Profiles of physical and psychological violence in childhood as a risk factor for poorer adult health: evidence from the 1995-2005 National Survey of Midlife in the United States

Early learning difficulties, childhood stress, race, and risk of cognitive impairment among US adults over age 50: A cross-sectional analysis

Background and Aims

Most literature linking childhood factors to cognitive health outcomes has focused on educational attainment-defined as years of education attained. However, less has been studied about the other aspects of education, such as early learning problems, and stressful family environments. This study examined whether early learning problems and childhood stressors were associated with mid- and later life cognitive impairment among US adults, and if these associations varied by race.

Methods

We conducted a cross-sectional analysis using the Health and Retirement Study (HRS) along with respondents' early educational experiences from the 2015 to 2017 Life History Mail Survey (N = 9703). Early learning problems were defined as having any of the following: scholastic problems (reading, writing, mathematics), speaking/language issues, and sensorimotor issues- hearing, vision, speech, and motor-coordination. Cognitive status was classified as three levels (normal, cognitively impaired not demented [CIND], and demented) using the HRS Langa-Weir algorithm. Multinomial logistic regression models using generalized logits, estimated relative risk ratios (RRRs), and 95% confidence intervals (CI) with adjustment for sociodemographic factors.

Results

Having at least one early learning problem was associated with increased risk of later life cognitive impairment (RRR: 1.75, 95% CI: 1.34-2.29 for dementia, RRR: 1.42, 95% CI: 1.20-1.67 for CIND). Parental death before the age of 16 was associated with 17% higher risk of CIND in later life (RRR: 1.17, 95% CI: 1.01-1.34). However, learning problem-related differences in risk of cognitive impairment were dependent on race (learning problems × race, p = 0.0001). In the demented group, Blacks were 2.7 times more likely to be demented (RRR: 2.66, 95% CI: 1.69-4.17) amongst older adults that experienced childhood learning problems.

Conclusions

Early life exposures predicted risk of cognitive impairment. Policies and interventions that enhance diagnosis of early learning problems and improve childhood social contexts are needed to promote healthy cognitive aging amongst Americans, regardless of race.

Anxiety, aggression, reward sensitivity, and forebrain dopamine receptor expression in a laboratory rat model of early-life disadvantage

Despite early-life disadvantage (ELD) in humans being a highly heterogenous construct, it consistently predicts negative neurobehavioral outcomes. The numerous environmental contributors and neural mechanisms underlying ELD remain unclear, though. We used a laboratory rat model to evaluate the effects of limited resources and/or heavy metal exposure on mothers and their adult male and female offspring. Dams and litters were chronically exposed to restricted (1-cm deep) or ample (4-cm deep) home cage bedding postpartum, with or without lead acetate (0.1%) in their drinking water from insemination through 1-week postweaning. Restricted-bedding mothers showed more pup-directed behaviors and behavioral fragmentation, while lead-exposed mothers showed more nestbuilding. Restricted bedding-raised male offspring showed higher anxiety and aggression. Either restricted bedding or lead exposure impaired goal-directed performance in a reinforcer devaluation task in females, whereas restricted bedding alone disrupted it in males. Lead exposure, but not limited bedding, also reduced sucrose reward sensitivity in a progressive ratio task in females. D1 and D2 receptor mRNA in the medial prefrontal cortex and nucleus accumbens (NAc) were each affected by the early-life treatments and differently between the sexes. Most notably, adult males (but not females) exposed to both early-life treatments had greatly increased D1 receptor mRNA in the NAc core. These results illuminate neural mechanisms through which ELD threatens neurobehavioral development and highlight forebrain dopamine as a factor.

Violência emocional intrafamiliar contra crianças e adolescentes e suas repercussões

O objetivo deste estudo foi identificar as repercussões na infância, na adolescência e na vida adulta da violência emocional intrafamiliar vivenciada no período infanto-juvenil em artigos publicados entre 2009 e 2019, por meio de uma revisão sistemática de literatura. Para a organização dos dados, utilizou-se o software Zotero; para a sistematização e análises, o software SPSS (versão 2.3). Na infância e na adolescência, as principais repercussões foram sintomas internalizantes (ex.: ansiedade, depressão, problemas psicossomáticos, insegurança), problemas cognitivo-comportamentais e impactos no rendimento escolar. Na idade adulta, as principais repercussões foram sintomas externalizantes (ex.: agressividade, reprodução da violência) e sintomas internalizantes. Conclui-se que a violência emocional vivenciada na infância e na adolescência é transcultural, transgeracional e um fator de risco para o desenvolvimento, podendo ocasionar prejuízos cognitivo-comportamentais e interferir nos relacionamentos interpessoais ao longo do ciclo de vida. Tornar visível este tipo de violência contribui para enfrentamento e minimização dos efeitos negativos da violência.

Childhood Disadvantage and Adult Functional Status: Do Early-Life Exposures Jeopardize Healthy Aging?

OBJECTIVES

To examine whether childhood disadvantage is associated with later-life functional status and identify mediating factors.

