The Relationship of Adverse Childhood Events to Smoking, Overweight, Obesity and Binge Drinking Among Women in Hawaii

Tobacco use behavior among adults exposed to cumulative adverse childhood experiences: A systematic review and meta analysis

BACKGROUND

Tobacco use remains one of the most used substances among adults globally and substantially impacts individuals and society. Adverse childhood experiences (ACEs) contribute to tobacco use. However, the association between cumulative ACEs and tobacco use behaviors (TUB) has not been established in the literature. In this review, we aimed to estimate the prevalence of ACEs among adult tobacco users and evaluated the relationship between cumulative ACEs and TUB.

METHODS

We identified original articles published before October 2022 by searching PubMed, CINAHL, and Psych INFO databases. Inclusion criteria were: English language, adults and used instruments assessing for cumulative ACEs defined as four or more ACEs.

RESULTS

Forty-two studies, totaling 674,087 participants; predominantly cohort and cross-sectional in study design (n = 33). Exposure to 4 ≥ ACEs was significantly associated with increasing the odds of current tobacco use (n = 35), ever or former tobacco use (n = 13), tobacco use initiation, (n = 3) nicotine dependence (n = 1), and ever using electronic cigarettes (n = 1). In the meta-analysis, as compared to those without ACEs, those with 4 ≥ ACEs were twice as likely to have ever used tobacco (OR = 2.16, 95 %CI:1.73-2.70) and approximately four times more likely to have used tobacco currently (OR = 3.73, 95 %CI:2.69-5.18).

CONCLUSION

The cumulative ACEs exposure can increase the risk for TUB. However, the evidence is limited primarily to cigarette use. Ongoing research into the effects of cumulative ACEs on TUB is needed to integrate trauma-informed intervention in treating tobacco use and guide public health initiatives aimed to reduce the prevalence of ACEs and TUB among adults.

Prediction of Addiction Relapse Based on Perceived Social Support and Childhood Trauma

Background

The adverse effects of addiction relapse have always been major challenges in addiction treatment. Perceived social support and childhood trauma are determinants of drug addiction and relapse prevention. The current study aimed to predict drug addiction relapse based on perceived social support and childhood trauma in drug addiction treatment centers in Qom, Iran.

Methods

The present study examined 320 individuals, who visited drug addiction treatment centers in Qom, Iran and were selected using the purposive sampling method. The data collection tools included a demographic information questionnaire, the Social Support Scale, the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and the Addiction Relapse Frequency Questionnaire. Data were analyzed using SPSS 20 and independent t-tests, analysis of variance (ANOVA), Pearson test, and multivariate regression.

Findings

The research results indicated that 49.4% (n=158) of cases used opium. The results of multivariate regression of the factors related to addiction relapse indicated that the childhood trauma score had a significant effect on the relapse of more than 3 times in a way that childhood trauma increased the relapse rate of more than 3 times by 13%, but social support caused a significant reduction in the relapse rate of more than 3 times.

Conclusion

The research findings indicated that addiction relapse had a significant relationship with childhood trauma and perceived social support. The results can be a guide for future studies to expand psychological knowledge about the determinants of the treatment and prevention of addiction relapse and help to develop psychological explanations of this disorder.

Adverse childhood experiences and risky behaviors in male college students

Objective: The current study examined associations between ACEs and health-risk behaviors in male college students.Participants:795 men who attended a large southern public university.Method:One-way ANOVA was used to explore whether the ACEs of sexual abuse, exposure to interparental violence, household mental illness, and household substance abuse significantly affected male college students' high risk drinking, number of sexual partners, and/or impulsivity.Results:Sexual abuse was significantly associated with all three measured outcomes and had the strongest associations of all assessed ACEs. Exposure to interparental violence was significantly associated only with number of sexual partners. Household substance abuse was significantly associated with high risk drinking and number of sexual partners. A simple linear regression revealed that for each additional ACE, students in the sample increased their risky behaviors.Conclusions:Results confirm a dose-response between ACEs and negative outcomes. Mindfulness training, policy/funding advocacy, and trauma-informed support are discussed as implications.

