Adversity and Research

The complexity of social adversity: Areas of research to explore

Our Challenge

One of the biggest challenges preventing social adversity in the form of barriers to vital services for surviving and thriving is that understanding root causes and solutions requires exploring many fields of research.

We provide you with a starting point, exploring the frameworks and theories that guide our 100% New Mexico initiative. These include the social determinants of health and the social-ecological model. We also provide links to research articles on health equity and racial equity, two goals of our initiative. We also offer links to frameworks that guide our capacity-building process: Maslow’s hierarchy of need, frameworks for change, continuous quality improvement, adaptive leadership and collective impact. Lastly, we offer articles on addressing the digital divide, which focuses on providing web-based information, support and services to all our residents in rural and urban New Mexico across 33 counties.

References and Reading

The research articles offered here, primarily from peer-reviewed journals, are focused on frameworks, theories and strategies for addressing inequities. They can provide ongoing professional development, research, analysis of best practice, and promotion of community dialogue and attention focused on educating all providers and residents about the emotional and financial costs of social adversity. It is worth noting that while social adversity can exist in rural and urban environments and among all socio-economic groups, local public acknowledgement of the magnitude of social adversity, including racial inequities, may differ based on community norms. Familiarity with research on social adversity-related topics is the most effective way for an organization to develop a countywide prevention and intervention strategy to ensure equity for 100% of residents.

Social Determinants of Health

The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, live, work and age,” which are “shaped by the distribution of money, power and resources.” The evidence base for the impact of social determinants of health has been strengthened considerably over the last decades and those seeking to address disparities and racial inequities are using the research focused on the social determinants of health to support arguments and initiative actions to change government policies to address lack of vital services for surviving and thriving.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: a social determinants of health lexicon for health care systems1, social determinants of health: coming of age2, social determinants of health equity3, leveraging the social determinants of health4, improving health and reducing disparities5, evidence from systematic reviews6, strategies for reducing health disparities7, future directions for health disparities research8, systems change9, polarizing effect of news media messages about the social determinants of health10, creating change in government11, considering the causes of causes12, a conceptual framework13, and social determinants of health and related inequalities14.


  1. Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems. Hugh Alderwick and Laura M. Gottlieb. 2019.
  2. The Social Determinants of Health: Coming of Age. Paula Braveman, Susan Egerter and David R. Williams. 2011.
  3. Social Determinants of Health Equity. Michael Marmot, PhD and Jessica J. Allen, PhD. 2014.
  4. Leveraging the Social Determinants of Health: What Works? Lauren A. Taylor, Annabel Xulin Tan, Caitlin E. Coyle, Chima Ndumele, Erika Rogan, Maureen Canavan, Leslie A. Curry and Elizabeth H. Bradley. 2016
  5. Moving Upstream: How Interventions that Address the Social Determinants of Health can Improve Health and Reduce Disparities. David R. Williams, PhD, MPH, Manuela V. Costa, MPH, Adebola O. Odunlami, MPH and Selina A. Mohammed, PhD. 2012.
  6. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. C. Bambra, M. Gibson, A. Sowden, K. Wright, M. Whitehead and M. Petticrew. 2010.
  7. Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Rachel L. J. Thornton, Crystal M. Glover, Crystal W. Cené, Deborah C. Glik, Jeffrey A. Henderson and David R. Williams. 2016.
  8. Social Determinants of Health: Future Directions for Health Disparities Research. Richard C. Palmer, Dr, PH, JD, Deborah Ismond, PhD, Erik J. Rodriquez, PhD, MPH and Jay S. Kaufman, PhD 2019.
  9. Systems change for the social determinants of health. Gemma Carey and Brad Crammond. 2015.
  10. The Polarizing Effect of News Media Messages About the Social Determinants of Health. Sarah E. Gollust, PhD, Paula M. Lantz, PhD and Peter A. Ubel, MD. 2011.
  11. Creating change in government to address the social determinants of health: how can efforts be improved? Gemma Carey, Brad Crammond and Robyn Keast. 2014.
  12. The Social Determinants of Health: It's Time to Consider the Causes of the Causes. Paula Braveman, MD, MPH and Laura Gottlieb, MD, MPH. 2014.
  13. A Conceptual Framework for Action on the Social Determinants of Health. Orielle Solar and Alec Irwin. 2010.
  14. Social Determinants of Health and Related Inequalities: Confusion and Implications. M. Mofizul Islam. 2019.

