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Amanda Merck

Merck completed her MPH with a concentration in Physical Activity and Health. She curates content for Salud America! (@SaludAmerica), a Latino childhood obesity prevention project based at the Institute for Health Promotion Research at UT Health San Antonio. She focuses on the latest research, resources, and stories related to policy, systems, and environmental changes to enhance equitable access to safe places for kids and families to walk, bike, and play.

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Articles by Amanda Merck

Toxic Stress in the Justice System and How to Prevent It


Toxic Stress in the Justice System and How to Prevent It EJ USA

Exposure to adverse childhood experiences (ACEs), such as poverty or abuse, is a known risk factor involvement in the justice system. And, involvement in the justice system may be an indicator of toxic stress. Thus, the justice system plays an important role in preventing the effects of ACEs and toxic stress. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Salud America! is exploring the report as part of its 11-part series on toxic stress. “Factors that underlie connections between victimization or trauma and later criminal justice involvement provide a window into areas for primary and secondary intervention ...

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Toxic Stress in Early Childhood and How to Prevent It



Since the turn of the century, research has highlighted the importance of early life experiences on long-term health and social outcomes. While childhood exposure to severe or prolonged toxic stress can negatively impact the brain, body, and behavior, early interventions can increase the odds of positive health and social outcomes. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Salud America! is exploring the report as part of its 11-part series on toxic stress. “The pervasive, high prevalence of [adverse childhood experiences (ACEs)] and the enormous costs of health, economic, criminal justice, and other downstream effects ...

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How to Use Social Service Strategies to Address Toxic Stress


How to Use Social Service Strategies to Address Toxic Stress

The child welfare system plays a critical role in identifying, investigating, and intervening to protect children facing abuse and neglect. However, the child welfare system traditionally isn’t as focused on preventing abuse and neglect. Because abuse and neglect are among the adverse childhood experiences (ACEs) associated with toxic stress and some of the most common and serious health and social conditions, the social services sector is needed to help prevent these experiences before they occur. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. She, along with numerous health and child welfare professionals, wants to engage a ...

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Using Public Health Strategies to Address Toxic Stress


Using Public Health Strategies to Address Toxic Stress

Exposure to domestic violence and other adverse childhood experiences (ACEs) can trigger the toxic stress response for a long time, disrupting brain and body development and contributing to some of the most serious health conditions facing our society. Public health can help prevent, detect, and mitigate toxic stress. That’s why Dr. Nadine Burke Harris’ recent Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health calls on public health leaders to address ACEs and toxic stress among Latinos and all people. “The public health field plays an important role in ensuring that communities have healthy environments that support healthy behaviors and reduce risk of harmful exposures,” Burke Harris’ roadmap ...

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Healthcare Strategies for Preventing and Addressing ACEs and Toxic Stress


Healthcare Strategies for Preventing and Addressing ACEs and Toxic Stress

Through prolonged activation of the toxic stress response, adverse childhood experiences (ACEs), like neglect and poverty, disrupt the development of brain architecture and other organ systems and are strongly associated with some of the most common and serious health conditions facing our society. This means toxic stress is a health condition with clinical implications. The healthcare system can play a central role in preventing, detecting, and mitigating toxic stress. That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. Salud America! is exploring this as part of its 11-part series on toxic stress. Below are primary, secondary, ...

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#SaludTues Tweetchat 2/9: Understanding ACEs and Toxic Stress


Understanding ACEs and toxic stress

Our bodies are wired for survival, thanks to our biological stress response system. However, without buffering protections, Adverse Childhood Experiences (ACEs), like neglect and abuse, can lead to a toxic stress response. The toxic stress response is a dysregulated biological stress response and subsequent changes to other physiological functions like the brain, hormonal systems, metabolism, immune response, and gene regulation. ACEs and the toxic stress response are associated with some of the most common, costly, and serious health conditions, including heart disease, cancer, dementia, and suicide. Fortunately, we can prevent and even mitigate toxic stress. Let’s use #SaludTues on Feb. 9, 2021, to Tweet about the lifelong consequences of ACES and toxic stress and ...

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Cut Toxic Stress with 3 Types of Public Health Prevention Interventions


Cut Toxic Stress with 3 Types of Public Health Prevention Interventions

To reduce the impact of a disease like diabetes, public health leaders usually apply a three-part preventive approach of prevention, early detection, and early intervention. But this preventive approach hasn’t been applied to toxic stress. Toxic stress is the body’s response to prolonged trauma─like abuse or discrimination─with no support. It can harm lifelong mental, physical, and behavioral health, especially for Latinos and others of color. Amid COVID-19, civil unrest, and an economic crisis, we need a public health prevention approach to address toxic stress now more than ever. A new roadmap can help. Dr. Nadine Burke Harris’ Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health proposes a ...

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We Need to Recognize Toxic Stress as a Health Condition with Clinical Implications


Toxic stress is a health condition with clinical implications

There is a common health condition with serious medical consequences that has not been nationally recognized by the medical or public health community—toxic stress response. Toxic stress is the body’s response to prolonged trauma─like abuse or discrimination─with no support. It can harm lifelong mental, physical, and behavioral health, especially for Latinos and others of color. But few, if any, clinical treatment guidelines have strategies for mitigating the toxic stress response. That’s why Dr. Nadine Burke Harris’ Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health wants California and others to recognize and respond to toxic stress as a health condition with clinical implications. “We ...

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Toxic Stress and its Lifelong Health Consequences


Toxic stress is a health crisis

Toxic stress is brought about by repeated stressful and traumatic experiences with no supportive relationships. This is causing huge mental and physical health problems for people across the nation, including Latinos and other people of color. Dr. Nadine Burke Harris even calls toxic stress a public health crisis. This is why she authored the Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health. “We now understand that a key mechanism by which ACEs [adverse childhood experiences, such as divorce, abuse, poverty, etc.] lead to increased health risks is through a health condition called the toxic stress response,” Burke Harris’ roadmap states. Salud America! is exploring this issue as part of its ...

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