Morgan Vien, the child of Vietnamese refugees and herself a San Francisco Bay Area native, says her ACE score is zero. That’s because she grew up with her parents and a younger brother “in a very safe and nurturing atmosphere.”
It wasn’t until her junior year at Santa Clara University, where she earned a B.S. in public health science with minors in sociology and biology, that she learned about adverse childhood experiences — ACEs — in a public health class. That knowledge was “transformational,” she says.
Understanding her parents’ traumatic experiences
The first-generation American knew that her parents had suffered from persecution by the Communist Party during the Vietnam War and risked death to flee the country. But she explains that “it didn’t come together until I learned about ACEs. It opened my eyes to how much traumatic experiences can affect health outcomes.”
ACEs refers to the CDC-Kaiser Permanente Adverse Childhood Experiences Studyof more than 17,000 adults. The study linked 10 types of childhood trauma to the adult onset of chronic diseases, mental illness, violence, being a victim of violence, difficulty in holding a job, and financial issues, among other consequences.
The study found that ACEs are remarkably common — most people have at least one. People who have four or more different types of ACEs — about 12 percent of the general population, but more in communities in people of color and/or White people where policies keep them impoverished — have a 1,200 percent higher risk of attempting suicide and a 700 percent higher risk of becoming an alcoholic, compared with people who have no ACEs. Many other types of ACEs — including racism, bullying, a father being abused, and community violence — have been added to subsequent ACE surveys. (PACEs Science 101; Got Your ACE/Resilience Score?)
The epidemiology of childhood adversity is one of five parts of PACEs (positive and adverse childhood experiences) science. The other parts include how toxic stress from ACEs affects children’s brains, the short- and long-term health effects of toxic stress, how toxic stress is passed on from generation to generation, and research on resilience, which includes how individuals, organizations, systems and communities can integrate PACEs science to solve our most intractable problems.
With a knowledge of PACEs, Vien realized why some of the behaviors her parents practiced — about work and food — resulted from their history in Vietnam and “keeps them resilient after the trauma they faced as refugees.” One way that immigrants rebound in the U.S. as refugees is to become extremely determined to reach their goals and to provide a better start for their children. That made her parents driven in their work.
She also recalls the moment she understood why her parents ate certain Vietnamese foods that tend to have higher levels of fat, salt, and sugar. Applying her PACEs insights, she realized these foods “allow them to feel more comfortable and at home,” practicing resilience in a unique way.
After learning and applying PACEs to her understanding of people’s behaviors, Vien’s relationship with her parents changed. She asked more about their experiences, their lives in Vietnam. As a result, she said, she ended up “building up a better bond and connection with them.”
Her experiences have also brought her a unique understanding of the current escalation in hate crimes against Asian Americans and Pacific Islanders. In a blog post last month “Being Asian American during the COVID-19 pandemic”, Vien wrote:
Traditionally taught to keep silent and work hard to blend in, this approach does not work. It is time to speak up. Historically underrepresented in the workplace and higher education, systematically discriminated against via policies and regulations, consistently excluded from research that informs interventions/policies/access, and the multitude of disparities continue. Our cultures are taken from us and appropriated. Every day, there are racist or micro-aggressive comments and actions towards AAPI, and as of COVID-19, these were encouraged by the former administration.
Incorporating PACEs into her studies
In 2015, while still an undergraduate at Santa Clara University, Vien conducted a three-year study enlisting over 960 students on stress and mental health. PACEs elements, such as parental care and parental control, were correlated with stress and mental health, including depression and anxiety symptoms, although the study did not screen for ACEs. Results of this study are still being analyzed and will be published.
Vien earned a master’s degree in public health at the University of California, Berkeley while working part-time at ACEs Connection (now PACEs Connection) as resources center administrator and co-manager of the Practicing Resilience for Self-Care and Healing community.
Immediately upon graduation, she was hired full-time as project manager for a hypertension study at UC Berkeley; the project is funded by the Dr. Jeffrey Thomas Stroke Shield Foundation in Fremont.
This study trains student coaches from UC Berkeley to conduct motivational interviews with participants in Alameda and Contra Costa counties. Over nine months, the student coaches offer hypertension management by providing cuffs and monitors as well as setting goals to lower blood pressure through lifestyle change and other resiliency practices.
Before COVID-19 struck, approximately 40 participants were enrolled from community organizations, federally qualified health centers, and local hospitals. The study started two years ago, and this past year all the work has been conducted online. Enrollment now stands at around 80 participants. The project aims to include 150 participants before analyzing and presenting the results in a scientific publication.
Her time at PACEs Connection
The summer after Vien first heard Dr. Brigid McCaw speak about ACEs at Santa Clara University, she worked on an ACEs and resilience project with Dr. Paul Espinas at Kaiser Permanente in Hayward. Afterwards, she reached out to McCaw and was encouraged to contact PACEs Connection.
Warmly welcomed, Vien stayed with the PACEs Connection team for three years while evolving from a new college grad to a new MPH grad. The PACEs Connection team “was my work family,” she says. She interacted with everyone on the small staff but worked most closely with Jane Stevens, Gail Kennedy, Cissy White, and Donielle Prince.
Not only does she find the entire PACEs Connection team amazing, strong, uplifting, and motivated, she says they are also funny.
During a Zoom video meeting, the team had revised a statement together.
After the edits, several joked, “I’m terrified to have my writing go in front of our journalists!” (Several of the PACEs team are journalists.) Vien says, “The diverse expertise and collaboration really creates the best statements and ACEs work.
What’s next?
Vien plans to work a few years in public health settings and then return to school to earn a doctorate of public health with an emphasis on developing resiliency and programs for management and reduction of cardiometabolic diseases and conditions.
She also says she “plans to be a lifetime member of PACEs Connection.”
It seems as if this child of Vietnamese refugees is just as work-driven as her parents, and one might suspect the epigenetic effects of PACEs have been handed down to her advantage.
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