Less than ideal cardiovascular health among adults is associated with experiencing adverse childhood events: BRFSS 2019

Ideal cardiovascular health (CVH) is associated with a lower risk of heart disease and stroke while adverse childhood events (ACEs) are related to health behaviors (e.g., smoking, unhealthy diet) and conditions (e.g., hypertension, diabetes) associated with CVH. Data from the 2019 Behavioral Risk Factor Surveillance System was used to explore ACEs and CVH among 86,584 adults ≥18 years from 20 states. CVH was defined as poor (0-2), intermediate (3-5), and ideal (6-7) from summation of survey indicators (normal weight, healthy diet, adequate physical activity, not smoking, no hypertension, no high cholesterol, and no diabetes). ACEs was summed by number (0,1, 2, 3, and ≥4). A generalized logit model estimated associations between poor and intermediate CVH (ideal as referent) and ACEs accounting for age, race/ethnicity, sex, education, and health care coverage. Overall, 16.7% (95% Confidence Interval[CI]:16.3-17.1) had poor, 72.4% (95%CI:71.9-72.9) had intermediate, and 10.9% (95%CI:10.5-11.3) had ideal CVH. Zero ACEs were reported for 37.0% (95%CI:36.4-37.6), 22.5% (95%CI:22.0-23.0) reported 1, 12.7% (95%CI:12.3-13.1) reported 2, 8.5% (95%CI:8.2-8.9) reported 3, and 19.3% (95%CI:18.8-19.8) reported ≥4 ACEs. Those with 1 (Adjusted Odds Ratio [AOR] = 1.27;95%CI = 1.11-1.46), 2 (AOR = 1.63;95%CI:1.36-1.96), 3 (AOR = 2.01;95%CI:1.66-2.44), and ≥ 4 (AOR = 2.47;95%CI:2.11-2.89) ACEs were more likely to report poor (vs. ideal) CVH compared to those with 0 ACEs. Those who reported 2 (AOR = 1.28;95%CI = 1.08-1.51), 3 (AOR = 1.48;95%CI:1.25-1.75), and ≥ 4 (AOR = 1.59;95%CI:1.38-1.83) ACEs were more likely to report intermediate (vs. ideal) CVH compared to those with 0 ACEs. Preventing and mitigating the harms of ACEs and addressing barriers to ideal CVH, particularly social and structural determinants, may improve health.

Prevalence and Associated Factors of E-Cigarette Use among Adolescents in Southeast Asia: A Systematic Review

The use of e-cigarettes in adolescents remains a major public health concern. Like other tobacco products, e-cigarettes pose health risks to adolescents. Understanding the magnitude of this problem and identification of its associated factors will serve as a guide for development of preventive interventions. This systematic review aims to identify and discuss current epidemiological data on the prevalence and associated factors of e-cigarette use among adolescents in Southeast Asia. The reporting of this systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. We carried out a literature search through three databases (Scopus, PubMed, Web of Science) and targeted original English-language articles published between 2012 and 2021. A total of 10 studies were included in this review. The prevalence of current e-cigarette uses ranges from 3.3% to 11.8%. Several associated factors of e-cigarette use were identified, including sociodemographic factors, traumatic childhood experience, peer and parental influence, knowledge and perception, substance use, and accessibility of e-cigarettes. These factors should be addressed though multifaceted interventions which simultaneously target multiple factors. Laws, policies, programs, and interventions must be strengthened and tailored to the needs of adolescents at risk of using e-cigarettes.

