California’s first Surgeon General, Dr. Nadine Burke Harris, made national headlines in October 2019 for her recommendation that every child in school be screened for trauma. Although this may seem like a radical suggestion, approximately two-thirds of youth in the U.S. experience at least one potentially traumatic event (PTE) before age 16 (Copeland et al. 2007; Substance Abuse and Mental Health Services Administration 2017), with approximately 50% of youth experiencing serious interpersonal trauma before age 18 (Finkelhor et al. 2013; Kilpatrick et al. 2003b). Exposure to PTEs is greatest among youth from socially disadvantaged backgrounds, with Black youth reporting the highest rates (López et al. 2017). These disparities may be explained, in part, due to the overrepresentation of Black youth in contexts where PTEs are more likely to occur, such as low-income communities, juvenile detention centers, and foster care placements (Andrews et al. 2015; Wamser-Nanney et al. 2018).

Although exposure to PTEs are detrimental to the well-being of all youth, their effects may be particularly harmful among Black youth given the relevance and impact of racism and racial discrimination. Racism is defined as “the exercise of power against a racial group defined as inferior by individuals and institutions with the intentional or unintentional support of the entire culture” (Jones 1972, p. 117), whereas experiences of racial discrimination (i.e., individual racism) represent behavioral enactments of racism that reinforce beliefs that one racial group is inferior to another (Jones 1972). Racial discrimination is nearly ubiquitous, with recent data indicating that Black youth average five experiences of racial discrimination per day (English et al. 2020). This is concerning given the myriad of adverse consequences linked to racial discrimination among Black youth including decreased psychological, physical, behavioral, and emotional functioning (Cave et al. 2020; Priest et al. 2013). The harmful indirect effects of racial discrimination are equally potent (Jones et al. 2016), with research illustrating that the deleterious effects of other stressors may be amplified for Black youth who have experienced racial discrimination, thereby compounding risk for negative mental health outcomes (De Coster and Thompson 2017).

A growing body of research has demonstrated that the profound effects of racial discrimination on health may be best understood through a traumatic stress perspective (i.e., racial trauma). However, the majority of extant work detailing the traumatic implications of racial discrimination has been conducted among Black adults (Bryant-Davis and Ocampo 2005; Carter 2007; Williams et al. 2018), with considerably few studies taking steps to consider racial discrimination as a PTE for Black youth (Anderson and Stevenson 2019; Jernigan and Daniel 2011; Saleem et al. 2019). As such, there is a shortage of comprehensive conceptual models that forecast how racial discrimination can be conceptualized as a PTE to inform mental health trajectories among Black youth. Thus, the goal of the current paper is to propose a culturally-informed adaptation of the Adverse Childhood Experiences (ACEs) conceptual framework – a well-known and highly referenced framework for understanding the mental and behavioral health consequences of PTEs among youth (Felitti et al. 1998). The proposed model integrates childhood models of racial trauma into the ACEs framework, detailing how manifestations of racism (e.g., racial discrimination) can simultaneously serve as an ACE exposure risk factor, a discrete ACE category, and a determinant of post-ACE mental health outcomes. Subsequently, we discuss how the present adaptation of the ACEs model provides direction for future research that can inform public health efforts centered on clarifying and addressing the impact of racism on Black youth.

The ACEs Conceptual Framework

Several theoretical frameworks highlight the increased health risk conferred by childhood traumatic stress and exposure to PTEs (Ford and Greene 2017), with the ACEs framework representing perhaps one of the most widely-acknowledged among them. Based on the seminal work of Felitti et al. (1998), the ACEs model provides a risk-based framework in which childhood exposure to PTEs are theorized to have a dose-dependent effect on health risk behaviors, developmental disruptions, and mental and physical illness during childhood that extends well into adulthood (Felitti et al. 1998; Hughes et al. 2017; Kalmakis and Chandler 2015). According to the Centers for Disease Control and Prevention (CDC), ACEs represent any individual or environmental experience that disrupts a child’s sense of safety, stability, or bonding (CDC 2020a). Though broadly defined, ACEs literature has generally examined the implications of exposure to the following adverse events: childhood abuse (sexual, physical, emotional), household substance abuse and mental illness, neglect, parental separation or divorce, and household criminality (Hughes et al. 2017).

The nature and impact of ACEs can be best understood by referencing the ACE pyramid (CDC 2020b), which depicts factors influencing exposure to ACEs and how ACEs are connected with poor health outcomes. Positioned at the base of the ACE pyramid is historical trauma, which refers to the notion that the collective traumatic experiences of one generation (e.g., a parent’s own trauma history) can increase predispositions for disease and suboptimal psychological functioning in future generations (Brave Heart and DeBruyn 1998). Historical trauma informs the local context and social conditions (e.g., home environment, socioeconomic resources, neighborhood safety) in which youth maturate, directly effecting the likelihood of exposure and/or direct encounters with ACEs. Upon exposure to ACEs, whether directly (e.g., physical abuse) or indirectly (e.g., witnessing interpersonal violence), youth may experience disruptions in neurodevelopment (e.g., prefrontal brain regions), which can subsequently impair social (e.g., connectedness), emotional (e.g., emotion regulation), and cognitive (e.g., executive functioning) functioning. These impairments, in turn, are shown to heighten risk for the adoption of health risk behaviors (e.g., substance and alcohol use), which subsequently increase risk for poor health outcomes (disease, psychological and physical functioning), and ultimately early death.

Ample research has supported the ACEs pyramid, highlighting the harmful and widespread effects that ACEs can have on health across the lifespan. For instance, research examining the intergenerational transmission of historical trauma has shown that parental ACEs are associated with poorer infant health outcomes (Racine et al. 2018) and later childhood health and health risk behavior (Lê-Scherban et al. 2018). As it relates to the family context, parents with a history of ACEs are also at increased risk for anxiety and depression (Letourneau et al. 2019), have greater difficulty forming secure attachments to their offspring (Iyengar et al. 2014), and are at greater risk to engage in behaviors (e.g., substance use) that impair positive parenting (Meulewaeter et al. 2019). Together, these parental risk factors can foster an ACE prone environment for youth. Upon experiencing ACEs, youth are at greater risk of neurological (e.g., physiological damage), social-emotional (e.g., emotion reactivity), and cognitive impairments (e.g., executive functioning), and are more likely to engage in maladaptive health risk behaviors including substance use and juvenile offenses (Danese and McEwen 2012; Guinosso et al. 2016; Kalmakis and Chandler 2015). ACEs have also been linked with chronic physical health conditions such as cardiovascular disease, respiratory disease, and cancer, especially among those who have experienced multiple ACEs (Bellis et al. 2019; Hughes et al. 2017; Kalmakis and Chandler 2015). The effects of ACEs may be most pronounced in the context of mental health, with literature suggesting that ACEs could account for as much as 30% of cases of anxiety, 40% of cases of depression in North America, and increased rates of suicide (Bellis et al. 2019; Sachs-Ericsson et al. 2016).

ACEs among Black Youth

Unfortunately, significant disparities exist with respect to ACE exposure. Socially disadvantaged groups, and Black youth in particular, are more likely to report multiple ACEs relative to their White counterparts (Bruner 2017; Maguire-Jack et al. 2019; Slopen et al. 2016; Strompolis et al. 2019). This disproportionate exposure may help to explain why Black youth evidence greater health risk behaviors (e.g., conduct problems, substance use) and mental health concerns following exposure to ACEs, compared to youth from other racial and ethnic backgrounds (Fagan and Novak 2018; Lee and Chen 2017; Liu et al. 2018). The psychological burden of ACEs have lasting consequences that continue to disparately plague Black youth as they age into adulthood, and has been linked to increases in symptoms of depression, anxiety, and posttraumatic stress symptoms, as well as increased tobacco, alcohol, and marijuana use (Elkins et al. 2019; Mersky et al. 2013).

Despite the increased mental health risk that Black youth face because of their increased exposure to ACEs, research examining why these disparities exist is scarce. One possible explanation for this lack of research is that the conventional ACEs framework overlooks unique stressors faced by Black youth and youth from other racial and ethnic minority groups (Strompolis et al. 2019; Wang et al. 2019). To this end, scholars have pointed to the necessity of expanding the conceptualization of ACEs to incorporate stressful life experiences of particular relevance to historically disadvantaged and marginalized groups. In a qualitative examination of ACEs within a sample of low-income youth (71% Black), Wade et al. (2014) found that youth spoke about ACEs in ways that extended beyond the traditional conceptualization. Specifically, while some responses aligned with conventional ACEs (e.g., familial substance, physical abuse), youth also described experiences that have not been customarily discussed within ACEs literature including racial discrimination, community violence, poverty, and interactions with juvenile justice and foster care system. As such, the authors concluded that the ACEs framework should be expanded to be more representative of the unique PTEs that youth of color encounter.

In support of this expanded ACEs approach, a study by Cronholm et al. (2015) compared the conventional ACEs framework to an expanded version that included PTEs relevant to experiences of community violence, racial discrimination, foster care placement, and other experiences among a racially diverse adult population. Their findings revealed that racial and ethnic minority adults endorsed more ACEs using their expanded framework, relative to their White counterparts. More recent investigations have yielded similar results finding that Black youth were more likely to report ACEs consistent with the expanded framework (e.g., discrimination and community violence), compared to their White counterparts who were more likely to endorse ACEs that more so aligned with the conventional framework (e.g., exposure to parental drug and alcohol use; Maguire-Jack et al. 2019). Taken together, significant variation exists in the typology of ACEs, which may differ as a function of one’s racial and ethnic background. Despite this evidence, PTEs that disparately occur among youth of color remain on the periphery of scholarly investigations. Integration of culturally-informed PTEs within the broader ACEs framework is an essential first step for understanding and addressing critical gaps in the empirical literature on childhood adversity and traumatic stress.

