Some problems with life event lists and health outcomes

Epidemiology of Trauma History and Body Pain: A Retrospective Study of Community-Based Australian Women

OBJECTIVE

To assess whether body pain was associated with different trauma histories (physical injury vs. interpersonal injury [IPI]) within Australian women, along with body pain and trauma history associations with biological and psychological (biopsycho) confounders.

METHODS

A retrospective cross-sectional analysis was conducted on the Australian Longitudinal Study on Women's Health (ALSWH) 1973-1978 birth cohort wave 6 data. Relevant life events were categorized into two types of traumatic experience and included as exposure variables in a multinomial regression model for body pain subgroups. Also, subgroup analyses considered trauma and pain effects and interactions on biopsycho burden.

RESULTS

The unadjusted multinomial regression model revealed that a history of physical injury was found to be significantly associated with body pain severity, as was a history of IPI trauma. After the model was adjusted to include biopsycho confounders, the association between IPI and body pain was no longer significant, and post hoc analysis revealed the relationship was instead mediated by biopsycho confounders. Women with a history of IPI and body pain were also found to have the greatest biopsycho (physical functioning, stress, anxiety, and depression) burden.

DISCUSSION

The relationship between IPI and body pain was found to be mediated by biopsycho burden, whereas the relationship between physical injury and body pain was not. Also, a history of IPI was associated with a greater biopsycho burden than was a history of physical injury. These results suggest there is clinical value in considering the comprehensive trauma history of patients with pain when developing their biopsychosocial model of care.

Retrospective Reports of Negative Early Life Events Over a 4-Year Period: A Test of Measurement Invariance and Response Consistency

Objectives

The present study examined measurement invariance (i.e., construct validity), response consistency (i.e., test-retest reliability), and potential predictors of response consistency to the Health and Retirement Study (HRS) negative early life events questionnaire over two time points.

Method

The study was based on the HRS psychosocial questionnaire, which is a U.S. nationally representative survey of individuals older than 50 years and their spouses of any age. Overall, 4,541 individuals older than 50 years were eligible to complete the questionnaire and responded to all four negative early life events items in 2008 and 2012.

Results

Only partial invariance across the two time points was established (with three of the four loadings and two thresholds remaining constant over time). For 20% of the sample, at least one item was inconsistently reported across waves. A positive response to a negative early life event item in 2008 was the most consistent predictor of response inconsistency over time.

Conclusions

The measure of negative early life events has limited construct validity and test-retest reliability. Inconsistency is particularly high among those who had first endorsed an item. The use of this retrospective measure for the understanding of age and aging should be considered with caution. Panel surveys might consider probing about early life events repeatedly to better address inconsistencies over time.

A standardized list of affect-related life events

In experimental contexts, affect-related word lists have been widely applied when examining how cognitive processes interact with emotional processes. These lists, however, present limitations when studying the relation between emotion and cognitive processes such as time and number processing because affective words do not inherently contain time or quantity information. Live events, in contrast, are experienced by an observer and therefore inherently carry affect information. Unfortunately, existing life-event lists and inventories have been largely applied within clinical contexts as diagnostic tools, and therefore are not suitable for many experimental contexts because they do not contain a balanced number of reliably positive, negative, and neutral life events. In Experiment 1, we create a standardized affect-related life-events list with 171 positive, negative, and neutral affect-related life events. In Experiment 2, we show that strength of affect and significance of the event are integral dimensions, suggesting that these two features are difficult to separate perceptually. The implications of these findings and some potential future applications of the created life-events list are discussed.

Life Course Pathways of Economic Hardship and Mobility and Midlife Trajectories of Health

We utilize over 40 years of prospective data from the Panel Study of Income Dynamics (N = 1,229) and repeated-measures latent class analysis to examine how long-term patterns of stability and change in economic hardship from childhood to adulthood are related to subsequent trajectories of midlife health. We review conceptual and methodological approaches to examining health inequality across the life course and highlight the contribution of a person-centered, disaggregated approach to modeling health and its association with long-term pathways of economic resources, including changing resources associated with mobility. Findings suggest those who experienced early mobility out of economic hardship were less likely than those in persistent economic hardship to experience a high-risk health trajectory, while experiencing later mobility did not lessen this risk. We conclude with a call for further investigation into the role of social mobility and the timing, degree, and direction of change in investigations of health inequality.

Childhood Trauma and Illicit Drug Use in Adolescence: A Population-Based National Comorbidity Survey Replication-Adolescent Supplement Study

OBJECTIVE

Although potentially traumatic events (PTEs) are established risk factors for substance use disorders among adults, little is known about associations with drug use during adolescence, an important developmental stage for drug use prevention. We examined whether childhood PTEs were associated with illicit drug use among a representative sample of US adolescents.