Examining Adverse Childhood Experiences (ACEs) within Indigenous Populations: a Systematic Review

Health concerns in Indigenous people are often greater in comparison to those in non-Indigenous populations, including increased rates of chronic diseases and mental health concerns. Adverse childhood experiences (ACEs) may be an explanatory variable for such heightened rates of mental and physical health difficulties for Indigenous populations as these communities have experienced a lack of adequate health care due to remoteness, historical traumas, cultural insensitivity, racism, and perpetuating systemic discrimination. To date, relatively few studies have examined ACEs within an Indigenous population and their relevance to both physical and mental health outcomes. The present study explored existing ACE literature relevant to Indigenous populations and mental or physical health outcomes by retrieving and organizing available ACE literature. A systematic review was conducted using 14 electronic databases of peer-reviewed literature and 18 grey literature databases. Twenty-one publications investigating general health outcomes and prevalence of ACEs met eligibility criteria. ACEs were reported to be higher in Indigenous populations when compared to non-Indigenous population. Higher ACE scores for Indigenous participants were associated with increased rates of suicidality and psychological distress. Protective factors to reduce the impact of ACEs were cultural identity and connectedness, education, social support, and psychological resilience. Future research may further explore the relationship between ACE scores and protective factors, varying prevalence within specific sub-populations, and consistent reporting of outcomes across studies. Ongoing research has the potential to clarify existing dose-response relationships between early traumatic experiences and current health disparities experienced within some Indigenous communities.

Native Hawaiian and other pacific islanders' leading risk factors for ischemic stroke: A comparative ethnographic study

INTRODUCTION

Hawaii is a multicultural state with many different ethnicities, including Native Hawaiians and other Pacific Islanders (NHOPI). This demographic has not been thoroughly studied, despite its significantly higher prevalence of stroke. This study aimed to characterize risk factors for ischemic stroke in NHOPI compared to other ethnicities.

METHODS

An Institutional Review Board (IRB) sanctioned retrospective chart review was conducted at a multi-site community neurology clinic from June 2017 through June 2019. Prospective patients were identified from the database using the International Classification of Diseases 10th Edition (ICD-10) codes for ischemic stroke. 326 patients (99 NHOPI, 116 Asian, 111 Caucasian) with a history of ischemic stroke met the inclusion criteria. Risk factors were determined based on the American Stroke Association guidelines; ethno-racial grouping was based on self-identification; and average household income levels were estimated based on patient zip codes US Census Bureau data. Continuous variable risk factors were analyzed using an analysis of variance (ANOVA) and post-hoc pairwise comparisons using Tukey-Kramer; a multivariate analysis was conducted.

RESULTS

Compared to Asians and Caucasians, NHOPI patients were on average 11 years younger at the onset of stroke and more likely to be women. The NHOPI group also had the highest rates of diabetes and obesity. NHOPI average income was significantly lower compared to the Caucasian group. Hypertension and hyperlipidemia were found to be higher in the Asian population. Alcohol consumption was reported more frequently among Caucasian patients.

CONCLUSIONS

These results better-characterized risk factors for ischemic stroke among NHOPI in Hawaii. The younger age of stroke onset in NHOPI patients is likely due to the higher burden of cardiovascular risk factors like obesity, smoking, and diabetes. Identifying such disparities in associated risk for NHOPI and other ethnicities can allow targeted stroke prevention and outpatient care in a multicultural setting.

An Association of Adverse Childhood Experiences with Binge Drinking in Adulthood: Findings from a Population-Based Study

Background: Adverse childhood experiences (ACEs) are a major public health issue linked to negative health outcomes. Yet, few recent studies drawing on national data have examined the association between ACEs and binge drinking. Objective: The objective of this study was to examine the association between ACEs and binge drinking among adults in the United States and whether this association is dependent on sex. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System survey. An analytic sample of 41,322 adults aged 18-64 years (50.7% male) from 17 states was analyzed using binary logistic regression. The outcome variable was binge drinking, and the main explanatory variable was ACEs. Results: Of the 41,322 respondents, 21.3% engaged in binge drinking. About 30% of the respondents had no ACEs and 23.9% had four or more ACEs. In the multivariable logistic regression, we observed that sex moderated the association between ACEs and binge drinking. Odds were 1.36 times higher for females who experienced two ACEs (aOR = 1.36 p < .05, 95% CI = 1.04-1.77) and 1.58 times higher for females who experienced three ACEs (aOR = 1.58 p < .01, 95% CI = 1.17-2.12) to engage in binge drinking. Other factors associated with binge drinking include younger age, non-Hispanic White, higher income level, higher education, not being married, being overweight, and history of cigarette smoking. Conclusion: The findings of this study underscore the importance of developing sex-appropriate screening and intervention strategies to support individuals exposed to ACEs and potentially mitigate negative health outcomes later in life.