While several unique PTEs fit within this expanded conceptualization of ACEs, racism-related experiences, and racial discrimination in particular, are among the most chronic and taxing stressors that Black youth negotiate throughout development (Jones et al. 2020; Priest et al. 2013). In cross-sectional and longitudinal studies of Black youth, racism-related experiences have been directly and indirectly associated with greater perceptions of other stressors, increased symptoms of anxiety and depression, hypervigilance, suicidality, lower self-esteem, and emotion and behavioral regulation difficulties (Cave et al. 2020; Himmelstein et al. 2015; Kirkinis et al. 2018; Priest et al. 2013). Indeed, racism has been extensively discussed as key social determinant to ACE exposure and health disparity (Williams and Williams-Morris 2000; Williams et al. 2019; Williams and Collins 2001; Williams and Mohammed 2009), suggesting that racism-related experiences are central to pinpoint when discussing PTEs among Black youth.

Conceptualizing Racial Discrimination as Racial Trauma

Given the enduring and pervasive negative impact of racism on Black youth’s psychological adjustment, scholars have argued that the effects of racism-related encounters (e.g., racial discrimination) should be conceptualized as a distinct form of traumatic stress, otherwise referred to as “racial trauma.” Racial trauma can be defined as “the emotional and psychological response to racism-related incidents that are unexpected, experienced as threatening, and result in significant psychological stress” (Pieterse 2018, p. 205). The concept of racial trauma stems from Carter’s (2007) theory of race-based traumatic stress (Carter 2007), which asserts that racism related experiences can cause emotional and psychological injury which threatens an individual’s sense of safety and security, subsequently triggering a traumatic stress response (e.g., intrusive thoughts, anxiety and depression, avoidance, vigilance).

In support of the notion of racial trauma, scholarship has documented the considerable overlap between the consequences of racial discrimination and traumatic stress sequelae. For example, racial discrimination has been found to predict negative outcomes that strongly parallel post-traumatic stress reactions (Bryant-Davis and Ocampo 2005; Carter et al. 2020). The connection between racism-related experiences and trauma-related symptoms remains even after controlling for general life stressors and other PTEs (Mendez et al. 2020; Pieterse et al. 2010; Polanco-Roman et al. 2016), suggesting that this association may be particularly robust. Thus, it follows that a recent systematic review has implicated racial discrimination as a significant risk factor for trauma symptomatology (Kirkinis et al. 2018).

Given the potentially traumatic implications of racial discrimination, recent literature has taken steps to highlight the developmental implications of racial trauma among Black youth. For example, Jernigan and Daniel (2011) assert that Black youth are particularly vulnerable to racial trauma as they have yet to develop the skills necessary to adaptively process and cope with racism-related encounters. According to Jernigan and Daniel, the school environment is the primary context in which Black youth are repeatedly subjected to racial discrimination by teachers and peers, and without considerable support and advocacy, it may be very difficult to reduce or overcome these traumatic experiences. The Developmental and Ecological Model of Youth Racial Trauma (DEMYth-RT; Saleem et al. 2019) builds upon the work of Jernigan and Daniel by providing a framework to explain how historical trauma, present day interpersonal racism, and ecological factors interact to contribute to posttraumatic stress symptoms among youth of color. Consistent with the intergenerational transmission of stress (Bowers and Yehuda 2016), the DEMYth-RT model asserts that historical trauma (i.e., racial oppression, slavery, parent experiences of racism) informs baseline stress levels, contributing to social and epigenetic dispositions in ways that increase vulnerability to contemporary expressions of racism. Present-day encounters of racial discrimination may further amplify these vulnerabilities and increase risk for traumatic stress responses, with child appraisals, perceptions, and responses to racism-related experiences being further influenced by developmental age and the multiple ecological contexts in which youth are imbedded (e.g., family, community, school).

Although this literature makes a compelling case to suggest that racial trauma represents a pernicious reality for Black youth and other youth of color, it is important to acknowledge that person mediated expressions of racial discrimination represent only a piece of the racism picture (Harrell 1999). Indeed, racism simultaneously operates at the individual (e.g., racial discrimination), institutional (e.g., mass incarceration), and cultural (e.g., stereotypical representations in media) level (Jones 1972) to increase risk for ACEs exposure and health vulnerability among Black youth. Further, racial trauma does not exist in isolation to hinder health trajectories of Black youth. That is, Black youth are not only expected to navigate racism, but also do so while negotiating exposure to other stressors and PTEs that shape physical and psychological outcomes over time. Despite increasing calls to acknowledge the importance of the multilevel nature of racism (Neblett 2019), in addition to how racism-related experiences may interact with other stressors to inform health outcomes (De Coster and Thompson 2017; Peters and Massey 1983), such considerations remain absent within the ACEs literature. As such, a comprehensive conceptual model of childhood adversity that fully acknowledges the pervasive, distinct, and interactive influence of racism on the lived experiences of Black youth is needed.

A Culturally-Informed ACEs Model

Inspired by developmental frameworks elucidating the significance of racial trauma on health among Black youth (Jernigan and Daniel 2011; Saleem et al. 2019), we present a culturally-informed ACEs model, or “C-ACE,” for understanding the pervasive mental health impact of racism on Black youth. This targeted C-ACE model presents racism as a unique sociocultural factor with historical underpinnings that contribute to present day ACE exposure disparities and subsequent stress-related psychopathology among Black youth.

Leveraging the preexisting infrastructure of the ACEs pyramid, the proposed model first recognizes risk factors that increase exposure and vulnerability to ACEs, beginning with historical trauma (see Fig. 1). Unique to the present model is our conceptualization of historical trauma through a historical racism perspective. This allows for the formal recognition of the historical and intergenerational effects of racism, particularly as it pertains to ACE exposure and health disparities that disproportionately impact Black youth. With this historical backdrop serving as the foundation of our C-ACE model, we then present evidence illustrating how historical racism continues to shape present-day social conditions (path a), biological predispositions of Black youth (path b), and overall biopsychosocial vulnerability and risk of ACEs (paths c and d). We next present how contemporary manifestations of racism qualify as ACEs, and how the distinct and stress-amplifying characteristics of racism are influenced by post-ACE risk factors (path e and f) to influence health outcomes (path g and h). Below, we describe the model in detail, discussing relevant pathways where appropriate. The discussion integrates several bodies of empirical literature, content from which is presented in abbreviated fashion to maintain focus on presenting the fundamental components of the C-ACE model.

Culturally informed adverse childhood experiences framework for understanding the pervasive mental health impact of racism on black youth.

Historical Trauma

As referenced previously, the intergenerational transmission of historical trauma may inform the extent to which youth are exposed to and affected by adverse experiences. The multigenerational nature of historical trauma was initially examined in relation to the Holocaust, with the psychological effects of this mass trauma continuing to be detected in the offspring of Holocaust survivors and even three generations later (Giladi and Bell 2013; Kellerman 2001; Scharf 2007). Building from this compelling evidence, scholars have continued to link historical trauma to contemporary health disparities, particularly among groups who have been subjected to mass trauma as a result of historical colonization, marginalization, genocide, family separation, generational displacement, and other traumatic losses (Brave Heart 2003; Brockie et al. 2015; Mohatt et al. 2014; Sotero 2006). In the United States, historical trauma is especially important to consider for individuals of African descent, with their ancestors being forcefully taken from their homeland, shipped across the Atlantic, and forced into slavery (Harrell 2000).

The atrocities that occurred during American slavery are well-documented and included the abduction and separation of families, sexual exploitation, chronic abuse, and mass murder (Kolchin 2003). Enslaved youth and adults were subjugated to these daily traumatic experiences for generations. The systematic disenfranchisement and persecution of Black Americans continued following the abolishment of slavery at the end of American Civil War, as evidenced by the widespread practice of lynching and eventual institutionalization of Jim Crow laws, which reinforced and maintained the dehumanized and devalued status of Black individuals in America. The historical legacy of racism and slavery in the United States has been linked to the continued marginalization of Black communities within contemporary society, chiefly operating through institutional and structural practices that sustain inequity across multiple sociocultural domains (Williams et al. 2019).

Historical Racism and Current Social Conditions

As noted by Ruef and Fletcher (2003), the enduring effects of historical racism on contemporary social conditions (path a) represents an institutional legacy, or “the reproduction of material-resource and cultural conditions from a social institution despite the fact that the institution has been formally dismantled” (p. 447). That is, while formal practices of chattel slavery, lynchings, and Jim Crow laws may have ended, the ideologies, behaviors, and beliefs that undergirded these practices continue to shape the current cultural context, and serve to maintain economic, educational, and social disadvantage within the Black community (Williams et al. 2019). To this end, the effects of historical racism can be detected within numerous structural systems including housing and lending, residential segregation, education and employment, and access to healthcare (Williams et al. 2019), which in turn, increase risk to ACE exposure and health disparities (path c).

Although there are several ways that historical racism has shaped present day social conditions, perhaps the most influential on the social landscape of the United States is the unequal distribution of wealth, particularly between White and Black households (Thomas et al. 2020). Recent estimates suggest that the medium household income for Black families is only 61% of that of White households, and that this disparity has only marginally improved since 1970 (Pew Research Center 2020). This unequal distribution continues to exist even after accounting for educational attainment and other factors traditionally affiliated with economic mobility, such as home ownership (Darity et al. 2018). This financial disparity may help to explain why Black youth are more likely to live beneath the poverty line compared to youth of any other racial demographic (Bruner 2017), which factors into the maintenance of residential segregation practices, and the disproportionate concentration of Black families within impoverished and high-crime communities (Williams 2018; Williams and Collins 2001). Such, financial disparities and institutional practices increase risk of exposure to ACEs such as community violence, food insecurity, and household instability (Graves et al. 2010).

