Can Changing How We Talk About Childhood Toxic Stress Influence Policy?

How do you get people to support public policies that help children thrive? Do you emphasize the possible health consequences of child abuse, or do you emphasize the financial consequences for society as a whole? If you focus on consequences, does this messaging have the unintended consequence of creating prejudices towards vulnerable children and their families?

When it comes to informing and persuading, how we deliver a message matters as much as the message itself. With a $500,000 grant from the Robert Wood Johnson Foundation, Jonathan Purtle, DrPH, an assistant professor at Drexel University’s Dornsife School of Public Health, will investigate how adjusting messaging can influences public opinions and policymaking about the science of child development.

Purtle will focus on how to better communicate with legislators and lay audiences about what can happen when children experience toxic levels of stress. While stress results from a range of both positive and negative responses to life circumstances, toxic stress occurs when a child experiences a prolonged stress response.

Exposure to poverty, community violence, abuse and neglect can be sources of toxic stress during childhood. Nearly half (46 percent) of children in the United States have experienced at least one adverse childhood experience. The rates are higher for black children (61 percent) and Hispanic children (51 percent).

Research studies show that children who live with toxic stress can experience changes in brain function and structure, which may affect learning ability and the capacity to adapt to adversity in healthy ways. The biological impacts of toxic stress include measurable increases in inflammation and altered immune function that may increase the child’s risk of developing cardiovascular disease and cancer later in life. Purtle is concerned that, if communicated carelessly, information about this science could result in prejudices towards vulnerable children and families.

Purtle says the grant will allow him and his team to explore rare territory — conducting a real-world communications experiment to determine the effects of different messages on how legislators and the general public think about the issue of toxic stress and what types of policies they support to address it.

“I hope the study will generate knowledge that can be used to improve the effectiveness of advocacy efforts and advance policies that reduce exposure to toxic stress and enhance resilience,” Purtle said.

One of the study’s greatest strengths is its innovative experimental design, according to Purtle.

“By randomizing lay people and policymakers to read messages in which toxic stress is framed in different ways, and then assessing their opinions, the study will produce solid evidence about the most effective ways of communicating about toxic stress,” Purtle said.  

The researchers will begin by analyzing news media coverage about toxic stress and childhood adversity and conducting interviews with people engaged in advocacy for child development policy. The second phase of the study will focus on public opinion experiments, in which the researchers will test the effects of different ways of framing evidence about toxic stress on support for child development policies and the prejudices they might generator towards vulnerable children and families. The final phase will test of ways of framing evidence for state legislators who sit on health, education, or child welfare committees.

The grant will also allow Purtle to expand his work developing strategies to communicate with legislators, policymakers and health advocates in ways that will lead to more effective methods of reducing health inequality across the population.

The project team includes Sarah Gollust, PhD, an associate professor of Health Policy and Management at the University of Minnesota; John Rich, MD, PhD, a professor at Drexel’s Dornsife School of Public Health; Michael Yudell, PhD, an associate professor at Dornsife; and

Félice Lê-Scherban, PhD, an assistant professor at Dornsife. The study builds on prior research Purtle has conducted with state legislators about mental health and substance abuse issues.