Maternal relationship during adolescence predicts cardiovascular disease risk in adulthood

Cascade effects of a parenting-focused program for divorced families on three health-related outcomes in emerging adulthood

Using data from a 15-year longitudinal follow-up of a randomized controlled trial of a parenting-focused preventive intervention for divorced families (N = 240) with children aged 9-12, the current study examined alternative cascading pathways through which the intervention led to improvements in offspring's perceived health problems, BMI, and cigarette smoking in emerging adulthood. It was hypothesized that the program would lead to improvements in these health-related outcomes during emerging adulthood through progressive associations between program-induced changes in parenting and offspring outcomes, including mental health problems, substance use, and competencies. Intervention-induced improvements in positive parenting at posttest led to improvements in mental health problems in late childhood/early adolescence, which led to lower levels of mental health and substance use problems as well as higher levels of competencies in adolescence, which led to improvements in the health-related outcomes. Academic performance predicted all three health-related outcomes and other aspects of adolescent functioning showed different relations across outcomes. Results highlight the potential for intervention effects of preventive parenting interventions in childhood to cascade over time to affect health-related outcomes in emerging adulthood.

Associations Between Mother-Adolescent and Father-Adolescent Relationships and Young Adult Health

IMPORTANCE

Studies linking the quality of parent-adolescent relationships with young adult health outcomes could inform investments to support these complex relationships.

OBJECTIVE

To evaluate whether consistently measured, modifiable characteristics of parent-adolescent relationships are associated with young adult health across multiple domains.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from waves I (1994-1995; ages 12-17 years) and IV (2008-2009; ages 24-32 years) of the US National Longitudinal Study of Adolescent to Adult Health. Of 20 745 adolescents enrolled in wave I, 15 701 of 19 560 who were eligible completed wave IV (response rate, 80.3%). Data analyses were conducted from February 2019 to November 2020.

EXPOSURES

Parental warmth, parent-adolescent communication, time together, relationship and communication satisfaction, academic expectations, and maternal inductive discipline as reported at wave I by adolescent participants.

MAIN OUTCOMES AND MEASURES

Wave IV participant-reported self-rated health, depression, stress, optimism, nicotine dependence, substance abuse symptoms (alcohol, cannabis, or other drugs), unintended pregnancy, romantic relationship quality, physical violence, and alcohol-related injury. Separate regression models were run for mother-adolescent and father-adolescent relationships while controlling for age, biological sex, race and ethnicity, parental educational level, family structure, and child maltreatment experiences.

RESULTS

A total of 10 744 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 52.0% female; 67.3% non-Hispanic White) and 8214 participants (mean [SD] age at wave IV, 28.2 [1.8] years; 50.8% female; 71.9% non-Hispanic White) had valid sampling weights and complete data for mother-adolescent and father-adolescent relationship characteristics, respectively. Adolescents who reported higher levels of mother-adolescent warmth (β = 0.11 [95% CI, 0.06-0.15]), communication (β = 0.02 [95% CI, 0.00-0.04]), time together (β = 0.07 [95% CI, 0.05-0.09]), academic expectations (β = 0.05 [95% CI, 0.02-0.08]), relationship or communication satisfaction (β = 0.07 [95% CI, 0.04-0.10]), and inductive discipline (β = 0.03 [95% CI, 0.01-0.05]) reported significantly higher levels of self-rated general health in young adulthood. Adolescents who reported higher levels of father-adolescent warmth (β = 0.07 [95% CI, 0.03-0.11]), communication (β = 0.03 [95% CI, 0.01-0.05]), time together (β = 0.06 [95% CI, 0.03-0.08]), academic expectations (β = 0.04 [95% CI, 0.01-0.06]), and relationship satisfaction (β = 0.07 [95% CI, 0.04-0.10]) also reported significantly higher levels of self-rated general health in young adulthood. Adolescents reporting higher levels of all exposures also reported significantly higher levels of optimism and romantic relationship quality in young adulthood (β coefficient range, 0.02 [95% CI, 0.00-0.04] to 0.24 [95% CI, 0.15-0.34]) and lower levels of stress and depressive symptoms (β coefficient range, -0.07 [95% CI, -0.12 to -0.02] to -0.48 [95% CI, -0.61 to -0.35]). Higher levels of parental warmth, time together, and relationship or communication satisfaction were significantly associated with lower levels of nicotine dependence (odds ratio range, 0.78 [95% CI, 0.72-0.85] to 0.89 [95% CI, 0.81-0.98]) and substance abuse symptoms (incidence rate ratio range, 0.60 [95% CI, 0.50-0.73] to 0.94 [95% CI, 0.89-0.99]), as well as lower odds of unintended pregnancy (odds ratio range, 0.81 [95% CI, 0.74-0.88] to 0.93 [95% CI, 0.86-0.99]). Patterns were less consistent for physical violence and alcohol-related injury. Characteristics of mother-adolescent and father-adolescent relationships were similarly associated with young adult outcomes.