Moreover, the historical legacy of slavery and racism has fundamentally altered the way broader society perceives Black youth and the Black community as a composite. People, including police officers, are more likely to perceive Black youth as older, less innocent, less intelligent, and more violent compared to youth from other demographic backgrounds (Epstein et al. 2017; Goff et al. 2014). As evidenced by the countless incidents of racial profiling (e.g., stop and frisk, driving while Black) and murders of innocent Black youth and adults by law enforcement and others in the community (e.g., Trayvon Martin, Tamir Rice, Renisha McBride, Ahmuad Arbery, Breoana Taylor, George Floyd), these negative perceptions can have traumatic and potentially lethal consequences. Literature has tied these skewed perceptions of Black individuals to the negative historical depictions and portrayals of Black individuals during and after slavery (Goff et al. 2014; Smiley and Fakunle 2016), which has only continued in modern day media and news (Entman and Rojecki 2001). Such negative depictions and perceptions of Black people may inform, in part, why Black youth are suspended from school, arrested, incarcerated, and more harshly sentenced in the justice system relative to their White peers (Jarvis and Okonofua 2020; Mallett 2018; Morris and Perry 2016), each of which may considerably increase risk for ACEs. This may also help to explain why Black youth in the U.S. are six times more likely to have a parent in jail, compared to White youth (Sykes and Pettit 2014). Although having a parent in prison is currently conceptualized as an ACE, it also increases ACE exposure for youth by reducing the ability of Black families to establish stability and independence, financially support children, and attain social mobility (Harris et al. 2010; Sykes and Pettit 2014).

Historical Racism and Biological Predispositions

Historical trauma also contributes to the biological predisposition of Black youth (path b) in ways that increase risk of ACEs (path d). Behavioral expressions of racism (i.e., racial discrimination) have been shown to compromise health from one generation to the next, particularly through its influence on the prenatal environment of Black women (Alhusen et al. 2016; Dominguez 2008). Racial discrimination has been implicated as a key mechanism to explain why Black mothers face significant disparities in rates of birth complications, preterm births, and low birthweight babies, regardless of sociodemographic characteristics and maternal health behaviors (Alhusen et al. 2016; Giurgescu et al. 2011).

The link between racial discrimination and adverse birth outcomes among Black women has been conceptualized as a result of stress-induced disruptions in immune and inflammatory processes that negatively impact the prenatal environment (Christian 2012). For example, among pregnant Black women, racial discrimination has been associated with abnormal cortisol levels produced by the Hypothalamic-Pituitary-Adrenal (HPA) axis–one of the body’s major neuroendocrine stress response systems. Abnormal cortisol levels have been connected with pregnancy and delivery complications, such as preeclampsia, fetal growth delay, and preterm birth (Davis and Sandman 2006; Nepomnaschy et al. 2006; Reis et al. 1999), all of which are disparately observed within Black women (Giscombé and Lobel 2005; Lu and Halfon 2003; Slaughter-Acey et al. 2019). Maternal experiences of racial discrimination have also been linked to decreased cellular immune function (Christian et al. 2012), which increases risk for infection and birth complications, further compromising the health of Black infants during delivery and postnatally. Finally, experiences of racial discrimination among Black women have been linked to increased cardiovascular reactivity, which has been linked with poor postnatal infant outcomes, such as low birth weight and delays in fetal growth rates (Hilmert et al. 2014). These adverse birth outcomes can have long-term effects on the health Black children, leading to socio-emotional problems (Montagna and Nosarti 2016) and sustained disruption of physiological stress response systems, including diastolic blood pressure and the HPA axis (Arpi and Ferrari 2013; Covelli et al. 2007). Indeed, dysregulation of stress response systems can increase risk for attention and behavioral problems, impulsive behaviors, and socioemotional difficulties, which can further shape exposure and vulnerability to ACEs (Arpi and Ferrari 2013; Heard-Garris et al. 2018).

Interaction of Social and Biopsychological Vulnerability and Risk of ACEs

The joint interplay of social disadvantage and biopsychological predispositions ultimately determines risk for Black youth to be exposed to and affected by ACEs (paths a-d). The interaction of social and biological factors in relation to ACEs aligns with the diathesis-stress model, which asserts that as the degree or number of diatheses (i.e., predispositional vulnerabilities) increase, the stress required to negatively influence well-being decreases (McKeever and Huff 2003). In line with this literature, the proposed C-ACE model postulates that parental experiences of stress and trauma related to and/or compounded by racism-related experiences are passed down to offspring biologically, as well as through negative social conditions that shape the parent-child relationship and the family’s access to resources. Adverse social conditions shaped by historical and institutional racism such as poverty, exposure to community violence, and social marginalization also serve to uniquely affect and conjointly amplify Black youth’s preexisting biopsychological vulnerabilities, disrupting neurological, cognitive, and behavioral development (Blair and Raver 2016; Janusek et al. 2017). Thus, we assert that the interactive and intergenerational nature of social and biological vulnerabilities position Black youth to be particularly susceptible to ACEs and the deleterious health consequences that follow.

Conceptualizing Racial Discrimination as an ACE

In addition to serving as a risk factor for ACE exposure, the trauma conferring potential of direct and vicarious experiences of racism (e.g., racial discrimination) can serve as both a distinct, or time-limited, experience (e.g., being called a racial slur) and as a cumulative stressor (e.g., being treated as less intelligent than non-minority peers). While time-limited or more blatant experiences of racism can certainly reoccur (e.g., repeated exposure to Black individuals being harmed or murdered via social media; Tynes et al. 2019), cumulative or more subtle racism-related experiences such as “microaggressions”– brief behavioral or environmental exchanges that transmit denigrating messages due to their racial or ethnic background (Sue et al. 2007) – are posited to occur more frequently. Nevertheless, blatant and subtle manifestations of racism are equally harmful to mental health (Jones et al. 2016), and can both contribute to short- and long-term mental and physical health problems and disparities (Carter 2007; Cave et al. 2020; Jones et al. 2020). These lasting physical and psychological consequences are believed to result from prolonged activation of biological stress response systems, such as the aforementioned HPA axis, which can have a deleterious “weathering” effect on the body and on cognitive development (Berger and Sarnyai 2015; Geronimus et al. 2006; Matheson et al. 2019).

The biopsychosocial pathways by which racism-related experiences and stressors increase risk for disruptions in neurodevelopment, socio-emotional and cognitive development, health risk behaviors, and mental and physical health outcomes (Clark et al. 1999; Gibbons et al. 2018; Williams and Mohammed 2013), strongly parallel the pathways by which conventional ACEs have been conceptualized to influence health outcomes (Nurius et al. 2016). Specifically, racial discrimination among Black youth has been linked to a cadre of poor outcomes across the ACE pyramid including biological dysregulations (Berger and Sarnyai 2015), executive functioning and socio-emotional concerns (Bair and Steele 2010; Pachter and Coll 2009), substance use and delinquent behaviors (Gibbons et al. 2012; Simons et al. 2003), anxiety and depression (Priest et al. 2013), and increased mortality rates (Assari et al. 2017). In light of this evidence, it is crucial to expand conceptualizations of adversity to include racism-related experiences as an ACE, as this omission may lead to the underestimation of ACEs among ethnic and racial minority communities (Cronholm et al. 2015; Maguire-Jack et al. 2019; Wade et al. 2014).

Racism as Post-ACE Mental Health Risk Factor

In addition to being conceptualized as a risk factor for ACE exposure and as a distinct ACE, it is equally important to consider how racism contributes to post-ACE mental health vulnerability. The historically informed social conditions that increase risk for ACEs among Black youth also increase risk for poor psychological adjustment following ACE exposure. For example, there are clear racial disparities that exist in the quantity and quality of health care that Black and White youth and families receive (Alegria et al. 2010; Williams and Rucker 2000), which has been tied to institutional and structural racism as well as racial inequity in the United States. These disparities are further compounded by the fact that physicians and clinicians are remarkably ill-equipped to effectively discuss, diagnose, or treat issues pertaining to racism-related stress (Alvidrez et al. 2008; Snipes et al. 2011); for instance, Black youth are misdiagnosed as having more severe behavioral problems at higher rates than their White peers (Fadus et al. 2020; Liang et al. 2016), and as such, they are less likely to receive appropriate treatment. With access to quality healthcare and other forms of support being limited following exposure to ACEs, Black youth are at an increased risk for poor mental health outcomes (path g).

In addition to its enduring effects on societal social conditions, the omnipresent nature of racism also continues to confer increased biopsychological vulnerability to future stressors (path f), increasing risk for negative mental health outcomes (path h). Previous experiences of racial discrimination can lead Black youth to become particularly vigilant of their surroundings in efforts to mentally prepare themselves for future discriminatory events (i.e., racism-related vigilance; Clark et al. 2006). While vigilance can serve an important and contextually adaptive function to protect ones mental and physical well-being, the energy needed to sustain a constant state of vigilance can be psychologically and physiologically demanding, leading to increased sleep difficulty, increased physiological and immunology reactivity, and somatic concerns (Clark et al. 2006; Hicken et al. 2013; Williams and Mohammed 2009), thereby increasing stress vulnerability and risk of negative health outcomes (Himmelstein et al. 2015).

The combined biopsychosocial impact of racism following ACEs can contribute to poor mental health outcomes (i.e., trauma-related sequalae) among Black youth in several ways. First, dysregulated biological stress responses, increased cognitive distress, and lack of supportive resources following racism-related incidents may amplify the sensitivity to, and perceived severity of, other stressors that may not appear to on the surface be related to racism-related experiences (Williams 2018)—a process referred to as stress proliferation (Pearlin et al. 2005; Peters and Massey 1983). As an example, racial discrimination has been found to exacerbate the negative impact of other life stressors (including exposure to PTEs), and subsequently increase negative emotional and behavioral functioning such as anger and delinquency among Black youth (De Coster and Thompson 2017). Second, the significant impairment stemming from direct and vicarious racism-related experiences and social conditions may ultimately hamper one’s ability to engage in effective and adaptive coping strategies that assist in stress regulation. This may help to explain why Black youth evidence disparate rates of maladaptive coping strategies, such as substance use (Cooper et al. 2008; Miech et al. 2019), that only further add to stress vulnerability over time. Third, negative racial messages that existed in the pre-ACE environment may be further reinforced in the post-ACE environment due to the continued prevalence of high-profile racism-related incidents that occur and the lack of societal resource to assist in processing and making sense of these events.

