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Abstract
AIMS Research shows persistent ethnic inequities in mental health experiences and outcomes, with a higher incidence of illnesses among minoritised ethnic groups. People with psychosis have an increased risk of multiple long-term conditions (MLTC; multimorbidity). However, there is limited research regarding ethnic inequities in multimorbidity in people with psychosis. This study investigates ethnic inequities in physical health multimorbidity in a cohort of people with psychosis. METHODS In this retrospective cohort study, using the Clinical Records Interactive Search (CRIS) system, we identified service-users of the South London and Maudsley NHS Trust with a schizophrenia spectrum disorder, and then additional diagnoses of diabetes, hypertension, low blood pressure, overweight or obesity and rheumatoid arthritis. Logistic and multinomial logistic regressions were used to investigate ethnic inequities in odds of multimorbidity (psychosis plus one physical health condition), and multimorbidity severity (having one or two physical health conditions, or three or more conditions), compared with no additional health conditions (no multimorbidity), respectively. The regression models adjusted for age and duration of care and investigated the influence of gender and area-level deprivation. RESULTS On a sample of 20 800 service-users with psychosis, aged 13-65, ethnic differences were observed in the odds for multimorbidity. Controlling for sociodemographic factors and duration of care, compared to White British people, higher odds of multimorbidity were found for people of Black African [adjusted Odds Ratio = 1.41, 95% Confidence Intervals (1.23-1.56)], Black Caribbean [aOR = 1.79, 95% CI (1.58-2.03)] and Black British [aOR = 1.64, 95% CI (1.49-1.81)] ethnicity. Reduced odds were observed among people of Chinese [aOR = 0.61, 95% CI (0.43-0.88)] and Other ethnic [aOR = 0.67, 95% CI (0.59-0.76)] backgrounds. Increased odds of severe multimorbidity (three or more physical health conditions) were also observed for people of any Black background. CONCLUSIONS Ethnic inequities are observed for multimorbidity among people with psychosis. Further research is needed to understand the aetiology and impact of these inequities. These findings support the provision of integrated health care interventions and public health preventive policies and actions.
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Baranyi G, Sieber S, Pearce J, Cullati S, Dibben C, Cheval B. Lower social participation partly explains the association between perceived neighbourhood crime and depressive symptoms in European adults aged 50 years or older: A longitudinal mediation analysis. Prev Med 2022; 155:106954. [PMID: 35065978 DOI: 10.1016/j.ypmed.2022.106954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/28/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
Neighbourhood crime likely increases the risk of developing depression among older adults. However, little is known about the underlying behavioural and social pathways. We examined the association between perceived neighbourhood crime and depressive symptoms and whether this relationship was mediated by health behaviours (physical activity, smoking, and alcohol consumption) and social participation. Furthermore, we explored differential vulnerability across age, gender, education and household wealth. Data were drawn from six waves of longitudinal data (from 2004/2005 to 2017) of approximately 15,000 adults aged 50 years and older, derived from the multi-national Survey of Health, Ageing and Retirement in Europe. Perceived neighbourhood crime and covariates were measured at baseline, time-variant mediators and depressive symptoms across all waves. Confounder-adjusted mediator and outcome models were fitted with mixed-effects models. Total association was decomposed into direct and indirect pathways applying causal mediation analyses with Monte-Carlo simulations. Perceived crime was associated with higher risk of depressive symptoms; 4.6% of the effect was mediated via lower engagement in social activities (b = 0.005; 95% CI: 0.001-0.009). No mediation was detected through physical activity, smoking or alcohol consumption. Exploratory analyses revealed that the mediating role of social participation was more pronounced among participants with low household wealth (b = 0.012; 95% CI: 0.004-0.023; 7.3% mediated). Lower engagement in social activities partly explained the association between perceived neighbourhood crime and depressive symptoms in adults aged 50 years or older. Policies targeting disadvantaged communities to prevent crime and support social participation might be beneficial for population mental health, especially among financially vulnerable older residents.