METHODS

Unique and additive effects of five childhood domains on functional status were assessed at baseline (2006) and over time (2006-2016) in a sample of 13,894 adults from the Health and Retirement Study (>50 years). Adult health behaviors and socioeconomic status (SES) were tested as mediators.

RESULTS

Respondents exposed to multiple childhood disadvantages (OR = .694) as well as low childhood SES (OR = .615), chronic diseases (OR = .694), impairments (OR = .599), and risky adolescent behaviors (OR = .608) were less likely to be free of functional disability by baseline. Over time, these unique and additive effects of childhood disadvantage increased the hazard odds of eventually developing functional disability (e.g., additive effect: hOR = 1.261). Adult health behaviors and SES mediated some of these effects.

DISCUSSION

Given the enduring effects of childhood disadvantage, policies to promote healthy aging should reduce exposure to childhood disadvantage.

Adverse childhood experiences and future self-rated health: a prospective cohort study

BACKGROUND

Negative life events (re) occurring during childhood is often described as adverse childhood experiences (ACEs) and may have long-lasting negative effects on health. Previous studies on the association between ACEs and self-rated health (SRH) have primarily been focusing on chronic diseases in elderly, non-Scandinavian populations using a cross-sectional design. The aim of the study was to examine the associations between ACEs and SRH in early adulthood and to investigate if disadvantageous health-behavioral strategies explain the association between ACEs and SRH.

METHODS

A prospective cohort study using data from The West Jutland Cohort Study (N = 2.255). Baseline data on exposure to ACEs were collected from surveys at the age of 15 and 18 and respondents were categorized into having experienced 0, 1-2, 3 or > 4 ACEs. The outcome SRH stems from surveys at the age of 21 and 28 and was dichotomized into moderate and good SRH. The association between ACE-categories and SRH at age 21 and 28 were analyzed separately by logistic regression with a two-step adjustment model, adjusting for potential confounders and disadvantageous health-behavioral strategies.

RESULTS

More than half of the participants reported at least one ACE (56.3%) with "bullying" and "loss of parent, parental separation or divorce" being the most prevalent. Participants who reported > 4 ACEs, compared to those with 0 ACEs, had a 2.6-fold increased odds (95% CI 1.3; 5.1) of having moderate SRH at the age of 21, and a 2.7-fold increased odds (95% CI 1.4; 5.4) of moderate SRH at the age of 28 years, when adjusted for potential confounders. Further, small attenuations of the estimates were seen when adjusting for disadvantageous health-behavioral strategies. A significant exposure response relationship between the ACE-categories and moderate SRH were seen both at age 21 and 28.

CONCLUSION

The study showed an association between ACEs and moderate SRH in young adulthood, and experiencing multiple ACEs increased the odds of reporting moderate SRH. Information on ACEs could help identifying people with a higher risk of future health problems and accentuates a growing need for early prevention in homes with children who has experienced adverse events.

Childhood trauma, life-time self-harm, and suicidal behaviour and ideation are associated with polygenic scores for autism

Autistic individuals experience significantly elevated rates of childhood trauma, self-harm and suicidal behaviour and ideation (SSBI). Is this purely the result of negative environmental experiences, or does this interact with genetic predisposition? In this study we investigated if a genetic predisposition for autism is associated with childhood trauma using polygenic scores (PGS) and genetic correlations in the UK Biobank (105,222 < N < 105,638), and tested potential mediators and moderators of the association between autism, childhood trauma and SSBI. Autism PGS were significantly associated with childhood trauma (max R2 = 0.096%, P < 2 × 10-16), self-harm ideation (max R2 = 0.108%, P < 2 × 10-16), and self-harm (max R2 = 0.13%, P < 2 × 10-16). Supporting this, we identified significant genetic correlations between autism and childhood trauma (rg = 0.36 ± 0.05, P = 8.13 × 10-11), self-harm ideation (rg = 0.49 ± 0.05, P = 4.17 × 10-21) and self-harm (rg = 0.48 ± 0.05, P = 4.58 × 10-21), and an over-transmission of PGS for the two SSBI phenotypes from parents to autistic probands. Male sex negatively moderated the effect of autism PGS on childhood trauma (β = -0.023 ± 0.005, P = 6.74 × 10-5). Further, childhood trauma positively moderated the effect of autism PGS on self-harm score (β = 8.37 × 10-3 ± 2.76 × 10-3, P = 2.42 × 10-3) and self-harm ideation (β = 7.47 × 10-3 ± 2.76 × 10-3, P = 6.71 × 10-3). Finally, depressive symptoms, quality and frequency of social interactions, and educational attainment were significant mediators of the effect of autism PGS on SSBI, with the proportion of effect mediated ranging from 0.23 (95% CI: 0.09-0.32) for depression to 0.008 (95% CI: 0.004-0.01) for educational attainment. Our findings identify that a genetic predisposition for autism is associated with adverse life-time outcomes, which represent complex gene-environment interactions, and prioritizes potential mediators and moderators of this shared biology. It is important to identify sources of trauma for autistic individuals in order to reduce their occurrence and impact.