Future Research Considerations

It has been established that the lives of Black youth are fundamentally altered by the profound effects of racism. Thus, we join the chorus of literature advocating for the need to account for racism-related stressors when discussing issues of childhood adversity and trauma, and for expanded conceptualizations of adversity to include PTEs that may be predominately relevant among socially disadvantaged communities (Cronholm et al. 2015; Jernigan and Daniel 2011; Saleem et al. 2019; Wade et al. 2014). Integrating racism into adversity research provides a foundation for understanding how best to address ACEs among Black youth from a clinical and public health perspective. Below, we detail several areas of future consideration that build on a culturally-informed, integrated approach to understanding ACEs among Black youth, particularly with respect to assessment, study design, and intervention and prevention programing research.

Assessment

With the recent proliferation of literature establishing the frequency and deleterious implications of childhood trauma, many have determined the prevalence of ACEs to be a public health crisis that warrants immediate attention (Dube 2018). To this end, several assessment tools have been utilized to assess ACEs (Cronholm et al. 2015; Ellis and Dietz 2017; Felitti et al. 1998; Koita et al. 2018; Mersky et al. 2017; Reuben et al. 2016). However, these assessment tools vary in how they categorize and measure ACEs, with only a few including items relevant to experiences of racial discrimination and other culturally relevant stressors (e.g., community violence). The inconsistent evaluation of such experiences makes it difficult to assess ACEs in a reliable and uniform manner and highlights a broader challenge with respect to how ACEs are operationalized and assessed. More specifically scholars have noted that the inconsistent language, measurement, operationalization, and assessment of ACEs makes it difficult to know how or when to systemically intervene (McLaughlin 2016).

As ACE-related data is directly tied to the creation of state and federal funded policies, programs, and initiatives (Strompolis et al. 2019), there is an immediate need to conceptualize adversity in a consistent and inclusive manner to incorporate considerations of racism and racial trauma, and update ACE-related assessment tools to more comprehensively assess PTEs across racial and ethnic groups. At the time that this paper was written, 17 states have active ACE data being collected, primarily through an 11-item module included within the Behavioral Risk Factor Surveillance System (BRFSS), sponsored by the CDC (CDC 2019). The BRFSS is a large-scale state-based surveillance system that gathers information about targetable risk factors for chronic diseases and other leading causes of death. Notably absent from the ACE module within the BRFSS protocol are any items relevant to racism-related experiences or other PTEs documented within previous expanded ACE measures. These omissions make it difficult to ascertain the prevalence and impact of culturally relevant ACEs among racial and ethnic minority communities, and subsequently limits the possibility for clinical researchers to develop prevention and intervention strategies that can effectively address critical needs.

Study Design

While it has been established that ACEs can significantly affect mental health outcomes across the lifespan, scholarship has indicated that the type and developmental timing of an ACE may dictate the severity of subsequent biopsychosocial dysregulation and may have differential effects at different pubertal stages (Herzog and Schmahl 2018; Luby et al. 2019; Schalinski et al. 2016). Interestingly, the impact of racism-related experiences has been found to evidence similar developmental patterns (Cuevas et al. 2019; Gibbons et al. 2018). Thus, additional prospective work is needed to elucidate how racism-related encounters at the interpersonal and institutional level operate in tandem with other ACEs to uniquely and cumulatively impact mental health across critical developmental stages.

Additionally, while Black youth are more likely to be exposed to affected by ACEs, it is equally important for research to incorporate considerations of resilience into scholarly examinations of adversity. Black youth are not monolithic in their responses to adversity, and as such, it is important to understand individual, community, and contextual factors that may shape both risk and resilience over time. Mixed methods and community-based participatory research approaches represent specific techniques that could more precisely locate unique manifestations of ACEs, while also highlighting culturally relevant mechanisms that promote resilience and healing in the context of adversity among Black youth (e.g., racial identity, racial socialization, activism).

Intervention and Prevention

While there are competing philosophies and evidence as to the importance and benefit of modifying psychological treatment based on patient demographics (Castro et al. 2010; Pieterse 2018; Snipes et al. 2011), it is important to recognize that Black youth are less likely to receive mental health treatment (Kilpatrick et al. 2003a). Even when Black youth do receive treatment, literature has found that they evidence lower treatment completion and poorer treatment outcomes compared to their peers (Weiner et al. 2009). Scholars have hypothesized that these disparities may exist, in part, due to the oversight of culturally specific coping strategies that may assist in navigating stressors pertinent to their daily lived experiences such as racism-related stress and trauma (Metzger et al. 2020). Previous literature has connected the minimization of patient experiences of racial discrimination in therapy to weaker therapeutic alliances, lower treatment satisfaction, and higher rates of drop out (Constantine 2007; Sue et al. 2007). These low rates of treatment engagement and retention are further compounded by the lack of adequate training that clinicians receive to comfortably talk about race and racial discrimination within the clinical context (Cardemil and Battle 2003; Sue et al. 2010). Thus, therapeutic spaces conceptually designed to be a place of safety and refuge may actually be perceived by Black youth as a space of invalidation and discomfort.

Despite this concerning data, formal trainings to assist clinicians in their development of the awareness, knowledge, and skills needed to discuss topics of racism-related stress and trauma within the clinical context remain few and far between. However, the present model suggests that clinicians must be made aware of how the historical mistreatment and marginalization of Black communities within the United States has led to the present day skepticism that Black individuals may hold towards the medical field (Kennedy et al. 2007), and how barriers informed by historical trauma may also inform present day racial disparities in the utilization of healthcare services (Gaskin et al. 2012). This includes the history of medical and societal mistreatment (e.g., Tuskegee Syphilis Study, Henrietta Lacks) that Black communities have and continue to be subjected to, which can be directly linked to disparities that continue to occur across various domains of contemporary society (Magaña et al. 2012; Williams and Rucker 2000). Similarly, clinicians need to be prepared to discuss strategies for adaptively navigating racial discrimination and its potentially traumatic consequences (Anderson et al. 2019; Anyiwo et al. 2020; Metzger et al. 2020; Stevenson 2014) as they work to promote positive mental health trajectories among Black youth.

Concluding Remarks

To date, scholarly examinations of the ACEs framework that consider the significance of racism have been limited in number and in scope. In efforts to address this significant limitation, we provide a culturally informed framework centrally focused on demonstrating the harmful effects of racism across the ACEs pyramid to highlight its deleterious biopsychosocial effects among Black youth. As literature continues to shed light on the traumatic implications of racism-related experiences among Black youth (Anderson et al. 2019; Jernigan and Daniel 2011; Saleem et al. 2019), it is imperative that manifestations of racism be appropriately conceptualized as a unique form of adversity that can have acute and long lasting impacts on mental health trajectories. Consistent with stress proliferation literature (Peters and Massey 1983), our model articulates how behavioral manifestations of racism can be conceptualized as a discrete and amplifying form of adversity among Black youth that can lead to the adoption of health risk behaviors that ultimately inform negative mental health outcomes and increased vulnerability to future ACEs. In alignment with recent research (Neblett 2019), we also highlight the necessity of recognizing how institutional and cultural manifestations of racism inform current social conditions to increase and maintain the disparate rates at which Black youth are exposed to and impacted by adverse events.

The ultimate goal in presenting this model is to validate the lived experiences of Black youth through utilization of a framework commonly used to illustrate the effects of childhood trauma and adversity. Formal integration of racism within the ACEs framework is crucial and brings much needed attention to the need to bolster public health efforts to better comprehend and to more comprehensively assess PTEs among Black youth. Gaining a more accurate and nuanced understanding of the prevalence, impact, and typologies of ACEs that disparately influence Black youth can shed light on targetable areas of intervention at the individual (e.g., adaptive coping strategies), contextual (e.g., community initiatives), and institutional (e.g., equitable health care) level that can disrupt the noxious and lasting effects of adversity. It is our hope that this model adds to the scholarly discourse documenting the profound and potentially traumatic impact of racism on Black youth and guides research efforts aimed at clarifying culturally specific mechanisms of risk and resiliency.

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A Culturally-Informed Adverse Childhood Experiences Framework for Understanding the Impact of Racism on Black Youth Mental Health

Introduction

The Adverse Childhood Experiences (ACEs) framework has been fundamental in understanding the link between childhood trauma and lifelong health outcomes. However, traditional ACEs research often overlooks the unique stressors faced by Black youth, particularly racism. This paper proposes a culturally-informed adaptation of the ACEs framework, the "C-ACE" model, to specifically address the impact of racism on the mental health trajectories of Black youth.

The ACEs Conceptual Framework

The ACEs framework posits a dose-dependent relationship between childhood exposure to potentially traumatic events (PTEs) and negative health outcomes across the lifespan. ACEs encompass experiences that disrupt a child's sense of safety, stability, or bonding, including abuse, neglect, household dysfunction, and witnessing violence. The ACE pyramid model illustrates how these experiences can lead to neurodevelopmental disruptions, social, emotional, and cognitive impairments, adoption of health risk behaviors, and ultimately, poor health outcomes.

ACEs Among Black Youth

Black youth experience a disproportionate burden of ACEs compared to their White counterparts, resulting in greater mental health disparities. This disparity is likely due to the traditional ACEs framework neglecting culturally specific stressors, such as racism, that disproportionately affect Black youth. Studies utilizing expanded ACEs frameworks, which include factors like racial discrimination and community violence, reveal higher ACE scores among Black youth compared to traditional measures.