Classes of lifetime adversities among emerging adult women by race/ethnicity and their associations with weight status in the United States

This cross-sectional study examines the association of childhood and adolescent/adult adversities with obesity across four racial/ethnic groups among emerging adult women aged 18 to 25 (n = 9310). Latent class analysis was used to identify racial/ethnicity-specific classes arising from childhood and adolescent/adult adversity indicators in the 2015 and 2018 College Student Health Surveys (sampled from Minnesota, U.S.) Distal outcome procedure and Bolck-Croon-Hagenaars methods were used to assess each class's association with body mass index (BMI) and obesity probability. Models were adjusted for post-secondary school type and parental education. We identified 7 classes for White women, 4 classes for Asian and Latina women, and 5 classes for Black women. Weight distributions of Black and Latina women leaned towards "overweight", whereas White and Asian women's BMI leaned towards "normal weight." Latina and Black women had a wider BMI range (~5 kg/m²) between classes with the highest versus lowest BMI than White and Asian women (~3 kg/m²), suggesting a stronger association between adversities and BMI. For Asian, Black, and White women, the "Low Adversities" class had the lowest obesity prevalence, while the "High Lifetime Adversities" class had the highest prevalence. In contrast, Latina women had the lowest obesity prevalence in the "High Adolescent/Adult Adversities & Low Childhood Adversities" class, and highest prevalence in the "Household Mental Illness" class. Results indicate that racial/ethnic disparities in obesity-related measures are reduced when racial/ethnic groups experience low adversity. Future research should explore tailored adversity interventions that consider adversity exposure differences across race/ethnicity as a strategy for reducing obesity risk.

Plant-based dietary intake moderates adverse childhood experiences association with early mortality in an older Adventist cohort

BACKGROUND

Adverse Childhood Experiences (ACEs) consistently predict poor mental and physical health as well as early all-cause mortality. Much work examines health harming behaviors that may be used to cope with ACEs associated stress responses and dysregulation. Limited research has been conducted assessing plant-based dietary intake on the ACEs and mortality relationship. We investigate moderators of the ACEs and mortality association including plant-based dietary intake.

OBJECTIVE

The purpose of this study is to examine if the association between ACEs and early mortality is potentially moderated by plant-based dietary intake.

PARTICIPANTS

An observational, prospective cohort study that included 9301 Seventh-day Adventists were assessed from 2006 to 2017 in the Biopsychosocial Religion and Health Study (BRHS).

METHODS

We examined the potential impact of plant-based intake frequency on the ACEs and all-cause mortality relationship, while adjusting for potential confounders (e.g., demographics, health risks, mental and physical health) in a cox regression survival analysis.

RESULTS

ACEs were adversely associated with survival time (HR = 2.76, 95% CI: 1.15-6.64). Plant-based intake was associated with a reduction in the association of 4+ ACEs with early mortality (HR = 0.73, 95% CI: 0.59-0.90) above and beyond demographics, animal-based intake, physical health, mental health, BMI, exercise, and worship. We estimate that after 4+ ACEs, those eating high versus low plant-based dietary intake may live 5.4 years longer.

CONCLUSION

Plant-based dietary intake may potentially moderate the ACEs and early mortality relationship; however, observational studies cannot determine causality.

