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Living with the bear — Brittany Smith

young woman, hair up in bun, bright pink jacket, black top

Brittany Smith found her calling in the WVU School of Public Health. Her goal is to earn her Ph.D. and then teach the next generation of public health professionals. 


Brittany Smith, a Ph.D. candidate, defines public health professionals as those who go into a community and put into place the things that promote a shift in maladaptive cultural norms. That’s a high level way of saying they give communities tools to change harmful patterns that may have been in place for generations. 

Smith’s education about those kinds of patterns began at home, in her community of Cannelton, West Virginia. She was raised in a home affected by substance use disorder. On top of that, Smith is an African American Appalachian from a rural area.  

“I’ve always been more than a minority, in my opinion, because even other African Americans are kind of confused by my culture,” Smith said. “A lot of people do not associate African Americans with having a country life. We’re often overlooked. You have to understand where I come from to know the real meaning because this wasn’t something I just picked up and thought was cool.”

The layered effects of cultural identity and childhood adversity led Smith to developing ostensibly positive persona. She was a model student in both behavior and academic achievement, but that, she discovered later was its own form of addiction. 

Smith wanted to be a nurse but left school in her second year after she suddenly began to cry hysterically for reasons she didn’t understand and she couldn’t overcome. She left the School of Nursing and was subsequently diagnosed with depressive and anxiety disorders. 

“I was lost,” she recalled. “I did not know what to do or what was going on at all. School was the one thing I’ve always truly loved. I was just trying to figure out what I was going to do next.” 

In therapy she learned about Adverse Childhood Experiences, potentially traumatic events that occur before age 18 and put children at risk for many disorders. Once she learned what was happening, she grew passionate about learning and doing more. A friend who was already enrolled in the School of Public Health showed her a study guide and she latched onto the idea of being comfortable and making a living and, as she said, “flying under the radar.”

She got the flying part right. Under the radar, not so much. 

It all started with the idea she should do research which eventually led to her presenting the work at international, national, and local conference as well as publishing that research on ACEs. The supportive faculty at the WVU School of Public Health were a catalyst to these achievements,  particularly,  the connection to Dr. Michael Brumage, whom she decided to contact, just in case he’d take an interest in her work. She didn’t expect much, Brumage had been on panels with then-President Barack Obama, and was considered “the ACEs guy” at WVU; but Smith thought it was worth a shot. Smith was pretty surprised when he emailed her back and gauged her interest and her motivation for work on the childhood trauma of having parents with substance use disorder. Brumage became something of a polar star for Smith and helped her design her own undergrad research study, backing her as she explored the root of her own and many others’ childhood trauma.

“When it comes to ACEs, the research shows that when you experience normally four or more, you’ll often see that there’s a dysregulated stress response in the body and that’s what leads to many health problems,” she said. “We have a stress response system that’s meant to protect us. The classic example is to say, when we see a bear, we activate our stress response and different things in our body start to change: our heart rate increases, digestion decreases, an most importantly, we release cortisol, a stress hormone.” 

The body isn’t made to live in that condition long term, but when children are exposed to stressful situations, things that are unpredictable like abuse and neglect, their bodies are marinating in cortisol.

“They’re living with the bear,” she said. That leads to inflammation issues and irregular brain development, including a different brain architecture. The fear center is much larger and the prefrontal cortex, which regulates how people pay attention, control their impulses, remember planned tasks or events and “read the room” or adapt behavior to a dynamic environment, is not fully developed. 

“Even when you escape that environment, you’re already programmed,” Smith said. “You’re programmed to be hypervigilant about things that normally don’t stress others. It can be very dangerous.” 

Smith went to a substance use treatment center and asked women about their ACEs, and then to describe their children’s. Smith and Brumage found that both mothers in substance use treatment and their children had significantly higher ACE scores than mothers and children who were not. It was the first published study to address ACEs in children of addicts. The study also found that ACEs may be intergenerational.

The path for her was set; she’d found her passion, found her heart, found her home among professionals who embraced her and gave her time to rest when she needed it. And for the child within her, the one without a safety net, the one who over-achieved to have positive reinforcement from adults, the one “from the holler,” all of them melded into an adult whose trajectory exploded and who can grow to be who and what she wants to be. For right now, that’s to join the people who opened the path and who nurtured her along the way as faculty in a school of public health. 

“Public health is the art and science of preventing suffering,” Smith said. “That’s what we do.”