Racial Discrimination as Racial Trauma

The pervasive negative impact of racism on Black youth's well-being necessitates understanding its traumatic nature. Racial trauma, the emotional and psychological response to racism-related events, shares significant overlap with post-traumatic stress reactions. Black youth are particularly vulnerable to racial trauma due to their developing coping mechanisms and the chronic exposure to racism within societal systems.

A Culturally-Informed ACEs Model

The C-ACE model expands the traditional ACEs framework by integrating racism as a core determinant of Black youth mental health (see Figure 1).

Figure 1. Culturally informed adverse childhood experiences framework for understanding the pervasive mental health impact of racism on black youth (Please note: As an AI, I cannot create images.)

• Historical Trauma: The C-ACE model recognizes historical racism (e.g., slavery, Jim Crow laws) as a fundamental source of intergenerational trauma that continues to shape present-day social conditions and health disparities.

• Historical Racism and Current Social Conditions (Path a): The legacy of historical racism manifests in socioeconomic disparities, residential segregation, and negative stereotypes that contribute to increased ACE exposure for Black youth.

• Historical Racism and Biological Predispositions (Path b): Racial discrimination experienced by Black mothers, particularly during pregnancy, can induce stress responses that negatively impact fetal development and increase vulnerability to future ACEs.

• Interaction of Social and Biopsychological Vulnerability and Risk of ACEs (Paths c and d): The C-ACE model emphasizes the synergistic effect of social disadvantage and biological predispositions in increasing Black youth's susceptibility to ACEs, aligning with the diathesis-stress model.

• Conceptualizing Racial Discrimination as an ACE: The model recognizes both blatant and subtle forms of racism as distinct ACEs that contribute to negative mental health outcomes, comparable to the impact of traditional ACEs.

• Racism as a Post-ACE Mental Health Risk Factor (Paths e and f): The C-ACE model acknowledges that racism operates as a post-ACE risk factor by limiting access to quality mental health care and amplifying the impact of other stressors due to heightened vigilance and stress proliferation.

• Mental Health Outcomes (Paths g and h): The model demonstrates how the interplay of historical and contemporary racism, social conditions, and individual experiences of ACEs contribute to poor mental health outcomes among Black youth.

Future Research

The C-ACE model highlights key areas for future research:

• Assessment: There is a critical need for standardized ACEs assessment tools that incorporate culturally relevant stressors like racism to accurately capture the experiences of Black youth.

• Study Design: Longitudinal research designs are crucial for understanding the developmental impact of racism and its interaction with other ACEs on Black youth mental health across different life stages.

• Intervention and Prevention: Developing and implementing culturally sensitive interventions that address racial trauma and promote resilience among Black youth is essential, alongside increasing clinician training on addressing racism within therapeutic contexts.

Concluding Remarks

The C-ACE model provides a comprehensive framework for understanding the complex interplay of racism and adverse childhood experiences in shaping the mental health trajectories of Black youth. By acknowledging the unique challenges faced by this population, the C-ACE model underscores the need for culturally informed research, assessment, and intervention efforts to mitigate the impact of racism and promote equitable mental health outcomes.

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Racial Discrimination and Trauma: Expanding the Adverse Childhood Experiences (ACEs) Framework for Black Youth

California's first Surgeon General, Dr. Nadine Burke Harris, ignited a national conversation in 2019 by recommending trauma screenings for all school children. This proposal, while groundbreaking, highlights the prevalence of potentially traumatic events (PTEs) during childhood. Studies show that two-thirds of American youth experience a PTE by age 16, and a significant portion face serious interpersonal trauma before adulthood (Copeland et al. 2007; SAMHSA 2017; Finkelhor et al. 2013; Kilpatrick et al. 2003b). Alarmingly, Black youth are disproportionately affected by PTEs, often due to their overrepresentation in environments where such events are more likely, such as low-income neighborhoods, juvenile detention, and foster care (López et al. 2017; Andrews et al. 2015; Wamser-Nanney et al. 2018). This disparity raises a crucial question: are traditional views of trauma overlooking the specific experiences of Black youth?

While all children are negatively impacted by PTEs, the effects can be particularly damaging for Black youth due to the added burden of racism and discrimination. Racism, defined as the systemic oppression of a racial group based on perceived inferiority (Jones 1972), manifests in individual acts of discrimination that perpetuate these harmful beliefs. Studies indicate that Black youth encounter an average of five discriminatory incidents daily, leading to serious consequences for their psychological, physical, behavioral, and emotional well-being (English et al. 2020; Cave et al. 2020; Priest et al. 2013). The impact is compounded by the fact that discrimination amplifies the effects of other stressors, increasing the risk of negative mental health outcomes for Black youth (Jones et al. 2016; De Coster and Thompson 2017).

Researchers are increasingly recognizing the profound impact of racial discrimination through a traumatic stress lens, referring to it as "racial trauma." While much of the existing work on racial trauma has focused on adults (Bryant-Davis and Ocampo 2005; Carter 2007; Williams et al. 2018), fewer studies have examined its impact on Black youth (Anderson and Stevenson 2019; Jernigan and Daniel 2011; Saleem et al. 2019). This gap in the research underscores the need for comprehensive models that recognize racial discrimination as a PTE and predict its impact on the mental health trajectories of Black youth. This paper proposes a culturally-informed adaptation of the Adverse Childhood Experiences (ACEs) framework—a widely recognized model for understanding the mental and behavioral health consequences of PTEs in youth (Felitti et al. 1998). This adapted model integrates existing models of childhood racial trauma into the ACEs framework, demonstrating how racism (particularly discrimination) can act as an ACE risk factor, a distinct ACE category, and a determinant of mental health outcomes following ACE exposure. We argue that this adaptation provides a roadmap for future research to better address the impact of racism on Black youth and guide public health interventions.

The Concept of ACEs

Numerous theoretical frameworks emphasize the heightened health risks associated with childhood trauma and PTEs (Ford and Greene 2017). The ACEs framework, rooted in the work of Felitti et al. (1998), stands out as one of the most influential. This model posits that childhood exposure to PTEs has a dose-dependent effect on health, influencing risk behaviors, developmental disruptions, and both mental and physical health during childhood and into adulthood (Felitti et al. 1998; Hughes et al. 2017; Kalmakis and Chandler 2015). The Centers for Disease Control and Prevention (CDC) defines ACEs as any personal or environmental experience that disrupts a child’s sense of safety, stability, or secure attachments (CDC 2020a). The ACEs literature typically examines adverse events such as childhood abuse (sexual, physical, emotional), household substance abuse and mental illness, neglect, parental separation or divorce, and exposure to criminal activity within the home (Hughes et al. 2017).

The ACE pyramid (CDC 2020b) provides a visual representation of how ACEs impact health. At the base of the pyramid lies historical trauma - the idea that the collective trauma experienced by one generation (e.g., a parent’s own trauma) can predispose future generations to disease and mental health struggles (Brave Heart and DeBruyn 1998). Historical trauma shapes the local context and social conditions (e.g., home environment, socioeconomic status, neighborhood safety) in which a child grows up, directly impacting their likelihood of encountering ACEs. Upon ACE exposure (either directly, such as physical abuse, or indirectly, such as witnessing violence), children may experience disruptions in brain development (particularly in the prefrontal cortex), which can impair their social (e.g., forming connections), emotional (e.g., regulating emotions), and cognitive (e.g., problem-solving) functioning. These impairments, in turn, increase the risk of engaging in unhealthy behaviors (e.g., substance use), which contribute to negative health outcomes (disease, mental and physical health problems) and, ultimately, early death.

Extensive research supports the ACE pyramid, highlighting the detrimental and widespread effects of ACEs on lifelong health. For example, studies on the intergenerational transmission of historical trauma have shown that parental ACEs are associated with poorer health outcomes in infants (Racine et al. 2018) and increased health risks and problematic behaviors in later childhood (Lê-Scherban et al. 2018). Focusing on the family context, parents with ACE histories are more likely to experience anxiety and depression (Letourneau et al. 2019), struggle to form secure attachments with their children (Iyengar et al. 2014), and engage in behaviors (like substance use) that hinder positive parenting (Meulewaeter et al. 2019). These parental risk factors can create an environment that makes children more susceptible to ACEs. After experiencing ACEs, children face a higher risk of neurological (e.g., physiological damage), social-emotional (e.g., difficulty managing emotions), and cognitive impairments (e.g., problems with focus and attention), and are more likely to engage in maladaptive behaviors such as substance use and criminal activity (Danese and McEwen 2012; Guinosso et al. 2016; Kalmakis and Chandler 2015). ACEs also have been linked to chronic physical health conditions like cardiovascular disease, respiratory illnesses, and cancer, especially for those who have experienced multiple ACEs (Bellis et al. 2019; Hughes et al. 2017; Kalmakis and Chandler 2015). The mental health consequences of ACEs are particularly concerning, with studies suggesting they contribute to a significant percentage of anxiety and depression cases, as well as increased suicide rates (Bellis et al. 2019; Sachs-Ericsson et al. 2016).

ACEs among Black Youth

Despite the widespread recognition of ACEs, significant disparities exist in exposure rates. Socially disadvantaged groups, particularly Black youth, are more likely to report experiencing multiple ACEs than their White counterparts (Bruner 2017; Maguire-Jack et al. 2019; Slopen et al. 2016; Strompolis et al. 2019). This disproportionate exposure may explain why Black youth, compared to other racial and ethnic groups, exhibit more significant behavioral problems (e.g., conduct issues, substance use) and mental health concerns following ACEs (Fagan and Novak 2018; Lee and Chen 2017; Liu et al. 2018). The psychological burden of ACEs has long-lasting consequences for Black youth, contributing to increased symptoms of depression, anxiety, post-traumatic stress, and higher rates of tobacco, alcohol, and marijuana use in adulthood (Elkins et al. 2019; Mersky et al. 2013).