CONCLUSIONS AND RELEVANCE

The findings of this cohort study suggest that adolescents' positive perceptions of their relationships with their mothers and fathers are associated with a wide range of favorable outcomes in young adulthood. Investments in improving parent-adolescent relationships may have substantial benefits for young adult population health.

Adverse Childhood Experiences and Cardiovascular Health: An Exploration of Protective Social Determinants Among Young Adult Black Women

This study sought to advance the literature on Black women's cardiovascular health (CVH) by examining maternal relationship, religion and spirituality, and social connections as potential protective social determinants that buffer the stress of adverse childhood experiences (ACEs). The outcome was the American Heart Association's ideal CVH score. Neither maternal relationship nor religion/spirituality was able to buffer the stress of ACEs on ideal CVH. Findings are discussed in terms of cultural aspects of potential protective factors that are critical for future research. Identifying protective factors that may buffer the influence of ACEs on CVH remains a priority to promote health equity.

Beyond Early Adversity: The Role of Parenting in Infant Physical Health

OBJECTIVE

Although ample evidence indicates that child health is compromised by early adversity (e.g., abuse and poverty), less is known about the contribution of parenting in low-stress contexts to child health, especially in infancy. This longitudinal study extends previous research on early adversity to ask the question: Does quality of parental care predict infant health in a low-risk community sample?

METHOD

Participants were 187 healthy mothers and their full-term infants (86 girls) from the Netherlands, followed from birth to age 1. Home observations of mothers' behavior were conducted during a naturalistic task (bathing session) when infants were 5 weeks old. Trained researchers interviewed mothers about the infants' health and prescribed antibiotic use every month for 12 months. Infant health problems were categorized into 4 domains according to the International Classification of Primary Care to capture a range of outcomes: respiratory, digestive, skin, and general illnesses and symptoms.

RESULTS

Controlling for health-related covariates (e.g., maternal smoking and breastfeeding), maternal sensitivity predicted reduced rates of infant respiratory symptoms and skin conditions and marginally lower prescribed antibiotic use over the first year. Maternal behavior was unrelated to infant digestive and general illnesses.

CONCLUSION

Even in the absence of adversity, quality of maternal care may have implications for the development of physical health, beginning as early as the first year of life. That such findings emerge in a low-risk sample helps rule out potential confounders and underscores the importance of parenting for physical and psychological health outcomes.

Childhood socioeconomic hardship, family conflict, and young adult hypertension: The Santiago Longitudinal Study

OBJECTIVE

Stress derived from socioeconomic disadvantage can be damaging to mental and physical health. This study uses longitudinal data on a large prospectively studied cohort to examine how socioeconomic hardship during childhood leads to hypertension in young adulthood by its effects on family conflict, anxiety-depression, and body mass.

METHOD

Data are from 1,039 participants of the Santiago Longitudinal Study who were studied in childhood (M age 10 years), adolescence (14-17 years), and young adulthood (21-26 years). As young adults, 26% had elevated blood pressure or hypertension.

RESULTS

Children from more economically disadvantaged families experienced higher levels of family conflict, which related to significant increases in anxiety-depression and body mass over time, both of which were directly linked to hypertension in young adulthood.

CONCLUSIONS

Findings provide an understanding of how early-life adversity associated with socioeconomic hardship manifests as stress-related health problems in adulthood. Intervention efforts that target overweight/obesity and anxiety and depression that stem from childhood poverty might be useful for reducing the socioeconomic disparities in adult health.