Associations between Obesity and Adverse Childhood Experiences in the United States

Background: Obesity leads to serious health consequences in children and is potentially associated with increased adverse childhood experiences (ACEs). Nationally representative studies examining associations between obesity and ACEs are lacking. Therefore, we aimed to determine the relationship between ACEs and childhood obesity. Methods: We performed a retrospective cross-sectional study of children 10-17 years of age, who participated in the 2018 National Survey of Children's Health (NSCH), a national population-based survey. Obesity was determined by CDC definitions using BMI calculated by the NSCH from self-reported height/weight. Logistic regression, adjusted for key sociodemographic factors, determined differences in rates of ACEs between children with obesity (BMI ≥95th percentile) and those without (BMI <95th percentile). Results: Weighted NSCH data included 29,696,808 children 10-17 years of age, 15% with obesity. Obesity was associated with having more ACEs compared to other children (p < 0.01). In adjusted analyses, children with obesity were more likely than other children to report most ACEs, including food/housing insecurity [adjusted odds ratio (aOR) 1.64, confidence interval (95% CI) 1.26-2.13], parental divorce [1.67 (1.32-2.13)], witnessing physical violence [1.49 (1.03-2.16)], be a victim of violence [1.99, (1.27-3.12)], or live with a person with drug/alcohol abuse [1.65, (1.24-2.2)]. Children with obesity were also more likely to report ≥4 ACEs compared to other children (p < 0.001). Conclusion: Children with obesity are more likely to report ACEs overall and have more ACEs compared to other children. Obesity negatively affects child health; in combination with ACEs, health outcomes of children may be disproportionately affected, highlighting the importance of preventive screening and social interventions in childhood.

Adverse Childhood Experiences and Prevalence of Cigarette and E-Cigarette Use Among Adolescents in Bangkok, Thailand

Currently, e-cigarettes are the most popular tobacco product among adolescents. The purpose of this study was to explore the relationship between exposure to adverse childhood experiences (ACEs) and use of cigarettes, e-cigarettes, and dual use in a sample of adolescents in Bangkok, Thailand. The sample comprises 6167 students from 48 schools (grades 9, 11, and vocational year 2) who participated in the 2019 round of the Behavior Surveillance Survey. History of 11 ACEs was used to calculate a cumulative ACE score (range 0-11). Multinomial logistic regression was used to assess the relationship between history of ACEs and smoking. In the sample, 7.0% reported using e-cigarettes only and 9.5% used e-cigarettes and cigarettes (dual use). After controlling for sociodemographic characteristics, history of ACEs was associated with increased odds of dual use. The odds of cigarette, e-cigarette, and dual use was significantly greater if the adolescent had a history of ≥4 ACEs. Special attention is needed to prevent smoking of different types among those with a history of ACEs.

Identifying a Fine Line between Food Insecurity and Food Acquisition Stress: A Mixed Methods Exploration

This study introduces the concept of Food Acquisition Stress (FAS), stress associated with food acquisition among those who do not necessarily screen positive for food insecurity.. This study used an exploratory sequential mixed methods approach among a sample of predominantly early childhood educators to develop a 7-item tool for measuring current and retrospective FAS. Using this tool, we identified that 61% of individuals who had FAS did not meet criteria for food insecurity. Capturing FAS, even among those categorized as food secure, has the potential to identify individuals who may need supportive interventions. Future research can explore how FAS is related to health behaviors.

Adverse childhood experiences, depression, and cardiometabolic disease in a nationally representative sample

OBJECTIVE

Adverse childhood experiences (ACEs) and depression are both independently associated with increased risk of diabetes and cardiovascular disease (CVD). The objective was to determine if the association of ACEs, examined with Latent Class Analysis (LCA), with CVD and diabetes was stronger in patients with versus without depression.

METHODS

Participants were 78,435 non-institutionalized adults in the United States completing the ACEs module in the 2011-2012 Behavioral Risk Factor Surveillance System. LCA grouped participants into ACE classes. Respondents self-reported ACEs and lifetime depression, diabetes and CVD. Complex survey weighted logistic regression models assessed the relationships between ACEs, diabetes, and CVD overall and in those with and without depression.