METHOD

Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), which included adolescents aged 13 to 18 years (N = 9,956). Weighted logistic regression models estimated risk ratios for lifetime use of marijuana, cocaine, nonmedical prescription drugs, other drugs, and multiple drugs.

RESULTS

Exposure to any PTE before age 11 years was reported by 36% of the sample and was associated with higher risk for use of marijuana (risk ratio [RR] = 1.50), cocaine (RR = 2.78), prescription drugs (RR = 1.80), other drugs (RR = 1.90), and multiple drugs (RR = 1.74). A positive monotonic relationship was observed between number of PTEs and marijuana, other drug, and multiple drug use. Interpersonal violence was associated with all drug use outcomes. Accidents and unspecified events were associated with higher risk for marijuana, cocaine, and prescription drug use.

CONCLUSION

Potentially traumatic events in childhood are associated with risk for illicit drug use among US adolescents. These findings add to the literature by illustrating a potentially modifiable health behavior that may be a target for intervention. The results also highlight that adolescents with a trauma history are a high-risk group for illicit drug use and may benefit from trauma-focused prevention efforts that specifically address traumatic memories and coping strategies for dealing with stressful life events.

Alcohol Expectancies Mediate the Relationship Between Age of First Intoxication and Drinking Outcomes in College Binge Drinkers

BACKGROUND

While prior research has shown that age of first intoxication (AI) is associated with negative alcohol outcomes, limited research has examined factors accounting for this relationship. Alcohol expectancies, or beliefs about the effects of alcohol, may explain such associations as both positive and negative expectancies have been shown to be key predictors of drinking outcomes.

OBJECTIVE

The present study examined expectancies as mediators between early AI and alcohol-related outcomes.

METHOD

Data collection occurred in 2012 and 2013. Participants were college students (N = 562, 65.8% women) who completed an online survey including measures of alcohol use history, alcohol expectancies, typical alcohol consumption, and alcohol-related problems. Structural equation modeling was used to test the hypothesized model.

RESULTS

Our findings support a model whereby AI is associated with drinking through its influence on both positive and negative expectancies. Specifically, an earlier AI was associated with stronger alcohol expectancies, which in turn, was associated with heavier alcohol use and alcohol-related problems.

CONCLUSIONS/IMPORTANCE

These findings are consistent with expectancy theory and previous research suggesting that more experienced drinkers hold stronger drinking-related beliefs, be it positive or negative, and these expectancies ultimately explain variability in alcohol use and problems. Our findings further support that expectancies play an important role in the initiation of drinking behavior.

Life events and chronic physical conditions among left-behind farmers in rural China a cross-sectional study

BACKGROUND

This study investigates the relationships between life events and chronic physical conditions among left behind farmers, a newly emerged weak group in vast rural China.

METHODS

The study collected information about life events, chronic physical conditions, blood pressure and fasting blood glucose from 4681 famers living in 18 randomly selected villages (Lu'an, Anhui, China) from early November 2013 to the end of December 2013. It compared the risk and odds ratios (RRs/ORs) among different subgroups divided according two life event indices derived by adding up un-weighted-ratings and weighted-ratings based on multivariate logistic regression coefficients respectively.

RESULTS

A total of 4040 (86.3 % eligible) farmers completed the survey. RRs between farmers with lower than the first 1/15-percentile of life event index and with higher life event index scores ranged 1.43-5.79 for chronic gastritis and 0.42-9.07 for prostatitis, 1.01-4.97 for cervicitis/vaginitis, 1.45-3.28 for cardio-cerebrovascular diseases, 1.12-1.58 for hypertension, 1.00-1.66 for diabetes, 1.07-3.35 for pre-diabetes and 5.00-55.00 for "other chronic physical conditions".

CONCLUSIONS

Life events were independently linked with most of the chronic physical conditions in a dose-effectiveness way. RRs between subgroups divided by given percentile cutoff points of life event index compiled using logistic regression models turned out to be substantially higher than that between subgroups divided by same cutoff points of life event index produced via summing up the un-weighted Likert ratings of all the events studied.

