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Trofimoff AS, Jones F, Bird CL, Wood M, Bisel K, Bider E, Poje A. Integrating Trauma-Informed Care into the University of Kansas School of Medicine Utilizing the Curriculum, a Student Interest Group, and Community Partnerships. Kans J Med 2024; 17:69-72. [PMID: 38859987 PMCID: PMC11164427 DOI: 10.17161/kjm.vol17.21695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Affiliation(s)
- Anna S Trofimoff
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Felicia Jones
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Cole L Bird
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
| | - Morgan Wood
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Emergency Medicine
| | - Kelly Bisel
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Psychiatry & Behavioral Sciences
| | - Erin Bider
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Psychiatry & Behavioral Sciences
| | - Albert Poje
- University of Kansas School of Medicine-Kansas City, Kansas City, KS
- Department of Psychiatry & Behavioral Sciences
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Lietzén R, Suominen S, Sillanmäki L, Virtanen P, Virtanen M, Vahtera J. Multiple adverse childhood experiences and asthma onset in adulthood: Role of adulthood risk factors as mediators. J Psychosom Res 2021; 143:110388. [PMID: 33639528 DOI: 10.1016/j.jpsychores.2021.110388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood. METHODS Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators). RESULTS Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE-asthma association were 'severe financial difficulties' (24%), 'emotional, physical or sexual violence' (15%), 'major increase in marital problems' (8%), 'severe conflicts with supervisor' (7%), and 'divorce or separation' (5%). CONCLUSIONS Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset.
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Affiliation(s)
- Raija Lietzén
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
| | - Sakari Suominen
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; University of Skövde, School of Health Sciences, Department of Public Health, Sweden.
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Department of Public Health, University of Helsinki, Finland.
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland.
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
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Lopes S, Hallak JEC, Machado de Sousa JP, Osório FDL. Adverse childhood experiences and chronic lung diseases in adulthood: a systematic review and meta-analysis. Eur J Psychotraumatol 2020; 11:1720336. [PMID: 32128046 PMCID: PMC7034480 DOI: 10.1080/20008198.2020.1720336] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/18/2019] [Accepted: 01/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Adverse childhood experiences (ACE) affect physical and mental health and may appear as risk factors for the development of different conditions in adult life. Objective: To perform a literature review and meta-analysis on risk indicators for the development of chronic lung diseases in adulthood associated with ACE. Method: We conducted a systematic literature review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases PubMed, PsycINFO, and Web of Science. Quantitative studies involving male and female adults were included. Fixed- and random-effect models were used in the estimation of meta-analytical measures. The heterogeneity between studies was assessed using I2 statistics and Cochran's Q test. Results: A total of 19 studies were selected for the meta-analysis. The analyses showed statistically significant associations between ACE and lung diseases in general (OR = 1.41; CI 95%: 1.28-1.54), besides specific associations with asthma (OR = 1.32; CI 95%: 1.13-1.50) and COPD (OR = 1.44; CI 95%: 1.13-1.76). When the mediating effect of smoking was assessed separately we found a significant - although not quite expressive - association (OR = 1.06; CI 95%: 1.02 to 1.10), which weakens the hypothesis that a direct relationship exists between childhood trauma and the occurrence of lung diseases. Conclusions: ACE are an important risk factor for the development of lung diseases in adulthood, whether through direct or indirect contribution to this outcome, which highlights the relevance of increasing the awareness of health staff for the early detection and intervention in situations of vulnerability or risk in childhood as an important preventative measure.
