Social Context). Ground-level fine particulate matter (PM 2.5 ) concentrations were matched to residential locations for the 1 and 12 months before biospecimen collection. We used multivariable linear regression models to examine for independent associations between continuous PM 2.5 exposure and PEARLS score/domains with rBTL. In addition, effect modification by PEARLS scores and domains on associations between PM 2.5 exposure and rBTL was examined. RESULTS Study participants were 47% girls, with mean (standard deviation) age of 5.9 (3.4) years, median reported PEARLS score of 2 (interquartile range [IQR], 4), median 12-month prior PM 2.5 concentrations of 11.8 μg/m 3 (IQR, 2.7 μg/m 3 ), median 1-month prior PM 2.5 concentrations of 10.9 μg/m 3 (IQR, 5.8 μg/m 3 ), and rBTL of 0.1 (IQR, 0.03). Mean 12-month prior PM 2.5 exposure was inversely associated with rBTL ( β = -0.02, 95% confidence interval = -0.04 to -0.01). Although reported PEARLS scores and domains were not independently associated with rBTL, we observed a greater decrement in rBTL with increment of average annual PM 2.5 as reported Social Context domain items increased ( p -interaction < .05). CONCLUSIONS Our results suggest that adverse Social Context factors may accelerate the association between chronic PM 2.5 exposure on telomere shortening during childhood.
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Affiliation(s)
- Rosemarie de la Rosa
- Environmental Health Sciences Division, University of California, Berkeley, School of Public Health
- University of California, San Francisco, Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Austin Le
- Environmental Health Sciences Division, University of California, Berkeley, School of Public Health
| | - Stephanie Holm
- Western States Pediatric Environmental Health Specialty Unit
| | - Morgan Ye
- University of California, San Francisco, Department of Medicine, Division of Pulmonary and Critical Care Medicine
| | - Nicole R. Bush
- University of California San Francisco, Department of Psychiatry and Behavioral Science
- University of California, San Francisco, Department of Pediatrics
| | - Danielle Hessler
- University of California San Francisco, Department of Family and Community Medicine
| | | | | | - Dayna Long
- University of California, San Francisco, Department of Pediatrics
- UCSF Benioff Children’s Hospital Oakland
| | - Neeta Thakur
- University of California, San Francisco, Department of Medicine, Division of Pulmonary and Critical Care Medicine
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Butzin-Dozier Z, Mertens AN, Tan ST, Granger DA, Pitchik HO, Il'yasova D, Tofail F, Rahman MZ, Spasojevic I, Shalev I, Ali S, Karim MR, Shahriar S, Famida SL, Shuman G, Shoab AK, Akther S, Hossen MS, Mutsuddi P, Rahman M, Unicomb L, Das KK, Yan L, Meyer A, Stewart CP, Hubbard AE, Naved RT, Parvin K, Mamun MMA, Luby SP, Colford JM, Fernald LCH, Lin A. Stress biomarkers and child development in young children in Bangladesh. Psychoneuroendocrinology 2024; 164:107023. [PMID: 38522372 PMCID: PMC11157411 DOI: 10.1016/j.psyneuen.2024.107023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/31/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh. METHODS We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables. RESULTS We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We detected a significant relationship between HPA axis activity and child development, where increased HPA axis activity was associated with poor development outcomes. Specifically, we found that cortisol reactivity (coefficient -0.15, 95% CI (-0.29, -0.01)) and post-stressor levels (coefficient -0.12, 95% CI (-0.24, -0.01)) were associated with CDI comprehension score, post-stressor cortisol was associated with combined EASQ score (coefficient -0.22, 95% CI (-0.41, -0.04), and overall glucocorticoid receptor methylation was associated with CDI expression score (coefficient -0.09, 95% CI (-0.17, -0.01)). We did not detect a significant relationship between SAM activity or oxidative status and child development. CONCLUSIONS Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.
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Affiliation(s)
| | - Andrew N Mertens
- School of Public Health, University of California, Berkeley, CA, USA
| | - Sophia T Tan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, CA, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen O Pitchik
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Shahjahan Ali
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Sunny Shahriar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Gabrielle Shuman
- School of Public Health, University of California, Berkeley, CA, USA
| | - Abul K Shoab
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Salma Akther
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Saheen Hossen
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Palash Mutsuddi
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kishor K Das
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Alan E Hubbard
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Kausar Parvin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, CA, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, CA, USA.