Childhood trauma and disordered eating: Exploring the role of alexithymia and beliefs about emotions

Although often perceived as non-threatening, disordered eating poses a significant risk to physical and psychological wellbeing. Given the modest effectiveness of current interventions, there is a need to identify specific psychological targets for treatment. One risk factor that has long been liked to eating issues is childhood trauma. The present study aimed to clarify the associations between five distinct forms of trauma and three disordered eating behaviours (Cognitive Restraint, Uncontrolled Eating, and Emotional Eating). In addition, it aimed to determine the role of alexithymia and beliefs about emotions in this association. Three hundred and thirty-two participants from the Australian community completed an online questionnaire measuring alexithymia, beliefs about emotions, disordered eating, and childhood trauma. Hierarchical multiple regression analyses were conducted to examine total effects between independent forms of childhood trauma and eating behaviours, followed by bootstrapped confidence intervals to delineate indirect effects. A significant direct association was evidenced between Childhood Emotional Abuse and Cognitive Restraint, in addition to Childhood Sexual Abuse and Emotional Eating. Numerous indirect effects were detected involving the beliefs that emotions are 'Overwhelming and Uncontrollable' and 'Damaging'. Findings indicated that experiences of childhood trauma were associated with disordered eating behaviours through the detection of significant total and/or indirect effects. However, effect sizes of indirect effects (involving beliefs about emotions) were small, suggesting that there are additional factors involved. Further longitudinal research is necessary to determine the causal direction of these findings.

A Community-Academic Partnership for School-Based Nonviolence Education: The Healthy Power Program

BACKGROUND

Youth violence is a significant problem affecting community health. Community-academic partnerships can advance youth nonviolence education by synergizing the strengths of collaborators while working toward a common goal. We describe a collaboration between an urban public middle school, community nonprofit, and university-based graduate school of nursing in implementing and evaluating the Healthy Power program, a school-based youth nonviolence program for middle-school boys.

METHODS

A participatory program evaluation approach was used to plan and implement evaluation of the Healthy Power program with a cohort of 8 students. Collaborative planning allowed for the selection of measures that reflected program objectives and were of value to community partners while also scientifically sound. A mixed-methods approach included a focus group and a pretest-posttest with quantitative items and open-ended questions.

RESULTS

While the quantitative pre-posttest did not show any significant change, the open-ended questions and focus group suggested that students had advanced their understanding and application of conflict resolution skills.

CONCLUSIONS

The findings support the usefulness of community-academic partnerships for peace/conflict resolution education and program evaluation. Such programs may benefit from mixed methods of evaluation.

Pathways linking combinations of early-life adversities to adult mortality: Tales that vary by gender

RATIONALE

Socioeconomic disadvantage, family instability, and abuse are widely studied early-life adversities (ELAs) that may co-occur in the lives of many. The detrimental effects of these adversities may result in elevated risk of mortality in midlife and old age.

OBJECTIVE

We investigate how combinations of these three ELAs affect later-life mortality and the life-course mediators that explain the associations.

METHOD

Data come from the first two waves of the Midlife in the United States (MIDUS) study and mortality records over a 20-year period (1995/96-2015). We used latent class analysis (LCA) to identify patterns of ELAs across the three domains and incorporated four life-course mediators: material, psychological, social resources, healthy lifestyle and substance abuse.

RESULTS

LCA yielded six distinct combinations of ELAs, with patterns of socioeconomic status (SES) and abuse being most salient. We found that childhood abuse exists across all levels of childhood SES. For both genders, individuals who experienced low SES combined with frequent abuse have the highest risk of death. For women but not men, frequent abuse increases the risk of mortality even if they grew up in middle or high SES families. For both genders, material resource is a significant contributor on the pathway from ELAs to mortality. Life-course mediators partially accounted for the observed associations between ELAs and mortality, but attenuation was stronger for men than women. This is partially attributed to the stronger direct effects of life-course resources on mortality for men than women.

CONCLUSIONS

Our findings suggest that ELAs are an important determinant of mortality in midlife and old age. Traumatic experiences during the critical period of early life may compromise later-life heath more for women than men.

Domains of Childhood Disadvantage and Functional Limitation Trajectories Among Midlife Men and Women in China

Objective: To examine the impacts of four childhood disadvantage domains-parental behavior, hunger, health, and socioeconomic status (SES)-on functional limitation trajectories among midlife adults in China. Method: Data (2011-2015) from the China Health and Retirement Longitudinal Study (N = 8,646) were used to examine the associations between different domains of childhood disadvantage and functional limitation trajectories among adults aged 45 to 64. Results: Adverse parental behavior was not associated with baseline functional limitation but was associated with steeper trajectories for men. Health, hunger, and SES were associated with more functional limitations at baseline, and SES with steeper trajectories for men and women. Adulthood SES largely accounted for the associations between childhood SES and functional limitations for men. Discussion: It is important to examine multiple domains of childhood conditions because the type and magnitude of disadvantage may influence functional limitations in different ways among men and women in China.