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Affiliation(s)
- Gergő Baranyi
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Stefan Sieber
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, Switzerland; Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland; Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Chris Dibben
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Switzerland; Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland
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Hughes K, Ford K, Bellis MA, Glendinning F, Harrison E, Passmore J. Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e848-e857. [PMID: 34756168 PMCID: PMC8573710 DOI: 10.1016/s2468-2667(21)00232-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with increased health risks across the life course. We aimed to estimate the annual health and financial burden of ACEs for 28 European countries. METHODS In this systematic review and meta-analysis, we searched MEDLINE, CINAHL, PsycINFO, Applied Social Sciences Index and Abstracts, Criminal Justice Databases, and Education Resources Information Center for quantitative studies (published Jan 1, 1990, to Sept 8, 2020) that reported prevalence of ACEs and risks of health outcomes associated with ACEs. Pooled relative risks were calculated for associations between ACEs and harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular disease, stroke, and respiratory disease. Country-level ACE prevalence was calculated using available data. Country-level population attributable fractions (PAFs) due to ACEs were generated and applied to 2019 estimates of disability-adjusted life-years. Financial costs (US$ in 2019) were estimated using an adapted human capital approach. FINDINGS In most countries, interpersonal violence had the largest PAFs due to ACEs (range 14·7-53·5%), followed by harmful alcohol use (15·7-45·0%), illicit drug use (15·2-44·9%), and anxiety (13·9%-44·8%). Harmful alcohol use, smoking, and cancer had the highest ACE-attributable costs in many countries. Total ACE-attributable costs ranged from $0·1 billion (Montenegro) to $129·4 billion (Germany) and were equivalent to between 1·1% (Sweden and Turkey) and 6·0% (Ukraine) of nations' gross domestic products. INTERPRETATION Availability of ACE data varies widely between countries and country-level estimates cannot be directly compared. However, findings suggest ACEs are associated with major health and financial costs across European countries. The cost of not investing to prevent ACEs must be recognised, particularly as countries look to recover from the COVID-19 pandemic, which interrupted services and education, and potentially increased risk factors for ACEs. FUNDING WHO Regional Office for Europe.
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Affiliation(s)
- Karen Hughes
- WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK
| | - Kat Ford
- College of Human Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Wrexham, UK.
| | | | - Emma Harrison
- College of Human Sciences, Bangor University, Wrexham, UK; Psychology Department, Glyndwr University, Wrexham, UK
| | - Jonathon Passmore
- WHO Regional Office for Europe, United Nations Campus, Bonn, Germany
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Giovanelli A, Reynolds AJ. Adverse childhood experiences in a low-income black cohort: The importance of context. Prev Med 2021; 148:106557. [PMID: 33857559 PMCID: PMC8594423 DOI: 10.1016/j.ypmed.2021.106557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/11/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
Adverse Childhood Experiences (ACEs) have been definitively linked with cross-domain life course well-being. While scales measuring the ten "Conventional" ACEs (ACEs-C; intrafamilial experiences of abuse, neglect, and household dysfunction) are parsimonious, use of such scales alone may fail to capture crucial information about adversity, particularly in youth growing up in underresourced areas. Patterns and disparities in Conventional and Expanded ACEs (ACEs-E; experiences more common in impoverished and densely populated areas) were examined in the large, primarily Black Chicago Longitudinal Study cohort. This cohort has been followed from the 1980s to the present. Participants in the present study, comprising over 70% of the original sample, responded to a follow-up survey between 2012 and 2017. ACE information was collected both prospectively and retrospectively. Overall ACE prevalence and differences in ACEs by sex and risk were explored using logistic regression with adjusted and unadjusted odds ratios, and chi-squared tests. Higher sociodemographic risk in early childhood was associated with higher rates of ACEs-C through adolescence. Males endorsed higher rates of ACEs-E, particularly relating to violent crime. Nearly 1/5 of participants reported only ACEs-E, which are often not measured when assessing ACEs. Findings underscore enduring effects of early childhood risk factors on ACE exposure, as well as contributions of community characteristics to childhood adversity. Given strong associations between ACEs, environment, and well-being, enhancing inclusivity in our understanding of childhood adversity is a public health priority.