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3
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Pantell MS, Silveira PP, de Mendonça Filho EJ, Wing H, Brown EM, Keeton VF, Pokhvisneva I, O'Donnell KJ, Neuhaus J, Hessler D, Meaney MJ, Adler NE, Gottlieb LM. Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children. Pediatr Res 2024; 95:1553-1563. [PMID: 38233512 PMCID: PMC11126389 DOI: 10.1038/s41390-023-02992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/17/2023] [Accepted: 11/11/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Prior work has found relationships between childhood social adversity and biomarkers of stress, but knowledge gaps remain. To help address these gaps, we explored associations between social adversity and biomarkers of inflammation (interleukin-1β [IL-1β], IL-6, IL-8, tumor necrosis factor-alpha [TNF-α], and salivary cytokine hierarchical "clusters" based on the three interleukins), neuroendocrine function (cortisol, cortisone, dehydroepiandrosterone, testosterone, and progesterone), neuromodulation (N-arachidonoylethanolamine, stearoylethanolamine, oleoylethanolamide, and palmitoylethanolamide), and epigenetic aging (Pediatric-Buccal-Epigenetic clock). METHODS We collected biomarker samples of children ages 0-17 recruited from an acute care pediatrics clinic and examined their associations with caregiver-endorsed education, income, social risk factors, and cumulative adversity. We calculated regression-adjusted means for each biomarker and compared associations with social factors using Wald tests. We used logistic regression to predict being in the highest cytokine cluster based on social predictors. RESULTS Our final sample included 537 children but varied based on each biomarker. Cumulative social adversity was significantly associated with having higher levels of all inflammatory markers and with cortisol, displaying a U-shaped distribution. There were no significant relationships between cumulative social adversity and cortisone, neuromodulation biomarkers or epigenetic aging. CONCLUSION Our findings support prior work suggesting that social stress exposures contribute to increased inflammation in children. IMPACT Our study is one of the largest studies examining associations between childhood social adversity and biomarkers of inflammation, neuroendocrine function, neuromodulation, and epigenetic aging. It is one of the largest studies to link childhood social adversity to biomarkers of inflammation, and the first of which we are aware to link cumulative social adversity to cytokine clusters. It is also one of the largest studies to examine associations between steroids and epigenetic aging among children, and one of the only studies of which we are aware to examine associations between social adversity and endocannabinoids among children. CLINICAL TRIAL REGISTRATION NCT02746393.
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Affiliation(s)
- Matthew S Pantell
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California, San Francisco, CA, USA.
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA.
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA.
| | - Patricia P Silveira
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Euclides José de Mendonça Filho
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Holly Wing
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | | | - Victoria F Keeton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 490 Illinois St, Box 2930, 94143, San Francisco, CA, USA
| | - Irina Pokhvisneva
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
| | - Kieran J O'Donnell
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Yale Child Study Center & Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - John Neuhaus
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Danielle Hessler
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Michael J Meaney
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
| | - Laura M Gottlieb
- Center for Health and Community, University of California, San Francisco, San Francisco, CA, USA
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
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4
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Sullivan ADW, Roubinov D, Noroña-Zhou AN, Bush NR. Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review. Psychoneuroendocrinology 2024; 162:106949. [PMID: 38295654 DOI: 10.1016/j.psyneuen.2023.106949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 03/04/2024]
Abstract
BACKGROUND Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts. METHODS We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field. RESULTS Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers. CONCLUSIONS We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.
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Affiliation(s)
- Alexandra D W Sullivan
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA.
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | - Amanda N Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA.
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5
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Bush NR. Programming the next generation of prenatal programming of stress research: A review and suggestions for the future of the field. Dev Psychopathol 2024:1-14. [PMID: 38482548 DOI: 10.1017/s0954579424000488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
In this article, I highlight core ideas, empirical findings, and advances in the study of how stress during pregnancy may prenatally program child neurodevelopmental, psychopathological, and health outcomes, emphasizing reviews, metanalyses, and recent contributions of conceptual and empirical work. The article offers a perspective on the history of this area of science, the underrecognized contributions of influential scholars from diverse fields of study, what we know from the evidence to date, the persistent challenges in sorting through what is left to learn, and suggestions for future research. I include sections focused on promoting resilience, pregnancy interventions that demonstrate positive effects across two generations, and the translational implications of the accruing data for practice and policy, highlighting opportunities for integrating across a range of fields and sectors. In the concluding sections, I discuss lessons learned from conducting this work and provide a closing summary of progress and future directions. The goal of this writing was to provide a viewpoint on some ways that emerging intergenerational transmission scholars might responsibly contribute to the future of the field of developmental psychopathology.