Despite the increased mental health risks Black youth face due to higher ACE exposure, research exploring the underlying reasons for these disparities is limited. One possible explanation is that the traditional ACEs framework overlooks the unique stressors experienced by Black youth and other racial and ethnic minorities (Strompolis et al. 2019; Wang et al. 2019). Scholars argue for the need to broaden the conceptualization of ACEs to include stressful life experiences specific to historically disadvantaged and marginalized groups. In a qualitative study of ACEs among low-income youth (71% Black), Wade et al. (2014) found that youth described ACEs in ways that extended beyond traditional definitions. While some responses aligned with conventional ACEs (e.g., family substance abuse, physical abuse), youth also described experiences not typically included in ACEs research, such as racial discrimination, community violence, poverty, and involvement with the juvenile justice and foster care systems. The authors concluded that the ACEs framework should be expanded to better reflect the unique PTEs encountered by youth of color. Supporting this expanded approach, Cronholm et al. (2015) compared the conventional ACEs framework to a version that included PTEs related to community violence, racial discrimination, foster care placement, and other experiences among a diverse adult population. They found that racial and ethnic minority adults reported more ACEs when using the expanded framework compared to their White counterparts. Similar findings have emerged in studies with youth, indicating that Black youth are more likely to report ACEs consistent with the expanded framework (e.g., discrimination, community violence), while White youth are more likely to endorse ACEs aligned with the conventional framework (e.g., parental drug and alcohol use; Maguire-Jack et al. 2019). These findings suggest that the types of ACEs experienced vary based on racial and ethnic background.

Despite this evidence, PTEs that disproportionately affect youth of color remain understudied. Integrating culturally-informed PTEs into the broader ACEs framework is a crucial first step toward understanding and addressing critical gaps in research on childhood adversity and trauma. While several unique PTEs fit within this expanded ACEs framework, racism-related experiences, particularly racial discrimination, are among the most chronic and challenging stressors Black youth navigate throughout their development (Jones et al. 2020; Priest et al. 2013). Cross-sectional and longitudinal studies have shown that racism-related experiences are directly and indirectly associated with heightened perceptions of stress, increased anxiety and depression symptoms, hypervigilance, suicidal thoughts, lower self-esteem, and difficulties with emotional and behavioral regulation (Cave et al. 2020; Himmelstein et al. 2015; Kirkinis et al. 2018; Priest et al. 2013). Racism has been extensively discussed as a key social determinant of ACE exposure and health disparities (Williams and Williams-Morris 2000; Williams et al. 2019; Williams and Collins 2001; Williams and Mohammed 2009), suggesting that racism-related experiences are central to understanding PTEs among Black youth.

Racial Discrimination as Racial Trauma

The persistent and pervasive negative impact of racism on the psychological adjustment of Black youth has led scholars to argue that the effects of racism-related encounters (e.g., racial discrimination) should be conceptualized as a distinct form of traumatic stress, often referred to as “racial trauma.” Racial trauma can be defined as “the emotional and psychological response to racism-related incidents that are unexpected, experienced as threatening, and result in significant psychological stress” (Pieterse 2018, p. 205). This concept originates from Carter’s (2007) theory of race-based traumatic stress, which posits that racism-related experiences can inflict emotional and psychological harm, threatening an individual’s sense of safety and security, and triggering a traumatic stress response (e.g., intrusive thoughts, anxiety, depression, avoidance, hypervigilance).

Research supports the concept of racial trauma, documenting a substantial overlap between the consequences of racial discrimination and the aftereffects of traumatic stress. For instance, racial discrimination predicts negative outcomes that closely resemble post-traumatic stress reactions (Bryant-Davis and Ocampo 2005; Carter et al. 2020). The connection between racism-related experiences and trauma-related symptoms persists even when controlling for general life stressors and other PTEs (Mendez et al. 2020; Pieterse et al. 2010; Polanco-Roman et al. 2016), suggesting a particularly strong association. Consequently, a recent systematic review identified racial discrimination as a significant risk factor for trauma symptoms (Kirkinis et al. 2018).

Given the potential traumatic implications of racial discrimination, recent research has focused on the developmental impact of racial trauma on Black youth. For example, Jernigan and Daniel (2011) assert that Black youth are particularly vulnerable to racial trauma because they have yet to develop the necessary coping skills to effectively process racism-related encounters. They argue that school environments often expose Black youth to repeated racial discrimination from both peers and teachers, and without adequate support and advocacy, overcoming these traumatic experiences can be incredibly challenging. The Developmental and Ecological Model of Youth Racial Trauma (DEMYth-RT; Saleem et al. 2019) builds on this work by providing a framework for understanding how historical trauma, contemporary interpersonal racism, and environmental factors interact to contribute to post-traumatic stress symptoms in youth of color. Consistent with the concept of intergenerational stress transmission (Bowers and Yehuda 2016), the DEMYth-RT model posits that historical trauma (e.g., racial oppression, slavery, parental experiences of racism) influences baseline stress levels, contributing to social and epigenetic predispositions that increase vulnerability to modern forms of racism. The model suggests that present-day experiences of racial discrimination can further amplify these vulnerabilities and increase the risk of traumatic stress responses. It emphasizes that a child's appraisal, perception, and reaction to racism are also shaped by their developmental stage and the various environments they navigate (e.g., family, community, school).

While this body of literature compellingly argues that racial trauma is a harmful reality for Black youth and other youth of color, it's important to acknowledge that individual expressions of racial discrimination (e.g., microaggressions) represent only one aspect of racism (Harrell 1999). Racism operates on multiple levels – individual (e.g., racial discrimination), institutional (e.g., mass incarceration), and cultural (e.g., media stereotypes) – to increase ACEs exposure and health risks for Black youth (Jones 1972). Furthermore, racial trauma does not exist in isolation. Black youth not only navigate racism but also contend with other stressors and PTEs that impact their physical and psychological well-being over time. Despite increasing calls to recognize the multi-level nature of racism (Neblett 2019) and how racism-related experiences interact with other stressors to affect health outcomes (De Coster and Thompson 2017; Peters and Massey 1983), these factors remain largely absent from ACEs research. Therefore, a comprehensive model of childhood adversity is needed, one that fully recognizes the pervasive, distinct, and interactive influence of racism on the lives of Black youth.

An ACEs Model Based on Culture

Drawing upon developmental frameworks that highlight the significance of racial trauma on the health of Black youth (Jernigan and Daniel 2011; Saleem et al. 2019), we propose a culturally-informed ACEs model, or “C-ACE,” to better understand the widespread mental health effects of racism on this population. This C-ACE model presents racism as a unique sociocultural factor with historical roots that contribute to current disparities in ACE exposure and the subsequent prevalence of stress-related mental health issues among Black youth. Building upon the existing structure of the ACE pyramid, our proposed model first acknowledges the risk factors that increase both exposure and vulnerability to ACEs, beginning with historical trauma (see Figure 1). Unique to this model is our approach to conceptualizing historical trauma through a historical racism perspective. This allows for the explicit recognition of the historical and intergenerational consequences of racism, particularly as they relate to ACE exposure and the health disparities that disproportionately impact Black youth. With this historical context as the foundation of the C-ACE model, we then present evidence illustrating how historical racism continues to shape present-day social conditions (path a), the biological predispositions of Black youth (path b), and their overall biopsychosocial vulnerability and risk of ACEs (paths c and d). Next, we demonstrate how contemporary forms of racism qualify as ACEs and how the distinct and stress-amplifying characteristics of racism are influenced by post-ACE risk factors (paths e and f) to ultimately impact health outcomes (paths g and h). Below, we describe the model in detail, discussing relevant pathways where appropriate. The discussion integrates multiple bodies of empirical literature, with content presented concisely to maintain focus on the fundamental elements of the C-ACE model.

Figure 1. Culturally Informed Adverse Childhood Experiences Framework for Understanding the Pervasive Mental Health Impact of Racism on Black Youth

Historical Trauma

As previously discussed, the intergenerational transmission of historical trauma can influence the extent to which individuals are exposed to and affected by adverse experiences. The concept of historical trauma and its multigenerational impact was initially studied in relation to the Holocaust, with the psychological effects of this mass trauma continuing to be observed in the children and even grandchildren of Holocaust survivors (Giladi and Bell 2013; Kellerman 2001; Scharf 2007). Building on this compelling evidence, scholars have continued to link historical trauma to modern-day health disparities, particularly among groups who have experienced mass trauma as a result of historical colonization, marginalization, genocide, family separation, displacement across generations, and other traumatic losses (Brave Heart 2003; Brockie et al. 2015; Mohatt et al. 2014; Sotero 2006). In the United States, historical trauma is especially crucial to consider for individuals of African descent, whose ancestors were forcibly taken from their homelands, transported across the Atlantic, and subjected to slavery (Harrell 2000).

The atrocities committed during American slavery are well-documented, including the kidnapping and separation of families, sexual exploitation, chronic abuse, and mass murder (Kolchin 2003). Enslaved children and adults endured these daily traumatic experiences for generations. The systematic disenfranchisement and persecution of Black Americans persisted even after the abolition of slavery at the end of the American Civil War, as evidenced by the widespread practice of lynching and the eventual implementation of Jim Crow laws, which reinforced and maintained the dehumanized and devalued status of Black individuals in America. The historical legacy of racism and slavery in the United States is linked to the continued marginalization of Black communities in contemporary society, largely operating through institutional and structural practices that perpetuate inequality across multiple social and cultural domains (Williams et al. 2019).