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Affiliation(s)
- Alison Giovanelli
- Institute of Child Development, University of Minnesota, Minneapolis, MN, United States of America; Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Arthur J Reynolds
- Institute of Child Development, University of Minnesota, Minneapolis, MN, United States of America
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Adverse childhood experiences: Mechanisms of risk and resilience in a longitudinal urban cohort. Dev Psychopathol 2021; 32:1418-1439. [PMID: 31663487 DOI: 10.1017/s095457941900138x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is an extensive literature describing the detrimental effects of adverse childhood experiences (ACE; e.g., abuse, neglect, and household dysfunction) on physical and mental health. However, few large-scale studies have explored these associations longitudinally in urban minority cohorts or assessed links to broader measures of well-being such as educational attainment, occupation, and crime. Although adversity and resilience have long been of interest in developmental psychology, protective and promotive factors have been understudied in the ACE literature. This paper investigates the psychosocial processes through which ACEs contribute to outcomes, in addition to exploring ways to promote resilience to ACEs in vulnerable populations. Follow-up data were analyzed for 87% of the original 1,539 participants in the Chicago Longitudinal Study (N = 1,341), a prospective investigation of the impact of an Early Childhood Education program and early experiences on life-course well-being. Findings suggest that ACEs impact well-being in low-socioeconomic status participants above and beyond the effects of demographic risk and poverty, and point to possible mechanisms of transmission of ACE effects. Results also identify key areas across the ecological system that may promote resilience to ACEs, and speak to the need to continue to support underserved communities in active ways.
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Amemiya A, Fujiwara T, Shirai K, Kondo K, Oksanen T, Pentti J, Vahtera J. Association between adverse childhood experiences and adult diseases in older adults: a comparative cross-sectional study in Japan and Finland. BMJ Open 2019; 9:e024609. [PMID: 31446402 PMCID: PMC6720330 DOI: 10.1136/bmjopen-2018-024609] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE We aimed to examine the association between adverse childhood experiences (ACEs) and diseases in older adults in Japan and Finland. DESIGN Cross-sectional comparative study. SETTING Data from a gerontological study in Japan and two public health studies in Finland were evaluated. PARTICIPANTS A total of 13 123 adults (mean age, 69.5 years) from Japan and 10 353 adults (mean age, 64.4 years) from Finland were included in this study. Logistic regression was used to examine the association of each of, any of and the cumulative number of ACEs (parental divorce, fear of a family member and poverty in childhood; treated as ordered categorical variables) with poor self-rated health (SRH), cancer, heart disease or stroke, diabetes mellitus, smoking and body mass index. Models were adjusted for sex, age, education, marital status and working status. RESULTS Of the respondents, 50% of those in Japan and 37% of those in Finland reported having experienced at least one of the measured ACEs. Number of ACEs was associated with poor SRH in both countries, and the point estimates were similar (OR: 1.35, 95% CI: 1.25 to 1.46 in Japan; OR: 1.34, 95% CI: 1.27 to 1.41 in Finland). Number of ACEs was associated with the prevalence of cancer, heart disease or stroke, diabetes mellitus, current smoking and an increase in body mass index in both countries. CONCLUSIONS The association between ACEs and poor SRH, adult diseases and health behaviours was similar among older adults in both Japan and Finland. This international comparative study suggests that the impact of ACEs on health is noteworthy and consistent across cultural and social environments.
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Affiliation(s)
- Airi Amemiya
- Department of Health Economics and Epidemiology Research, University of Tokyo School of Public Health, Bunkyo-ku, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kokoro Shirai
- Department of Public Health, Osaka University, Suita, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
| | - Tuula Oksanen
- Finnish Institute of Occupational Health, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Turku, Finland
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Kreatsoulas C, Fleegler EW, Kubzansky LD, McGorrian CM, Subramanian SV. Young Adults and Adverse Childhood Events: A Potent Measure of Cardiovascular Risk. Am J Med 2019; 132:605-613. [PMID: 30639555 DOI: 10.1016/j.amjmed.2018.12.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While cardiovascular disease is the leading cause of death, its determinants include unhealthy behaviors and clinical risk factors and are recognized as the "actual causes" of death. Risk likely accumulates over the life course, and adverse childhood experiences may increase the risk of "actual causes" of death. The objectives of the study are to determine the prevalence and test the association of adverse childhood experiences among unhealthy behaviors and risk factors as a primordial risk factor among young adults. METHODS Data were extracted from the 2009 and 2011 Behavioural Risk Factor Surveillance System. Individuals ages 18-99 years provided complete information on adverse childhood experiences, health behaviors, and risk factors. Adverse childhood experiences were categorized and evaluated as cumulative burden. Multivariable logistic models, including stratified analysis for young adults, tested the association of adverse childhood experiences burden with unhealthy behaviors and risk factors. RESULTS Among 45,482 study participants, 52% report one adverse childhood experience and 25% report 2 adverse childhood experience categories. Among the total study population, 37% report violence/emotional abuse, 34% report neglect, and 12% report sexual abuse. Even one adverse childhood experience is strongly associated with hypertension, dyslipidemia, and diabetes, and while the association increases in a dose-response (P trend < .001) for all, it is especially more pronounced among the younger adults, with minimal attenuation of effects in the fully adjusted models. CONCLUSION The prevalence of adverse childhood experiences in this study population is high. Even one adverse childhood experience is strongly and independently associated with cardiovascular risk factors, with implications for primordial prevention. Future studies are needed to develop screening and treatment strategies targeted to this high-risk group, especially among young adults.