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Affiliation(s)
- Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, CA, USA
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6
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Black MM. Indigenous children: opportunities for early childhood development through book-sharing. Lancet Glob Health 2024; 12:e12-e13. [PMID: 37956685 DOI: 10.1016/s2214-109x(23)00511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Maureen M Black
- RTI International, Research Triangle Park, NC 27709, USA; University of Maryland School of Medicine, Baltimore, MD, USA.
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7
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Gilgoff R, Mengelkoch S, Elbers J, Kotz K, Radin A, Pasumarthi I, Murthy R, Sindher S, Harris NB, Slavich GM. The Stress Phenotyping Framework: A multidisciplinary biobehavioral approach for assessing and therapeutically targeting maladaptive stress physiology. Stress 2024; 27:2327333. [PMID: 38711299 PMCID: PMC11219250 DOI: 10.1080/10253890.2024.2327333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 05/08/2024] Open
Abstract
Although dysregulated stress biology is becoming increasingly recognized as a key driver of lifelong disparities in chronic disease, we presently have no validated biomarkers of toxic stress physiology; no biological, behavioral, or cognitive treatments specifically focused on normalizing toxic stress processes; and no agreed-upon guidelines for treating stress in the clinic or evaluating the efficacy of interventions that seek to reduce toxic stress and improve human functioning. We address these critical issues by (a) systematically describing key systems and mechanisms that are dysregulated by stress; (b) summarizing indicators, biomarkers, and instruments for assessing stress response systems; and (c) highlighting therapeutic approaches that can be used to normalize stress-related biopsychosocial functioning. We also present a novel multidisciplinary Stress Phenotyping Framework that can bring stress researchers and clinicians one step closer to realizing the goal of using precision medicine-based approaches to prevent and treat stress-associated health problems.
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Affiliation(s)
- Rachel Gilgoff
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Summer Mengelkoch
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Jorina Elbers
- Trauma recovery Program, HeartMath Institute, Boulder Creek, CA, USA
| | | | | | - Isha Pasumarthi
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Reanna Murthy
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | - Sayantani Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, CA, USA
| | | | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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8
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Eyre HA, Stirland LE, Jeste DV, Reynolds CF, Berk M, Ibanez A, Dawson WD, Lawlor B, Leroi I, Yaffe K, Gatchel JR, Karp JF, Newhouse P, Rosand J, Letourneau N, Bayen E, Farina F, Booi L, Devanand DP, Mintzer J, Madigan S, Jayapurwala I, Wong STC, Falcoa VP, Cummings JL, Reichman W, Lock SL, Bennett M, Ahuja R, Steffens DC, Elkind MSV, Lavretsky H. Life-Course Brain Health as a Determinant of Late-Life Mental Health: American Association for Geriatric Psychiatry Expert Panel Recommendations. Am J Geriatr Psychiatry 2023; 31:1017-1031. [PMID: 37798224 PMCID: PMC10655836 DOI: 10.1016/j.jagp.2023.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities. Furthermore, our statement underscores the significance of prevention, early detection, and intervention in identifying cognitive decline, mood changes, and related mental illness. Action should also be taken to understand and address the needs of communities that traditionally have unequal access to preventive health information and services. By implementing culturally relevant and tailored evidence-based practices and advancing research in geriatric psychiatry, behavioral neurology, and geroscience, we can enhance the quality of life for older adults facing the unique challenges of aging. This position statement emphasizes the intrinsic link between brain health and mental health in aging, urging healthcare professionals, policymakers, and a broader society to prioritize comprehensive strategies that safeguard and promote brain health from birth through later years across all communities. The AAGP Expert Panel has the goal of launching further activities in the coming months and years.
