WhenCorinne Peek-Asawas an undergraduateatthe University of New Mexico,the idea of becoming anepidemiologist wasnton herradar.

In fact, she says,It was through a series of fortuitous events that I discovered what Iloved.

After graduating with a degree in biochemistry, Peek-Asa went to medical school thinking it would align with her interests in public health andresearch.

But duringclinical rotations,Peek-Asasoonrealizedshe didnt want to focusonpatient care.After transitioningtoforensic pathology,sheworkedin a medical examiners officecollecting tumorsfora cancer study and met a publichealth researcher whogave herthe opportunity to assist witha studyonpedestriansinNew MexicosPueblopopulation.

I didnt know it at the time, but I was really seeking something interdisciplinary,something that looks intocomplex problems thatrequirea lot of fields to solve, she says.SoI quit med school, applied foragraduateprogram in epidemiology, and it was very much afit.

Peek-Asa earneda masters in public health and a PhDfrom the University of California, Los Angeles, where she trained as an epidemiologist to investigate patterns and causes of injury.Specializingin implementing andanalyzingprevention programs and policies, Peek-Asais interested inthe larger goal of reducing thelong-termnegative health outcomesthat traumatic injuries cancause.

Anassociate dean for research in the University of Iowa College of Public Health and professor in the Department of Occupational and Environmental Health,Peek-Asadirects IowasInjury Prevention Research Center (IPRC)and is an appointed member of the National Academy of Medicines Global Violence PreventionForum.

Peek-Asa will deliver Iowas 37th annual Presidential Lecture, Violence, Syndemics, and the Biology of Trauma, on Feb.16.

Why is childhood trauma so important to the research youll be focusing on in yourlecture?

Were learning about how trauma and violence in early childhood not only impact your development but can do so in a way that sets you up for many different health problems. So this leads to the question, if we can prevent extreme childhood adversity, traumatic stress, and abuse, can we show a lifelong trajectory of improved health? We need to look at a lot of outcomes, and the framework that takes this approach is called asyndemic.

Adverse childhood events, or ACEs, are traumatic experiences that impact brain development, causing a cascade of reactions that influence long-term health. These types of trauma can include emotional abuse and neglect, physical and sexual violence, household violence, substance abuse, mental illness, and even parental separation or divorce. Increasinglyall over the world, but especially in the U.S.ACEs are being recognized for their damaging impact on brain development. This concept is recognized as the biology of trauma. In short, the brain will organize around the most common and intense experiences, turning them into a baseline, defining what is normal. We know that people with six or more ACEs have a life expectancy 20 years shorter than those withnone.

How does a syndemic differ from an epidemic, and how does one unfold? Are we experiencing any syndemics in theU.S.?

As we know, an epidemic is a health problem affecting a large number of people that has increased beyond what was anticipated. In addition to the current opioid epidemic in our country, were also dealing with an epidemic of suicides and substance use. According to a report from the nonprofit Trust for Americas Health, this can actually be seen as a larger epidemic of despair. Were seeing increases in substance abuse, alcohol, and violence, and recognizing that theres an underlying epidemic of despair leading tothese.

A syndemic is a cluster of related epidemicssynergistic epidemicswhich are epidemics that have related causal factors and outcomes and involve larger socialdeterminants.

Another component of a syndemic is that the underlying causal factors interact with each other. So, for example, a child who falls off of their bike, then gets exposed to a cold virus at the same time is not experiencing interacting causal factors. Instead, imagine a child who is a victim of abuse: suffering from that abuse leads to having a depressed immune system, which then leads them to being susceptible to infectious disease. So, the risk factors are not just paralleltheyinteract.

Adverse childhood experiences, which have health implications so early in life, are a component of many violence syndemics. Childhood adversity, for example, is an underlying element in many of the diseases of despairsubstance use, alcohol use, and suicide. The work we do at the Injury Prevention Research Center is pushing the boundaries of how we can address some of the larger social determinants of these violence syndemics. For example, policies in the workplace can reduce the risk for homicide and suicide and can support a trauma-informed environmentone that is sensitive to the past experiences that might be predicting current health andbehavior.

What sparked your interest in syndemics, and how do you see it being most useful in your areas ofresearch?

The component of syndemics that most interests me has to do with cultural and social determinants. In other words, the nexus of adverse childhood experiences and substance use is concentrated in populations of people with limited access to health care, lower education levels, less access to resources, and fewer social connections. From a public health standpoint, its important to address these connections to social inequity and poverty. And that can include changing the way we design our studies to think about these broader contexts. For example, we have done some studies in Romania showing that when the country joined the European Union, new roads were built in ways that did not accommodate pedestrians, especially those who had some physical limitations, like the elderly; they were having challenges getting across the road. It became clear that safety had not been a priority in decisions about transportationinfrastructure.

So the syndemic framework is helpful in that it shows us were not going to solve the problem by installing lights, adding more stop signs or crosswalks, or having police do more patrols. Were only going to solve the problem by building roads that accommodate all users, and by making health and safety a priority in transportation decisions. This approach, called Health in All Policy, is becoming a higher priority everywhere from the U.S. Department of Transportation to the WorldBank.

What kinds of shifts in public health, or society at large, might be required to see more effective prevention orintervention?

We need to invest in early childhood injury intervention and prevention programs, and to think much more about health outcomes as a life trajectory. When we think about adverse childhood experiences and their ties to future substance use, we need to realize that a systems-oriented solution goes far beyond helping addicted people in rehab; a systemicapproach will prevent the adverse childhood experiences. How do we as a society think about preventing child abuse? Thats a really hard question because its such a complex issue. Abuse isoften

intergenerational. It can be hard to detect. So, while were working on answers to this question, I want us to do our work thinking more in the big picture, focus on prevention, and how it can fit into these thorny societalissues.

What does being selected for the Presidential Lecture mean toyou?

Its a wonderful opportunity to show how much of the work the UI does in this area of public health and how it truly impacts the community, how much it helps the populations not just in Iowa but all over theworld.

Academics are passionate about their research, so to have the opportunity to showcase itand that others are interested in itmeans a lot to me as well as to my team. Its really a greathonor.

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Preventing childhood trauma and reducing its long-term effects - Iowa Now