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Affiliation(s)
- Catherine Kreatsoulas
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Mass; Dalla Lana School of Public Health, University of Toronto, Ont.
| | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Mass
| | - Laura D Kubzansky
- Department of Social and Behavioural Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | | | - Subu V Subramanian
- Department of Social and Behavioural Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
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Cosanella T, Youkhaneh N, Bennett N, Morrell HER. Demographic Moderators of the Relationship Between Adverse Childhood Experiences and Cigarette Smoking. Subst Use Misuse 2019; 54:2229-2240. [PMID: 31339418 DOI: 10.1080/10826084.2019.1642358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Research suggests that there is a dose-response relationship between Adverse Childhood Experiences (ACEs) and cigarette smoking, such that as ACE score increases, so do the odds of smoking behavior, but little is known about what factors moderate this relationship. Objectives: The goal of this study was to examine demographic characteristics as potential moderators of relationship between ACE score and cigarette smoking. Methods: A secondary data analysis was conducted using the 2013 California Behavioral Risk Factor Surveillance System data. The sample included 2,604 U.S. adults (54.8% female; Age: M = 53.3, SD = 8.10). We used multinomial logistic regression to test sex, race, income, and education as moderators of the relationship between ACE score and smoking. Results: ACEs were not significantly associated with smoking behavior. No interactions between ACE score and sex, race, education, or income significantly predicted smoking outcomes. Sex, race, education, and income were significantly and independently associated with smoking outcomes. Men, individuals with lower income and education, and certain ethnic/racial groups reported greater odds of smoking. Conclusions/Importance: Results suggest that there may not be a relationship between ACEs and smoking later in life. Additionally, the relationship between ACEs and smoking in adulthood may not depend on basic demographic features. Knowing which populations are more vulnerable to smoking can help clinicians better assess and tailor interventions to meet the needs of their patients by using culturally sensitive interventions and obtaining resources to help improve treatment access, motivation, and success.
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Affiliation(s)
- Taylor Cosanella
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
| | - Nicolette Youkhaneh
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
| | - Nicole Bennett
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
| | - Holly E R Morrell
- Department of Psychology, Loma Linda University , Loma Linda, California , USA
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9
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Hartman TJ, Calafat AM, Holmes AK, Marcus M, Northstone K, Flanders WD, Kato K, Taylor EV. Prenatal Exposure to Perfluoroalkyl Substances and Body Fatness in Girls. Child Obes 2017; 13:222-230. [PMID: 28128969 PMCID: PMC5444423 DOI: 10.1089/chi.2016.0126] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Perfluoroalkyl substances (PFASs) are used in surface coatings that resist stains, grease, and water. METHODS The association between in utero PFAS exposure and girls' body fatness at age 9 was analyzed in The Avon Longitudinal Study of Parents and Children (UK). Maternal serum [median 15 weeks: interquartile range (IQR) 10 and 28 weeks of gestation] was analyzed for perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorohexane sulfonate (PFHxS), and perfluorononanoate (PFNA). Body composition was measured by dual X-ray emission absorptiometry, and percent total body fat (%BF) was calculated. Associations between PFASs and body fatness were modeled by multivariable linear regression. RESULTS Among 359 girls, median (IQR) %BF was 27.5 (IQR 21.7-34.6). Median (IQR) concentrations (all ng/mL) were 3.7 (2.9-4.8) for PFOA, 19.8 (15.0-25.3) for PFOS, 1.6 (1.3-2.2) for PFHxS, and 0.5 (0.4-0.7) for PFNA. Maternal PFAS concentrations were not significantly associated with daughters' total %BF overall. Mothers' educational status modified associations for PFOA and PFOS with %BF (P-interactions: 0.005 and 0.02, respectively). %BF was higher [1.4%; 95% confidence interval (95% CI): 0.3 to 2.5] for each one unit (ng/mL) higher PFOA among girls with mothers in the middle education group, but lower (-0.6%; 95% CI: -1.12 to -0.04) for the corresponding comparison among girls with mothers with the highest education. %BF was lower (-0.2%; 95% CI: -0.3 to -0.1) for each one unit higher PFOS among girls with the most educated mothers. CONCLUSIONS Prenatal exposure to PFOA and PFOS was associated with girls' %BF within some strata of maternal education status. PFHxS and PFNA were not associated with %BF.