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Affiliation(s)
- Samuel Lopes
- Medical School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil
| | - Jaime Eduardo Cecilio Hallak
- Medical School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.,National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
| | - João Paulo Machado de Sousa
- Medical School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.,National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
| | - Flávia de Lima Osório
- Medical School of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil.,National Institute for Science and Technology (INCT-TM, CNPq), Brasília, Brazil
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Eze IC, Foraster M, Schaffner E, Vienneau D, Héritier H, Pieren R, Thiesse L, Rudzik F, Rothe T, Pons M, Bettschart R, Schindler C, Cajochen C, Wunderli JM, Brink M, Röösli M, Probst-Hensch N. Transportation noise exposure, noise annoyance and respiratory health in adults: A repeated-measures study. ENVIRONMENT INTERNATIONAL 2018; 121:741-750. [PMID: 30321849 DOI: 10.1016/j.envint.2018.10.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 10/02/2018] [Indexed: 05/17/2023]
Abstract
Transportation noise leads to sleep disturbance and to psychological and physiological sustained stress reactions, which could impact respiratory health. However, epidemiologic evidence on associations of objective transportation noise exposure and also perceived noise annoyance with respiratory morbidity is limited. We investigated independent associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms and incident asthma in adults. Using 17,138 observations (from 7049 participants) from three SAPALDIA (Swiss Cohort Study on Lung and Heart Diseases in Adults) surveys, we assessed associations of transportation noise exposure and noise annoyance with prevalent respiratory symptoms, and with incident asthma (in 10,657 nested observations from 6377 participants). Annual day-evening-night transportation noise comprising road, railway and aircraft Lden (Transportation Lden) was calculated for the most exposed façade of participants' residence using Swiss noise models. Transportation noise annoyance was assessed using an 11-point scale, and participants reported respiratory symptoms and doctor-diagnosed asthma at each survey. We estimated associations with transportation Lden (as well as source-specific Lden) and noise annoyance, independent of air pollution and other potential confounders, using mutually-adjusted mixed logistic and Poisson models and applying random intercepts at the level of the participants. Prevalent respiratory symptoms ranged from 5% (nocturnal dyspnoea) to 23% (regular cough/phlegm). Transportation noise annoyance, but not Lden, was independently associated with respiratory symptoms and current asthma in all participants, with odds ratios (OR) and 95% confidence intervals (CI) ranging between 1.03 (95%CI: 1.01, 1.06) and 1.07 (95% CI: 1.04, 1.11) per 1-point difference in noise annoyance. Both noise annoyance and Lden showed independent associations with asthma symptoms among asthmatics, especially in those reporting adult-onset asthma [ORLden: 1.90 (95% CI: 1.25, 2.89) per 10 dB; p-value of interaction (adult-onset vs. childhood-onset): 0.03; ORnoise annoyance: 1.06 (95%CI: 0.97, 1.16) per 1-point difference; p-value of interaction: 0.06]. No associations were found with incident asthma. Transportation noise level and annoyance contributed to symptom exacerbation in adult asthma. This suggests both psychological and physiological noise reactions on the respiratory system, and could be relevant for asthma care. More studies are needed to better understand the effects of objective and perceived noise in asthma aetiology and overall respiratory health.
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Affiliation(s)
- Ikenna C Eze
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Maria Foraster
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; ISGlobal, Barcelona Institute for Global Health, University Pompeu Fabra, Barcelona, Spain; CIBER Epidemiologia y Salud Publica, Madrid, Spain; Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain
| | - Emmanuel Schaffner
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Harris Héritier
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Reto Pieren
- Empa Laboratory for Acoustics/Noise Control, Swiss Federal Laboratories for Material Science and Technology, Dübendorf, Switzerland
| | - Laurie Thiesse
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Franziska Rudzik
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Thomas Rothe
- Abteilung Innere Medizin, Kantonsspital Graubunden, Chur, Switzerland
| | - Marco Pons
- Department of Internal Medicine, Regional Hospital of Lugano, Lugano, Switzerland
| | | | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Christian Cajochen
- Center for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Jean-Marc Wunderli
- Empa Laboratory for Acoustics/Noise Control, Swiss Federal Laboratories for Material Science and Technology, Dübendorf, Switzerland
| | - Mark Brink
- Federal Office for the Environment, Bern, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
