Links Between Childhood Exposure to Violent Contexts and Risky Adolescent Health Behaviors

Longitudinal impacts of adverse childhood experiences on multidimensional health outcomes: Predicting trajectories in mental, physical, and behavioral health

BACKGROUND

Adverse childhood experiences (ACEs) elevate the risk of poor health later in life.

OBJECTIVE

This study aims to provide a more comprehensive investigation of the multidimensional health risks associated with ACEs, to address a gap in the understanding of their longitudinal impact on mental, physical, and behavioral health domains.

PARTICIPANTS AND SETTING

This study included 6, 504 participants (51.61 % females) from the National Longitudinal Study of Adolescent to Adult Health (1994-2018).

METHODS

We utilized latent class growth analysis to identify trajectories from adolescence to adulthood in three health domains: depression (Mental Health, MH), self-report physical health (SRH), and binge drinking frequency (BDF). Binary logistic regression was then used to assess the unique contributions of different types of ACEs to these longitudinal health trajectories.

RESULTS

Three to four trajectories were identified for MH (consistently low, decreasing, increasing), SRH (consistently low, decreasing, increasing, consistently high), and BDF (consistently low, decreasing, moderate). Regression results showed that experience of emotional abuse and witnessed community violence elevated the risk associated with unfavorable trajectories in the mental health and behavioral health domains, respectively.

CONCLUSIONS

Individual ACEs differentially predicted mental, physical, and behavioral health trajectories, potentially through various pathways. Prevention of ACEs could mitigate health risks for adolescents and young adults across these domains.

Longitudinal Associations Between Community Violence Exposure and Mental Health Problems in Inner-City Youth: Ethnicity and Gender Perspectives

There is a lack of agreement on whether children and adolescents with different cultural/ethnic backgrounds react to trauma in a similar fashion. This study adds to the existing literature by providing ethnicity and gender perspectives on the longitudinal associations between the degree of community violence exposure (CVE) and mental health problems in U.S. inner-city youth. The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2,794; 54.1% female; age 11-16 years old (M [SD] = 12.77 [1.29]); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on CVE in year 1 and on mental health problems (depressive symptoms, posttraumatic stress, alcohol use, and conduct problems) in year 1 and year 2. Multivariate analyses of covariance (MANCOVA) were used to compare mental health problems in youth from the three ethnic groups in relation to the different degrees of CVE experienced one year prior, while controlling for their baseline mental health problem levels, age, and socio-economic status. Mental health problems in year 2 increased in a similar fashion in relation to the degree of severity of CVE in year 1 in all three ethnic groups. The interaction effects suggested a gender-specific response to CVE, where girls in the three ethnic groups reported higher levels of depression and posttraumatic stress in relation to the same degree of CVE, as compared to boys. Adolescents from different ethnic backgrounds respond similarly to differing degrees of CVE with an increase in mental health problems over time. In response to a similar degree of exposure, girls tend to experience greater levels of internalizing problems than boys. Timely recognition of traumatic exposure and associated mental health problems is important for early prevention and intervention strategies.

Adversity and child body mass index in Fragile Families over 15 years: Do type and timing matter?

Background

Weight status has been linked to adverse childhood experiences. Existing research, however, is limited to unidimensional assessments of cumulative risk and does not account for the complex nature of adversity experienced by children in high-risk settings. We fill existing gaps by assessing how four subtypes of adversity across two primary dimensions of threat and deprivation-based adversity are associated with changes in body mass index (BMI) across child ages 3 through 15 years.

Method

U.S. mothers and fathers (n = 2412) in the Fragile Families and Child Wellbeing Study were interviewed when children were born, and again at ages 1, 3, 5, 9, and 15 years. Independent variables include interpersonal (e.g., domestic violence), family (e.g., mental health), economic (e.g., housing insecurity), and community (e.g., witness/victim of violence) adversity from ages 1 through 9 years. Path analysis regressed changes in BMIz from ages 3 through 15 on past adversity exposures.

Results

Increased interpersonal and community adversity subtypes from ages 3 to 5 were associated with decreased BMIz from ages 5-9 years. Increased economic adversity from age 3 to 5 was associated with increased BMIz from ages 5 to 9, adjusted for mother age, race, and education.