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Affiliation(s)
- Terryl J. Hartman
- Centers for Disease Control and Prevention, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.,Winship Cancer Institute, Emory University, Atlanta, GA
| | | | | | - Michele Marcus
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Kate Northstone
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - W. Dana Flanders
- Centers for Disease Control and Prevention, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.,Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kayoko Kato
- Centers for Disease Control and Prevention, Atlanta, GA
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Gerra G, Manfredini M, Somaini L, Milano G, Ciccocioppo R, Donnini C. Perceived parental care during childhood, ACTH, cortisol and nicotine dependence in the adult. Psychiatry Res 2016; 245:458-465. [PMID: 27631565 DOI: 10.1016/j.psychres.2016.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/18/2016] [Accepted: 09/04/2016] [Indexed: 02/07/2023]
Abstract
Studies evidenced the relationship between adverse childhood experiences (ACEs) and tobacco smoking in adulthood. An appropriate parenting style has been found to be associated with children's less frequent tobacco consumption. Hypothalamus-pituitary-adrenal (HPA) axis hyperactivity could represent the potential link between ACEs, mood disorders and smoking susceptibility. We studied a sample of 50 male smokers, affected by nicotine dependence and 50 controls who never smoked. Self-reported retrospective perception of neglect (Child Experience of Care and Abuse: CECA-Q questionnaire), age of smoking onset, number of cigarette/day, psychiatric symptoms (Symptoms Check List 90 scale: SCL 90) and basal level of ACTH and cortisol have been evaluated. Total SCL-90 scores, CECA-Q values and cortisol plasma level were significantly higher among smokers. Cortisol and ACTH values showed a significant direct correlation with CECA-Q and SCL90 total score and an inverse significant correlation with the age of smoking. Cortisol and ACTH did not correlate with the number of cigarette smoked. Once controlled for SCL90 and CECA-Q with multiple regression measures, the association between smoking and hormone levels reversed, suggesting that increased cortisol and ACTH basal levels were attributable to preexisting conditions such as early-life exposure to emotional neglect, psychological problems and a predisposition to addictive behavior.
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Affiliation(s)
- Gilberto Gerra
- Drug Prevention and Health Branch, Division for Operations, United Nation Office on Drugs and Crime, Vienna, Austria
| | | | - Lorenzo Somaini
- Addiction Treatment Center, Local Health Service, Cossato, Biella, Italy.
| | - Giulia Milano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Roberto Ciccocioppo
- School of Pharmacy, Pharmacology Unit, University of Camerino, Camerino, Italy
| | - Claudia Donnini
- Department of Life Sciences, University of Parma, Parma, Italy
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11
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Savitsky B, Manor O, Friedlander Y, Burger A, Lawrence G, Calderon-Margalit R, Siscovick DS, Enquobahrie DA, Williams MA, Hochner H. Associations of socioeconomic position in childhood and young adulthood with cardiometabolic risk factors: the Jerusalem Perinatal Family Follow-Up Study. J Epidemiol Community Health 2016; 71:43-51. [PMID: 27417428 DOI: 10.1136/jech-2014-204323] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 11/30/2015] [Accepted: 06/29/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several stages in the life course have been identified as important to the development of cardiovascular disease. This study aimed to assess the associations of childhood and adulthood socioeconomic position (SEP) and social mobility with cardiometabolic risk factors (CMRs) later in life. METHODS We conducted follow-up examinations of 1132 offspring, aged 32, within a population-based cohort of all births in Jerusalem from 1974 to 1976. SEP was indicated by parents' occupation and education, and adulthood SEP was based on offspring's occupation and education recorded at age 32. Linear regression models were used to investigate the associations of SEP and social mobility with CMRs. RESULTS Childhood-occupational SEP was negatively associated with body mass index (BMI; β=-0.29, p=0.031), fat percentage (fat%; β=-0.58, p=0.005), insulin (β=-0.01, p=0.031), triglycerides (β=-0.02, p=0.024) and low-density lipoprotein cholesterol (LDL-C; β=-1.91, p=0.015), independent of adulthood SEP. Adulthood-occupational SEP was negatively associated with waist-to-hip ratio (WHR; β=-0.01, p=0.002), and positively with high-density lipoprotein cholesterol (HDL-C; β=0.87, p=0.030). Results remained similar after adjustment for smoking and inactivity. Childhood-educational SEP was associated with decreased WHR and LDL-C level (p=0.0002), and adulthood-educational SEP was inversely associated with BMI (p=0.001), waist circumference (p=0.008), WHR (p=0.001) and fat% (p=0.0002) and positively associated with HDL-C (p=0.030). Additionally, social mobility (mainly upward) was shown to have adverse cardiometabolic outcomes. CONCLUSIONS Both childhood and adulthood SEP contribute independently to CMR. The match-mismatch hypothesis may explain the elevated CMRs among participants experiencing social mobility. Identification of life-course SEP-related aspects that translate into social inequality in cardiovascular risk may facilitate efforts for improving health and for reducing disparities in cardiovascular disease.