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Tomasdottir MO, Sigurdsson JA, Petursson H, Kirkengen AL, Krokstad S, McEwen B, Hetlevik I, Getz L. Self Reported Childhood Difficulties, Adult Multimorbidity and Allostatic Load. A Cross-Sectional Analysis of the Norwegian HUNT Study. PLoS One 2015; 10:e0130591. [PMID: 26086816 PMCID: PMC4472345 DOI: 10.1371/journal.pone.0130591] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 05/22/2015] [Indexed: 12/21/2022] Open
Abstract
Background Multimorbidity receives increasing scientific attention. So does the detrimental health impact of adverse childhood experiences (ACE). Aetiological pathways from ACE to complex disease burdens are under investigation. In this context, the concept of allostatic overload is relevant, denoting the link between chronic detrimental stress, widespread biological perturbations and disease development. This study aimed to explore associations between self-reported childhood quality, biological perturbations and multimorbidity in adulthood. Materials and Methods We included 37 612 participants, 30–69 years, from the Nord-Trøndelag Health Study, HUNT3 (2006–8). Twenty one chronic diseases, twelve biological parameters associated with allostatic load and four behavioural factors were analysed. Participants were categorised according to the self-reported quality of their childhood, as reflected in one question, alternatives ranging from ‘very good’ to ‘very difficult’. The association between childhood quality, behavioural patterns, allostatic load and multimorbidity was compared between groups. Results Overall, 85.4% of participants reported a ‘good’ or ‘very good’ childhood; 10.6% average, 3.3% ‘difficult’ and 0.8% ‘very difficult’. Childhood difficulties were reported more often among women, smokers, individuals with sleep problems, less physical activity and lower education. In total, 44.8% of participants with a very good childhood had multimorbidity compared to 77.1% of those with a very difficult childhood (Odds ratio: 5.08; 95% CI: 3.63–7.11). Prevalences of individual diseases also differed significantly according to childhood quality; all but two (cancer and hypertension) showed a significantly higher prevalence (p<0.05) as childhood was categorised as more difficult. Eight of the 12 allostatic parameters differed significantly between childhood groups. Conclusions We found a general, graded association between self-reported childhood difficulties on the one hand and multimorbidity, individual disease burden and biological perturbations on the other. The finding is in accordance with previous research which conceptualises allostatic overload as an important route by which childhood adversities become biologically embodied.
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Affiliation(s)
- Margret Olafia Tomasdottir
- Department of Family Medicine, University of Iceland and Primary Health Care of the Capital Area, Reykjavik, Iceland
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- * E-mail:
| | - Johann Agust Sigurdsson
- Department of Family Medicine, University of Iceland and Primary Health Care of the Capital Area, Reykjavik, Iceland
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Halfdan Petursson
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anna Luise Kirkengen
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of General Practice, UiT The Arctic University, Tromsø, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | - Bruce McEwen
- Laboratory of Neuroendocrinology, The Rockefeller University, New York, New York, United States of America
| | - Irene Hetlevik
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Linn Getz
- General Practice Research Unit, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Exley D, Norman A, Hyland M. Adverse childhood experience and asthma onset: a systematic review. Eur Respir Rev 2015; 24:299-305. [DOI: 10.1183/16000617.00004114] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Adverse childhood experiences such as abuse and neglect are associated with subsequent immune dysregulation. Some studies show an association between adverse childhood experiences and asthma onset, although significant disparity in results exists in the published literature.We aimed to review available studies employing a prospective design that investigates associations between adverse childhood experience and asthma. A search protocol was developed and studies were drawn from four electronic journal databases. Studies were selected in accordance with pre-set inclusion criteria and relevant data were extracted.12 studies, assessing data from a total of 31 524 individuals, were identified that investigate the impact of a range of adverse childhood experiences on the likelihood of developing asthma. Evidence suggests that chronic stress exposure and maternal distress in pregnancy operate synergistically with known triggers such as traffic-related air pollution to increase asthma risk.Chronic stress in early life is associated with an increased risk of asthma onset. There is evidence that adverse childhood experience increases the impact of traffic-related air pollution and inconsistent evidence that adverse childhood experience has an independent effect on asthma onset.