Conclusion

Findings highlight the differential influence of past adversity type and timing on child BMI. Interpersonal and community adversity were associated with decreased BMIz, and economic adversity with increased BMIz. Differences in directionality of associations suggest research should capture multiple dimensions of adversity in early childhood and possible positive and negative trends in effects on child weight as children grow from early to mid-childhood.

Violence Exposure, Self-Reported Mental Health Concerns and Use of Alcohol and Drugs for Coping among Youth in the Slums of Kampala, Uganda

This study aimed to a) compute the prevalence of violence exposure types, polyvictimization, and self-reported depression, anxiety, and using substances to cope among youth ages 12 to 18 years living on the streets or in the slums of Kampala, Uganda, (b) examine the independent associations among orphan status, violence exposure types, and self-reported mental health concerns, and c) explore the association between polyvictimization and mental health concerns. Data are from a 2014 cross-sectional survey of service-seeking youth ages 12 to 18 years (N = 1134) in Kampala, Uganda. Violence exposure types explored in this study were: witnessing family physical violence, direct physical abuse by a parent, any rape history, and physical dating violence. We used descriptive statistics and multivariable logistic regression to test study objectives. Over half of the sample (60.5%) reported experiencing at least one type of violence exposure; many youth endorsed self-reported depression (57.8%), anxiety (76.8%), and substance use to cope (37.0%). Exposure to violence was associated with higher odds for self-reported depression, anxiety, and using substances to cope. These findings underscore the urgent need to implement evidence-based interventions among this young, underserved population and their families to prevent violence, improve mental health outcomes, and promote resilience.

Associations between childhood maltreatment and psychiatric disorders: analysis from electronic health records in Hong Kong

There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.

Indirect Associations between Middle-Childhood Externalizing Behaviors and Adolescent Substance Use through Late-Childhood Exposure to Violence

Longitudinal research to understand individual risk factors in childhood associated with exposure to violence and substance use is needed to inform prevention efforts. The present study tested indirect associations between age 8.5 externalizing behaviors and age 16 substance use through age 9.5 violence victimization and witnessing. Participants were 650 racially diverse (48.6% European American, 28.1% African American, 13.3% multiracial, and 10.0% other), predominantly socioeconomically disadvantaged youth (49% female). Externalizing behaviors were associated with higher levels of violence victimization and witnessing. The indirect path from externalizing behaviors to substance use was significant through victimization but not witnessing violence. Interventions aimed at reducing early externalizing behaviors may reduce risk for violence victimization, which may, in turn, reduce risk for adolescent substance use.

Social and Relational Health Risks and Common Mental Health Problems Among US Children: The Mitigating Role of Family Resilience and Connection to Promote Positive Socioemotional and School-Related Outcomes

Nearly 70% (67.6%) of US children with mental, emotional, and behavioral problems (MEB) experienced significant social health risks (SHR) and/or relational health risks (RHR). Shifts are needed in child mental health promotion, prevention, diagnosis, and treatment to address both RHR and SHR. Public health approaches are needed that engage families, youth, and the range of child-serving professionals in collaborative efforts to prevent and mitigate RHR and SHR and promote positive mental health at a community level. Building strong family resilience and connection may improve SR and, in turn, academic and social outcomes among all US children with or without MEB.

Contributions of the Fragile Families and Child Wellbeing Study to Child Development

We describe the promise of the Fragile Families and Child Wellbeing Study (FFCWS) for developmental researchers. FFCWS is a birth cohort study of 4,898 children born in 1998-2000 in large US cities. This prospective national study collected data on children and parents at birth and during infancy (age 1), toddlerhood (age 3), early childhood (age 5), middle childhood (age 9), adolescence (age 15), and, in progress, young adulthood (age 22). Though FFCWS was created to understand the lives of unmarried parent families, its comprehensive data on parents, children, and contexts can be used to explore many other developmental questions. We identify six opportunities for developmentalists: (a) analyzing developmental trajectories, identifying the importance of the timing of exposures for later development, (c) documenting bidirectional influences on development, (d) understanding development in context, (e) identifying biological moderators and mechanisms, and ( f ) using an urban-born cohort that is large, diverse, and prospective.