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Affiliation(s)
- B Savitsky
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Y Friedlander
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - A Burger
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - G Lawrence
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - R Calderon-Margalit
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - D S Siscovick
- Cardiovascular Health Research Unit, Department of Medicine and Epidemiology, University of Washington, Seattle, Washington, USA
| | - D A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - M A Williams
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - H Hochner
- The Braun School of Public Health, The Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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12
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Giovanelli A, Reynolds AJ, Mondi CF, Ou SR. Adverse Childhood Experiences and Adult Well-Being in a Low-income, Urban Cohort. Pediatrics 2016; 137:peds.2015-4016. [PMID: 26966132 PMCID: PMC4991352 DOI: 10.1542/peds.2015-4016] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study tests the association between adverse childhood experiences (ACEs) and multidimensional well-being in early adulthood for a low-income, urban cohort, and whether a preschool preventive intervention moderates this association. METHODS Follow-up data were analyzed for 1202 low-income, minority participants in the Chicago Longitudinal Study, a prospective investigation of the impact of early experiences on life-course well-being. Born between 1979 and 1980 in high-poverty neighborhoods, individuals retrospectively reported ACEs from birth to adolescence, except in cases of child abuse and neglect. RESULTS Nearly two-thirds of the study sample experienced ≥1 ACEs by age 18. After controlling for demographic factors and early intervention status, individuals reporting ACEs were significantly more likely to exhibit poor outcomes than those with no ACEs. Those with ≥4 ACEs had significantly reduced likelihood of high school graduation (odds ratio [OR] = 0.37; P < .001), increased risk for depression (OR = 3.9; P < .001), health compromising behaviors (OR = 4.5; P < .001), juvenile arrest (OR = 3.1; P < .001), and felony charges (OR = 2.8; P < .001). They were also less likely to hold skilled jobs (OR = 0.50; P = .001) and to go further in school even for adversity measured by age 5. CONCLUSIONS ACEs consistently predicted a diverse set of adult outcomes in a high-risk, economically disadvantaged sample. Effective and widely available preventive interventions are needed to counteract the long-term consequences of ACEs.
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Affiliation(s)
- Alison Giovanelli
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - Arthur J. Reynolds
- Address correspondence to Arthur Reynolds, PhD, Institute of Child Development, 51 E. River Rd, Minneapolis, MN 55455. E-mail:
| | - Christina F. Mondi
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - Suh-Ruu Ou
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
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Gooding HC, Milliren C, Austin SB, Sheridan MA, McLaughlin KA. Exposure to violence in childhood is associated with higher body mass index in adolescence. CHILD ABUSE & NEGLECT 2015; 50:151-158. [PMID: 26303827 PMCID: PMC4688211 DOI: 10.1016/j.chiabu.2015.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/29/2015] [Accepted: 08/07/2015] [Indexed: 05/30/2023]
Abstract
To determine whether different types of childhood adversity are associated with body mass index (BMI) in adolescence, we studied 147 adolescents aged 13-17 years, 41% of whom reported exposure to at least one adversity (maltreatment, abuse, peer victimization, or witness to community or domestic violence). We examined associations between adversity type and age- and sex-specific BMI z-scores using linear regression and overweight and obese status using logistic regression. We adjusted for potential socio-demographic, behavioral, and psychological confounders and tested for effect modification by gender. Adolescents with a history of sexual abuse, emotional abuse, or peer victimization did not have significantly different BMI z-scores than those without exposure (p>0.05 for all comparisons). BMI z-scores were higher in adolescents who had experienced physical abuse (β=0.50, 95% CI 0.12-0.91) or witnessed domestic violence (β=0.85, 95% CI 0.30-1.40). Participants who witnessed domestic violence had almost 6 times the odds of being overweight or obese (95% CI: 1.09-30.7), even after adjustment for potential confounders. No gender-by-adversity interactions were found. Exposure to violence in childhood is associated with higher adolescent BMI. This finding highlights the importance of screening for violence in pediatric practice and providing obesity prevention counseling for youth.
