A longitudinal examination of childhood maltreatment and adolescent obesity: results from the National Longitudinal Study of Adolescent Health (AddHealth) Study

Shifts in naturalistic behaviors induced by early social isolation stress are associated with adult binge-like eating in female rats

Binge eating (BE) is a highly pervasive maladaptive coping strategy in response to severe early life stress such as emotional and social neglect. BE is described as repeated episodes of uncontrolled eating and is tightly linked with comorbid mental health concerns. Despite social stressors occurring at a young age, the onset of BE typically does not occur until adulthood providing an interval for potential therapeutic intervention. Currently, our knowledge of longitudinal noninvasive digital biomarkers predictive of BE needs further development. Monitoring longitudinal impacts of adolescent social isolation stress on naturalistic behaviors in rats will enable the identification of noninvasive digital markers of disease progression to predict adult eating strategies. Recognizing adolescent naturalistic behaviors shaped by social stress informs our understanding of the underlying neurocircuits most effected. This study aimed to monitor and identify longitudinal behavioral shifts to enhance predictive capabilities in a rat model of social isolation stress-induced BE. We placed Paired (n = 12) and Socially Isolated (SI, n = 12) female rats in observational home cages weekly for seven weeks to evaluate the effect of SI on 10 naturalistic behaviors. All 10 naturalistic behaviors were simultaneously detected and tracked using Noldus Ethovision XT automated recognition software. Composite phenotypic z-scores were calculated by standardizing all 10 behaviors. When transitioning into adulthood, all rats underwent conventional emotionality testing and were exposed to a Western-like high fat diet (WD, 43% kcal from fat) to evaluate BE. Longitudinal assessments revealed SI-induced shifts in adolescent phenotypic z-scores and that sniffing, unsupported rearing, jumping, and twitching were the most susceptible to SI. SI increased emotionality compared to the Paired controls. Finally, we identified adolescent twitching as a digital biomarker of adult WD consumption. Our findings suggest that home cage monitoring can detect disrupted naturalistic behaviors associated with maladaptive coping.

Association of adverse childhood experiences and overweight or obesity in adolescents: A systematic review and network analysis

This systematic review with meta-analysis assessed the effects of adverse childhood experiences (ACEs) linked to overweight or obesity in adolescents. Twenty-eight studies (cross-sectional, case-control, or cohort) were included, which described individuals with a history of ACE or adverse family experiences, such as physical, emotional, or psychological abuses; neglect; exposure to domestic violence or peer violence; and sexual abuse. Body mass index (BMI) or BMI z score was used by the study to define adolescents with overweight or obesity. Adolescents who reported childhood experiences, mainly physical, sexual, and emotional abuses, were more associated with overweight/obesity, especially those who experienced four or more ACEs. Network meta-analysis indicated that physical, sexual, and neglect were the most common ACEs associated with obesity in adolescents. Due to significant differences and imprecision among the studies, network meta-analysis was inconclusive in determining the impact of other types of ACE on outcomes. However, evidence suggests that exposure to sexual and physical abuse, as well as neglect, is associated with adolescents who are obese or overweight, as well as with the number of ACE experienced. The study presented evidence suggesting that dealing with many ACEs may be a risk factor for overweight and obesity in adolescents.

Let it go, let it go: Stop measuring child maltreatment as a binary yes/no

Numerous methods are used in the measurement of child maltreatment (CM) exposure. As a science, it is necessary that the field of CM research evaluate its measurement approaches periodically to ensure that the common approaches are the best approaches. A prominent method for measuring CM in research as a predictor variable is to conceptualize CM as a two-level, yes/no binary variable (e.g., 0 = No CM exposure, 1 = CM exposure). While there is no consensus on what method is the best approach for measuring CM, empirical evidence suggests that the binary measurement approach to CM has significant limitations. The current paper sought to progress the field of CM and trauma research forward by reviewing several lines of research demonstrating why the use of a binary yes/no CM measurement approach is problematic. As evidence for why a binary measurement of CM should be halted, this paper reviews research on: why the characteristics or details of CM exposure matter, risk of CM "contamination," and CM's relation with environmental or systemic factors. The ethical and clinical implications of a CM binary measurement approach are also discussed. Several recommendations for the field are provided on how researchers can improve the measurement of CM and ensure accurate and replicable studies are being published.

Childhood sexual abuse and IL6 mediated by change in BMI over an 18-year period: A growth curve model

BACKGROUND

Childhood sexual abuse can increase both body weight and inflammation later in life. Higher weight or faster changes in weight, as measured by changes in body mass index (BMI), may mediate the relationship between childhood sexual abuse and inflammation, however, most studies to date have used a cross-sectional design limiting causal inferences.

OBJECTIVE

The current study aimed to investigate the interrelationships between childhood sexual abuse, BMI, and C-reactive protein (CRP) and interleukin-6 (IL6).

PARTICIPANTS AND SETTING

Data from 461 adults who participated in the Midlife in the United States (MIDUS) study were utilized.

METHODS

Growth curve modeling was used to test initial levels of BMI and changes of BMI over an 18-year period as mediators linking childhood sexual abuse to CRP and IL6.

RESULTS

Sexual abuse was not significantly associated with the initial level of BMI; however, sexual abuse was associated with the slope of BMI (b = 0.072, p = .006). BMI intercept (b = 0.080, p = .001) and slope (b = 0.240, p = .002) predicted IL6 values whereas the slope of BMI (b = 0.398, p = .033) but not intercept predicted CRP values. The indirect effect from sexual abuse to IL6 through BMI slope was significant (b = 0.017, 95 % [CI.001, 0.033]) while the indirect effect from sexual abuse to CRP through BMI slope was not significant (b = 0.028, 95 % [CI -0.004, 0.061]).

CONCLUSION

Childhood sexual abuse was indirectly associated with IL6 through rates of change in BMI over time.

Obesity in childhood: associations with parental neglect, nutritional habits, and obesity awareness

Background

The relationships underlying the dynamic between obesity and parental neglect in terms of nutritional habits and obesity awareness are unclear. Parental neglect remains a significant subject of concern that needs to be examined in the context of obesity.

Methods

The aim was to examine the relationships between childhood obesity, parental neglect, children's eating habits and obesity. The study group consisted of 404 children and their parents from Ankara, Turkiye. As data collection tools, an Individual Information Form, Obesity Awareness Scale, the Parents Form of the Multidimensional Neglectful Behaviors Scale were administered. In addition, information on the children's body mass indexes was obtained by anthropometric measurements and the findings were recorded on the questionnaires of each child.

Results

It was found that 98 (24.3%) of the children included in the study were overweight and 63 (15.6%) were obese. The results of the multinomial logistic regression analysis indicated that in the underweight and overweight group, the parents' perception of their child's weight predicted body mass index in children, and in the obese group, along with the parents' perception of their child's weight, the age and gender of the child, eating fast, obesity in the family and parental neglect were also predictors.

Conclusion

Practitioners such as nurses, dietitians and child developmentalists working in schools should consider weight problems in children as one of the indicators of parental neglect and should implement interventive efforts to enhance parental supervision of children at risk.

Childhood Maltreatment and Body Mass Index in Older Adults With Chronic Illness

Background

Childhood trauma has been associated with greater psychological and physical morbidity, including a greater risk of developing coronary artery disease (CAD). Emotional dysregulation and increased body mass index (BMI) may be involved. This study evaluated whether (1) childhood maltreatment is associated with a higher BMI at study onset and with greater increases in BMI 5 years later among older adults with CAD or other chronic illnesses; (2) sex and/or CAD status moderate these results; and (3) baseline symptoms of anxiety, depression, and perceived stress (emotional dysregulation) mediate the association between childhood maltreatment and BMI at follow-up.