Social Ecological Model

The socio-ecological model (SEM) was first introduced as a conceptual model for understanding human development was developed and formalized as a theory by psychologist Urie Bronfenbrenner in the 1970s and 1980s. The use of the term “social-ecological system” (SES) in scientific literature has grown. This model illustrates how behaviors form based on characteristics of individuals, communities, cities, states, nations and levels in between. In examining how these “levels” interact, community health advocates can develop strategies to promote well-being and ensure vital services with a comprehensive plan that acknowledges the role of the individual, family relationships, community relationships and political agents within larger political systems.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: the social-ecological model and challenges in implementation of interventions1 social ecological approaches to individuals and their contexts2, a social-ecological framework of theory, assessment, and prevention of suicide3, social ecological approaches to community health research and action4, the social-ecological systems discourse 20 years later5, social-ecological systems from an Institutional perspective6, social-ecological systems literature review7, breath of model8, ecological model and stressors associated with youth and HIV9, the model and policy and environmental change10, the model and minority and underserved communities11, and the model used for improving care for youth and adults12.


  1. Health-promotion research over three decades: The social-ecological model and challenges in implementation of interventions. Bente Wold and Maurice B. Mittelmark. 2018.
  2. Social Ecological Approaches to Individuals and Their Contexts: Twenty Years of Health Education & Behavior Health Promotion Interventions. Shelley D. Golden, MPH, Jo Anne L. Earp, ScD, and Jo Anne L. Earp. 2012
  3. A Social-Ecological Framework of Theory, Assessment, and Prevention of Suicide. Robert J. Cramer and Nestor D. Kapusta. 2017.
  4. Introduction to Special Issue on Social Ecological Approaches to Community Health Research and Action. David William Lounsbury and Shannon Gwin Mitchell. 2009.
  5. Exploring the social-ecological systems discourse 20 years later. Johan Colding and Stephan Barthel. 2019.
  6. A Framework to Analyze the Robustness of Social-ecological Systems from an Institutional Perspective. John M. Anderies, Marco A. Janssen and Elinor Ostrom. 2004
  7. What do We Talk about When We Talk about Social-Ecological Systems? A Literature Review. Cristina Herrero-Jáuregui, Cecilia Arnaiz-Schmitz, María Fernanda Reyes, Marta Telesnicki, Ignacio Agramonte, Marcos H. Easdale, María Fe Schmitz, Martín Aguiar, Antonio Gómez-Sal and Carlos Montes. 2018.
  8. Breadth of the Socio-Ecological Model. Jill F. Kilanowski, PhD, RN, APRN,CPNP, FAAN. 2017.
  9. An Ecological Model of Stressors Experienced by Youth Newly Diagnosed With HIV An Ecological Model of Stressors Experienced by Youth Newly Diagnosed With HIV. Sybil G. Hosek, Gary W. Harper, Diana Lemos, and Jaime Martinez. 2008.
  10. Upending the Social Ecological Model to Guide Health Promotion Efforts Toward Policy and Environmental Change. Lisa D. Lieberman, Shelley D. Golden, Kenneth R. Mcleroy and Lawrence W. Green. 2015.
  11. Socio-ecological Model as a Framework for Overcoming Barriers and Challenges in Randomized Control Trials in Minority and Underserved Communities. Hamisu M. Salihu, MD, PhD, Ronee E. Wilson, PhD, MPH, Lindsey M. King, MPH, CHES, CCRP, Phillip J. Marty, PhD, and Valerie E. Whiteman, MD. 2015.
  12. Using the Social-Ecological Model to Improve Access to Care for Adolescents and Young Adults. Christopher R. Harper, Ph.D., Riley J. Steiner, M.P.H. and Kathryn A. Brookmeyer, Ph.D. 2018.