Early Life Adversity as a Predictor of Sense of Purpose during Adulthood

Feeling a sense of purpose in life appears to hold consistent benefits for positive aging and well-being. As such, it is important to consider the potential factors that promote or hinder the development of purposefulness over the lifespan. For instance, it remains unclear whether early life experiences, particularly adverse ones, may hold lasting influences on whether one feels purposeful into adulthood. The current study examined whether early life adversity predicted a diminished sense of purpose in adulthood using data from participants (N = 3835) in the Midlife in the United States (MIDUS) study. Reports of early life adversity were associated with lower levels of purpose in adulthood, and chronological age failed to moderate this relationship.

A cross-sectional study of emergency care utilization and associated costs of violent-related (assault) injuries in the United States

BACKGROUND

Violent-related (assault) injuries are a leading cause of death and disability in the United States. Many violent injury victims seek treatment in the emergency department (ED). Our objectives were to (1) estimate rates of violent-related injuries evaluated in United States EDs, (2) estimate linear trends in ED visits for violent-related injuries from 2000 to 2010, and (3) to determine the associated health care and work-loss costs.

METHODS

We examined adults 18 years and older from a nationally representative survey (the National Hospital Ambulatory Medical Care Survey) of ED visits, from 2000 to 2010. Violent injury was defined using International Classification of Diseases-9th Rev.-Clinical Modification, diagnosis and mechanism of injury codes. We calculated rates of ED visits for violent injuries. Medical and work-loss costs accrued by these injuries were calculated for 2005, inflation-adjusted to 2011 dollars using the WISQARS Cost of Injury Reports.

RESULTS

An annual average of 1.4 million adults were treated for violent injuries in EDs from 2000 to 2010, comprising 1.6% (95% confidence interval, 1.5%-1.6%) of all US adult ED visits. Young adults (18-25 years), men, nonwhites, uninsured or publically insured patients, and those residing in high poverty urban areas were at increased risk for ED visits for violent injury. The 1-year, inflation-adjusted medical and work-loss cost of violent-inflicted injuries in adults in the United States was US $49.5 billion.

CONCLUSION

Violent injuries account for over one million ED visits annually among adults, with no change in rates over the past decade. Young black men are at especially increased risk for ED visits for violent injuries. Overall, violent-related injuries resulted in substantial financial and societal costs.

LEVEL OF EVIDENCE

Epidemiological study, level III.

The impact of perceived childhood victimization and patriarchal gender ideology on intimate partner violence (IPV) victimization among Korean immigrant women in the USA

Childhood victimization experiences are common among intimate partner violence (IPV) victims. This study examines the link between childhood physical and sexual victimization experiences and adulthood IPV among Korean immigrant women in the USA. As Korean immigrants often use physical punishment to discipline their children, and reporting sexual abuse is discouraged due to stigmatization in this community, cultural factors (e.g. patriarchal values) related to childhood victimization and IPV were also examined. Survey data from Korean immigrant women in the USA were collected. Using a case-control design, we compared 64 Korean immigrant women who have experienced IPV in the past year with 63 Korean immigrant women who have never experienced IPV in their lifetime. The findings of this study reveal that IPV victims, compared with non-victims, experienced higher childhood victimization rates. Logistic regression analysis demonstrated that childhood victimization and patriarchal gender ideology strongly predict IPV victimization among Korean immigrants. However, patriarchal values did not moderate the relationship between childhood victimization and IPV. To prevent IPV among Korean immigrant population, we need to make special efforts to prevent childhood abuse and change ingrained cultural attitudes about child physical and sexual abuse among immigrant communities through culturally sensitive programs.

Childhood adversities and chronic conditions: examination of mediators, recall bias and age at diagnosis

OBJECTIVES

The aim of this study was to (1) identify the influence of childhood socioeconomic status (CSES) on five chronic conditions: asthma, bronchitis, hypothyroid, migraine, and psychiatric disorders in later life; (2) determine the mediating role of childhood abuse (CA) in these associations, and (3) quantify recall bias due to respondent's mental health in these associations.

METHODS

10,325 men and women from the Tromsø Study were followed for 13 years, and Poisson regression models were used.

RESULTS

Low CSES was associated with a 16-23% higher risk of chronic conditions, and CA was associated with a 16-58% higher risk of chronic conditions (p < 0.05). A minor proportion of the association between CSES and CA (3.98%, p < 0.05); CSES and chronic conditions (5.54-8.71%, p < 0.05); and CA and chronic conditions (9.51-19.52%, p < 0.05), were driven by recall bias due to the respondent's mental health. CA mediated the association between CSES and chronic conditions (9.58-25.06%, p < 0.05).

CONCLUSIONS

Low CSES and CA are associated with higher risk of chronic conditions in later life. A minor proportion of these associations are driven by recall bias.

Association of Reports of Childhood Abuse and All-Cause Mortality Rates in Women

IMPORTANCE

Research has linked childhood abuse to a variety of adult psychiatric problems, but little is known about associations of child abuse with adult mortality.

OBJECTIVE

To test associations of retrospective reports of physical and emotional abuse in childhood with all-cause mortality rates in adulthood.

DESIGN, SETTING, AND PARTICIPANTS

National sample of 6285 adults (aged 25-74 years at baseline) from the survey of Midlife Development in the United States. Baseline psychosocial data were collected in 1995 and 1996, with follow-up mortality data collected through October 2015.