Effects of mother-offspring and father-offspring dynamics on emerging adults' adjustment: The mediating role of emotion regulation

The present study tested a theoretical model of emotion regulation between parent-offspring dynamics and emerging adults' adjustment. The mediating role of emotion regulation strategies, including cognitive reappraisal and expressive suppression, were investigated for the effects of mother-offspring and father-offspring dynamics on emerging adults' adjustment. A sample of 352 Chinese emerging adults in Hong Kong (230 female, 121 male) participated in this study. Participants were asked to complete a set of self-reported questionnaires. Findings based on structural equation modeling indicated that greater mother-offspring intimacy and father-offspring intimacy predicted emerging adults' better cognitive reappraisal and psychological, social, and general health. Greater mother-offspring conflict also predicted more expressive suppression and poorer psychological and social functioning. Distinctive mediation pathways as a function of parents' gender were identified. These findings enrich the literature for parent-offspring dynamics and emotion regulation as explanatory processes of emerging adults' adjustment.

The Role of Parent-Adolescent Relationships in the Development of (Pre)Hypertension in Young Adulthood in the U.S

BACKGROUND

Hypertension is a strong factor for stroke and coronary disease, and it has been found that 1 in 4 young adults are experiencing pre-hypertension in the United States This study was designed to examine the role of parent-adolescent relationships in the risk of developing (pre)hypertension in young adulthood, and to explore potential mediator(s).

METHODS

Our analysis was based on the data from the National Longitudinal Study of Adolescent to Adult Health, Wave 1 (aged 13-18) and Wave 4 (aged 25-32) (N = 3,350). Three parent-adolescent relationships were extracted from a factor analysis, and four different specifications of (pre)hypertension were generated and tested individually. We applied generalised structural equation modelling to perform path analysis estimations.

RESULTS

We found that mother-reported relationship quality had both a direct and an indirect effect via alcohol consumption, on the likelihood of (pre)hypertension in young adulthood. The path from relationship quality to (pre)hypertension via alcohol consumption was consistent with three different specifications of hypertension (pre-hypertension, clinical/experienced hypertension, and experienced hypertension), suggesting the path relation was evident. Our study also showed that both relationship quality and adolescent-reported maternal warmth/responsiveness were associated with the risk of clinical/experienced hypertension via mental health problems. Parental control was found to have a direct and protective effect on clinical/experienced hypertension.

CONCLUSIONS

Early family relationships in adolescence predict (pre)hypertension in young adulthood. Initiatives related to parent-adolescent relationships, and the associated effects on later alcohol consumption and mental health problems, may have a long implication on the risk of (pre)hypertension in adulthood.

Threat vigilance and socioeconomic disparities in metabolic health

A quarter of the global population meets diagnostic criteria for metabolic syndrome (MetS). MetS prevalence stratifies by socioeconomic status (SES), such that low SES is associated with higher MetS risk starting in childhood. Despite this trend, some low-SES children maintain good metabolic health across the life span, but the factors responsible for their resilience are not well understood. This study examined the role of threat vigilance as either a moderator or a mediator of the effects of low early life SES on adult metabolic risk. Three hundred twenty-five Canadians aged 15-55 participated (M = 36.4 years, SD = 10.7; 55.4% female). We coded parental occupational status between the ages of 0 and 5 to index early life SES. We used the International Diabetes Federation case definition for MetS based on waist circumference, blood pressure, triglyceride levels, HDL cholesterol, and glycosylated hemoglobin measures. Threat vigilance was assessed using the Weapons Identification Procedure, a visual discrimination paradigm that captures implicit perceptions of threat. Analyses supported the moderator hypothesis: low early life SES was associated with MetS diagnosis exclusively among those with high levels of threat vigilance. This suggests that low early life SES environments that heighten vigilance to threat might be particularly detrimental for metabolic health. Conversely, low threat vigilance may buffer against the metabolic risks associated with socioeconomic disadvantage.