Adverse childhood experiences and the substance use behaviors of Latinx youth

PURPOSE

Adverse childhood experiences (ACEs) are associated with substance use, how cultural factors influence this association for Latinx youth is unknown. This study uses longitudinal data to examine associations of cultural factors, ACEs and substance use among Latinx young adults.

METHODS

Latinx youth (N = 1179) completed surveys from a longitudinal study at seven assessment points from 2005 to 2016; ACEs was assessed when participants were on average 21.6 and substance use 23.9 years. ACEs measured psychological, physical, and sexual abuse, parental violence, divorce, substance use, mental illness, and incarceration. A three-stage hierarchical ordinary least squares (alcohol use) and negative binomial regression models (problematic alcohol, marijuana and tobacco use) were estimated to evaluate the role of cultural factors (acculturation, enculturation and ethnic identity) and ACEs in shaping substance use behaviors.

RESULTS

Controlling for cultural variables, ACEs sum (B = 0.03, p = .01), maltreatment (B = 0.16, p < .01), and household (B = 0.12, p = .03) subdomains predicted alcohol use. One additional increase in maltreatment (IRR=1.23, 95 % CI: 1.00, 1.53) predicted 23 % higher count of problematic alcohol use. Maltreatment (IRR=1.50, 95 % CI: 1.05, 2.13) and household (IRR=1.66, 95 % CI: 1.18, 2.32) subdomains predicted increased counts of marijuana use. Four or more ACEs predicted increased counts of tobacco use (IRR=1.49, 95 % CI: 1.08, 2.06) among Latinx young adults.

CONCLUSIONS

Results suggest a predictive relationship between ACEs, and alcohol, marijuana and tobacco use, after accounting for cultural factors. Beyond acculturation, enculturation and ethnic identity, findings identify ACEs as a salient predictor of substance use among Latinx young adults.

Structural relationships among adolescents' peer attachment, career-related self-efficacy, parents' attitudes and health risk behaviours

Aim

This study aimed to determine whether the peer attachment of adolescents, mediated by career‐related self‐efficacy and having parents with positive attitudes, influences health risk behaviours.

Design

A cross‐sectional questionnaire survey.

Methods

This study adopted the secondary data analysis method, using the 2010 Korean Children and Youth Panel Survey (KCYPS). The 7th‐wave panel data of 1,932 first graders in high schools were analysed using structural equation modelling.

Results

The final model provided a good fit for the data. Having a close relationship with peers had a direct effect on adolescents’ health risk behaviours. High peer attachment also had an indirect effect on health risk behaviours, mediated by career‐related self‐efficacy and having parents with positive attitudes. Though adolescents with broad and intimate peer relationships may be exposed to more temptations towards health risk behaviours and tend to make riskier decisions, these influences are reduced by being exposed to positive parenting attitudes and having clear, conscious career goals.

Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health

By focusing on the safe, stable, and nurturing relationships (SSNRs) that buffer adversity and build resilience, pediatric care is on the cusp of a paradigm shift that could reprioritize clinical activities, rewrite research agendas, and realign our collective advocacy. Driving this transformation are advances in developmental sciences as they inform a deeper understanding of how early life experiences, both nurturing and adverse, are biologically embedded and influence outcomes in health, education, and economic stability across the life span. This revised policy statement on childhood toxic stress acknowledges a spectrum of potential adversities and reaffirms the benefits of an ecobiodevelopmental model for understanding the childhood origins of adult-manifested disease and wellness. It also endorses a paradigm shift toward relational health because SSNRs not only buffer childhood adversity when it occurs but also promote the capacities needed to be resilient in the future. To translate this relational health framework into clinical practice, generative research, and public policy, the entire pediatric community needs to adopt a public health approach that builds relational health by partnering with families and communities. This public health approach to relational health needs to be integrated both vertically (by including primary, secondary, and tertiary preventions) and horizontally (by including public service sectors beyond health care). The American Academy of Pediatrics asserts that SSNRs are biological necessities for all children because they mitigate childhood toxic stress responses and proactively build resilience by fostering the adaptive skills needed to cope with future adversity in a healthy manner.