RESULTS

Half of participants were female (48.6%) and 82.3% White, non-Hispanic. LCA identified a four-class solution characterized as 'low adversity', 'verbal/physical abuse', 'sexual abuse', and 'high adversity'. The odds ratios for each ACE class and diabetes were similar in those with and without depression. An overall adjusted model showed that 'sexual abuse' versus 'low adversity' was significantly associated with diabetes (OR = 1.30; 95% CI: 1.05-1.61). Effect modification was present for CVD such that among those with depression, but not among those without, 'high adversity' had over two times the odds of CVD than 'low adversity' (OR = 2.17; 95% CI: 1.06-2.93).

CONCLUSIONS

'High adversity' in those with but not without depression is positively associated with CVD. 'Sexual abuse' is positively associated with diabetes independent of depression. The study is relevant to trauma-informed care and highlights the contribution of ACEs and depression to poor health outcomes.

Association of Childhood History of Parental Incarceration and Juvenile Justice Involvement With Mental Health in Early Adulthood

IMPORTANCE

Young adults with a childhood history of parental incarceration (PI) or juvenile justice involvement (JJI) are more likely to have worse mental health outcomes than their peers. However, the association between mental health and exposure to both PI and JJI (PI plus JJI) is unclear.

OBJECTIVE

To determine the association of PI plus JJI exposure with mental health outcomes in young adulthood.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study of the US National Longitudinal Survey of Adolescent to Adult Health was conducted to examine the associations between PI, JJI, and PI plus JJI and mental health outcomes (ie, depression, anxiety, posttraumatic stress disorder, suicidal ideation, and mental health counseling). In-home interviews were conducted of 13 083 participants; 704 participants with PI after age 18 years were excluded, and 12 379 participants formed the analysis sample. Participants were in grades 7 to 12 in 1994 to 1995 and were ages 24 to 32 years at follow-up in 2008. Data analysis was completed in 2019.

EXPOSURES

Parental incarceration, JJI, or PI plus JJI before age 18 years.

MAIN OUTCOMES AND MEASURES

Mental health outcomes in early adulthood (ages 24-32 years). The analysis included multivariable logistic regression models; accounted for individual, family, and geographic-level factors; and generated adjusted odds ratios.

RESULTS

Among 13 083 participants (6962 female; weighted proportion, 49.6%) with a mean age at wave 1 of 15.4 years (95% CI, 15.2-15.7 years), 10 499 (80.2%) did not have a history of PI or JJI, 1247 (9.1%) had childhood PI, 704 (5.2%) had PI after age 18 years, 492 (4.5%) had JJI only, and 141 (1.2%) had PI plus JJI. Sociodemographic characteristics varied by exposure. Exposure to both PI and JJI was associated with a greater risk of depression (adjusted odds ratio, 2.80; 95% CI, 1.60-4.90), anxiety (adjusted odds ratio, 1.89; 95% CI, 1.08-3.31), and posttraumatic stress disorder (adjusted odds ratio, 2.92; 95% CI, 1.09-7.82) compared with peers with neither exposure. Exposure to both PI and JJI did not have an additive association with mental health beyond PI or JJI alone.

CONCLUSIONS AND RELEVANCE

This study suggests that exposure to the criminal justice system during childhood places individuals at risk for poor mental health outcomes in early adulthood. Clinical, advocacy, and policy efforts that prioritize reducing the impact of the US criminal justice system on children may yield substantive improvements in the mental well-being of those individuals as adults.

Adverse childhood events and risk of diabetes onset in the 1979 National longitudinal survey of youth cohort

Background

Type 2 diabetes is a major public health problem with considerable personal and societal costs. Adverse childhood experiences (ACE) are associated with a number of serious and chronic health problems in adulthood, but these experiences have not been adequately studied in relation to diabetes in a US national sample. The association between ACE and poor health can be partially explained by greater risky health behaviors (RHB) such as smoking, heavy alcohol use, or obesity. Few studies have examined ACE in relation to adult onset Type 2 diabetes mellitus (T2DM) taking into account the role of RHB. Using longitudinal data from a representative US population sample followed over 30 years, this study examines the impact of ACE on the risk of diabetes onset.