Impact of childhood parent-child relationships on cardiovascular risks in adolescence

This study aims to determine prospective effects of the childhood parent-child relationships on the development of cardiovascular risks in adolescence. Using available 917 parent-child dyads from the Study of Early Child Care and Youth Development (1991 to 2006), we analyzed the prospective effects of childhood parent-child relationships of Conflict and Closeness, as well as their categorized combinations (Harmonic, Dramatic, Hostile, and Indifferent) on the development of subscapular and triceps skinfold thickness (SST/TST), body mass index (BMI), systolic and diastolic blood pressure (SBP/DBP), and heart rate (HR) during adolescence. We found that higher levels of Conflict in the relationship with mothers (slope=0.05, P<0.001) and fathers (slope=0.04, P=0.03) increased the growth rate of TST among girls during adolescence, but not among boys. The maternal-girl dyadic with higher Conflict scores also increased girl's growth rate of BMI percentile (slope=0.10, P=0.02), though the paternal-boy dyadic with higher Conflict scores decreased boy's growth rate of BMI percentile (slope=-0.13, P=0.04). A Hostile maternal-son relationship lowered boy's growth rate of SBP (slope=-3.15, P<0.001) and DBP (slope=-4.42, P<0.001). A Dramatic maternal-son relationship increased boy's growth rate of SST (slope=0.89, P<0.001) and TST (slope=0.64, P=0.03). Hostile paternal-daughter relationships were positively associated with the growth rate of TST (slope=0.28, P=0.03). Overall, there was a significant influence of childhood parent-child relationships on the development of cardiovascular risks during adolescence, and the effect was further modified by both parents' and child's gender.

Pathways between childhood/adolescent adversity, adolescent socioeconomic status, and long-term cardiovascular disease risk in young adulthood

OBJECTIVE

The current study investigated mediators between childhood/adolescent adversities (e.g., dating violence, maltreatment, homelessness, and parental death), low socioeconomic status (SES) during adolescence, and cardiovascular disease (CVD) risk in young adulthood. The purpose of these analyses was to understand whether SES during adolescence and childhood/adolescent adversities affect CVD risk through similar pathways, including maternal relationship quality, health behaviors, financial stress, medical/dental care, educational attainment, sleep problems, and depressive symptoms.

METHODS

Using the National Longitudinal Study of Adolescent to Adult Health (N = 14,493), which has followed US adolescents (Wave 1; M = 15.9 years) through early adulthood (Wave 4; M = 28.9 years), associations were examined between childhood/adolescent adversity and SES to 30-year CVD risk in young adulthood. The outcome was a Framingham-based prediction model of CVD risk that included age, sex, body mass index, smoking, systolic blood pressure, diabetes, and antihypertensive medication use at Wave 4. Path analysis was used to examine paths through the adolescent maternal relationship to young adult mediators of CVD risk.

RESULTS

Childhood/adolescent adversity significantly predicted greater adult CVD risk through the following pathways: maternal relationship, health behaviors, financial stress, lack of medical/dental care, and educational attainment; but not through depressive symptoms or sleep problems. Lower SES during adolescence significantly predicted greater adult CVD risk through the following pathways: health behaviors, financial stress, lack of medical/dental care, and educational attainment, but not maternal relationship, depressive symptoms, or sleep problems.

CONCLUSIONS

Childhood/adolescent adversities and SES affected CVD risk in young adulthood through both similar and unique pathways that may inform interventions.

Positive childhood experiences and ideal cardiovascular health in midlife: Associations and mediators

In 2010, the American Heart Association introduced a new conceptual framework to encourage a focus on primary prevention and provided a definition for "ideal cardiovascular health". In this study we examined the relationship between positive childhood experience and ideal cardiovascular health in mid-life, and the extent to which education, depression, and social support mediate this association. Data are from participants in the Midlife and Aging in the United States study who completed a clinic-based assessment of health (N=1255, aged 34-84years, 2004-2005). We created a positive childhood experiences index based on retrospective report of eight childhood experiences, and calculated a continuous ideal cardiovascular health score for each participant following the American Heart Association's definition of ideal, intermediate and poor cardiovascular health across seven health metrics (analyses conducted in 2015-2016). Positive childhood experiences were associated with ideal cardiovascular health: compared to individuals in the lowest quartile, respondents in the second, third, and fourth quartile of positive childhood experiences scored 0.42 (standard error (SE)=0.18), 0.92 (SE=0.18) and 1.04 (SE=0.18) units higher on ideal cardiovascular health, adjusting for age, sex, and race. Respondent's education, depression status, and social support fully mediated the direct effect of positive childhood experiences on ideal cardiovascular health, with the largest indirect effect for education. These results suggest that positive childhood experiences are associated with ideal cardiovascular health in midlife. Strategies to promote cardiovascular wellbeing may benefit from a focus on social interventions early in life; educational attainment, major depression, and social support may represent key points of intervention.