MAIN OUTCOMES AND MEASURES

Participants completed questionnaires at baseline about self-report of childhood emotional abuse, moderate physical abuse, and severe physical abuse. Mortality data during the next 20 years was tracked using the National Death Index.

RESULTS

Of the 6285 participants included in the study sample, 2987 were men (48%) and 5581were white (91%), with a mean (SD) age of 46.9 (12.95) years. Women who reported childhood emotional abuse (hazard ratio [HR], 1.22; 95% CI, 1.01-1.49; P = .04), moderate physical abuse (HR, 1.30; 95% CI, 1.05-1.60; P = .02), or severe physical abuse (HR, 1.58; 95% CI, 1.20-2.08; P = .001) were at increased risk for all-cause mortality during the follow-up period. Reports of more types of childhood abuse were also associated with a greater risk of all-cause mortality in women (all vs none HR, 1.68; 95% CI, 1.24-2.30; P = .001; some vs none HR, 1.24; 95% CI, 1.01-1.52; P = .04). These effects could not be accounted for by childhood socioeconomic status, personality traits, or adult depression. No associations were observed in men.

CONCLUSIONS AND RELEVANCE

These results suggest that in addition to the established psychiatric consequences of abuse, women who report childhood abuse also remain vulnerable to premature mortality into adulthood. Thus, reported childhood abuse may have long-term ramifications for health and longevity in women.

Genetic and Environmental Overlap Between Childhood Maltreatment and Adult Physical Health

Past research demonstrates a phenotypic relationship between childhood maltreatment and adult health problems. Explanations of this association usually point to either: (a) a direct causal link, whereby exposure to early stress disrupts biological functioning during sensitive periods of development; or (b) an indirect effect operating through socioeconomic attainment, poor health behaviors, or some other pathway leading from childhood to adulthood. The current study examined whether the association between childhood maltreatment and adult health reflects genetic or environmental mediation. Using a large sample of adult American twins, we separately estimated univariate biometric models of child maltreatment and adult physical health, followed by a bivariate biometric model to estimate genetic and environmental correlations between the two variables. We found that a summary count of chronic health conditions shared non-trivial genetic overlap with childhood maltreatment. Our results have implications for understanding the relationship between maltreatment and health as one of active interplay rather than a simple cause and effect model that views maltreatment as an exogenous shock.

Adverse childhood experiences and later life adult obesity and smoking in the United States

PURPOSE

Prior work demonstrates associations between physical abuse, household alcohol abuse, and household mental illness early in life with obesity and smoking. Studies, however, have not generally been in nationally representative samples and have not conducted analyses to account for bias in the exposure.

METHODS

We used data from the 1979 U.S. National Longitudinal Survey of Youth to test associations between measures of adverse childhood experiences with obesity and smoking and used an instrumental variables approach to address potential measurement error of the exposure.

RESULTS

Models demonstrated associations between childhood physical abuse and obesity at age 40 years (odds ratio [OR] 1.23; 95% confidence interval [CI], 1.00-1.52) and ever smoking (OR 1.83; 95% CI, 1.56-2.16), as well as associations between household alcohol abuse (OR 1.53; 95% CI, 1.31-1.79) and household mental illness (OR 1.29; 95% CI, 1.04-1.60) with ever smoking. We find no evidence of association modification by gender, socioeconomic position, or race and/or ethnicity. Instrumental variables analysis using a sibling's report of adverse childhood experiences demonstrated a relationship between household alcohol abuse and smoking, with a population attributable fraction of 17% (95% CI, 2.0%-37%) for ever smoking and 6.7% (95% CI, 1.6%-12%) for currently smoking.

CONCLUSIONS

Findings suggest long-term impacts of childhood exposure to physical abuse, household alcohol abuse, and parental mental illness on obesity and smoking and that the association between household alcohol abuse and smoking is not solely due to measurement error.

Nurse practitioner screening for childhood adversity among adult primary care patients: A mixed-method study

BACKGROUND AND PURPOSE

Researchers have demonstrated an association between experiencing childhood abuse and multiple chronic health conditions in adulthood, yet this evidence has not been routinely translated to practice. The purpose of this research study was to examine nurse practitioner (NP) practices, skills, attitudes, and perceived barriers associated with screening adult patients for childhood abuse to determine the extent to which evidence of the association between childhood abuse and negative health outcomes has been translated to NP practice.

METHODS

A mixed-method approach with web-based questionnaires and online focus groups was used to examine NP screening for histories of childhood abuse.

CONCLUSIONS

A total of 188 complete NP surveys were analyzed along with data from focus groups with 12 NPs. One third of the NPs regularly screened for childhood abuse and believed screening was their responsibility. Six barriers, including insufficient time and lack of confidence when inquiring about abuse, were significantly associated with NP screening practices. The focus group participants discussed how and when one should ask about childhood abuse, and the need for education about screening.

IMPLICATIONS FOR PRACTICE

Time constraints and NPs' lack of confidence in their ability to screen for histories of childhood abuse must be addressed to encourage routine screening in primary care practice.

