Martha E. Wadsworth - US grants

Hurricane Katrina required an extraordinary response from government and voluntary organizations. While the most devastating impact was in the Gulf Coast and neighboring states, states throughout the country accepted evacuees. Colorado received well over 2000 evacuees in the initial weeks following the Hurricane, many housed in a temporary shelter at an old air force base in a county neighboring Denver. Evacuees continued arriving even a month later, with as many as 30 new evacuees a day arriving in need of services in mid-October when temporary shelters in Lousiana were phased out. To respond to this substantial need, state and local officials had to determine where to provide housing, how to provide medical care, what cash assistance evacuees needed, and how to get children settled into schools. A significant portion of these efforts relied on the work of private agencies, as they become increasingly central to provision of aid. This research examines how Colorado coordinated delivery of services to evacuees. How did the churches and other charities advocate for evacuees, provide goods, and assist in accessing social services? Who coordinated crisis services and will there be a coordinated long-term response?

Evacuees suffered a trauma in fleeing their homes. This research also examines how evacuees experienced that trauma? What aspects of the experience were most stressful for them? What external supports and resources and which internal coping skills helped evacuees get through the days, weeks, and months following involuntary relocation to a new state? Did they come with friends or family or community members, and to what extent have they been able to connect with communities in Colorado? How did evacuees experience receipt of services and how are evacuees faring psychologically now and over time? How has poverty compounded the experience of being an evacuee?

Finally, the news has been full of stories about evacuees. Most Americans learn about evacuees from the news rather than from personal experience. This research also examines the type, range, and depth of the information presented by the print and televised news media. We will track and analyze news coverage in Colorado over the course of a year to examine the media's initial response, and also how coverage changes as the disaster fades from public consciousness.

DESCRIPTION (provided by applicant): Physical and mental health disparities stemming from socioeconomic inequality and poverty are well documented (Evans, Wolf & Adler, 2012). There is clear evidence that (a) the groundwork for lifelong disease and premature death is laid during childhood (e.g., Chen & Miller, 2012), and (b) damage to and deregulation of the physiologic stress response is one of the most powerful mechanisms of the effects of poverty and economic inequality on illness and disease (e.g., Evans & Kim, 2012). To contribute solutions to health disparities, we need interventions that affect the physiologic systems that confer the risk. Since the stress response systems (hypothalamic-pituitary-adrenal axis/HPA and sympathetic-adrenomedullary/SAM) are a central mechanism for SES-based disparities, these are critical systems to target. Improving children's ability to cope with stress and regulate their reactivity has the potential to break the cycle of damage, but only if the coping strategies and regulatory processes that we target have effects at the physiologic level-we have preliminary findings suggesting that they do. The proposed project seeks to firmly establish this connection. Preadolescence is a crucial time during which children's ability to recognize stress and its causes matures, and repertoires for coping with stress grow in both size and complexity. Preadolescents are, therefore, at a ripe stage to both inform our basic science questions and benefit from future coping-based prevention. Our team has compiled a basic understanding of the efficacious and inefficacious forms of coping used by children and adolescents exposed to poverty-related stress (e.g., Santiago, Wadsworth et al., 2011; Wadsworth & Compas, 2002; Wadsworth & Santiago, 2008, 2009), and we have discovered that living with poverty-related stress constrains the development of and/or ability to utilize efficacious coping (Santiago, Etter et al., 2011; Wadsworth et al., 2011). We do not yet know whether coping that is efficacious at the behavioral level has concomitant effects on the underlying physiologic stress response systems in poor, rural preadolescents. The current project will use an experimental approach and data from multiple levels of analysis, including measures of both HPA and SAM activity, observational coding of in vivo coping, and experimental manipulation of coping to: (a) compare the physiologic downregulation of randomly assigned in vivo efficacious (secondary control) and ineffective (disengagement) coping in low-income preadolescents, (b) examine how preadolescents' typical strategies for coping moderate their ability to either make use of secondary control strategies or to regulate themselves despite being primed for avoidance, (c) identify subgroups of preadolescents with different reactivity and regulation profiles, and (d) examine the individual and family characteristics of the identified subgroups, including who is more and less successful in each condition-potentially identifying person-specific intervention targets. Discovery of ways to prevent and/or halt this progression of damage to a child's stress response system can offer new directions for combatting health disparities.

? DESCRIPTION (provided by applicant): Mental health problems are proportionately affect racial and ethnic minority populations, as well as populations that face chronic economic hardship (Evans, Wolf & Adler, 2012). There is clear evidence that (1) the processes that lay the groundwork for mental health disparities is laid during childhood (e.g., Chen & Miller, 2012) and (2) that damage to and dysregulation of the physiologic stress response is a powerful mechanism of the effects of chronic stress such as that associated with poverty on psychopathology (e.g., Evans & Kim, 2012). To contribute solutions to mental health disparities, we need interventions capable of affecting the systems that confer the risk. Since the psychobiologic stress response system (e.g., hypothalamic-pituitary- adrenal axis; HPA) is a central mechanism linking health disparities to chronic stress, the stress response is a critical system to target. Improving children's ability to cope with stress and regulate their reactivity ha the potential to break the cycle of damage, especially if the coping strategies and regulatory processes that we target have effects at the physiologic level. Preliminary evidence from the PIs research lab has emerged showing that different types of coping are evident at the level of the HPA-it is, therefore, time to evaluate whether a coping intervention designed for children facing chronic stress will both (a) improve children's ability to use primary and secondary control coping, and (b) have sustained effects at the physiologic level. We have developed just such an intervention, which builds on these exciting new findings and is designed to address core underlying mechanisms of risk and repair in the highly stressful context of poor, urban youths' lives. Preadolescence is a crucial time during which children's ability to recognize stress and it causes matures, and repertoires for coping with stress grow in both size and complexity. In addition, preadolescence is a time of increased brain changes and growth in key self-regulatory organs and systems. Preadolescents are, therefore, at a ripe stage to benefit from coping-based prevention and the plasticity of this developmental period suggests that such changes have the potential to be long-lasting. Our new prevention program is designed to prevent the onset of anxiety, depression, and post-traumatic stress symptoms in preadolescent children facing chronic stress. Two mechanisms of action are targeted in this project. First, the project seeks to demonstrate that children facing chronic stress stemming from poverty, discrimination, and violence exposure can acquire and utilize new ways of coping that are adaptive in a wide variety of circumstances. Second, the project will examine the extent to which improved coping resulting from the intervention engages the physiologic intermediate mechanism of the HPA. Finally, the project aims to link changes in coping and the HPA to changes in internalizing symptoms that would signal prevention of the emergence of new or worsening of existing symptoms. Discovery of ways to prevent and/or halt this progression of damage to a child's stress response system that leads to psychopathology can offer new directions for combatting health disparities.