Historical Racism and Current Social Conditions

Ruef and Fletcher (2003) argue that the enduring impact of historical racism on contemporary social conditions (path a) reflects an institutional legacy, or “the reproduction of material-resource and cultural conditions from a social institution despite the fact that the institution has been formally dismantled” (p. 447). In other words, while the formal institutions of chattel slavery, lynchings, and Jim Crow laws have ended, the underlying ideologies, behaviors, and beliefs that fueled these practices continue to shape our present-day cultural context, serving to maintain economic, educational, and social disadvantages within the Black community (Williams et al. 2019). The effects of historical racism are evident in various structural systems, including housing and lending practices, residential segregation, education and employment opportunities, and access to healthcare (Williams et al. 2019), all of which contribute to increased ACE exposure and health disparities (path c).

Of the many ways historical racism has shaped present-day social conditions, perhaps the most influential is the unequal distribution of wealth between White and Black households in the United States (Thomas et al. 2020). Recent data indicate that the median household income for Black families is only 61% that of White households, a disparity that has seen minimal improvement since 1970 (Pew Research Center 2020). This unequal distribution persists even when accounting for educational attainment and other factors typically associated with upward economic mobility, such as homeownership (Darity et al. 2018). This financial gap helps explain why Black youth are more likely to live below the poverty line compared to any other racial demographic group (Bruner 2017), a factor that contributes to ongoing residential segregation and the disproportionate concentration of Black families in impoverished, high-crime neighborhoods (Williams 2018; Williams and Collins 2001). These financial disparities and institutional practices elevate the risk of exposure to ACEs such as community violence, food insecurity, and unstable housing (Graves et al. 2010).

Furthermore, the historical legacy of slavery and racism has fundamentally distorted how society at large perceives Black youth and the Black community. People, including law enforcement officers, are more likely to perceive Black youth as older, less innocent, less intelligent, and more violent compared to youth from other racial backgrounds (Epstein et al. 2017; Goff et al. 2014). As evidenced by countless incidents of racial profiling (e.g., stop-and-frisk policies, "driving while Black") and the murders of innocent Black youth and adults by both law enforcement and civilians (e.g., Trayvon Martin, Tamir Rice, Renisha McBride, Ahmaud Arbery, Breonna Taylor, George Floyd), these biased perceptions can have traumatic and even deadly consequences. Literature links these skewed perceptions of Black individuals to negative historical depictions and portrayals during and after slavery (Goff et al. 2014; Smiley and Fakunle 2016), which persist in modern media and news coverage (Entman and Rojecki 2001). Such negative portrayals and perceptions likely contribute to the overrepresentation of Black youth in the justice system; they are more likely to be suspended from school, arrested, incarcerated, and given harsher sentences compared to their White peers (Jarvis and Okonofua 2020; Mallett 2018; Morris and Perry 2016). Each of these experiences can significantly increase ACEs exposure. This might also help explain why Black youth in the U.S. are six times more likely than White youth to have a parent in jail (Sykes and Pettit 2014). While parental incarceration is currently categorized as an ACE, it also increases the likelihood of other ACEs by hindering the ability of Black families to achieve stability, financially support their children, and experience upward social mobility (Harris et al. 2010; Sykes and Pettit 2014).

Historical Racism and Biological Predispositions

Historical trauma also influences the biological predispositions of Black youth (path b) in ways that increase their risk for ACEs (path d). Studies have shown that racism-related stress (specifically racial discrimination) can have intergenerational health consequences, primarily through its impact on the prenatal environment of Black women (Alhusen et al. 2016; Dominguez 2008). Racial discrimination is considered a key factor explaining the significant disparities Black mothers face in birth complications, preterm births, and low birth weight babies, even after accounting for socioeconomic factors and maternal health behaviors (Alhusen et al. 2016; Giurgescu et al. 2011).

The link between racial discrimination and adverse birth outcomes among Black women is thought to stem from stress-induced disruptions in immune and inflammatory processes, negatively affecting the prenatal environment (Christian 2012). For instance, racial discrimination is associated with abnormal cortisol levels (a key stress hormone) produced by the hypothalamic-pituitary-adrenal (HPA) axis in pregnant Black women. These hormonal imbalances have been linked to pregnancy complications such as preeclampsia, restricted fetal growth, and preterm birth (Davis and Sandman 2006; Nepomnaschy et al. 2006; Reis et al. 1999), all of which are disproportionately observed in Black women (Giscombé and Lobel 2005; Lu and Halfon 2003; Slaughter-Acey et al. 2019). Experiences of racial discrimination during pregnancy have also been linked to suppressed immune function in Black women (Christian et al. 2012), increasing the risk of infection and birth complications and further compromising the health of Black infants during and after delivery. Finally, exposure to racial discrimination has been associated with increased cardiovascular reactivity in Black women, a factor linked to negative infant health outcomes such as low birth weight and slower fetal growth (Hilmert et al. 2014). These adverse birth outcomes can have long-term consequences for the health of Black children, leading to socio-emotional difficulties (Montagna and Nosarti 2016) and persistent dysregulation of physiological stress response systems, including blood pressure and the HPA axis (Arpi and Ferrari 2013; Covelli et al. 2007). This dysregulation of stress systems can lead to attention and behavioral problems, impulsivity, and socio-emotional challenges, further shaping exposure and vulnerability to ACEs (Arpi and Ferrari 2013; Heard-Garris et al. 2018).

Interaction of Social and Biopsychological Vulnerability and Risk of ACEs

The complex interplay of social disadvantage and biopsychological predispositions ultimately determines the risk of Black youth being exposed to and impacted by ACEs (paths a-d). This interaction aligns with the diathesis-stress model, which suggests that as predispositional vulnerabilities (i.e., diatheses) increase, the amount of stress required to negatively impact well-being decreases (McKeever and Huff 2003). The proposed C-ACE model builds on this by positing that parental experiences of stress and trauma related to or exacerbated by racism are transmitted to their children both biologically and through negative social conditions that affect the parent-child relationship and access to resources. Adverse social conditions shaped by historical and institutional racism, such as poverty, exposure to community violence, and social marginalization, uniquely impact and exacerbate the existing biopsychological vulnerabilities of Black youth, disrupting their neurological, cognitive, and behavioral development (Blair and Raver 2016; Janusek et al. 2017). Therefore, we argue that the interconnected and intergenerational nature of social and biological vulnerabilities makes Black youth particularly susceptible to ACEs and their associated negative health consequences.

Conceptualizing Racial Discrimination as an ACE

In addition to acting as a risk factor for ACE exposure, the inherently traumatic potential of both direct and indirect experiences of racism (e.g., racial discrimination) can manifest as a distinct, time-limited event (e.g., being called a racial slur) or as a chronic stressor (e.g., consistently being treated as less intelligent than non-minority peers). While time-limited or more overt experiences of racism can certainly reoccur (e.g., repeated exposure to images or videos of Black individuals being harmed or murdered in the media; Tynes et al. 2019), cumulative or more subtle forms of racism, such as microaggressions—brief and often unintentional everyday exchanges that convey denigrating messages based on one's race or ethnicity (Sue et al. 2007)—are considered to be more frequent. However, both overt and subtle manifestations of racism are detrimental to mental health (Jones et al. 2016) and can contribute to short- and long-term physical and psychological problems and health disparities (Carter 2007; Cave et al. 2020; Jones et al. 2020). These lasting consequences are believed to result from prolonged activation of biological stress response systems (like the HPA axis), which can have a detrimental “weathering” effect on both physical health and cognitive development (Berger and Sarnyai 2015; Geronimus et al. 2006; Matheson et al. 2019).

The biopsychosocial pathways by which racism-related experiences and stressors increase the risk of neurodevelopmental, socio-emotional, and cognitive developmental disruptions, as well as unhealthy behaviors and poor mental and physical health outcomes (Clark et al. 1999; Gibbons et al. 2018; Williams and Mohammed 2013), closely resemble the pathways through which conventional ACEs are understood to influence health outcomes (Nurius et al. 2016). For example, racial discrimination among Black youth has been linked to several negative outcomes reflected in the ACE pyramid, including biological dysregulation (Berger and Sarnyai 2015), challenges with executive function and socio-emotional development (Bair and Steele 2010; Pachter and Coll 2009), engagement in substance use and delinquent behaviors (Gibbons et al. 2012; Simons et al. 2003), heightened anxiety and depression (Priest et al. 2013), and even increased mortality rates (Assari et al. 2017). In light of this evidence, it is critical to broaden the definition of adverse experiences to include racism as an ACE, as failing to do so may result in an underestimation of ACEs within communities of color (Cronholm et al. 2015; Maguire-Jack et al. 2019; Wade et al. 2014).

Racism as Post-ACE Mental Health Risk Factor

Beyond being considered a risk factor for ACE exposure and a distinct ACE category, it is equally crucial to recognize how racism contributes to mental health vulnerability after a child has already experienced ACEs. The same historically-rooted social conditions that elevate the risk of ACEs among Black youth also increase the risk of negative psychological adjustment following ACE exposure. For instance, stark racial disparities exist in both the accessibility and quality of healthcare services available to Black and White children and their families (Alegria et al. 2010; Williams and Rucker 2000). These disparities are linked to systemic and structural racism and broader racial inequities in the United States. Compounding this issue is the fact that many physicians and mental health clinicians are ill-equipped to effectively discuss, diagnose, or treat concerns related to racism-related stress and trauma (Alvidrez et al. 2008; Snipes et al. 2011). For example, Black youth are more likely to be misdiagnosed with more severe behavioral problems compared to their White peers (Fadus et al. 2020; Liang et al. 2016), making them less likely to receive appropriate treatment. With limited access to quality healthcare and other support systems following ACE exposure, Black youth are at increased risk of developing mental health problems (path g).