Methods

A total of 1232 men and women (aged 60.86 [6.95] years) completed validated questionnaires on childhood maltreatment and symptoms of psychological distress. The weight and height of the participant were measured, and the BMI was calculated using the weight (kg)/height (m2) ratio.

Results

Childhood maltreatment was not significantly associated with BMI at study onset nor at follow-up. This relation did not differ as a function of sex nor CAD status. Although childhood maltreatment was associated with significantly greater psychological distress at study onset (all P < 0.001), there latter was not found to mediate the relation between maltreatment and change in BMI at follow-up.

Conclusions

In contrast to previous literature, childhood maltreatment was not associated with BMI nor with the change in BMI over 5 years in men and women with chronic disease. However, as psychological distress increases risk for morbidity and mortality, it may represent an important target for prevention and intervention in survivors of childhood maltreatment.

Multiple mediation of the association between childhood emotional abuse and adult obesity by anxiety and bulimia - a sample from bariatric surgery candidates and healthy controls

Bulimia, which means a person has episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over their eating, is the most primitive reason for being overweight and obese. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory, Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t-test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables' pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, and childhood emotional abuse as the predictive variable. Pairs of anxiety, bulimia, and depression, bulimia were selected as the mediating variables in different multiple mediation models separately. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482-2.141). The model using anxiety and bulimia as the multiple mediating variables is attested to play roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261-1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.

Sleep and childhood maltreatment: A matched-control study of sleep characteristics in Norwegian 16-19-year-olds

Sleep problems are an important but understudied health problem in adolescents exposed to childhood maltreatment. The current study aimed to examine sleep characteristics and insomnia in a population with maltreatment history and compare them to a general population sample of adolescents. Data from a sample of Norwegian 16-19-year-old adolescents with childhood maltreatment experiences (n = 62) were linked to an age- and sex-matched general population sample (n = 238). Independent samples t tests were used to compare the two groups on several detailed sleep parameters, while general linear models were used to control for mental health problems, assessed by the Strengths and Difficulties Questionnaire. Mental health was examined as a potential mediator between childhood maltreatment and sleep characteristics. Adolescents exposed to childhood maltreatment had longer sleep onset latency (1:15 h vs. 47 min, p < 0.001), longer wake after sleep onset (34 min vs. 15 min, p < 0.003), lower sleep efficiency in weekdays (77.8%, vs. 85%, p < 0.007), and lower sleep efficiency in weekends (81.8% vs. 88.9%, p < 0.001) than the reference group. Mental health problems fully mediated the association between childhood maltreatment exposure and longer sleep onset latency and wake after sleep onset. The rate of insomnia did not significantly differ between the groups. This study suggests that older adolescents exposed to childhood maltreatment have more sleep problems than the general adolescent population, and that these problems may be explained by co-existing mental health problems. These findings highlight the potential utility of assessing and providing sleep-focused treatment to adolescents with a history of childhood maltreatment and mental health problems.

Current Weight Status of Sexually Assaulted Pediatric Female Patients in an Emergency Department Setting

Background: The relationship between childhood sexual abuse (CSA) and childhood obesity (CO) is unclear with studies reporting conflicting results in female populations. This study aims to assess the association between suspected CSA and current emergency department (ED) weight status when compared with trauma patients. Methods: This is a single-center retrospective case-control study that utilized pediatric ED data (2016-2018) from identified female patients (6-17 years old) with a chief complaint of sexual assault and trauma registry patients. Focus was on female patients for literary comparisons. Two weight measurements were calculated based on available height data: BMI-for-age and weight-for-age. Nonparametric testing and binary logistic regression were utilized. Results: There were 2044 study participants: 1454 (71.1%) cases and 590 (28.9%) controls. Cases were older, underrepresented minorities (URMs), and carried public insurance (all p-values <0.001). Using BMI-for-age, patients with a sexual assault complaint had a 67% increased odds for CO after adjusting for age, URM status, and insurance type [adjusted odds ratio (aOR) = 1.67 (95% confidence intervals [CIs] 1.07-2.62); p-value = 0.03], whereas the weight-for-age metric increased the aOR odds by 58% [aOR = 1.58 (95% CI 1.14-2.17); p-value = 0.01] when compared with pediatric trauma patients. Similar results were found in a sensitivity analysis using patients matched on age and URM. Conclusion: Our data demonstrated an association between suspected CSA and CO. More research is needed to identify the biopsychosocial implications for this relationship and the potential to augment clinical care.

Childhood maltreatment predicts physical health in college students

Objective: Childhood maltreatment (CM) is associated with physical health problems throughout the lifespan, yet more research is needed regarding the trajectory of health problems (e.g., onset of health risk indicators) in young adults. The current study examined whether college students self-reporting higher levels of CM exhibited poorer physical health outcomes. Method: Young adults in college (N = 100) completed a physical health assessment (heart rate, body mass index (BMI), blood pressure, blood sugar, waist circumference), self-reported measures of health (symptoms of illness), and CM during spring semester 2018. Results: CM scores predicted higher heart rate and increased symptoms of illness. Females with maltreatment history presented higher levels of obesity and more metabolic syndrome conditions than their peers. Conclusions: Findings support the importance of examining the trajectory of CM to chronic disease, as health risk indicators are present in young adults.

Early-life stress and current stress predict BMI and height growth trajectories in puberty

In cross-sectional analyses, early institutional care is associated with shorter stature but not obesity during puberty in children adopted into US families. We examined whether shorter stature and leaner body composition in youth adopted internationally from institutions would continue as puberty progressed. We also examined whether current psychosocial stress would moderate the association between early institutional deprivation and growth during adolescence. Using an accelerated longitudinal design and linear mixed-effects models, we examined the height and body mass index (BMI) of 132 previously institutionalized (PI) and 176 nonadopted (NA) youth. We examined youth aged 7-15 at the beginning of the study three times across 2 years. Nurses assessed anthropometrics and pubertal status. Current psychosocial stress was measured using the Youth Life Stress Interview. Our results indicated that PI youth remained shorter and leaner across three assessments than NA youth. However, age-and-sex-adjusted BMI increased faster in PI youth. Psychosocial stress during puberty predicted greater age-and-sex-adjusted BMI, but this effect did not differ by group. The gap in BMI but not height appears to close between PI and NA youth. Higher psychosocial stress was associated with higher BMI during puberty.

Childhood adversity and cardiometabolic biomarkers in mid-adulthood in the 1958 British birth cohort

Studies that have examined associations between adverse childhood experiences (ACEs) and cardiometabolic biomarkers in adulthood are limited as they mainly focus on childhood maltreatment. This study aimed to examine the association between a range of prospectively and retrospectively reported ACEs and cardiometabolic biomarkers in mid-adulthood. Multiply-imputed data on 8511 participants from the National Child Development Study (1958 British birth cohort) were used. ACEs were prospectively reported at ages 7, 11 and 16, and retrospectively reported at age 33/44/45. Cardiometabolic outcomes assessed at age 44/45 included glycated haemoglobin (HbA1c), cholesterol (total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL)), triglycerides, blood pressure (systolic and diastolic), body mass index, waist circumference and metabolic syndrome. Parental separation/divorce, physical neglect, emotional neglect and psychological abuse were associated with lower HDL cholesterol. Parental offending and physical neglect were associated with higher triglyceride concentrations. Parental offending was also associated with increased HbA1c. Exposure to 2+ (vs. 0) prospective ACEs was associated with lower HDL cholesterol. All these associations were after adjustment for sex and multiple early life factors. To conclude, several individual ACEs are associated with poorer cardiometabolic risk factor profiles in mid-adulthood. Furthermore, exposure to two or more prospective ACEs is associated with lower HDL cholesterol concentrations in mid-adulthood.