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7
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Alonso J, de Jonge P, Lim CCW, Aguilar-Gaxiola S, Bruffaerts R, Caldas-de-Almeida JM, Liu Z, O'Neill S, Stein DJ, Viana MC, Al-Hamzawi AO, Angermeyer MC, Borges G, Ciutan M, de Girolamo G, Fiestas F, Haro JM, Hu C, Kessler RC, Lépine JP, Levinson D, Nakamura Y, Posada-Villa J, Wojtyniak BJ, Scott KM. Association between mental disorders and subsequent adult onset asthma. J Psychiatr Res 2014; 59:179-88. [PMID: 25263276 PMCID: PMC5120389 DOI: 10.1016/j.jpsychires.2014.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/18/2014] [Accepted: 09/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. METHODS During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. RESULTS 1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3-2.5), panic (OR = 1.4; 95%CI 1.0-2.0), generalized anxiety (OR = 1.3; 95%CI 1.1-1.7), specific phobia (OR = 1.3; 95%CI 1.1-1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1-1.9); binge eating (OR = 1.8; 95%CI 1.2-2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). CONCLUSIONS A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain.
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Carmen C W Lim
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Sergio Aguilar-Gaxiola
- University of California, Davis, Center for Reducing Health Disparities, School of Medicine, Sacramento, CA, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC - KUL), Leuven, Belgium
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, PR China
| | - Siobhan O'Neill
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Derry, Northern Ireland, UK
| | - Dan J Stein
- University of Cape Town, Department of Psychiatry & Mental Health, Groote Schuur Hospital, Cape Town, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | | | - Guilherme Borges
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry (Mexico) and Metropolitan Autonomous University, Mexico City, Mexico
| | - Marius Ciutan
- National School of Public Health and Professional Development, Bucharest, Romania
| | | | - Fabian Fiestas
- Evidence Generation for Public Health Research Unit, National Institute of Health, Lima, Peru
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; CIBER de Salud Mental (CIBERSAM), Spain; University of Barcelona, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jean Pierre Lépine
- Hôpital Saint-Louis Lariboisière Fernand Widal, INSERM U 705, CNRS UMR 8206, Paris, France
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi-ken, Japan
| | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, CALLE 28 No. 5B-02, Bogota, DC, Colombia
| | - Bogdan J Wojtyniak
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Kate M Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
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Halonen JI, Vahtera J, Kivimäki M, Pentti J, Kawachi I, Subramanian SV. Adverse experiences in childhood, adulthood neighbourhood disadvantage and health behaviours. J Epidemiol Community Health 2014; 68:741-6. [PMID: 24764352 DOI: 10.1136/jech-2013-203441] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Early life adversities may play a role in the associations observed between neighbourhood contextual factors and health behaviours. METHODS We examined whether self-reported adverse experiences in childhood (parental divorce, long-term financial difficulties, serious conflicts, serious/chronic illness or alcohol problem in the family, and frequent fear of a family member) explain the association between adulthood neighbourhood disadvantage and co-occurrence of behavioural risk factors (smoking, moderate/heavy alcohol use, physical inactivity). Study population consisted of 31 271 public sector employees from Finland. The cross-sectional associations were analysed using two-level cumulative logistic regression models. RESULTS Childhood adverse experiences were associated with the sum of risk factors (cumulative OR 1.32 (95% CI 1.25 to 1.40) among those reporting 3-6 vs 0 adversities). Adverse experiences did not attenuate the association between neighbourhood disadvantage and risk factors; this cumulative OR was 1.52 (95% CI 1.43 to 1.62) in the highest versus lowest quartile of neighbourhood disadvantage when not including adversities, and 1.50 (95% CI 1.40 to 1.60) when adjusted for childhood adversities. In adversity-stratified analyses those reporting 3-6 adversities had 1.60-fold (95% CI 1.42 to 1.80) likelihood of risk factors if living in the neighbourhood of the highest disadvantage, while in those with fewer adversities this likelihood was 1.09-1.34-fold (95% CI 0.98 to 1.53) (p interaction 0.07). CONCLUSIONS Childhood adverse experiences and adulthood neighbourhood disadvantage were associated with behavioural risk factors. Childhood experiences did not explain associations between neighbourhood disadvantage and the risk factors. However, those with more adverse experiences may be susceptible for the socioeconomic conditions of neighbourhoods.
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Affiliation(s)
| | - Jussi Vahtera
- Finnish Institute of Occupational Health, Helsinki, Finland Department of Public Health, University of Turku, and Turku University Hospital, Turku, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland Department of Epidemiology and Public Health, University College London Medical School, London, UK
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
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