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Affiliation(s)
- Harris A Eyre
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University (HAE), Houston, TX; Meadows Mental Health Policy Institute (HAE), Dallas, TX; Euro-Mediterranean Economists Association (HAE), Barcelona, Spain; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine (HAE), Houston, TX; Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center (HAE), Houston, TX; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Trinity College Dublin (HAE), Dublin, Ireland; FondaMental Fondation (HAE), Paris, France; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez (HAE, AI), Santiago de Chile, Chile; Houston Methodist Behavioral Health, Houston Methodist Academic Institute (HAE), Houston, TX.
| | - Lucy E Stirland
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh (LES), Edinburgh, UK
| | - Dilip V Jeste
- Global Research Network on Social Determinants of Mental Health and Exposomics (DVJ), La Jolla, CA
| | - Charles F Reynolds
- Department of Psychiatry, The University of Pittsburgh (CFR), Pittsburgh, PA
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne (MB), Parkville, Victoria, Australia; The Florey Institute for Neuroscience and Mental Health, University of Melbourne (MB), Parkville, Victoria, Australia; ORYGEN Youth Health, University of Melbourne (MB), Parkville, Victoria, Australia
| | - Agustin Ibanez
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez (HAE, AI), Santiago de Chile, Chile; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET) (AI), Buenos Aires, Argentina
| | - Walter D Dawson
- Brain Capital Alliance (HAE, AI, WDD), San Francisco, CA; Neuroscience-inspired Policy Initiative (NIPI), New Approaches to Economic Challenges, Office of the Chief Economist, Organisation for Economic Co-Operation and Development (HAE, AI, WDD), Paris, France; Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Oregon Alzheimer's Disease Research Center, School of Medicine, Oregon Health & Science University (WDD), Portland, OR; Institute on Aging, College of Urban & Public Affairs, Portland State University (WDD), Portland, OR
| | - Brian Lawlor
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA
| | - Iracema Leroi
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA
| | - Kristine Yaffe
- Department of Epidemiology and Biostatistics, University of California, San Francisco (KY), San Francisco, CA; Department of Psychiatry and Neurology, University of California, San Francisco (KY), San Francisco, CA
| | - Jennifer R Gatchel
- Division of Geriatric Psychiatry, McLean Hospital, Harvard Medical School (JRG), Belmont, MA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School (JRG), Boston, MA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona (JFK), Tucson, AZ
| | - Paul Newhouse
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center (PN), Nashville, TN; Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs-Tennessee Valley Health Care System (PN), Nashville, TN
| | - Jonathan Rosand
- McCance Center for Brain Health, Department of Neurology, Mass General Brigham (JR), Boston, MA; Broad Institute of MIT and Harvard (JR), Cambridge, MA
| | - Nicole Letourneau
- Alberta Children's Hospital Research Institute, University of Calgary (NL), Calgary, Alberta, Canada
| | - Eleonore Bayen
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Department of Physical and Rehabilitation Medicine, Sorbonne Université - Pitié-Salpêtrière Hospital (EB), Paris, France
| | - Francesca Farina
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University (FF), Chicago, IL
| | - Laura Booi
- Global Brain Health Institute, University of California, San Francisco (UCSF) (HAE, LES, AI, WDD, BL, IL, EB, FF, LB), San Francisco, CA; Centre for Dementia Research, School of Health, Leeds Beckett University (LB), Leeds, UK
| | - Devangere P Devanand
- Division of Geriatric Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University (DPD), New York, NY
| | - Jacobo Mintzer
- Ralph. H. Johnson VA Medical Center, Charleston, SC and Professor, College of Health Professions, Medical University of South Carolina (JM), Charleston, SC
| | - Sheri Madigan
- University of Calgary (SM), Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute (SM), Calgary, Alberta, Canada
| | | | - Stephen T C Wong