Health Equity

We are using a ‘health equity lens’ to bring inequities, social adversity, historical disparities, adverse childhood experiences and trauma into focus, providing a framework to prevent them by ensuring the ten vital services for surviving and thriving for all residents. Interventions to remove inequities and provide access to vital services are as diverse as the populations facing barriers. Achieving health equity requires an understanding of disparities based on race, gender, age, physical capacity, geographic location, sexual orientation and socio-economic class. Health equity strategies can be met when guided by an understanding of the social determinants of health.

The 100% New Mexico initiative framework reveals the full spectrum of inequities and adversity, identifies their root causes, and supports an applied science approach, turning research into real world solutions. The initiative, developed on the local level in counties across New Mexico, is a data-driven, collaborative, and technology-empowered solution guided by the principles of equity, powered by local county leaders and stakeholders.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: directions for pediatric health disparities research and policy1, social determinants of health in American Indian health2, racial/ethnic health disparities in children and adolescents3, service learning in the social determinants of health course4, social capital and health in a digital society5, social health and environmental behavior of students in the digital age6, children's health in a legal Framework7, child health and access to medical care8, using Maslow's hierarchy in a rural underperforming school.9, a resilience, health and well-being lens for education and poverty10, dismantling the imperialist discourse shadowing Mexican immigrant children11, the current scope of health disparities in the US12, implementation research methodologies for achieving scientific equity and health equity13, transitioning from health disparities to a health equity research agenda14, defining equity in health15, on the edge of a new frontier16, and navigating inequities: a roadmap out of the pandemic17.


  1. Observations from the Balcony: Directions for Pediatric Health Disparities Research and Policy. Jean Raphael. 2013.
  2. Development of a Pilot Grants Program in Social Determinants of Health in American Indian Health: A Program for Increasing the Representation of Underrepresented Groups in Funded Research. Alyson E. Becker, Jessica Heinzmann and DenYelle Baete Kenyon. 2018.
  3. Social Determinants of Racial/Ethnic Health Disparities in Children and Adolescents. Jame H. Price, Molly A. McKinney and Robert E. Braun. 2011.
  4. Enhancing Curriculum through Service Learning in the Social Determinants of Health Course. Ronica Nicole Rooks and Christine Tagliaferri Rael. 2013.
  5. Social Capital and Health in a Digital Society. Behjat A. Sharif. 2007.
  6. Social Health and Environmental Behavior of Students in the Digital Age. Vera A. Zakharova, Ilya V. Chernov, Tatiana INazarenko, Pavel V Pavlov, Vasily S. Lyubchenko and Anna A. Kulikova. 2020.
  7. Children's Health in a Legal Framework. Clare Huntington and Elizabeth Scott. 2015.
  8. Child Health and Access to Medical Care. Lindsay Leininger and Helen Levy. 2015.
  9. "From School of Crisis to Distinguished": Using Maslow's Hierarchy in a Rural Underperforming School. Molly H. Fisher and Ben Crawford. 2020.
  10. A Resilience, Health and Well-Being Lens for Education and Poverty. Liesel Ebersöhn. 2017.
  11. Dismantling the Imperialist Discourse Shadowing Mexican Immigrant Children. Lisa L. Miller. 2006.
  12. The Current Scope of Health Disparities in the U.S.: A Review of Literature. Michele L Pettit and Alyson R. Nienhaus. 2010.
  13. Implementation Research Methodologies for Achieving Scientific Equity and Health Equity. Moira McNulty, J.D. Smith, Juan Villamar, Inger Burnett-Zeigler, Wouter Vermeer, Nanette Benbow, Carlos Gallo, Uri Wilensky, Arthur Hjorth, Brian Mustanski, John Schneider and C. Hendricks Brown. 2019.
  14. Transitioning from Health Disparities to a Health Equity Research Agenda: The Time Is Now. Shobha Srinivasan, PhD and Shanita D. Williams, PhD, MPH, APRN. 2014.
  15. Defining equity in health. P. Braveman and S. Gruskin. 2003.
  16. Health Equity — Are We Finally on the Edge of a New Frontier? Michele K. Evans, M.D. 2020.
  17. Navigating inequities: a roadmap out of the pandemic. Shainoor J Ismail, Matthew C Tunis, Linlu Zhao and Caroline Quach. 2021.

