A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage.

Area of Science:

• Public Health
• Social Determinants of Health
• Health Equity

Background:

• The COVID-19 pandemic exacerbated existing racial inequities, disproportionately affecting children and families of color.
• Generational, systemic racism and historical inequities create toxic stress, impacting health outcomes.
• The "stress superstorm" of 2020 highlighted the urgent need for frameworks addressing these disparities.

Purpose of the Study:

• To introduce the Toxic Stress Schema (TSS) as an ecological framework with a social justice lens.
• To identify and alleviate stress and strengthen social determinants of health for vulnerable populations.
• To demonstrate the utility of the TSS framework for advanced nursing practice and health policy.

Main Methods:

• Literature review to understand the differential impacts of the 2020 "stress superstorm" on children of color.
• Analysis of family position on the advantage-disadvantage continuum to illustrate varied effects.
• Application of the TSS framework to real-world scenarios.

Main Results:

• The TSS framework effectively models the complex interplay of stressors on children of color.
• Examples illustrate how socioeconomic factors and racism compound pandemic-related stress.
• The framework is adaptable for identifying and addressing health inequities.

Conclusions:

• The COVID-19 pandemic underscored the critical need to address historical inequities faced by children and families of color.
• The TSS framework offers a structured approach for recognizing, organizing, and implementing interventions.
• Recommendations are provided for pediatric nurse practitioners to advocate for health policy changes.