- T.T. and W.F. Chao Center for BRAIN Houston Methodist Hospital (STCW), Houston, TX; Houston Methodist Cancer Center, Houston Methodist Hospital (STCW), Houston, TX; Department of Radiology, Weill Cornell Medicine (STCW), New York, NY; Department of Neurosciences, Weill Cornell Medicine (STCW), New York, NY; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine (STCW), New York, NY
| | - Veronica Podence Falcoa
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University and Barwon Health (HAE, MB, VPF), Geelong, Victoria, Australia; Hospital Beatriz Angelo (VPF), Lisbon, Portugal
| | - Jeffrey L Cummings
- Chambers-Grundy Center for Transformative Neuroscience, University of Nevada (JLC), Las Vegas, NV
| | - William Reichman
- Department of Psychiatry, Faculty of Medicine, University of Toronto (WR), Toronto, Ontario, Canada
| | - Sarah Lenz Lock
- Global Council on Brain Health, Policy and Brain Health, AARP (SLL), Washington, DC
| | - Marc Bennett
- School of Psychology, University College Dublin (MB), Belfield, Dublin, Ireland; MRC-Cognition and Brain Sciences Unit, University of Cambridge (MB), England, UK
| | - Rajiv Ahuja
- Center for the Future of Aging, The Milken Institute (RA), Washington, DC
| | - David C Steffens
- Department of Psychiatry, University of Connecticut School of Medicine (DCS), Farmington, CT
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University (MSVE), New York City, NY; American Heart Association/American Stroke Association (MSVE), Dallas, TX
| | - Helen Lavretsky
- David Geffen School of Medicine, University of California, Los Angeles (UCLA) (HL), Los Angeles, CA; Semel Institute for Neuroscience and Human Behavior, UCLA (HL), Los Angeles, CA
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9
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Butzin-Dozier Z, Mertens AN, Tan ST, Granger DA, Pitchik HO, Il’yasova D, Tofail F, Rahman MZ, Spasojevic I, Shalev I, Ali S, Karim MR, Shahriar S, Famida SL, Shuman G, Shoab AK, Akther S, Hossen MS, Mutsuddi P, Rahman M, Unicomb L, Das KK, Yan L, Meyer A, Stewart CP, Hubbard A, Tabassum Naved R, Parvin K, Mamun MMA, Luby SP, Colford JM, Fernald LCH, Lin A. Stress Biomarkers and Child Development in Young Children in Bangladesh. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.12.23295429. [PMID: 37745503 PMCID: PMC10516093 DOI: 10.1101/2023.09.12.23295429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Hundreds of millions of children in low- and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations between biological measures of chronic stress in early life and developmental outcomes in a large cohort of young children living in rural Bangladesh. Methods We assessed physiologic measures of stress in the first two years of life using measures of the hypothalamic-pituitary-adrenal (HPA) axis (salivary cortisol and glucocorticoid receptor gene methylation), the sympathetic-adrenal-medullary (SAM) system (salivary alpha-amylase, heart rate, and blood pressure), and oxidative status (F2-isoprostanes). We assessed child development in the first two years of life with the MacArthur-Bates Communicative Development Inventories (CDI), the WHO gross motor milestones, and the Extended Ages and Stages Questionnaire (EASQ). We compared development outcomes of children at the 75th and 25th percentiles of stress biomarker distributions while adjusting for potential confounders (hereafter referred to as contrasts) using generalized additive models, which are statistical models where the outcome is predicted by a potentially non-linear function of predictor variables. Results We analyzed data from 684 children (49% female) at both 14 and 28 months of age; we included an additional 765 children at 28 months of age. We observed 135 primary contrasts of the differences in child development outcomes at the 75th and 25th percentiles of stress biomarkers, where we detected significant relationships in 5 out of 30 contrasts (17%) of HPA axis activity, 1 out of 30 contrasts (3%) of SAM activity, and 3 out of 75 contrasts (4%) of oxidative status. These findings revealed that measures of HPA axis activity were associated with poor development outcomes. We did not find consistent evidence that markers of SAM system activity or oxidative status were associated with developmental status. Conclusions Our observations reveal associations between the physiological evidence of stress in the HPA axis with developmental status in early childhood. These findings add to the existing evidence exploring the developmental consequences of early life stress.