Racial Equity

Equity can be defined as the quality of individuals, organizations and institutions being just, impartial and fair. The concept of equity is synonymous with fairness and justice. Racial equity applies fairness and justice to people of all races that results in equitable opportunities and outcomes for everyone. A “racial justice” framework guides us to racial equity through a collaborative and measurable approach.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: trends in health equity in the united states by race/ethnicity, sex and income1, efforts to advance racial equity in a foundation2, the disproportionate impact of COVID-19 on communities of color3, reducing racial disparities in health care by confronting racism4, racial and social equity5, civil rights as determinants of public health and racial and ethnic health equity6, civic stratification and the exclusion of undocumented immigrants from cross-border health care7, sharpening our public health lens: advancing immigrant health equity during COVID-19 and beyond8.


  1. Trends in Health Equity in the United States by Race/Ethnicity, Sex and Income, 1993-2017. Frederick J. Zimmerman, PhD, and Nathaniel W. Anderson, BA. 2012.
  2. Prioritizing Racial Equity: How Efforts to Advance Racial Equity Helped Shape the W.K. Kellogg Food & Fitness Initiative. Mary M. Lee Esq. and Amanda Navarro, PhD. 2018.
  3. Addressing the Disproportionate Impact of COVID-19 on Communities of Color. Garth Graham. 2021.
  4. In Focus: Reducing Racial Disparities in Health Care by Confronting Racism. Martha Hostetter and Sarah Klein. 2018.
  5. Working toward racial and social equity: research and commentary. The Elsevier Community. 2020.
  6. Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States. R. A. Hahn, B. I. Truman and D. R. Williams. 2018.
  7. Civic stratification and the exclusion of undocumented immigrants from cross-border health care. Jacqueline M. Torres and Roger Waldinger. 2016.
  8. Sharpening our public health lens: advancing im/migrant health equity during COVID-19 and beyond. Stefanie Machado and Shira Goldenberg. 2021.

Maslow’s Hierarchy of Needs

Abraham Maslow, a psychologist and psychology professor, developed his “hierarchy of needs” framework through the 1940’s and 1950’s and it has remained very popular within the fields of sociology, psychology and public health. The five levels of the pyramid, a path for humans to climb in order to meet vital needs, are:

Physiological needs: the need for water, food, clean air, sleep, health, clothes and shelter.

Safety needs: the need for a safe living environment (a vital component of a trauma-free childhood), job security, financial security and emotional security.

Love needs: the need for love within the family and with friends and intimate relationships.

Esteem needs: the need for self-respect, self-confidence, independence and freedom. It can also include the need for respect from others.

Self-actualization needs: the need to realize one’s potential and to be all one can be. This need drives people to develop talents and the capacity to pursue and achieve goals.

Maslow hypothesized that a human must meet the needs of each level of the pyramid before climbing to the next one. On a practical level this meant that a 12-year-old would need to be fed, clothed, housed and kept safe (physiological and safety needs) before she would have the potential to build a meaningful future (meeting love, esteem and self-actualization needs).

It should be noted that some see the “pyramid” as a combination of overlapping spheres, suggesting that one can begin the process of self-actualization and altruism (near the top of Maslow’s pyramid) at any time along one’s life, even living in an environment where basic physical needs are barely met (surviving at the bottom of the pyramid).

Abraham Maslow, later in life, discussed adding another layer to the very tip of the pyramid. This would represent what he called “transcendence needs,” a phase in life where one sees oneself as an active participant in society with the need to contribute fully beyond oneself. This could be seen as a phase of altruism, demonstrated by the practice of selfless concern for the well-being of others. This is where feelings of care turn into action. We might call this phase one of socially-engaged awareness.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: Maslow’s theory1, Maslow’s later version of the hierarchy2, renovating the pyramid3, and measuring the satisfaction of need4.