Methods

Data from the 1982 to 2012 waves of the 1979 National Longitudinal Survey of Youth were analyzed, spanning ages 14 to 56. Bivariate and discrete-time survival models were used to assess the relationships between ACE and RHB including smoking, alcohol use, and obesity, and subsequent onset of diabetes.

Results

T2DM was reported by almost 10% of participants. Over 30% of women and 21% of men reported 2+ ACE events. Women reporting 2–3 or 4+ ACE events were more likely to develop diabetes with the mean number of ACE events being greater in those with diabetes compared to without (1.28 vs.1.05, p < .0001). For men there was no significant association between ACE and diabetes onset. For women, ACE was associated with heavy drinking, current smoking, and obesity. For men, ACE was associated with being underweight and daily smoking. In multivariate discrete-time survival models, each additional ACE increased risk of T2DM onset (OR_adj = 1.14; 95% CI 1.02–1.26) for women but not for men. The relationship in women was attenuated when controlling for body mass index (BMI).

Conclusion

ACE predicted diabetes onset among women, though this relationship was attenuated when controlling for BMI. Being overweight or obese was significantly more common among women with a history of ACE, which suggests BMI may be on the pathway from ACE to diabetes onset for women.

Adverse Childhood Experiences in Infancy and Toddlerhood Predict Obesity and Health Outcomes in Middle Childhood

BACKGROUND

The Adverse Childhood Experiences (ACEs) study articulated the negative effects of childhood trauma on adult weight and health. The purpose of the current study is to examine the associations between ACEs in infancy and toddlerhood and obesity and related health indicators in middle childhood.

METHODS

We used data collected from a sample of low-income families enrolled in the national evaluation of Early Head Start (EHS). Data come from 1335 demographically diverse families collected at or near children's ages 1, 2, 3, and 11. An EHS-ACE index was created based on interview and observation items from data collected at ages 1, 2, and 3, which were averaged to represent exposure across infancy and toddlerhood. At age 11, children's height and weight were measured and parents were asked about their child's health.

RESULTS

Children were exposed at rates of 30%, 28%, 15%, and 8% to one, two, three, and four or more EHS-ACEs, respectively. Logistic regressions revealed significant associations between EHS-ACEs in infancy/toddlerhood and obesity, respiratory problems, taking regular nonattention-related prescriptions, and the parent's global rating of children's health at age 11. Across all outcomes examined, children with four or more ACEs had the poorest health. Compared with children with no ACE exposure, the odds of each of the examined health outcomes were over twice as high for children who experienced four or more ACEs.

CONCLUSIONS

Findings highlight that ACEs experienced very early in development are associated with children whose health is at risk later in childhood.

Is the childhood home food environment a confounder of the association between child maltreatment exposure and adult body mass index?

Childhood maltreatment is consistently associated with adult obesity, leading to calls for tailored weight interventions for people with maltreatment histories. However, it is possible that the maltreatment-obesity association is spurious and driven by unmeasured confounding, in which case such interventions would be misplaced. The home food environment in childhood is a potential confounder, but its role in the association of maltreatment with obesity has not been examined. We used a longitudinal dataset (Project EAT) to examine the association of adult retrospective reports of maltreatment history in childhood (1+ types of maltreatment before age 18 years) with previously-collected prospective childhood reports of home food environment characteristics (availability of healthy foods, availability of sweet/salty snack food, family meal frequency, and food insufficiency). We then estimated the association between maltreatment and adult body mass index (BMI, kg/m²) with and without adjustment for these home food environment factors. After adjustment for sociodemographics, maltreatment had a 0.84 kg/m² (95% CI: 0.28, 1.41) higher BMI at age 24-39 years, compared to those with no maltreatment, after adjustment for sociodemographics, parenting style, and BMI in childhood. Additional adjustment for home food environment factors had little effect on this association (β = 0.78 kg/m²; 95% CI: 0.21,1.35), suggesting limited confounding influence of the home food environment factors. Findings provide additional robust evidence that childhood maltreatment is a risk factor for obesity that may warrant tailored interventions.