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Parental separation/divorce in childhood is associated with lower high-density lipoprotein cholesterol in mid-adulthood.

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Physical neglect in childhood is associated with poorer lipid profiles in mid-adulthood.

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Psychological abuse in childhood is associated with lower high-density lipoprotein cholesterol in mid-adulthood.

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Parental offending in childhood is associated with higher triglycerides and glycated haemoglobin in mid-adulthood.

The lasting consequences of childhood sexual abuse on human capital and economic well-being

Childhood sexual abuse is a prevalent problem, yet understanding of later-in-life outcomes is limited due to unobservable determinants. I examine impacts on human capital and economic well-being by estimating likely ranges around causal effects, using a nationally representative U.S. sample. Findings suggest that childhood sexual abuse leads to lower educational attainment and worse labor market outcomes. Results are robust to partial identification methods applying varying assumptions about unobservable confounding, using information on confounding from observables including other types of child abuse. I show that associations between childhood sexual abuse and education outcomes and earnings are at least as large for males as for females. Childhood sexual abuse by someone other than a caregiver is as influential or more so than caregiver sexual abuse in predicting worse outcomes. Considering the societal burden of childhood sexual abuse, findings could inform policy and resource allocation decisions for development and implementation of best practices for prevention and support.

Adversity and child body mass index in Fragile Families over 15 years: Do type and timing matter?

Background

Weight status has been linked to adverse childhood experiences. Existing research, however, is limited to unidimensional assessments of cumulative risk and does not account for the complex nature of adversity experienced by children in high-risk settings. We fill existing gaps by assessing how four subtypes of adversity across two primary dimensions of threat and deprivation-based adversity are associated with changes in body mass index (BMI) across child ages 3 through 15 years.

Method

U.S. mothers and fathers (n = 2412) in the Fragile Families and Child Wellbeing Study were interviewed when children were born, and again at ages 1, 3, 5, 9, and 15 years. Independent variables include interpersonal (e.g., domestic violence), family (e.g., mental health), economic (e.g., housing insecurity), and community (e.g., witness/victim of violence) adversity from ages 1 through 9 years. Path analysis regressed changes in BMIz from ages 3 through 15 on past adversity exposures.

Results

Increased interpersonal and community adversity subtypes from ages 3 to 5 were associated with decreased BMIz from ages 5-9 years. Increased economic adversity from age 3 to 5 was associated with increased BMIz from ages 5 to 9, adjusted for mother age, race, and education.

Conclusion

Findings highlight the differential influence of past adversity type and timing on child BMI. Interpersonal and community adversity were associated with decreased BMIz, and economic adversity with increased BMIz. Differences in directionality of associations suggest research should capture multiple dimensions of adversity in early childhood and possible positive and negative trends in effects on child weight as children grow from early to mid-childhood.

Obesity and accelerated epigenetic aging in a high-risk cohort of children

New insights into mechanisms linking obesity to poor health outcomes suggest a role for cellular aging pathways, casting obesity as a disease of accelerated biological aging. Although obesity has been linked to accelerated epigenetic aging in middle-aged adults, the impact during childhood remains unclear. We tested the association between body mass index (BMI) and accelerated epigenetic aging in a cohort of high-risk children. Participants were children (N = 273, aged 8 to 14 years, 82% investigated for maltreatment) recruited to the Child Health Study, an ongoing prospective study of youth investigated for maltreatment and a comparison youth. BMI was measured as a continuous variable. Accelerated epigenetic aging of blood leukocytes was defined as the age-adjusted residuals of several established epigenetic aging clocks (Horvath, Hannum, GrimAge, PhenoAge) along with a newer algorithm, the DunedinPoAm, developed to quantify the pace-of-aging. Hypotheses were tested with generalized linear models. Higher age-and sex- adjusted z-scored BMI was significantly correlated with household income, blood cell counts, and three of the accelerated epigenetic aging measures: GrimAge (r = 0.31, P < .0001), PhenoAge (r = 0.24, P < .0001), and DunedinPoAm (r = 0.38, P < .0001). In fully adjusted models, GrimAge (β = 0.07; P = .0009) and DunedinPoAm (β = 0.0017; P < .0001) remained significantly associated with higher age- and sex-adjusted z-scored BMI. Maltreatment-status was not associated with accelerated epigenetic aging. In a high-risk cohort of children, higher BMI predicted epigenetic aging as assessed by two epigenetic aging clocks. These results suggest the association between obesity and accelerated epigenetic aging begins in early life, with implications for future morbidity and mortality risk.

Childhood Abuse-Related Weight Gain: An Investigation of Potential Resilience Factors

INTRODUCTION

Childhood physical, sexual, and emotional abuse are linked to adult obesity, and little is known about what protective factors might mitigate this association.

METHODS

Data from female (n=4,247) and male (n=1,982) participants in the longitudinal Growing Up Today cohort study from 1996 to 2013 were used to examine whether factors found to promote mental health resilience after abuse also operate as buffers (modifiers) of the abuse-weight status association. At ages 20-25 years, participants were asked about their history of child abuse before age 18 years. Potential resilience factors (modifiers) included childhood family SES, neighborhood safety, supportive relationships with adult nonfamily members, quality of maternal relationship, family structure, religious service attendance, and prayer/meditation. Associations between child abuse and BMI at ages 25-32 years were modeled using linear regression, adjusted for sociodemographic variables and baseline BMI. Potential modifiers were tested with interaction terms. Analyses were run in 2019-2020.

RESULTS

Severe abuse was associated with 0.9 kg/m² (95% CI=0.5, 1.2) higher adult BMI than no abuse, corresponding to a 46% increased risk of obesity (95% CI=1.28, 1.67). Less severe abuse was not significantly associated with BMI (β=0.1, 95% CI= -0.2, 0.4). There were no significant interactions between modifiers and abuse.

CONCLUSIONS

Factors previously found to promote resilience to mental health sequelae after abuse did not modify the association of severe child abuse with higher weight status.

Using phenome-wide association studies and the SF-12 quality of life metric to identify profound consequences of adverse childhood experiences on adult mental and physical health in a Northern Nevadan population

In this research, we examine and identify the implications of Adverse Childhood Experiences (ACEs) on a range of health outcomes, with particular focus on a number of mental health disorders. Many previous studies observed that traumatic childhood events are linked to long-term adult diseases using the standard Adverse Childhood Experience Questionnaire. The study cohort was derived from the Healthy Nevada Project, a volunteer-based population health study in which each adult participant is invited to take a retrospective questionnaire that includes the Adverse Childhood Experience Questionnaire, the 12-item Short Form Survey measuring quality of life, and self-reported incidence of nine mental disorders. Using participant's cross-referenced electronic health records, a phenome-wide association analysis of 1,703 phenotypes and the incidence of ACEs examined links between traumatic events in childhood and adult disease. These analyses showed that many mental disorders were significantly associated with ACEs in a dose-response manner. Similarly, a dose response between ACEs and obesity, chronic pain, migraine, and other physical phenotypes was identified. An examination of the prevalence of self-reported mental disorders and incidence of ACEs showed a positive relationship. Furthermore, participants with less adverse childhood events experienced a higher quality of life, both physically and mentally. The whole-phenotype approach confirms that ACEs are linked with many negative adult physical and mental health outcomes. With the nationwide prevalence of ACEs as high as 67%, these findings suggest a need for new public health resources: ACE-specific interventions and early childhood screenings.

History of Depression, Elevated Body Mass Index, and Waist-to-Height Ratio in Preadolescent Children

OBJECTIVE

This study aimed to evaluate whether a history of depression or self-injurious thoughts and behaviors predict elevated body mass index (BMI) and elevated waist-to-height ratio in preadolescents.