  1. A Theory of Human Motivation. A. H. Maslow (1943) Originally Published in Psychological Review.
  2. Rediscovering the Later Version of Maslow’s Hierarchy of Needs: Self-Transcendence and Opportunities for Theory, Research, and Unification. Mark E. Koltko-Rivera. 2006.
  3. Renovating the Pyramid of Needs: Contemporary Extensions Built Upon Ancient Foundations. Douglas T. Kenrick, Vladas Griskevicius, Steven L. Neuberg, and Mark Schaller. 2011.
  4. Maslow and the Motivation Hierarchy: Measuring Satisfaction of the Needs. Robert J. Taormina and Jennifer H. Gao. 2013.

Framework for Change

The 100% New Mexico Initiative is guided by a theory of change which is a description of why a unique strategy focused on problem-solving will be effective, including its interrelated components or activities. We use a framework for change to create a shared understanding of how the 100% New Mexico initiative works on the county level.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: the difference between change theory and theory of change1, the use of a theory of change2, and theory of change analysis3.


  1. Change theory and theory of change: what’s the difference anyway? Daniel L. Reinholz and Tessa C. Andrews. 2020.
  2. The Development and Use of a Theory of Change to Align Programs and Evaluation in a Complex, National Initiative. Wendy M. Dubow and Elizabeth Litzler. 2018.
  3. Theory of Change Analysis: Building Robust Theories of Change. John Mayne. 2017.

Continuous Quality Improvement (CQI)

CQI is a data-driven process used in both the private and public sectors, based on four steps in project development that include: assessment, planning, action and evaluation. Each phase comes with its own set of questions and promotes a team process where everyone’s insights and experiences are valued. CQI will be used to identify and remove barriers to ensure access to 10 vital services for surviving and thriving. It should be noted that the entire county 100% New Mexico initiative is a process of CQI.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: CQI and clinical practice1, CQI and hospital improvement2, and conceptual and historical foundation of CQI3.


  1. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress. Stephen M. Shortell, Charles Bennett and Gayle R. Byck. 1998.
  2. Continuous Quality Improvement, Total Quality Management, and Reengineering: One Hospital’s Continuous Quality Improvement Journey. Donald Klein, Jaideep Motwani and Beth Cole. 1998.
  3. Quality Improvement in Health Care: Conceptual and Historical Foundations. David Colton. 2000.

Adaptive Leadership

Adaptive Leadership is a framework developed by Ronald A. Heifetz, Marty Linsky and Alexander Grashow, made popular through the publishing of their book The Practice of Adaptive Leadership: Tools and Tactics for Changing Your Organization and the World. This framework guides the process of change, empowering local stakeholders to successfully navigate the change process when encountering opposition from the official and unofficial power brokers. The authors provide a way to differentiate between what they call a technical challenge and an adaptive challenge. Adaptive leadership is a practical leadership framework that helps individuals and organisations to promote the process of change, pursue problem-solving, adapt policies and programs to meet the needs of communities and agencies.

A technical challenge is one where there is an agreed upon process for achieving a goal or completing a project. While a blueprint exists, opposition will be encountered. An adaptive challenge is one where there is not an agreed upon process for achieving a goal or completing a project. You are in uncharted waters with forces opposed to change. This framework helps change agents understand why people fear change, often related to a perceived loss of power and control.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: flexibility and adaptive leadership1, when change is not enough2, adaptive leadership and schools3, and addressing complex problems with adaptive leadership4.


  1. Why Flexible and Adaptive Leadership is Essential. Gary Yukl and Rubina Mahsud. 2010.
  2. Adaptive leadership: When change is not enough (part one). Jerry Glover, Harris Friedman and Gordon Jones. 2002.
  3. Investigating the Relationship of Adaptive Leadership and Leadership Capabilities on Leadership Effectiveness in Sarawak Schools. Madline Jayan, Khuan Wai Bing and Kamurudin Musa. 2016.
  4. Addressing Complex Challenges through Adaptive Leadership: A Promising Approach to Collaborative Problem Solving. Tenneisha Nelson and Vicki Squires. 2017.