Adolescent Exposure To Deadly Gun Violence Within 500 Meters Of Home Or School: Ethnoracial And Income Disparities

To identify the prevalence of and disparities in past-year exposure to deadly gun violence near adolescents' homes and schools, we linked national data on deadly gun violence incidents from the Gun Violence Archive to the age-fifteen wave of the Fragile Families and Child Wellbeing Study, a cohort of children born during 1998-2000 in large US cities. We found that 21 percent of adolescents in this cohort resided or attended school within 500 meters of a prior-year deadly gun violence incident during 2014-17. Rates of exposure were higher for Black and Hispanic adolescents than for White adolescents and higher for poor and near-poor adolescents than middle-to-high-income adolescents. Middle-to-high-income Black and Hispanic adolescents were more likely to be exposed to violence near home or school than poorer White adolescents. Because exposure to violence is detrimental to health, policies that reduce gun violence could improve population health disparities.

ASSOCIATION BETWEEN VIOLENCE IN CHILDHOOD AND INCREASE IN THE BODY MASS INDEX AMONG ADOLESCENTS

ABSTRACT Objective: to analyze the association between violence in childhood and increase in the Body Mass Index among adolescents. Method: a cross-sectional study, conducted with 136 adolescents aged from 10 to 19 years old, monitored by a Multiprofessional Residency Program in Adolescents' Health, in health units from the municipality of Divinópolis-MG. The anthropometric assessment was conducted from March to June 2018; and information was collected referring to the socioeconomic level, demographic factors, food consumption, and physical activity of the participants. The variable related to violence in childhood was composed of five groups, obtained from a factorial analysis. Multiple regression models were used to identify the variables associated with the increase in Body Mass Index, with a significance level of 5%. Results: the prevalence of excess weight was 31.8%. The adolescents participating in the study consumed soft drinks (66.2%) and industrialized food products (66.9%) every week and ate in front of the TV every day (54.4%). The most prevalent type of abuse was emotional neglect, which affected 100% of the sample under study. An association was evidenced of physical neglect in childhood and intake of industrialized food products with the increase in the Body Mass Index z-score. Conclusion: violence in childhood and the consumption of industrialized food products were associated to the increase in Body Mass Index among adolescents. Investments in public policies for comprehensive promotion of health and protection of children and adolescents are imperious.

Neighborhood Disorder, Family Functioning, and Risky Sexual Behaviors in Adolescence

Adolescent risky sexual behaviors can result in negative consequences such as sexually transmitted infection. However, much research effort has been placed on understanding individual characteristics, rather than the role of neighborhood environment. This study addressed the prospective effects of neighborhood and family functioning in preadolescence on risky sexual behaviors. Participants included 4179 youth (Mage = 11.01 years, range 8.64-13.83; 51% female) and their caregivers. Using objective and self-reported measures of neighborhood and family functioning, results from multilevel regression analyses indicated that youth residing in disordered neighborhoods or had poorer family functioning in preadolescence were more likely to initiate sexual intercourse at younger ages 5 years later. Specifically, neighborhood poverty and decay were linked to early sexual initiation, whereas neighborhood social and family processes were protective against early sexual initiation. Males were more likely to engage in risky sexual behaviors in neighborhoods with greater poverty or decay; neighborhood poverty was linked with sexual initiation in White but not African American youth. Finally, parental monitoring moderated relationships between neighborhood social resources and contraceptive use, with neighborhood social resources linked with greater contraceptive use at low levels of parental monitoring, but lower contraceptive use at high levels of parental monitoring. These findings underscore the importance of neighborhood and family contexts in adolescents' risky sexual behavior, suggesting that males and White youth are more vulnerable to the effects of neighborhood poverty and that more research is needed on the possible counterproductive function of parental monitoring in neighborhoods with greater social resources.