METHODS

Baseline data were evaluated from a large, nationally representative cohort study of 9- and 10-year-old children (unweighted n = 11,875), the Adolescent Brain and Cognitive Development study.

RESULTS

In the weighted sample, 10.6% of children had a history of depression, 7.0% had engaged in nonsuicidal self-injury, 13.1% had experienced suicidal ideation in their lifetime, and 1.1% had a history of attempted suicide. Among the children, 34.1% had an elevated BMI in the overweight or obese range and 31.9% had a waist-to-height ratio >0.5. In multivariate analyses, history of depression was associated with elevated BMI and waist-to-height ratio. Furthermore, interactions with sex were found; girls with a history of depression were more likely to have an elevated BMI (odds ratio = 1.47, 95% confidence interval = 1.24-1.74) and elevated waist-to-height ratio (odds ratio = 1.48, 95% confidence interval = 1.18-1.86) than girls without a history of depression, but no differences were observed between boys with and without a history of depression. Self-injurious thoughts and behaviors were not associated with elevated BMI or elevated waist-to-height.

CONCLUSIONS

In this study, 9- and 10-year-old girls with a history of depression were more likely to have an elevated BMI and elevated waist-to-height ratio than girls with no history of depression. These results provide important clinical context in caring for preadolescents with a history of depression.

Adverse Childhood Experiences Are Associated with Cardiometabolic Risk among Hispanic American Adolescents

OBJECTIVE

To assess the relationship between adverse childhood experiences (ACEs) and cardiometabolic risk among Hispanic adolescents.

STUDY DESIGN

This cross-sectional study was conducted at an academic research center in Gainesville, Florida. Participants were locally recruited, and data were collected from June 2016 to July 2018. Participants (n = 133, 60.2% female) were healthy adolescents aged 15-21 years who self-identified as Hispanic, were born in the US, and had a body mass index (BMI) between ≥18.5 and ≤40 kg/m². Primary outcomes were BMI, body fat percentage, waist circumference, and resting blood pressure. Associations between ACEs and cardiometabolic measures were assessed by multivariable logistic regression models, which controlled for sex, age, parental education, and food insecurity. Results were sex-stratified to assess potential variations.

RESULTS

Reporting ≥4 ACEs (28.6%) was significantly associated with a greater BMI (P = .004), body fat percentage (P = .02), and diastolic blood pressure (P = .05) compared with reporting <4 ACEs. Female participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04) and body fat percentage (P = .03) whereas male participants reporting ≥4 ACEs were significantly more likely to have a greater BMI (P = .04), systolic blood pressure (P = .03), and diastolic blood pressure (P = .03).

CONCLUSIONS

Hispanic adolescent participants who experienced ≥4 ACEs were more likely to have elevated risk markers of obesity and cardiometabolic disease. Further research is needed to elucidate the physiological mechanisms driving these relationships.

Evaluating measures of allostatic load in adolescents: A systematic review

BACKGROUND

Adolescents can experience heightened stress due to biopsychosocial changes that occur during this developmental stage. The 'wear and tear' of the physiological systems responsible for managing our stress response can lead to dysregulation of these systems, known as allostatic load (AL). AL is commonly measured within adult populations, however, inconsistencies exist across measures used to quantify the effects of stress on health. The aim of this review was to identify variations in measures across AL studies, and to consider how specific measures may be more appropriate for use within adolescent populations.

METHOD

Pubmed, PsycINFO, PsycARTICLES, Academic Search Complete, were searched in July 2020, using search terms 'allostatic load' and 'adolescence'. AL studies (1988-2020) with an adolescent population (age 10-24 years) were included. 354 records were screened by two reviewers and 41 full-text articles were assessed for eligibility.

RESULTS

25 studies were included in final synthesis. Biomarkers of AL ranged from 1 to 14. The most common index of AL consisted of 6 biomarkers; cortisol, epinephrine, norepinephrine, systolic blood pressure, diastolic blood pressure, and body-mass index.

FINDINGS

Defining measures of AL during adolescence may help to identify vulnerabilities specific to adolescents, which may shape their lifelong health trajectories.

Associations of Childhood Neglect With the ACTH and Plasma Cortisol Stress Response in Patients With Type 2 Diabetes

Background: Cross-sectional as well as longitudinal studies have linked childhood maltreatment to type 2 diabetes in adulthood with childhood neglect showing the strongest effect on type 2 diabetes risk. However, the mechanisms that link childhood maltreatment to type 2 diabetes are still unclear. Alterations in the psychological and physiological stress response system, specifically the hypothalamus-pituitary-adrenal (HPA) axis are a common finding in samples with a background of childhood neglect and are associated with type 2 diabetes. In the present study, we investigated the association between childhood neglect and the physiological and psychological stress response in patients with type 2 diabetes and healthy control participants. Method: We assessed emotional and physical childhood neglect in a sample of n = 74 patients with type 2 diabetes and n = 50 healthy control participants. We used the trier social stress test (TSST) to induce a stress response. Blood ACTH and cortisol levels were measured before (T₀), directly after (T₁) as well as 30 (T₂) and 60 (T₃) min after the TSST. Participants' subjective experience was assessed via visual analog scales before, directly after as well as at 45 min after the TSST. We used multiple regression analyses to predict the change in self-reported tension between T₀ and T_1. Multilevel models were applied to predict cortisol and ACTH levels across all measurement points. Results: We found a significant association between moderate to severe childhood neglect and a stronger psychological stress response in patients with type 2 diabetes, that was not present in healthy controls. In type 2 diabetes patients, but not in healthy controls, higher ACTH levels across all measurement points were significantly associated with higher severity of emotional neglect and higher severity of physical neglect was significantly associated with a stronger increase in plasma cortisol from T₀ to T₁. Conclusions: This is the first study to investigate whether childhood maltreatment in patients with type 2 diabetes could be associated with a dysregulated stress response. Our results show a link between the psychological and physiological stress response and childhood neglect in type 2 diabetes patients. This pathway is thus a possible mechanism connecting type 2 diabetes and childhood neglect.

Sex difference in the association of obesity with personal or social background among urban residents in Japan

The development of obesity is influenced by genetic and environmental factors and is associated with a variety of health problems. To gain insight into environmental factors that contribute to obesity, we analyzed the relation of personal or social background to obesity in men and women separately with the use of data from a community-based questionnaire survey of 5425 residents aged 20 to 64 years of Kobe, a representative large city in Japan. Obesity and normal weight were defined as a body mass index (BMI) of ≥25 and of ≥ 18.5 and < 25 kg/m2, respectively, according to the diagnostic criteria of the Japan Society for the Study of Obesity. The personal or social background factors examined included marital status, family structure, employment, household income, residence type, welfare enrollment, economic conditions of current life, educational level, extracurricular activity in school, living conditions at 15 years of age, and childhood adversity. We found that the prevalence of obesity was 27.2% and 10.6% in men and women, respectively. Among women, unmarried status, a low household income, welfare enrollment, difficult current economic conditions, a low educational level, and childhood adversity were associated with obesity, whereas none of the personal or social background factors examined were associated with obesity in men. Our results suggest that the development of obesity in women is strongly influenced by personal or social background, and such factors should be taken into consideration in the management of this condition in women.

Role of childhood maltreatment on weight and weight-related behaviors in adulthood

OBJECTIVE

This study investigated associations between child maltreatment and body mass, body weight perceptions, and weight control behaviors among men and women.

METHOD

Data were derived from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Multinomial logistic regression was used to investigate links between dimensions of childhood maltreatment and adult (a) classifications of body mass index (BMI), (b) discrepancies in perceived weight and actual BMI categories, and (c) normative and risky weight control behaviors.