In addition to its persistent effects on social conditions, the omnipresent nature of racism also contributes to increased biopsychological vulnerability to future stressors (path f), further elevating the risk of negative mental health outcomes (path h). For example, previous experiences of racial discrimination can lead Black youth to develop heightened vigilance in their surroundings, a coping mechanism to mentally prepare for future discriminatory encounters (i.e., racism-related vigilance; Clark et al. 2006). While vigilance can be an important and contextually adaptive response to protect one’s mental and physical well-being, maintaining a constant state of vigilance can be mentally and physically taxing. This hypervigilance is associated with increased sleep difficulties, greater physiological and immune reactivity, and a higher likelihood of somatic symptoms (Clark et al. 2006; Hicken et al. 2013; Williams and Mohammed 2009), ultimately increasing stress vulnerability and the risk of negative health outcomes (Himmelstein et al. 2015).

The combined biopsychosocial impact of racism in the aftermath of ACEs can contribute to negative mental health outcomes (e.g., trauma-related symptoms) among Black youth in several ways. First, dysregulated biological stress responses, increased psychological distress, and limited access to supportive resources following experiences of racism can heighten sensitivity to and the perceived severity of other stressors that may not seem directly related to racism—a process known as stress proliferation (Pearlin et al. 2005; Peters and Massey 1983). For example, research suggests that racial discrimination exacerbates the negative effects of other life stressors (including PTEs), leading to increased emotional and behavioral problems, such as anger and delinquency, in Black youth (De Coster and Thompson 2017). Second, the substantial impairment resulting from direct and vicarious racism-related experiences and their impact on social conditions can ultimately hinder an individual's ability to effectively cope with and regulate stress. This may explain why Black youth exhibit disproportionately higher rates of maladaptive coping strategies, such as substance abuse (Cooper et al. 2008; Miech et al. 2019), which only serve to increase stress vulnerability over time. Third, negative racial messages prevalent in the pre-ACE environment can be further reinforced in the post-ACE environment due to the ongoing occurrence of high-profile, racially-charged events and the lack of societal support in processing and making sense of these events.

Future Research Considerations

The profound and life-altering effects of racism on Black youth are undeniable. Therefore, we echo the call for research on childhood adversity and trauma to consider the impact of racism-related stressors, urging for expanded definitions of adversity that include PTEs particularly relevant to socially disadvantaged communities (Cronholm et al. 2015; Jernigan and Daniel 2011; Saleem et al. 2019; Wade et al. 2014). Integrating racism into adversity research provides a necessary foundation for understanding how to best address ACEs among Black youth from both clinical and public health perspectives. Below, we outline several areas for future research that emphasize a culturally informed and integrated approach to understanding ACEs among Black youth, particularly regarding assessment methods, study design, and intervention and prevention programming.

Assessment

The growing body of research documenting the prevalence and damaging consequences of childhood trauma has led many to declare the widespread impact of ACEs a public health crisis requiring immediate attention (Dube 2018). To address this, several assessment tools have been developed to measure ACEs (Cronholm et al. 2015; Ellis and Dietz 2017; Felitti et al. 1998; Koita et al. 2018; Mersky et al. 2017; Reuben et al. 2016). However, these tools vary in their categorization and measurement of ACEs, and only a few include items related to experiences of racial discrimination and other culturally-relevant stressors (e.g., community violence). This inconsistency in how such experiences are evaluated makes it challenging to assess ACEs in a reliable and standardized manner and highlights a broader challenge in how ACEs are operationalized and measured. Scholars have noted that inconsistencies in the language, measurement, operationalization, and assessment of ACEs make it difficult to determine when and how to intervene systematically (McLaughlin 2016).

Since ACE-related data directly inform the creation of state and federally funded policies, programs, and initiatives (Strompolis et al. 2019), there is an urgent need to approach adversity in a consistent and inclusive way that integrates considerations of racism and racial trauma. Updating existing ACE assessment tools to more comprehensively assess PTEs across racial and ethnic groups is critical. As of the writing of this paper, 17 states are actively collecting ACE data, primarily through an 11-item module included in the Behavioral Risk Factor Surveillance System (BRFSS) sponsored by the CDC (CDC 2019). Notably, this BRFSS ACE module lacks any items related to experiences of racism or other PTEs documented in previously developed expanded ACE measures. These omissions make it difficult to accurately determine the prevalence and impact of culturally relevant ACEs among racial and ethnic minority communities, hindering the ability of clinical researchers to develop effective prevention and intervention strategies that address critical needs.

Study Design

While research clearly demonstrates that ACEs can significantly impact lifelong mental health outcomes, there is growing evidence that the type and timing of an ACE during development might influence the severity of subsequent biopsychosocial dysregulation (Herzog and Schmahl 2018; Luby et al. 2019; Schalinski et al. 2016). For example, certain ACEs may have different effects depending on the child's stage of puberty. Interestingly, the impact of racism-related experiences appears to follow similar developmental patterns (Cuevas et al. 2019; Gibbons et al. 2018). Therefore, future research needs to investigate how interpersonal and institutional racism, along with other ACEs, uniquely and cumulatively affect mental health across various developmental stages.

Furthermore, while Black youth are disproportionately exposed to and impacted by ACEs, it is equally critical to incorporate considerations of resilience into research on adversity. Black youth are not a monolith in their responses to adversity, and therefore, understanding the individual, community, and contextual factors that shape both risk and resilience over time is essential. Mixed-methods studies and community-based participatory research approaches are particularly well-suited to identifying unique manifestations of ACEs and highlighting culturally-relevant mechanisms that foster resilience and healing within the context of adversity among Black youth (e.g., racial identity, racial socialization, activism).

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How Racism Hurts Young Black People: A Closer Look at Childhood Trauma

This article is going to break down how racism fits into the picture of childhood trauma.

The ACEs: A Way to Understand Trauma

Experts use something called the "ACEs framework" to understand childhood trauma. ACE stands for "Adverse Childhood Experience". Basically, ACEs are things that make a kid feel unsafe and insecure, like abuse, neglect, or having a parent with a drug problem. The more ACEs a kid has, the more likely they are to have problems later in life – things like mental illness, addiction, or even physical health problems.

The Problem with ACEs (and How It Affects Black Youth)

The problem is, the way we usually think about ACEs doesn't include all the bad stuff that happens specifically to Black kids. Imagine a Black teenager constantly dealing with racist comments or being treated unfairly by teachers. That's trauma too, but it's often not counted in the traditional ACEs. Research shows that Black youth are more likely to experience regular ACEs and more likely to experience racism, which is like a double whammy. This means they're at even greater risk for those long-term problems we talked about.

Racism: More Than Just a Bad Experience

Thinking of racism as just another ACE isn't enough. We need to understand how it impacts Black youth on a deeper level. Imagine a pyramid:

• The Bottom of the Pyramid: Historical Trauma At the bottom is "historical trauma," the pain and suffering passed down from older generations. For Black Americans, this means the trauma of slavery, segregation, and ongoing discrimination.

• The Middle of the Pyramid: How Historical Trauma Affects Life Today Historical trauma doesn't just disappear. It shows up in things like poverty, lack of opportunities, and even how Black people are treated by the police. All of these make it more likely for Black youth to experience those traditional ACEs, like violence or family instability.

• The Top of the Pyramid: Racism as Trauma Itself Racism isn't just a risk factor for other ACEs; it's traumatic in its own right. Being constantly exposed to racism, whether it's overt or subtle, takes a toll on mental and physical health. It's like constantly being on alert, which is exhausting and stressful.

What Needs to Change?

• How We Measure Trauma: We need better ways to measure ACEs that include racism and other experiences common to Black youth.

• How We Study Trauma: We need more research that specifically looks at how racism affects Black youth at different ages and how they cope with it.

• How We Treat Trauma: We need to train therapists and counselors to understand and address racial trauma, creating a safe space for Black youth to heal.

The Bottom Line

Racism isn't just a social issue; it's a public health crisis. By understanding how racism contributes to childhood trauma, we can start to create solutions that help Black youth thrive.

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Racism Hurts: Understanding Why Black Kids Have More Tough Experiences

Lots of kids go through tough stuff while they're growing up. These tough things, like having a parent with a drug problem or being bullied, can be like scars on the inside. Doctors and scientists use the term "ACEs" to talk about these tough experiences. ACE stands for Adverse Childhood Experiences.

Sadly, Black kids experience more of these ACEs than other kids. This article talks about how racism is a big reason why.

What are ACEs?

Imagine a pyramid. At the bottom of the pyramid is something called historical trauma. This means that painful things that happened a long time ago, like slavery, can still affect people today.

Historical trauma makes it more likely that families will have a hard time, maybe with money or feeling safe in their neighborhoods. When families struggle, kids are more likely to experience ACEs, like:

• Abuse (physical, emotional, or sexual)

• Neglect

• Having a parent with a mental illness or drug problem

• Witnessing violence

• Experiencing racism

These ACEs, like those scars on the inside, can make it harder for kids to learn, make friends, and feel good about themselves. They can even cause health problems later in life.

Racism Makes ACEs Worse for Black Kids

The article talks about how racism is like an extra weight on Black kids, making those ACEs even harder to deal with. Here's how:

• Historical racism: The unfair and cruel treatment of Black people in the past, like slavery and segregation, has made it harder for Black families to get ahead. This means Black kids are more likely to grow up in poverty and neighborhoods with more violence, which are ACEs in themselves.

• Racism as an ACE: Being treated unfairly because of your race, like being called names or treated like you're not as smart, is really hurtful. It can make kids feel scared, sad, and angry. These experiences are ACEs too.

• Racism after an ACE: Imagine a kid already dealing with a tough home life. Now imagine that same kid also has to deal with racism at school or in their community. It's like adding insult to injury. Racism makes it harder for Black kids to cope with other ACEs.

What Can We Do?

The article says that we need to:

• Talk about it: We need to have open and honest conversations about racism and how it hurts kids.

• Change the system: We need to fix the unfair systems that make it harder for Black families to thrive.

• Support Black kids: We need to make sure Black kids have the support they need to heal from ACEs and thrive.

This article is like a wake-up call. It's time to listen to Black kids and make sure they have the same opportunities as everyone else.

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