Economic hardship in childhood and adult health trajectories: An alternative approach to investigating life-course processes

In this study, we advance existing research on health as a life course process by conceptualizing and measuring both childhood disadvantage and health as dynamic processes in order to investigate the relationship between trajectories of early life socioeconomic conditions and trajectories of health in midlife. We utilize a trajectory-based analysis that takes a disaggregated, person-centered approach to understand dynamic trajectories of health as latent variables that reflect the timing, duration and change in health conditions experienced by respondents over a period of 10 years in midlife as a function of stability and change in exposure to economic hardship in early life. Results from repeated-measures latent class analysis of longitudinal data from the Panel Study of Income Dynamics indicate that economic hardship in childhood has long-term, negative consequences for health both among individuals beginning life and remaining in poverty as well as those moving into poverty. In contrast, adults with more advantaged early life experiences, or who moved out of poverty during the period of observation, were at a lower risk of experiencing health trajectories characterized by the early onset or increasing risk of disease. We argue that a person-centered, disaggregated approach to the study of the relationship between socioeconomic status and health across the life course holds potential for the study of health inequality and that a greater focus on trajectory-based analysis is needed.

Nine year changes in sitting time in young and mid-aged Australian women: findings from the Australian Longitudinal Study for Women's Health

OBJECTIVE

To examine changes in sitting time (ST) in women over nine years and to identify associations between life events and these changes.

METHODS

Young (born 1973-78, n=5215) and mid-aged (born 1946-51, n=6973) women reported life events and ST in four surveys of the Australian Longitudinal Study on Women's Health between 2000 and 2010. Associations between life events and changes in ST between surveys (decreasers ≥2 h/day less, increasers ≥2 h/day more) were estimated using generalized estimating equations.

RESULTS

Against a background of complex changes there was an overall decrease in ST in young women (median change -0.48 h/day, interquartile range [IQR]=-2.54, 1.50) and an increase in ST in mid-aged women (median change 0.43 h/day; IQR=-1.29, 2.0) over nine years. In young women, returning to study and job loss were associated with increased ST, while having a baby, beginning work and decreased income were associated with decreased ST. In mid-aged women, changes at work were associated with increased ST, while retiring and decreased income were associated with decreased ST.

CONCLUSIONS

ST changed over nine years in young and mid-aged Australian women. The life events they experienced, particularly events related to work and family, were associated with these changes.

Exploring relationships over time between psychological distress, perceived stress, life events and immature defense style on disordered eating pathology

Background

Perceived stress, immature defense style, depression and anxiety and negative life events all are known to be associated with eating disorders. The present study aimed to investigate the relationships between these factors and their relative strength of association with eating disorder symptoms over time.

Methods

This research was embedded in a longitudinal study of adult women with varying levels of eating disorder symptoms and who were initially recruited from tertiary educational institutions in two Australian states. Four years from initial recruitment, 371 participants completed the Eating Disorder Examination- Questionnaire (EDE-Q) for eating disorder symptoms.

Kessler-10 Psychological Distress Scale (K-10) as a measure of depression and anxiety, a Life Events Checklist as a measure of previous exposure to potentially traumatic events, the Defense Style Questionnaire (DSQ) and the Perceived Stress Scale (PSS) to determine perceived stress. One year later, in year 5, 295 (878.7%) completed follow-up assessments including the EDE-Q. The questionnaires were completed online or returned via reply paid post.

Results

All four independent factors were found to correlate significantly with the global EDE-Q score in cross-sectional analyses (all Spearman rho (r_s) >0.18, p < 0.01) and at one year follow-up (all r_s > 0.15, all p < 0.05). In multivariate linear regression modeling adjusted for age and year 4 global EDE-Q scores, perceived stress and psychological distress scores were significantly associated with year 5 global EDE-Q scores (p = 0.046 and <0.001 respectively).

Conclusions

Psychological distress, and to a lesser degree perceived stress had the strongest association with eating disorder symptoms over time The findings support further investigation of interventions to reduce distress and perceived stress in adult females with disordered eating.

Influences of Marriage, Motherhood, and Other Life Events on Australian Women’s Employment Aspirations

The study contributes to the understandings of how women negotiate work and family over the life course by investigating what factors impact young women’s aspirations for full time, part-time, and other forms of work. Using data from the Australian Longitudinal Study on Women’s Health (ALSWH) with its nationally representative sample of Australian women, the authors examine how women moving from their 20s to early 30s change their aspirations for employment (at the age of 35) after significant life events and changes, including the birth of a child. Multinomial logistic regression analyses across two transition periods ( N = 7,505 and N = 7,584) showed that changes in employment aspirations co-occurred with movement into marriage or stable relationships and with changes in aspirations for family size. As young women become mothers, or move into situations in which motherhood is likely, many adjusted their employment aspirations away from full-time employment and toward part-time work. The findings suggest a growing awareness of the practical difficulties of balancing paid work and family roles within the current context of work and family policy and practice in Australia. Women’s choices are not free of constraints; rather, younger generations of women negotiate work and family life by adjusting and changing their own aspirations within the context and circumstances of their lives.