RESULTS

Childhood maltreatment was highly predictive of BMI classification, weight perception discrepancies, and weight control behaviors for women. Women who reported physical abuse, sexual abuse, and neglect had increased risks for being slightly or very overweight, and among those who reported physical abuse and/or a combination of physical abuse and neglect, there is an increased likelihood of holding overweight perceptions. Finally, female victims of physical abuse, physical abuse and neglect, and of neglect only were more likely to adopt risky (e.g., diet pills or purging) versus normative (e.g., diet and exercise) weight control behaviors.

CONCLUSION

Results indicated that women who reported childhood maltreatment have increased risks for developing body and weight related issues, confirming research documenting female-specific effects of childhood maltreatment. For women, certain forms of maltreatment strongly predicted BMI groupings, discrepant weight perceptions, and risky weight behaviors. Taken together, findings suggest that child maltreatment is a predictor of health-related outcomes. Moreover, results highlight the importance of assessing gender-specific effects when examining outcomes related to body, weight, and dieting. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Risk and protective factors for child maltreatment: A review

PURPOSE OF REVIEW

The purpose of this review was to synthesize the empirical literature regarding key risk and protective factors for child maltreatment at each level of the socioecological model and to identify directions for future research and practice.

RECENT FINDINGS

Prior research has largely focused on risk and protective factors at the individual and interpersonal levels of the socioecological model. More recently, research has begun to examine risk and protective factors at the community and societal levels, with results suggesting that programmatic and policy interventions that reduce risk and enhance protection at these levels are promising primary prevention strategies for child maltreatment.

SUMMARY

Future research should continue to focus on risk and protective factors at the community and societal levels with the aim of building the evidence base for population-wide prevention strategies. Such strategies have the potential to create contexts in which families and children thrive.

Not the Root of the Problem-Hair Cortisol and Cortisone Do Not Mediate the Effect of Child Maltreatment on Body Mass Index

BACKGROUND

Experiencing maltreatment during childhood exerts substantial stress on the child and increases the risk for overweight and obesity later in life. The current study tests whether hair cortisol-a measure of chronic stress-and its metabolite cortisone mediate the relation between abuse and neglect on the one hand, and body mass index (BMI) on the other.

METHOD

The sample consisted of 249 participants aged 8 to 87 years (M = 36.13, SD = 19.33). We collected data on child abuse and neglect using questionnaires, measured cortisol and cortisone concentrations in hair, and BMI. In a structural model, the effects of abuse and neglect on hair cortisol, hair cortisone, and BMI were tested, as well as the covariance between hair cortisol and BMI, and hair cortisone and BMI.

RESULTS

Within the sample, 23% were overweight but not obese and 14% were obese. Higher levels of experienced abuse were related to higher cortisone concentrations in hair (β = 0.24, p < .001) and higher BMI (β = 0.17, p =.04). Neglect was not related to hair cortisol, hair cortisone, or BMI. Hair cortisol and cortisone did not mediate the association between maltreatment, and BMI. Sensitivity analyses demonstrate the same pattern of results in a subsample of adult participants currently not living with their parents. However, in younger participants who were still living with their parents, the associations between abuse and cortisone (β = 0.14, p =.35) and abuse and BMI (β = 0.02, p =.92) were no longer significant.

CONCLUSION

These findings confirm that experiencing abuse is related to higher BMI but suggest that hair cortisol and cortisone are not the mechanism underlying the association between child maltreatment and BMI. This is the first study to show abuse may be associated to elevated concentrations of hair cortisone-evidence of long-term alterations in chronic stress levels. Future research may benefit from exploring the effects of maltreatment on weight gain in longitudinal designs, including measures of other potential mediators such as eating as a coping mechanism, and more direct indicators of metabolic health.

Childhood Traumatic Experiences and Receptive Anal Intercourse Among Women

CONTEXT

Receptive anal intercourse (RAI), which has become increasingly common among U.S. heterosexual women, is associated with STDs, including HIV, when it is unprotected and coercive. Childhood traumatic experiences may increase sexual risk behavior, but the relationship between childhood trauma and RAI among women has not been examined.

METHODS

Data from 4,876 female participants in Waves 1 (1994-1995), 3 (2001-2002) and 4 (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health were used to examine associations between nine self-reported childhood traumas (neglect; emotional, physical and sexual abuse; parental binge drinking and incarceration; and witnessing, being threatened with and experiencing violence) and RAI during adulthood using modified Poisson regression analysis. Whether depression, low self-esteem, drug use, relationship characteristics or sex trade involvement mediated the relationship between trauma and RAI was also explored.

RESULTS

Forty percent of the sample reported having engaged in receptive anal intercourse. After adjustment for sociodemographic characteristics, eight of the nine childhood traumas were associated with increased risk of RAI (adjusted prevalence ratios, 1.2-1.5); the strongest association was with experience of violence. Each unit increase in the number of traumas yielded a 16% increase in RAI prevalence. In mediation analyses, only drug use and relationship factors slightly attenuated the association between childhood trauma and RAI (1.2 for each).

CONCLUSIONS

Women with a history of childhood trauma may be at increased risk of engaging in RAI, highlighting the importance of screening and trauma-informed education in sexual health settings. Pathways linking childhood trauma and RAI among women are complex and warrant further research.

Stressful Life Events and Negative Emotions on Delinquency Among Korean Youth: An Empirical Test of General Strain Theory Assessing Longitudinal Mediation Analysis

The current study examines the extent to which the argument of Agnew's general strain theory extends to a sample of South Korean youth to be able to explain the hypothesized direct and indirect/mediated effects of negative emotions derived from various negative life experiences of strain on delinquent behaviors. These experiences can include bullying victimization, parental abuse, poor friend quality, and poor physical functioning. Data for this study were compiled from the Korean Welfare Panel Study (KOWEPS), which is a longitudinal study among 7,027 Korean households surveyed from 2006 through 2012. This study utilizes the longitudinal mediation models for temporal precedence. Results reveal that adolescents with poor-quality friends during the previous year are more likely to engage in later delinquency, and adolescents who experience bullying victimization, child abuse, and poor friendship quality during the previous year are more likely to later feel negative emotions. Furthermore, early feelings of negative emotions are significantly related to later delinquent behaviors and partially mediate the link between poor friend quality and later delinquent behaviors. Finally, bullying victimization, child abuse, and poor friend quality generated negative emotions, which led to a greater likelihood of delinquent behavior later.

Effect of race on the relationship between child maltreatment and obesity in Whites and Blacks

This cross-sectional study was designed to determine what role race plays in the relationship between obesity and child maltreatment (CM), which is currently unknown. One hundred fifteen participants successfully completed the study, including Whites (n = 60) and Blacks (n = 55) of both sexes. CM was assessed using the Childhood Trauma Questionnaire. Total fat, trunk/total fat ratio, visceral adipose tissue (VAT), and VAT/trunk ratio, were measured through Dual Energy X-ray Absorptiometry (DXA) and Corescan software estimation. A significant interaction between identifying as White and having a history of CM was found to predict body mass index (BMI) (β = 5.02, p = .025), total fat (kg) (β = 9.81, p = .036), and VAT (kg) (β = 0.542, p = .025), whereas race by itself was an insignificant predictor. An interaction between having history of physical abuse and identifying as White was found to predict BMI (β = 6.993, p = .003), total fat (β = 12.683, p = .010), and VAT (β = 0.591, p = .018). An interaction between having multiple CM subtypes and identifying as White predicts increased total fat (β = 5.667, p = .034) and VAT (β = 0.335, p = .014). Our findings indicate that the relationship between CM and obesity, measured through BMI, total body fat, and VAT, is seen in Whites but not in Blacks. Future research should investigate the nature of this racial influence to guide obesity prevention and target at-risk populations.