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Affiliation(s)
| | - Andrew N. Mertens
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Sophia T. Tan
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Douglas A. Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Helen O. Pitchik
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA USA
| | - Shahjahan Ali
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Sunny Shahriar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syeda Luthfa Famida
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Gabrielle Shuman
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Abul K. Shoab
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Salma Akther
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Saheen Hossen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Palash Mutsuddi
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kishor K. Das
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | - Alan Hubbard
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | | | - Kausar Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Mahfuz Al Mamun
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA USA
| | - John M. Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Lia C. H. Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA USA
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA USA
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10
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Slopen N, Umaña-Taylor AJ, Shonkoff JP, Carle AC, Hatzenbuehler ML. State-Level Anti-Immigrant Sentiment and Policies and Health Risks in US Latino Children. Pediatrics 2023; 152:e2022057581. [PMID: 37581234 PMCID: PMC10565791 DOI: 10.1542/peds.2022-057581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Although systemic inequities, broadly defined, are associated with health disparities in adults, there is a dearth of research linking contextual measures of exclusionary policies or prejudicial attitudes to health impairments in children, particularly among Latino populations. In this study, we examined a composite measure of systemic inequities in relation to the cooccurrence of multiple health problems in Latino children in the United States. METHODS Participants included 17 855 Latino children aged 3 to 17 years from the National Survey of Children's Health (2016-2020). We measured state-level systemic inequities using a factor score that combined an index of exclusionary state policies toward immigrants and aggregated survey data on prejudicial attitudes toward immigrants and Latino individuals. Caregivers reported on 3 categories of child health problems: common health difficulties in the past year, current chronic physical health conditions, and current mental health conditions. For each category, we constructed a variable reflecting 0, 1, or 2 or more conditions. RESULTS In models adjusted for sociodemographic covariates, interpersonal discrimination, and state-level income inequality, systemic inequities were associated with 1.13 times the odds of a chronic physical health condition (95% confidence interval: 1.02-1.25) and 1.24 times the odds of 2 or more mental health conditions (95% confidence interval: 1.06-1.45). CONCLUSIONS Latino children residing in states with higher levels of systemic inequity are more likely to experience mental health or chronic physical health conditions relative to those in states with lower levels of systemic inequity.
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Affiliation(s)
- Natalie Slopen
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Center on the Developing Child
| | | | - Jack P. Shonkoff
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Center on the Developing Child
- Harvard Graduate School of Education, Harvard University, Cambridge, Massachusetts
- Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam C. Carle
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Psychology University of Cincinnati College of Arts and Sciences
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11
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Cholera R, Anderson DM, Chung R, Genova J, Shrader P, Bleser WK, Saunders RS, Wong CA. Analysis of North Carolina Medicaid Claims Data to Simulate a Pediatric Accountable Care Organization. JAMA Netw Open 2023; 6:e2327264. [PMID: 37540515 PMCID: PMC10403786 DOI: 10.1001/jamanetworkopen.2023.27264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
Importance Despite momentum for pediatric value-based payment models, little is known about tailoring design elements to account for the unique needs and utilization patterns of children and young adults. Objective To simulate attribution to a hypothetical pediatric accountable care organization (ACO) and describe baseline demographic characteristics, expenditures, and utilization patterns over the subsequent year. Design, Setting, and Participants This retrospective cohort study used Medicaid claims data for children and young adults aged 1 to 20 years enrolled in North Carolina Medicaid at any time during 2017. Children and young adults receiving at least 50% of their primary care at a large academic medical center (AMC) in 2017 were attributed to the ACO. Data were analyzed from April 2020 to March 2021. Main Outcomes and Measures Primary outcomes were total cost of care and care utilization during the 2018 performance year. Results Among 930 266 children and young adults (377 233 children [40.6%] aged 6-12 years; 470 612 [50.6%] female) enrolled in Medicare in North Carolina in 2017, 27 290 children and young adults were attributed to the ACO. A total of 12 306 Black non-Hispanic children and young adults (45.1%), 6308 Hispanic or Latinx children and young adults (23.1%), and 6531 White non-Hispanic children and young adults (23.9%) were included. Most attributed individuals (23 133 individuals [84.7%]) had at least 1 claim in the performance year. The median (IQR) total cost of care in 2018 was $347 ($107-$1123); 272 individuals (1.0%) accounted for nearly half of total costs. Compared with children and young adults in the lowest-cost quartile, those in the highest-cost quartile were more likely to have complex medical conditions (399 individuals [6.9%] vs 3442 individuals [59.5%]) and to live farther from the AMC (median [IQR distance, 6.0 [4.6-20.3] miles vs 13.9 [4.6-30.9] miles). Total cost of care was accrued in home (43%), outpatient specialty (19%), inpatient (14%) and primary (8%) care. More than half of attributed children and young adults received care outside of the ACO; the median (IQR) cost for leaked care was $349 ($130-$1326). The costliest leaked encounters included inpatient, ancillary, and home health care, while the most frequently leaked encounters included behavioral health, emergency, and primary care. Conclusions and Relevance This cohort study found that while most children attributed to the hypothetical Medicaid pediatric ACO lived locally with few health care encounters, a small group of children with medical complexity traveled long distances for care and used frequent and costly home-based and outpatient specialty care. Leaked care was substantial for all attributed children, with the cost of leaked care being higher than the total cost of care. These pediatric-specific clinical and utilization profiles have implications for future pediatric ACO design choices related to attribution, accounting for children with high costs, and strategies to address leaked care.