Clarifying Associations between Childhood Adversity, Social Support, Behavioral Factors, and Mental Health, Health, and Well-Being in Adulthood: A Population-Based Study

Previous studies have shown that socio-demographic factors, childhood socioeconomic status (CSES), childhood traumatic experiences (CTEs), social support and behavioral factors are associated with health and well-being in adulthood. However, the relative importance of these factors for mental health, health, and well-being has not been studied. Moreover, the mechanisms by which CTEs affect mental health, health, and well-being in adulthood are not clear. Using data from a representative sample (n = 12,981) of the adult population in Tromsø, Norway, this study examines (i) the relative contribution of structural conditions (gender, age, CSES, psychological abuse, physical abuse, and substance abuse distress) to social support and behavioral factors in adulthood; (ii) the relative contribution of socio-demographic factors, CSES, CTEs, social support, and behavioral factors to three multi-item instruments of mental health (SCL-10), health (EQ-5D), and subjective well-being (SWLS) in adulthood; (iii) the impact of CTEs on mental health, health, and well-being in adulthood, and; (iv) the mediating role of adult social support and behavioral factors in these associations. Instrumental support (24.16%, p < 0.001) explained most of the variation in mental health, while gender (21.32%, p < 0.001) explained most of the variation in health, and emotional support (23.34%, p < 0.001) explained most of the variation in well-being. Psychological abuse was relatively more important for mental health (12.13%), health (7.01%), and well-being (9.09%), as compared to physical abuse, and substance abuse distress. The subjective assessment of childhood financial conditions was relatively more important for mental health (6.02%), health (10.60%), and well-being (20.60%), as compared to mother's and father's education. CTEs were relatively more important for mental health, while, CSES was relatively more important for health and well-being. Respondents exposed to all three types of CTEs had a more than two-fold increased risk of being mentally unhealthy (RR Total Effect = 2.75, 95% CI: 2.19-3.10), an 89% increased risk of being unhealthy (RR Total Effect = 1.89, 95% CI: 1.47-1.99), and a 42% increased risk of having a low level of well-being in adulthood (RR Total Effect = 1.42, 95% CI: 1.29-1.52). Social support and behavioral factors mediate 11-18% (p < 0.01) of these effects. The study advances the theoretical understanding of how CTEs influence adult mental health, health, and well-being.

Childhood Disadvantage and Health Problems in Middle and Later Life: Early Imprints on Physical Health?

Drawing from cumulative inequality theory, we examine the relationship between childhood disadvantage and health problems in adulthood. Using two waves of data from Midlife Development in the United States, we investigate whether childhood disadvantage is associated with adult disadvantage, including fewer social resources, and the effect of lifelong disadvantage on health problems measured at the baseline survey and a 10-year follow-up. Findings reveal that childhood socioeconomic disadvantage and frequent abuse by parents are generally associated with fewer adult social resources and more lifestyle risks. Health problems, in turn, are affected by childhood disadvantage and by lifestyle risks, especially smoking and obesity. Not only was early disadvantage related to health problems at the baseline survey, but childhood socioeconomic disadvantage and frequent abuse also were related to the development of new health problems at the follow-up survey. These findings reveal the imprint of early disadvantage on health decades later and suggest greater attention to resources, even during midlife, can interrupt the chain of risks.

Health consequences of adverse childhood experiences: a systematic review

PURPOSE

Adverse childhood experiences (ACEs) have been associated with negative health outcomes, but the evidence has had limited application in primary care practice. The purpose of this study was to systematically review the research on associations between ACEs and adult health outcomes to inform nurse practitioners (NPs) in primary care practice.

DATA SOURCES

The databases PubMed, CINAHL, PsycINFO, and Social Abstracts were searched for articles published in English between 2008 and 2013 using the search term "adverse childhood experiences." Forty-two research articles were included in the synthesis. The evidence was synthesized and is reported following the preferred reporting items for systematic reviews and meta-analysis procedure (PRISMA).

CONCLUSIONS

ACEs have been associated with health consequences including physical and psychological conditions, risk behaviors, developmental disruption, and increased healthcare utilization. Generalization of the results is limited by a majority of studies (41/42) measuring childhood adversity using self-report measures.

IMPLICATIONS FOR PRACTICE

NPs are encouraged to incorporate assessment of patients' childhood history in routine primary care and to consider the evidence that supports a relationship between ACEs and health. Although difficult, talking about patient's childhood experiences may positively influence health outcomes.

Adverse childhood experiences and chronic hypothalamic-pituitary-adrenal activity

Inconsistencies exist in the current literature regarding hypothalamic-pituitary-adrenal (HPA) regulation following exposure to repeated stressful events. These inconsistencies stem, in part, from the limitations imposed by measuring cortisol in saliva or plasma (i.e. "point measures" of HPA activity). The present study used a cross-sectional, correlational design to examine the relationship between childhood stress (assessed using the adverse childhood experiences [ACEs] questionnaire) and hair cortisol (a biomarker of chronic HPA activity) in 55 healthy 18-24-year-old college students. Dichotomous ACE score for two models using different cut-points was significantly, inversely related to hair cortisol level (B = 1.03, p = 0.046 and B = 1.09, p = 0.031). These results are consistent with theoretical models where exposure to repeated stressful events results in chronic HPA dysregulation, which may include down-regulation under certain conditions.