Maltreatment experience in childhood and average excess body mass from adolescence to young adulthood

BACKGROUND

Prior studies have suggested maltreatment is a strong predictor of later weight outcomes, such that maltreatment experiences in childhood increase the likelihood of being overweight or obese in adulthood. Estimates of this relationship may be biased due to: 1) inadequate selection of covariates; 2) improper operationalization of child maltreatment; and 3) restricting analyses to cross-sectional outcomes.

OBJECTIVES

Evaluate how latent classes of child maltreatment experiences are associated with a longitudinal BMI measure from adolescence to adulthood.

PARTICIPANTS

Data from the National Longitudinal Study of Adolescent to Adult Health.

METHODS

We evaluated how previously developed latent classes of child maltreatment experiences were associated with average excess BMI from adolescence to adulthood using multivariate linear regression.

RESULTS

In the unadjusted model, individuals in the poly-maltreatment class (b = 0.46, s.e. = 0.20) and individuals who experienced adolescent-onset maltreatment (b = 0.36, s.e. = 0.11) had higher average excess BMI compared to individuals in the no maltreatment class. After adjusting for confounders, the relationship between poly-maltreatment and average excess BMI abated, whereas the relationship between adolescent-onset maltreatment and average excess BMI sustained (b = 0.28, s.e. = 0.11).

CONCLUSIONS

Contrary to previous findings, our analyses suggest the association between maltreatment experiences and longitudinal weight outcomes dissipates after controlling for relevant confounders. We did find a relationship, however, between adolescent-onset maltreatment and average excess BMI from adolescence to adulthood. This suggests the importance of maltreatment timing in the relationship between maltreatment and weight.

Sensitive Periods for the Association Between Childhood Maltreatment and BMI

INTRODUCTION

Although previous research has suggested a positive association between child maltreatment and BMI over the life course, it is unclear when this develops.

METHODS

The authors used time-varying effect models and data from a nationally representative, longitudinal, cohort study (Add Health), to test how childhood physical, sexual, and emotional abuse uniquely varied in associations with BMI from age 13 to 28 years, and whether different patterns existed for male and female participants. Add Health collected data from 1994 to 2008, and the present analyses took place in 2018.

RESULTS

Age 18 years was the earliest that a relationship between maltreatment and BMI emerged for either sex. Child sexual abuse was negatively associated with BMI among male participants from 18.5 to 20 years, but positively associated with BMI among female participants from 19 to 24.5 years, and childhood emotional abuse was positively associated with BMI among female participants from 18 to 28 years.

CONCLUSIONS

The relationship between child maltreatment and BMI varies as a function of type of maltreatment, sex, and time. Notably, associations between maltreatment and BMI did not emerge until young adulthood. Future research should investigate mechanisms by which the association between maltreatment and BMI changes over time to identify trauma-informed intervention targets for improving weight outcomes.

Childhood exposure to violence is associated with risk for mental disorders and adult's weight status: a community-based study in Tunisia

BACKGROUND

We sought to investigate the relationship between social violence and adult overweight/obesity and the role of common mental disorders (CMD) in mediating this relationship.

METHODS

A cross-sectional study was conducted from January to June 2016 in Tunisia. Participants were selected from randomly selected Primary Health Care Centers. The Arabic version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ) was used.

RESULTS

A total of 2120 participants were included. Women exposed to social ACEs had higher rates of overweight/obesity than men (13.5 versus 9.5%; P = 0.004). For women, statistically significant partial mediation effects of CMD were observed for exposure to community violence (% mediated = 17.7%). For men, partial mediation was found for the exposure to peer violence (% mediated = 12.5%).

CONCLUSION

Our results provide evidence of the independent increase of overweight/obesity after exposure to social ACEs. Efforts to uncover and address underlying trauma in health care settings may increase the effectiveness of obesity interventions.

Turkish Psychometric Properties of the Predictor Scales Affecting Adolescent Obesity

Adolescent obesity is one of the most important public health problems today. Identifying factors that affect obesity in adolescents and developing programs to prevent obesity are very important. This research aims to test Turkish psychometric properties of the scales to predict adolescent obesity (Healthy Lifestyle Choices Scale, Perceived Healthy Lifestyle Difficulty Scale, Activity Knowledge Scale, Nutrition Knowledge Scale, Healthy Lifestyle Attitude Scale, Healthy Lifestyle Belief Scale). The psychometric properties of the Scales were tested test-re-test reliability, the Cronbach's alpha coefficient, the item-total correlation, and the Confirmatory Factor Analysis. The relationship between the Scales was measured using the Spearman's correlation analysis. The level of internal consistency of the scales to predict adolescent obesity was found good. The goodness of fit values of the Belief Scale were measured as significantly high (χ2 = 177.24, df = 0.99, χ2/df = 1.79 (p < .001), Comparative Fit Index = 0.91, Goodness of Fit Index = 0.91, Normed Fit Index = 0.92, Incremental Fit Index = 0.92, Root Mean Square Residual = 0.05, Root Mean Square Error of Approximation Residual = 0.05). The psychometric analyses of the Scales were found to be very similar to the results of the original scales. There was a positive correlation between the Choice, Attitude, Belief, Nutrition and Activity Knowledge Scale, and a negative correlation with the Perceived Difficulty scale. The scales which measure adolescent obesity were accepted as valid and reliable measuring tools. This study will be an important resource for researchers working on the adolescent health and obesity.

Trajectories of child protective services contact among Alaska Native/American Indian and non-Native children

BACKGROUND

Contact with child protective services (CPS) functions as an independent marker of child vulnerability. Alaska children are an important population for understanding patterns of CPS contact given high rates of contact overall and among specific demographic groups.

OBJECTIVE

We aimed to identify longitudinal trajectory classes of CPS contact among Alaska Native/American Indian (AN/AI) and non-Native children and examine preconception and prenatal risk factors associated with identified classes.

PARTICIPANTS AND SETTING

We used data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) births with administrative data including CPS records.

METHODS

We conducted growth mixture modeling to identify trajectory classes of CPS contact from birth to age five years. We used Vermunt's three-step approach to examine associations with preconception and prenatal risk factors.

RESULTS

Among AN/AI children, we identified three classes: 1) no/low CPS contact (75.4%); 2) continuous CPS contact (19.6%), and 3) early, decreasing CPS contact (5.0%). Among non-Native children, we identified four classes: 1) no CPS contact (81.3%); 2) low, increasing CPS contact (9.5%); 3) early, rapid decline CPS contact (5.8%); and 4) high, decreasing CPS contact (3.3%). Maternal substance use had the largest impact on probabilities of class membership, increasing the probability of membership in classes characterized by CPS contact, among both AN/AI and non-Native children.

CONCLUSIONS

Results reveal heterogeneity in longitudinal patterns CPS contact across early childhood among Alaska children and identify maternal substance use as an important target for primary prevention.

Adverse Childhood Experiences, Early and Nonmarital Fertility, and Women's Health at Midlife

Adverse childhood experiences (ACEs) have powerful consequences for health and well-being throughout the life course. We draw on evidence that exposure to ACEs shapes developmental processes central to emotional regulation, impulsivity, and the formation of secure intimate ties to posit that ACEs shape the timing and context of childbearing, which in turn partially mediate the well-established effect of ACEs on women's later-life health. Analysis of 25 years of nationally representative panel data from the National Longitudinal Study of Youth (NLSY79; n = 3,893) indicates that adverse childhood experiences predict earlier age at first birth and greater odds of having a nonmarital first birth. Age and marital status at first birth partially mediate the effect of ACEs on women's health at midlife. Implications for public health and family policy aimed at improving maternal and child well-being are discussed.