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Affiliation(s)
- Holly C Gooding
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, USA; Department of Pediatrics, Harvard Medical School, USA
| | - Carly Milliren
- Clinical Research Center, Boston Children's Hospital, USA
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, USA; Department of Pediatrics, Harvard Medical School, USA; Department of Social and Behavioral Sciences, Harvard School of Public Health, USA
| | - Margaret A Sheridan
- Department of Pediatrics, Harvard Medical School, USA; Division of Developmental Medicine, Boston Children's Hospital, USA
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14
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Liu JJ, Lou F, Lavebratt C, Forsell Y. Impact of Childhood Adversity and Vasopressin receptor 1a Variation on Social Interaction in Adulthood: A Cross-Sectional Study. PLoS One 2015; 10:e0136436. [PMID: 26295806 PMCID: PMC4546684 DOI: 10.1371/journal.pone.0136436] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 08/03/2015] [Indexed: 01/08/2023] Open
Abstract
Background Arginine vasopressin (AVP) plays a role in social behavior, through receptor AVPR1A. The promoter polymorphism AVPR1A RS3 has been associated with human social behaviors, and with acute response to stress. Here, the relationships between AVPR1A RS3, early-life stressors, and social interaction in adulthood were explored. Methods Adult individuals from a Swedish population-based cohort (n = 1871) were assessed for self-reported availability of social integration and social attachment and for experience of childhood adversities. Their DNA samples were genotyped for the microsatellite AVPR1A RS3. Results Among males, particularly those homozygous for the long alleles of AVPR1A RS3 were vulnerable to childhood adversity for their social attachment in adulthood. A similar vulnerability to childhood adversity among long allele carriers was found on adulthood social integration, but here both males and females were influenced. Limitation Data were self-reported and childhood adversity data were retrospective. Conclusions Early-life stress influenced the relationship between AVPR1A genetic variants and social interaction. For social attachment, AVPR1A was of importance in males only. The findings add to previous reports on higher acute vulnerability to stress in persons with long AVPR1A RS3 alleles and increased AVP levels.
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Affiliation(s)
- Jia Jia Liu
- School of Nursing, Shandong University, Jinan, 250012, China
- Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fenglan Lou
- School of Nursing, Shandong University, Jinan, 250012, China
| | - Catharina Lavebratt
- Neurogenetics Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Yvonne Forsell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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15
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Halonen JI, Stenholm S, Pentti J, Kawachi I, Subramanian SV, Kivimäki M, Vahtera J. Childhood Psychosocial Adversity and Adult Neighborhood Disadvantage as Predictors of Cardiovascular Disease: A Cohort Study. Circulation 2015; 132:371-9. [PMID: 26068046 DOI: 10.1161/circulationaha.115.015392] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 05/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known. METHODS AND RESULTS Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models. CONCLUSIONS These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors.
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Affiliation(s)
- Jaana I Halonen
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.).
| | - Sari Stenholm
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Jaana Pentti
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Ichiro Kawachi
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - S V Subramanian
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Mika Kivimäki
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
| | - Jussi Vahtera
- From Finnish Institute of Occupational Health (J.I.H., J.P., M.K., J.V.); Department of Public Health, University of Turku, Finland (S.S., J.V.); School of Health Sciences, University of Tampere, Finland (S.S.); Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA (I.K., S.V.S.); Department of Epidemiology and Public Health, University College London Medical School, UK (M.K.); Clinicum, Faculty of Medicine, University of Helsinki, Finland (M.K.); and Turku University Hospital, Finland (J.V.)
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