Association between childhood physical abuse, unprotected receptive anal intercourse and HIV infection among young men who have sex with men in Vancouver, Canada

Introduction

The association between childhood sexual abuse and HIV risk among men who have sex with men (MSM) is well established. However, no studies have examined the potential impact of other forms of childhood maltreatment on HIV incidence in this population.

Methods

We explored the impact of child physical abuse (CPA) on HIV seroconversion in a cohort of gay/bisexual men aged 15 to 30 in Vancouver, Canada. Cox proportional hazard models were used, controlling for confounders.

Results

Among 287 participants, 211 (73.5%) reported experiencing CPA before the age of 17, and 42 (14.6%) reporting URAI in the past year. After a median of 6.6 years follow-up, 16 (5.8%) participants HIV-seroconverted. In multivariate analysis, CPA was significantly associated with HIV seroconversion (adjusted hazard ratio [AHR] = 4.89, 95% confidence interval (CI): 1.65–14.48), after controlling for potential confounders.

Conclusion

Our study uncovered a link between childhood physical violence and HIV incidence. Results highlight an urgent need for screening of young gay and bisexual men for histories of violence, and social and structural supports to prevent HIV transmission in this population.

A Life Course Model of Self-Reported Violence Exposure and Ill-health with A Public Health Problem Perspective

Violence has probably always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. In 1996, WHO:s Forty-Ninth World Health Assembly adopted a resolution, declaring violence a major and growing public health problem around the world. Public health work centers around health promotion and disease prevention activities in the population and public health is an expression of the health status of the population taking into account both the level and the distribution of health. Exposure to violence can have many aspects, differing throughout the life course ― deprivation of autonomy, financial exploitation, psychological and physical neglect or abuse — but all types share common characteristics: the use of destructive force to control others by depriving them of safety, freedom, health and, in too many instances, life; the epidemic proportions of the problem, particularly among vulnerable groups; a devastating impact on individuals, families, neighborhoods, communities, and society. There is considerable evidence that stressful early life events influence a variety of physical and/or psychological health problems later in life. Childhood adversity has been linked to elevated rates of morbidity and mortality from number of chronic diseases. A model outlining potential biobehavioural pathways is put forward that may be a potential explanation of how exposure to violence among both men and women work as an important risk factor for ill health and should receive greater attention in public health work.

Violência psicológica e contexto familiar de adolescentes usuários de serviços ambulatoriais em um hospital pediátrico público terciário

Buscou-se investigar a associação da violência psicológica (VP) na adolescência com fatores sociodemográficos, estrutura/relacionamento familiar e com outras formas de maus-tratos. Aplicou-se em 229 adolescentes (11-18 anos) um questionário, em serviços ambulatoriais de um hospital pediátrico público terciário. Encontrou-se que 26,4% dos entrevistados sofrem VP severa no contexto familiar, sendo que apenas cinco relataram não sofrer qualquer tipo de VP familiar, sugerindo que essa violência é considerada como uma forma corriqueira de relacionamento familiar. Comportamentos de VP familiares mais relatados: ser criticado pelo que faz ou diz, não ser encorajado quando tenta atuar de forma autônoma, ser chamado por nomes desagradáveis e ter adulto dizendo que está errado ao tentar agir. Insatisfação dos responsáveis com o adolescente, a estrutura familiar nuclear, a posição da criança entre os irmãos e o compartilhamento dos mesmos pais pelos irmãos mostraram-se associados à VP que ocorre no contexto familiar. O setor saúde, capacitando-se para detectar os sinais de VP, pode promover o direito à saúde integral de adolescentes, confirmando ser um dos principais setores sociais capazes de atuar preventivamente sobre as formas de violência sofridas e praticadas pelo grupo familiar.

Carrying the pain of abuse: gender-specific findings on the relationship between childhood physical abuse and obesity in adulthood

BACKGROUND

Childhood abuse has been associated with negative adult health outcomes, including obesity. This study sought to investigate the association between childhood physical abuse and adult obesity, while controlling for five clusters of potentially confounding factors: childhood stressors, socioeconomic indicators, marital status, health behaviors, and mental health.

METHODS

Representative data from the 2005 Canadian Community Health Survey were selected. The response rate was approximately 84%. Gender-specific logistic regression analyses determined the association between abuse and obesity, while controlling for age and race and five clusters of potentially confounding factors. Of the 12,590 respondents with complete data, 2,787 were obese and 976 reported physical abuse as a child or adolescent by someone close to them.

RESULTS

Among women with childhood physical abuse compared to no abuse, the odds of obesity were 35% higher, even when controlling for age, race, and the five clusters of factors (odds ratio (OR) = 1.35; 95% confidence interval (CI) = 1.09, 1.67). Childhood physical abuse was not associated with adult obesity among men (OR = 1.12; 95% CI = 0.82, 1.53).