Violence exposure and social deprivation is associated with cortisol reactivity in urban adolescents

The present study tested how two different dimensions of childhood adversity, violence exposure and social deprivation, were associated with the cortisol response to the Socially Evaluated Cold-Pressor task in a sample of 222 adolescents (n = 117 girls, n = 167 African American). Participants were part of the Fragile Families and Child Wellbeing Study, a probability sample of births in large US cities (>200,000) between 1998 and 2000. Our subsample includes births in three cities: Detroit, Toledo, and Chicago. The study design called for an oversampling of births to unmarried parents (3:1) which led to a large number of minority and economically disadvantaged adolescents. When children were ages 3, 5, and 9, mothers reported on exposures to violence and social deprivation that occurred in the past year. Exposures from the three waves were averaged to reflect violence exposure and social deprivation during childhood. Greater levels of violence exposure from ages 3 to 9 were associated with a blunted cortisol response to stress at age 15, even after controlling for social deprivation and other factors known to influence cortisol reactivity. Social deprivation from ages 3 to 9 was not associated with the cortisol response to stress; though in an exploratory analysis, social deprivation moderated the association between violence exposure and cortisol peak activation. In line with the Dimensional Model of Adversity and Psychopathology, these findings suggest that experiences of violence, but not social deprivation, during childhood may contribute to cortisol blunting that has been previously reported in samples with high levels of social deprivation. Findings from the present longitudinal study on a relatively large sample of under-represented minority youth provide insight into the ways two different dimensions of childhood adversity impact the cortisol response to stress.

Exposição à violência comunitária e familiar e autoavaliação de saúde na população brasileira

RESUMO: Introdução: Os impactos negativos isolados da violência comunitária e da violência familiar na autoavaliação de saúde (AAS) dos indivíduos são conhecidos, mas existe pouca evidência sobre o efeito combinado desses dois tipos de violência interpessoal. Objetivo: Analisar a associação entre a exposição à violência comunitária/por desconhecidos e à violência familiar/por conhecidos e a AAS negativa, distinguindo o tipo de violência sofrido e também considerando sua exposição cumulativa. Métodos: Estudo epidemiológico de corte transversal desenvolvido com os dados da Pesquisa Nacional de Saúde (PNS) 2013. Foram realizados modelos de regressão logística multinominal brutos e ajustados para teste de associação das variáveis. Resultados: Todos os tipos de violência analisados se associaram à AAS negativa. A violência interpessoal comunitária/por desconhecidos isolada esteve associada à AAS como regular (odds ratio - OR=1,38) e ruim (OR = 1,79). A exposição à violência familiar/por conhecidos mostrou-se associada à autoavaliação regular (OR = 1,52) e ruim (OR = 2,70). A exposição concomitante às duas violências mostrou-se associada à avaliação regular (OR = 4,00) e ruim da saúde (OR = 7,81), sendo essa associação de maior magnitude que aquelas para as violências isoladas. Conclusão: O efeito cumulativo da exposição à violência familiar/por conhecido e comunitária/por desconhecido potencializa a avaliação negativa do estado de saúde. Os profissionais de saúde devem estar atentos à polivitimização e ao seu impacto na saúde de vítimas que acessam os serviços de saúde.

Positive School Climate as a Moderator of Violence Exposure for Colombian Adolescents

In Colombia, many adolescents have experienced violence related to the decades-long armed conflict in the country and have witnessed or been directly victimized by violence in their communities, often related to gang activity or drug trafficking. Exposure to violence, both political and community violence, has detrimental implications for adolescent development. This study used data from 1857 Colombian adolescents in an urban setting. We aim to understand the relations between exposure to violence and adolescent outcomes, both externalizing behaviors and developmental competence, and then to understand whether school climate (i.e., safety, connectedness, services) moderates these relations. Results demonstrate that armed conflict, community violence victimization, and witnessing community violence are positively associated with externalizing behaviors, but only armed conflict is negatively associated with developmental competence. School safety, connectedness, and services moderate the relation between community violence witnessing and externalizing behaviors. School services moderates the relation between community violence victimization and developmental competence. As students perceived more positive school climate, the effects of community violence exposure on outcomes were weakened. This study identifies potential levers for intervention regarding how schools can better support violence-affected youth through enhancements to school safety, connectedness, and services.