National Study of Childhood Traumatic Events and Adolescent and Adult Criminal Justice Involvement Risk: Evaluating the Protective Role of Social Support From Mentors During Adolescence

OBJECTIVE

With nearly 11 million people in the United States arrested in 2015, the need to identify antecedent risk factors driving criminal justice involvement (CJI) and possible mitigating factors is crucial. This study examines the relation between childhood trauma and CJI in adolescence and adulthood and assesses how this relation is moderated by mentoring during young adulthood.

METHODS

The analysis included 3 waves of data-adolescents, young adults, and adults-collected from 1995 to 2008 from 12,288 adolescents who participated in the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents in grades 7 to 12. Logistic regression was used to examine how having a close mentor in adolescence moderated the relation between criminal justice involvement and 9 childhood traumatic events: (1) neglect, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, (5) parental incarceration, (6) parental binge drinking, (7) witnessed violence, (8) threatened with violence, and (9) experienced violence.

RESULTS

Cumulative exposure to childhood trauma was associated with CJI in adolescence (adjusted odds ratios [AORs] ranging from 2.24 to 25.98) and adulthood (AOR range, 1.82-6.69), and parental incarceration was consistently one of the, if not the, most strongly associated with each form of CJI; the strength of these associations was weakened for those who reported a close mentor compared to those who did not.

CONCLUSIONS

This study advances the literature regarding trauma and CJI, highlighting the role of social support and mentorship as protective factors for youth who experience childhood trauma. Interventions aimed at protecting vulnerable children from the harms of trauma should be the next priority.

Private vs public child welfare systems: A comparative analysis of national safety outcome performance

BACKGROUND

Ensuring the safety of American children is one of the chief mandates of the U.S. Child Welfare System. Yet system differences, including privatization remain an area of concern for whether safety of children is achieved.

OBJECTIVE

This study examined the effect of privatization policy on the performance of state child welfare systems in terms of achieving national safety outcome standards.

PARTICIPANTS AND SETTING

N₁ = 10 states systems (5 privatized and 5 public systems) with N₂ = 118,761 foster care cases located throughout the U.S.

METHOD

Using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS), safety outcome performance measures were assessed, as were child-/case factors to predict the likelihood of the system types meeting the national safety outcome standards.

RESULTS

Logistic regression models of child, case, and system factors predicting the likelihood state systems met national safety outcome performance standards were statistically significant. Private systems, compared to non-private systems, were found to have lower odds of meeting the safety outcome 1 standard (OR = 0.41, 95% CI = 0.40-0.42), but greater odds of meeting the safety outcome 2 standard (OR = 6.79, 95% CI = 6.56-7.02).

CONCLUSIONS

The implementation of privatization policy in state child welfare/foster care service delivery was found to have mixed results in terms of the national safety outcome standards.

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.

Infant Psychosocial Environment Predicts Adolescent Cardiometabolic Risk: A Prospective Study

OBJECTIVE

To prospectively assess whether the infant psychosocial environment was associated with cardiometabolic risk as early as adolescence.

STUDY DESIGN

Participants were recruited in Santiago, Chile, and have been followed from infancy. Inclusion criteria included healthy infants with birth weight ≥3 kg and a stable caregiver. The psychosocial environment, including depressive symptoms, stressful life events, poor support for child development, father absence, and socioeconomic status, was reported by mothers at 6-12 months. Body mass index (BMI) z score was assessed at 5 and 10 years. BMI z score, waist-to-hip ratio, systolic and diastolic blood pressure, fat mass and body fat percentage, fasting glucose, total and high-density lipoprotein cholesterol, and homeostatic model of insulin resistance were tested in adolescence.

RESULTS

Adolescents ranged from 16 to 18 years of age (n = 588; 48.1% female). A poorer infant psychosocial environment was associated with BMI z score at 10 years (β = 0.10, 95% CI = 0.00-0.19) and in adolescence (β = 0.15, 95% CI = 0.06-0.24) but not at 5 years. A poorer infant psychosocial environment was associated with higher blood pressure (β = 0.15, 95% CI = 0.05-0.24), greater anthropometric risk (β = 0.13, 95% CI = 0.03-0.22), greater biomarker (triglycerides, homeostatic model assessment of insulin resistance, total cholesterol) risk (β = 0.12, 95% CI = 0.02-0.22), and a higher likelihood of metabolic syndrome in adolescence (aOR = 1.50; 95% CI = 1.06-2.12).

CONCLUSIONS

These findings demonstrate that a poorer infant psychosocial environment was associated with greater adolescent cardiometabolic risk. The results support screening for infants' psychosocial environments and further research into causality, mechanisms, prevention, and intervention.

The association between allostatic load and anthropometric measurements among a multiethnic cohort of children

OBJECTIVE

This study investigated if levels of allostatic load (ALoad) differed according to race/ethnicity in children and if ALoad was associated with obesity-related measures.

METHODS

A multiethnic sample of 307 children aged seven to 12 was evaluated, composed of 39% European American (EA), 35% African American (AA), and 26% Hispanic American (HA) youth. Anthropometric measurements were evaluated by dual-energy X-ray absorptiometry, and other measurements included body mass index (BMI) and waist circumference (WC). Allostatic load scores were estimated based on two different calculations, including seven and eight biomarkers (ALoad1 and ALoad2), respectively. Analyses of variance, independence tests, and multiple regression models were performed.

RESULTS

From the total sample, 22.80% (n = 70) of children were characterized as "no load," 46.58% (n = 143) "low load," and 30.62% (n = 94) "high load." Hispanic American children showed the highest ALoad scores (2.07 ± 1.54; 95% CI, 1.73-2.41) compared with AA children (1.71 ± 1.43; 95% CI, 1.43-1.99) and EA children (1.56 ± 1.34; 95% CI, 1.32-1.80) (P < 0.05). Higher scores of ALoad (using both ALoad1 and ALoad2 calculations) were associated with higher BMI, total body fat mass, body percent fat, and WC (P < 0.05).

CONCLUSION

Significant differences in ALoad were observed in children according to race/ethnicity. Increased exposure to stressors captured by ALoad may result in increased risk for excessive adiposity and potential health risk in children. Further, ALoad may serve as a preventive marker for conditions known to continue throughout adulthood.

Links between traumatic experiences in childhood or early adulthood and lifetime binge eating disorder

OBJECTIVES

To evaluate the association between childhood or early adulthood traumatic experiences and adulthood binge eating disorder (BED) in 326 male and 1158 female patients. A structured clinical interview for the DSM-IV (SCID-I/P)-adapted to lifetime exploration for the diagnosis of BED and for DSM-IV Childhood Disorders was conducted by the psychiatrist.

RESULTS

Emotional neglect was the most frequent event experienced (77.8% of females vs. 63.5% of males, p < 0.0001), ahead of physical abuse (23.3%), witnessed domestic violence (17.7%) and sexual abuse (11.8% of females vs. 2.8% of males (p < 0.0001)). The prevalence rate for BED in the whole population was 34.9%. The independent predictors for BED were emotional neglect in male obese patients (OR = 3.49; IC95% (1.94-6.29); p < 0.0001) and physical abuse (OR = 1.56; IC95% (1.14-2.12); p = 0.0047), emotional neglect (OR = 1.83; IC95% (1.37-2.44); p < 0.0001), and sexual abuse (OR = 1.80; IC95% (1.22-2.65); p = 0.0029) in female patients. With a cut-off value of 17, the sensitivity of the Binge Eating Scale for BED during lifetime was 50.8% with 74.7% specificity.

CONCLUSIONS

This study shows that early psychological events are independent predictors of BED in obese female and male adults. The BES questionnaire is a poor predictor of BED during lifetime and a structured clinical interview should be recommended.

The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers: Results From a Randomized Controlled Trial

OBJECTIVE

Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence.

METHODS

The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers.

RESULTS

Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03).

CONCLUSIONS

The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.

CLINICAL TRIAL REGISTRATION

NCT00747396.