CONCLUSIONS

This study provides one of the first population-based, gender-specific analyses of the association between childhood physical abuse and obesity controlling for a wide range of factors. The gender-specific findings require further exploration.

Does childhood misfortune increase cancer risk in adulthood?

OBJECTIVE

To address the inconsistent findings on whether childhood misfortune increases adult cancer occurrence.

METHODS

This study uses longitudinal data from the National Survey of Midlife Development in the United States (MIDUS) that first sampled 3,032 respondents aged 25 to 74 during 1995-1996. A series of logistic regressions were estimated separately for men and women to test whether the effect of childhood misfortune on adult cancer was largely cumulative or specific to the type or profile of misfortune.

RESULTS

For men, additive childhood misfortune, physical abuse by father, and frequent abuse by either parent increased cancer risk. For women, physical abuse by mother and frequent abuse by either parent increased cancer risk.

DISCUSSION

Analyses revealed the importance of examining alternative specifications of childhood misfortune for men and women. Additive childhood misfortune predicted cancer for men only, whereas child abuse by parent of the same sex predicted cancer for men and women.

The effects of employment status and daily stressors on time spent on daily household chores in middle-aged and older adults

PURPOSE OF THE STUDY

This study examines how employment status (worker vs. retiree) and life course influences (age, gender, and marital status) are associated with time spent on daily household chores. Second, this study assesses whether the associations between daily stressors and time spent on daily household chores differ as a function of employment status and life course influences.

DESIGN AND METHODS

Men and women aged 55-74 from the National Study of Daily Experiences (N = 268; 133 workers and 135 retirees), a part of the National Survey of Midlife in the United States (MIDUS), completed telephone interviews regarding their daily experiences across 8 consecutive evenings.

RESULTS

Working women spent more than double the amount of time on daily household chores than working men. Unmarried retirees spent the most time on daily household chores in comparison to their counterparts. There was a trend toward significance for the association between home stressors from the previous day and time spent on daily household chores as a function of employment and marital status.

IMPLICATIONS

These findings highlight the importance of gender and marital status in the associations between employment status and time spent on daily household chores and the role that daily stressors, in particular home stressful events, have on daily household chore participation.

[The (in)visibility of psychological family violence in childhood and adolescence]

Psychological family violence in childhood and adolescence is still poorly studied, due to difficulties in its definition and detection. This article aims to examine how psychological family violence reported by children and adolescents has been addressed in academic studies, using a literature review (LILACS, MEDLINE, SciELO, PubMed, CAPES Portal, PsycINFO, and SCOPUS databases). Among 51 epidemiological studies, 16 articles met the review's objectives; some of the articles reported a high prevalence of such violence. The study showed that the issue has been studied more in the international literature than in Brazil, which has significantly increased its visibility in the last decade but still faces difficulties involving definition, conceptualization, and operationalization. Eliminating the invisibility of psychological violence in the family could help promote prevention of such violence and protection of children and adolescents.

Foundations of posttraumatic stress disorder: Does early life trauma lead to adult posttraumatic stress disorder?

The effects of childhood abuse are diverse, and although pathology is not the only outcome, psychiatric illness, including posttraumatic stress disorder (PTSD), can develop. However, adult PTSD is less common among those who experienced single-event traumas as children than it is among those who experienced childhood abuse. In addition, PTSD is more common among adults than children who experienced childhood abuse. Such evidence raises doubt about the direct, causal link between childhood trauma and adult PTSD. The experience of childhood trauma, and in particular abuse, has been identified as a risk factor for subsequent development of PTSD following exposure to adult trauma, and a substantial literature identifies revictimization as a factor that plays a pivotal role in this trajectory. The literature on the developmental effects of childhood abuse and pathways to revictimization, when considered in tandem with the biological effects of early stress in animal models, may provide some explanations for this. Specifically, it seems possible that permanent sensitization of the hypothalamic–pituitary–adrenal axis and behavioral outcomes are a consequence of childhood abuse, and these combine with the impact of retraumatization to sustain, perpetuate, and amplify symptomatology of those exposed to maltreatment in childhood.

Childhood trauma and chronic illness in adulthood: mental health and socioeconomic status as explanatory factors and buffers

Experiences of traumatic events in childhood have been shown to have long-term consequences for health in adulthood. With data from the 2005 Canadian Community Health Survey we take a life course perspective of cumulative disadvantage and examine the potential role of mental health and socioeconomic status in adulthood as multiple mediators of the link between childhood trauma and chronic illness in adulthood. Mental health and socioeconomic status are also tested as buffers against the typically adverse consequences of childhood trauma. The results suggest mental health and socioeconomic status partially explain the association of childhood trauma with chronic illness in adulthood, with mental health showing a stronger effect. In addition, an analysis of the interactions suggested higher socioeconomic status is a potential protective factor for those with a history of trauma. Results also suggest cumulative disadvantage following trauma may lead to chronic illness and suggest the need for public health expenditures on resources such as counseling and income supports to prevent or reduce psychological harm and chronic illness resulting from traumatic events.