Complementary Medicine Use by Middle-aged and Older Women

This study analysed NEO Five Factor Inventory (NEO-FFI) personality trait data in middle-aged and older Australian women and their CAM usage. Participants were women from the Longitudinal study of Ageing in Women (LAW study) aged 47 to 87 years ( N = 419). Only the NEO-FFI trait of Openness was significantly correlated with cumulative CAM product use. Regression models revealed that number of specialists’ consultations, number of CAM products used and reported level of physical and leisure activities were predictive of CAM therapy use; while age was predictive of CAM product use.

Life events and changing physical activity patterns in women at different life stages

BACKGROUND

The impact of life events on physical activity (PA) is little understood.

PURPOSE

The purpose of this study is to examine relationships between specific life events and changes in PA in three cohorts of Australian women.

METHODS

Young (N = 7,173; age 22-27 years), mid-age (N = 8,762; 51-56 years), and older (N = 6,660; 73-78 years) participants in the Australian Longitudinal Study on Women's Health completed surveys on two occasions, 3 years apart.

RESULTS

About one third of the young and mid-age women and one quarter of the older women were "active" at both times. Decreasing PA was associated with marriage and childbirth in young women and with declining health in older women. Increasing PA was associated with retirement and death of spouse in the mid-age women. Stressful events such as divorce, harassment at work, and violence were also associated with changing PA.

CONCLUSIONS

There were significant associations between age-specific life events and PA changes. Understanding these relationships could inform interventions for preventing declines in activity at specific life stages.

Adverse childhood experiences predict earlier age of drinking onset: results from a representative US sample of current or former drinkers

OBJECTIVE

Our goal was to determine whether adverse childhood experiences predicted the age at which drinking was initiated and drinking motives in a representative sample of current or former drinkers in the United States.

METHODS

In 2006, a probability sample of 3592 US current or former drinkers aged 18 to 39 were surveyed. Multinomial logistic regression examined whether each of 10 adverse childhood experiences was associated with earlier ages of drinking onset, controlling for demographics, parental alcohol use, parental attitudes toward drinking, and peers' drinking in adolescence. We also examined whether there was a graded relationship between the number of adverse childhood experiences and age of drinking onset and whether adverse childhood experiences were related to self-reported motives for drinking during the first year that respondents drank.

RESULTS

Sixty-six percent of respondents reported >or=1 adverse childhood experiences, and 19% reported experiencing >or=4. The most commonly reported adverse childhood experiences were parental separation/divorce (41.3%), living with a household member who was a problem drinker (28.7%), mental illness of a household member (24.8%), and sexual abuse (19.1%). Of the 10 specific adverse childhood experiences assessed, 5 were significantly associated with initiating drinking at <or=14 years of age (compared with at >or=21 years of age) after adjustment for confounders, including physical abuse, sexual abuse, having a mentally ill household member, substance abuse in the home, and parental discord or divorce. Compared with those without adverse childhood experiences, respondents with adverse childhood experiences were substantially more likely to report that they drank to cope during the first year that they used alcohol.

CONCLUSIONS

Results suggest that children with particular adverse childhood experiences may initiate drinking earlier than their peers and that they may be more likely to drink to cope with problems (rather than for pleasure or to be social).

Attrition in longitudinal studies: who do you lose?

OBJECTIVE

To describe the risk factors for various types of attrition in three age cohorts of women in a longitudinal study and to discuss strategies to minimise attrition.

METHODS

Analysis of survey data from the Australian Longitudinal Study on Women's Health, collected by mailed questionnaire. In 1996, the study recruited and surveyed a national random sample of 'younger' (18-23 years, n = 14,247), 'mid-age' (45-50 years, n = 13,716), and 'older' women (70-75 years, n = 12,432), and began a staggered cycle of mailed follow-up questionnaires: 1998 (mid-age), 1999 (older), 2000 (younger) and so on. Demographic, health and social risk factors for attrition were examined using multivariate analysis.

RESULTS

Attrition at survey 2 was highest among younger women (32%), mainly because of participants not being contactable (21%), and lower among the older (16%) and mid-age women (10%). At survey 1, the survey 2 non-respondents were more likely to report having less education, being born in a non-English-speaking country and being a current smoker, in all cohorts, and had poorer health (mid-age and older cohort) and more difficulty managing on their income (younger and mid-age).

CONCLUSION

Although the magnitude of different types of attrition was found to differ by age, there were several risk factors for attrition that remained consistent. These findings are important to inform future studies on ways to lessen or prevent systematic loss of participants.

IMPLICATIONS

Recruitment and follow-up methods in longitudinal studies should be tailored to maximise retention of participants at higher risk of dropout.