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Affiliation(s)
- Rushina Cholera
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Duke Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - David M. Anderson
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Duke Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Richard Chung
- Duke Department of Pediatrics, Duke University, Durham, North Carolina
| | - Jessica Genova
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Peter Shrader
- Duke Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - William K. Bleser
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Robert S. Saunders
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Charlene A. Wong
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Duke Department of Pediatrics, Duke University, Durham, North Carolina
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12
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Black MM, Walker SP, Attanasio O, Rubio-Codina M, Meghir C, Hamadani JD, Fernald LCH, Kowalski A, Grantham-McGregor S. Promoting Childhood Development Globally Through Caregiving Interventions. Pediatrics 2023; 151:191213. [PMID: 37125880 DOI: 10.1542/peds.2023-060221b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/02/2023] Open
Affiliation(s)
- Maureen M Black
- University of Maryland School of Medicine, Baltimore, Maryland
- RTI International, Research Triangle Park, North Carolina
| | - Susan P Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | | | | | | | - Jena D Hamadani
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Alysse Kowalski
- University of Maryland School of Medicine, Baltimore, Maryland
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13
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Wiltshire CA. Early Childhood Education Teacher Workforce: Stress in Relation to Identity and Choices. EARLY CHILDHOOD EDUCATION JOURNAL 2023:1-14. [PMID: 37360603 PMCID: PMC10024290 DOI: 10.1007/s10643-023-01468-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 06/28/2023]
Abstract
The early childhood education teacher workforce is consistently relied upon to bolster children's academic and socioemotional development in preparation for kindergarten and long-term outcomes. This is especially true of children who, historically overlooked and marginalized, are labeled "at risk." While research has focused on pervasive stressors as obstacles to these classroom professionals (e.g., teacher/teaching stress, curricular mandates, quality assessments, COVID-19), there is less research on stress in relation to the formation of teacher identity; specifically, how stress contributes to and detracts from the formation of a teacher's micro-identity, and how negative impacts of stress to the micro-identity may contribute to teachers' decisions to leave the field. Although once considered to be one of the fastest growing industries, The Great Resignation, as it has come to be known, estimates up to 25-30% of the workforce leave annually. To better understand the choices teachers make to leave the profession, the current study examined the influence of stress on teachers' microidentity by centering the voices of six Head Start teachers. Implementing a qualitative design, this investigation asked (a) Who are the Head Start teachers in the workforce today? (b) What are the particular stressors with which they contend? (c) How does the micro-identity of these teachers change as a result of stress, and what are the potential choices that follow? Results and findings indicated that Head Start teachers experience (1) stress as reality, (2) stress-shaped identities, and (3) identity-mediated choice. Implications and insights are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10643-023-01468-w.
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Affiliation(s)
- Cynthia A. Wiltshire
- Department of Teacher Education, College of Education, The University of Texas at El Paso, 500 W. University Ave, El Paso, TX 79968 USA
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14
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Gilgoff R, Schwartz T, Owen M, Bhushan D, Burke Harris N. Opportunities to Treat Toxic Stress. Pediatrics 2023; 151:190226. [PMID: 36450652 DOI: 10.1542/peds.2021-055591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Rachel Gilgoff
- Aurrera Health Group, Sacramento, California.,UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, California
| | | | - Mikah Owen
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, California
| | - Devika Bhushan
- Office of the California Surgeon General, Sacramento, California
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15
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Jones DD. Dismantling Institutional Racism: The Role of Behavioral Science. Int J Psychiatry Med 2022; 57:373-380. [PMID: 35950989 DOI: 10.1177/00912174221111661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Institutionalized racism embeds our systems of healthcare delivery and medical education. This produces racial healthcare disparities which have been shown to severely impact both physical and behavioral health outcomes. Efforts to address institutionalized racism often focus on individualized efforts directed towards the healthcare workforce. However, more effective system level approaches are emerging. The behavioral health sciences can play a role in dismantling institutionalized racism by providing the evidence needed to understand effects on individuals and develop targeted system level approaches.
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