Collective Impact

Collective impact is a tested process for creating a shared vision to achieve results, often large scale projects such as increasing literacy across a school district or cleaning up a toxic river. The five components of collective impact are:

  1. Shared vision and goals
  2. Shared understanding of data use
  3. Shared communication strategies
  4. Shared understanding of all interconnected activities
  5. A solid organizational foundation

The 100% New Mexico initiative and all its county initiative benefit from following the collective impact framework, ensuring all participants in the initiative are heard and have a voice in project development activities.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: collective impact1, collective impact and a review of peer-reviewed research2, collective impact and the potential in health promotion3, and where collective impact gets it wrong4.


  1. Collective Impact. John Kania and Mark Kramer. 2011.
  2. Collective Impact: A Review of the Peer-reviewed Research. Gretchen Ennis and Matalena Tofa. 2019.
  3. The Collective Impact Model and Its Potential for Health Promotion. Johnna Flood, Meredith Minkler, Susana Hennessey Lavery and Jessica Estrada. 2015.
  4. Ten Places Where Collective Impact Gets It Wrong. Tom Wolff. 2016.

Digital Divide/Net Equity

Many of us are privileged to live in a segment of society where many of our needs can be met through the internet and our various devices. We can have a variety of medical assessments, behavioral health care sessions, education and job searches online, along with ordering food and about anything that can be mailed. There are also those without access to the internet and the devices used to connect with it. Living without access to the net means driving and writing letters, not the most efficient way to secure a quality education, become job ready or get an interview. The digital divide separates communities across all fifty states and it's a problem we need to solve in order for 100% of our families to thrive. We certainly have the technology to do this, we just need the political will and good old-fashioned sense of fairness and justice.

Turning Research into Real World Solutions

The following research articles and resources can serve as a starting point for exploring a host of topics including: an interdisciplinary exploration of the digital divide1, how COVID-19 shines a spotlight on the digital divide2, the digital divide revisited3, debunking brave new world discourses4, digital divides and the schooling system5, re-conceptualization of digital divide among primary school children6, the evolving digital divide among K–12 students7, making equity actionable8, broadband access and the digital divide9.


  1. Poverty, Literacy and Social Transformation: An Interdisciplinary Exploration of the Digital Divide. Amy J. Bach, Todd Wolfson and Jessica K. Crowell. 2018.
  2. COVID-19 Shines a Spotlight on the Digital Divide. Gerardo E de los Santos and Wynn Rosser. 2021.
  3. The Digital Divide Revisited: What Is Next? Stephanie Huffman. 2018.
  4. Confronting the Digital Divide: Debunking Brave New World Discourses. Jennifer Rowsell, Ernest Morrell and Donna E. Alvermann. 2017.
  5. Negotiating Digital Divides: Perspectives from the New Zealand Schooling System. Louse Starkey, Allan Sylvester and David Jonestone. 2017.
  6. Re-Conceptualization of "Digital Divide" among Primary School Children in an Era of Saturated Access to Technology. Ebrahim Talaee and Omid Noroozi. 2019.
  7. Splicing the Divide: A Review of Research on the Evolving Digital Divide among K-12 Students. Jennifer E. Dolan. 2016.
  8. From Forty-to-One to One-to-One: Eliminating the Digital Divide and Making Equity Actionable. Rosanna Mucetti. 2017.
  9. Broadband Access and the Digital Divides. Policy Brief. Bryan Kelley and Lauren Sisneros. 2020.

Next Steps

100% New Mexico initiative participants and partners are encouraged to form reading and discussion circles, providing a structure for community stakeholders to read and discuss articles and perspectives on root causes, impact, prevention and treatment. A “lunch and learn” series focused on the complex arena of ACEs will not lack for reading material and research to enlighten and inspire.

These references are useful for developing policy, learning experiences, course development, grant writing and other activities focused on fund-raising.