Unpacking the Influence of Abuse and Depression on Grades among Urban Ethnic Minority Adolescents and Young Adults

BACKGROUND

Both depression and a history of abuse have known negative consequences on the overall health of adolescents and young adults (AYAs). Research is not clear, however, on the interactive influence of abuse and depression on academic achievement, especially among AYAs of color.

OBJECTIVE(S)

This study aims to assess the interactive influence of abuse and depression on academic grades among African American and Latino AYAs.

METHODS

The study sample was made up of 476 predominantly urban African American and Latino youth ages 14 to 24. Study participants completed a demographic questionnaire (which included self-reported grades) and the Beck Depression Inventory for Primary Care-Fast Screen. Screenings for abuse were done through three structured methods using the Childhood Maltreatment Interview Schedule-Short Form, a short-structured questionnaire, and a face-to-face unstructured interview with a clinical provider.

FINDINGS

Depression had a significant main effect on grades, while abuse did not. Abuse and depression had a significant interactive effect on grades in that non-depressed adolescents who reported abuse had an almost four point higher average grade score than their non-depressed counterparts who did not report abuse.

CONCLUSIONS

Our findings highlight an unexpected effect in AYAs of color with a history of abuse but no history of depression, suggesting that perhaps there is something intrinsic to this group's resilience or their support systems that protects both against depression and supports their academic achievement. In conclusion, abuse alone does not serve as a predictor of grade achievement. Further work should be done to determine influential factors behind this relationship, with recommendations for school-based counselors and medical providers to screen for depression along with abuse in AYAs in order to determine how best to support this population.

Body weight and academic achievement: The role of weight diversity in urban middle schools

The current study was designed to examine one possible weight stigma-reduction mechanism: school-level weight diversity. It was hypothesized that greater weight diversity among same-sex peers at school would attenuate the negative association between weight and academic achievement. Across 26 urban public middle schools, 5,991 sixth-grade students (52% girls) were included: 12% African American/Black, 14% East/Southeast Asian, 30% Latino, 21% White, and 23% from other specific ethnic groups. Weight diversity was estimated as the likelihood that two randomly selected students would be from different weight categories, using Simpson's index. Standardized achievement test scores and grade point average (GPA) were used to assess academic achievement. Consistent with our contextual moderator hypothesis, high levels of weight diversity at school served a protective function. The negative association between body mass index (BMI) and achievement test scores, as well as GPA (girls only) was nonsignificant at schools with high levels of weight diversity. The study results offer a potential explanation for inconsistent findings regarding body weight and achievement, and a novel methodological approach to capture weight diversity in ways that provide new insights for school-based interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Childhood psychosocial challenges and risk for obesity in U.S. men and women

Childhood psychosocial challenges (i.e., adversities, mental and substance use disorders, social challenges) may relate to the onset of obesity and extreme obesity. Identifying the types of psychosocial challenges most strongly associated with obesity could advance etiologic understanding and help target prevention efforts. Using a nationally representative sample of U.S. adults (N = 24,350), the present study evaluates relationships between childhood psychosocial challenges and development of obesity and extreme obesity. After mutually controlling, childhood poverty was a risk in men OR = 1.2 (1.0-1.4) and a significantly stronger one in women OR = 1.6 (1.4-1.8); maltreatment increased odds of obesity in both men and women OR = 1.3, 95% CI (1.1-1.4), and specifically increased odds of extreme obesity in women OR = 1.5 (1.3-1.9). Early childrearing (before age 18) was an independent risk factor in both men OR = 1.4 (1.0-1.9) and women OR = 1.3 (1.1-1.5); not finishing high school was the strongest childhood psychosocial challenge risk factor for extreme obesity in both men (OR = 1.6, 1.1-2.2) and women (OR = 2.0, 1.5-2.5). Psychiatric disorders (MDD, anxiety disorder, PTSD) before age 18 were not independently associated with adult obesity in men nor women, but substance use disorders (alcohol or drug) were inversely associated with adult obesity. Individuals who have experienced childhood adversities and social challenges are at increased risk for obesity. Previous findings also indicate that these individuals respond poorly to traditional weight management strategies. It is critical to identify the reasons for these elevated weight problems, and to develop interventions that are appropriately tailored to mitigate the obesity burden faced by this vulnerable population.

Mental and Physical Health Profiles of Maltreated Youth

To examine both mental and physical health profiles of children diagnosed as maltreated in the community, we studied diagnoses in the electronic health records (EHRs) of youth assigned maltreatment-related diagnoses (N = 406) and well-matched youth without a maltreatment-related diagnosis (N = 406) during a four-year period in a large healthcare system that covers eight hospitals and over 40 clinics. Data extracted automatically from the EHRs was supplemented by manual chart review. The odds of the maltreated group being assigned a code for mental illness was 2.69 times higher than the odds for the comparison group, with large differences in mood and anxiety disorders and suicidality. The odds of having an injury or poisoning diagnosis were 3.45 times higher in maltreated than in comparison youth. Maltreated youth were also less likely to have been immunized. Nevertheless, contrary to our hypothesis, maltreated youth had significantly lower rates of diagnoses across almost all major physical disease categories assessed and did not differ from comparison youth in terms of body mass index (BMI). Furthermore, maltreated youth were assigned fewer diagnoses than comparison youth whether they came in for at least one preventive visit or not. Findings suggest a need for health care professionals to be prepared to address the high rates of mental disorders in maltreated youth, to be more vigilant about possible physical disorders in this population, and to take greater advantage of opportunities to immunize these youth.

Relationship between Child Maltreatment and Adolescent Body Mass Index Trajectories

This study examines the relationship between childhood maltreatment experiences and body mass index (BMI) over time. Using data from the National Longitudinal Study of Adolescent to Adult Health, we use latent profile analysis to create child maltreatment experience classes and latent growth modeling to understand how classes relate to BMI trajectories from adolescence to early adulthood. The best-fitting model suggests four child maltreatment experience classes: 1) poly-maltreatment (n=607); 2) physical abuse (n=1,578); 3) physical abuse and neglect (n=345); and 4) no childhood maltreatment (n=4,188). Class membership differentially predicts BMI trajectories, such that individuals in the no maltreatment, physical abuse, and physical abuse plus neglect classes exhibit the most stable BMI, and individuals in the poly-maltreatment class increase most rapidly (Χ2[9]=149.9, p < 0.001). Individuals in the poly-maltreatment class experience significantly higher BMI over time compared to the other three classes. In addition to overall growth differing between classes, there is substantial inter-individual variability in BMI trajectories within each class. Because BMI trajectories differ across different childhood maltreatment experiences-and substantial variability in BMI trajectories exists within these different experiences-future analyses should investigate mediators and moderators of this relationship to inform trauma-based therapies and interventions.

Early socioeconomic adversity and cardiometabolic risk in young adults: mediating roles of risky health lifestyle and depressive symptoms

The study examined the mediating roles of risky health lifestyle and depressive symptoms in relation to childhood/adolescence adversity and young adult cardiometabolic risk with data from the National Longitudinal Study of Adolescent to Adult Health (n = 9421). Four classes of youth emerged from a latent class analysis with varying early adversity patterns: (a) both low disadvantaged SES and stressful experience (54.8%), (b) high disadvantaged SES and low stressful experience (31.0%), (c) low disadvantaged SES and high stressful experience (10.9%), and (d) both high disadvantaged SES and stressful experience (3.3%). Early adversity had multiple direct and indirect effects on CM risk for those experiencing SES-related adversities. Instead, early adversity generated mediational processes between adversity and CM risks through risky health lifestyle and depressive symptoms for those experiencing stressful experience. Implications for intervention when dealing with youths who have experienced multiple forms of early adversity are discussed.

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.