From risky behavior to health risk: continuity across two generations

A Pilot Controlled Trial of Relaxation Training Combined with a Video Game Reinforcing Emotional Regulation to Improve Anger Management in Children and Adolescents

Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813.

"Getting Moving" and Being "Active Fit": Class Differences and Similarities in Health-promoting Parenting through Children's Organized Athletic Activities

Parents are held increasingly responsible for acting intensively to protect their children's health through everyday decisions and practices. We add to this scholarship by considering how organized athletic activities, an important part of the lives of many children, help parents fulfill their responsibility to protect their children's health. Through qualitative analysis of 92 in-depth interviews with parents, we attend to how parents' class shapes their articulation of the relationship between their children's health and their extracurricular involvement, considering literature on the ubiquity of intensive parenting expectations and the possibility that health behaviors and understandings constitute health-related cultural capital. Contrary to previous research, overall, we find similarities across class in parents' understandings of the health benefits of organized athletic activities. We find that parents believe organized athletic activities protect their children's health from inactivity, excess technology usage, and fatness. We do find some class distinctions. Middle-class parents, and not working-class parents, believe that their children's athletic activities will instill a passion for exercise and staying in shape and give children the experience and knowledge to control their body size and promote their well-being through their lives. This may signal a transformation in the relationship between health-related parenting and class that could maintain middle-class children's advantage if it contributes to differences in health beliefs, narratives, or practices that are differentially rewarded by important institutions such as schools, the workplace, or the medical system.

Developing Health Lifestyle Pathways and Social Inequalities across Early Childhood

Lifestyles are a long-theorized aspect of social inequalities that root individual behaviors in social group differences. Although the health lifestyle construct is an important advance for understanding social inequalities and health behaviors, research has not theorized or investigated the longitudinal development of health lifestyles from infancy through the transition to school. This study documented children's longitudinal health lifestyle pathways, articulated and tested a theoretical framework of health lifestyle development in early life, and assessed associations with kindergarten cognition, socioemotional behavior, and health. Latent class analyses identified health lifestyle pathways using the US Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N≈6,550). Children's health lifestyle pathways were complex, combining healthier and unhealthier behaviors and changing with age. Social background prior to birth was associated with health lifestyle pathways, as were parents' resources, health behaviors, and non-health-focused parenting. Developing health lifestyle pathways were related to kindergarten cognition, behavior, and health net of social background and other parent influences. Thus, family context is important for the development of complex health lifestyle pathways across early childhood, which have implications for school preparedness and thus for social inequalities and well-being throughout life. Developing health lifestyles both reflect and reproduce social inequalities across generations.

Persistence of Effects of VLBW/PT Birth Status and Maternal Emotional Availability (EA) on Child EA Trajectories

Few studies have examined the longitudinal impact of birth status on the infant-mother relationship and on children's socio-emotional development. In the present study we investigated developmental patterns of such relationships [using the Emotional Availability (EA) Scales] in fullterm and VLBW/PT infants from infancy to emerging school age. Our objectives were to: (a) model the developmental trajectories of EA dimensions (maternal sensitivity, structuring, non-hostility; child responsiveness, involvement) in a VLBW/PT and fullterm sample, (b) identify potential effects of VLBW/PT status on these trajectories, and (c) determine whether the effects of VLBW/PT status on children's socio-emotional development (child EA) remained after accounting for the effect of maternal EA. Child-mother dyads (n = 109) were observed in home-based interactions (face-to-face and free play) when children were 6, 12, 18, and 57-months-old in fullterm (37-41 weeks, >2500 g; n = 48) and healthy VLBW/PT (26-32 weeks gestation, birth weight 800-1500 g, corrected for gestational age; n = 61) children. Developmental trajectories of maternal and child EA were assessed using multilevel growth modeling in Mplus. Results indicated that, even after controlling for maternal EA, there was a persistent negative effect of VLBW/PT birth status on child EA trajectories. Both initially and over time, VLBW/PT infants lagged behind their fullterm counterparts on levels of responsiveness and involvement with mothers. There was also a persistent positive effect of maternal EA (sensitivity and structuring) on child EA trajectories. Higher average levels of maternal sensitivity and structuring across time were also associated with higher and persistent levels of child responsiveness and involvement of their mothers. Importantly, results held after modeling both effects together, and after controlling for maternal education and child gender. Our results have implications for VLBW/PT children's development, the parent-child relationship, and integrating family level factors and relationship dimensions in early prevention and intervention programs.

Family, Peer, and School Influences on Children's Developing Health Lifestyles

Health lifestyles are important for health and social identity, yet little is known about their development in early life. We use data from the Early Childhood Longitudinal Study-Kindergarten Cohort of 1998-99 (ECLS-K; N = 8,786) to track children's health lifestyles and assess a theoretical model of health lifestyle development. Latent class analyses identify health lifestyles at four time points from first to eighth grade, and multivariate models investigate their interrelationships and social contextual influences. Health lifestyles are multidimensional and dynamic, and children demonstrate distinct combinations of risks and protections. Family factors, such as resources and parenting, shape earlier health lifestyles, which influence later lifestyles. Results show that development and contexts drive changes in health lifestyles, as family factors decrease in influence with age while some school and peer influences appear to emerge. Policy makers and researchers interested in shaping health behaviors should consider the multidimensional and dynamic nature of health lifestyles.

EMOTIONAL AVAILABILITY IN EARLY MOTHER-CHILD INTERACTIONS FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS, OTHER PSYCHIATRIC DISORDERS, AND DEVELOPMENTAL DELAY

Emotional availability (EA) is a method to assess early parent-child dyadic interactions for emotional awareness, perception, experience, and expression between child and parent that describe global relational quality (Z. Biringen & M. Easterbrooks, 2012). The current study aimed to examine the effects of an infant's diagnosis of autism spectrum disorders (ASDs), other psychiatric disorders (OPD), and developmental delay (DD) on the maternal EA Scale (EAS; Z. Biringen & M. Easterbrooks, 2012; Z. Biringen, J.L. Robinson, & R.N. Emde, 2000) scores and the relative contributions of infant's age, gender, diagnosis, developmental level, and maternal education on EAS scores in a clinical Turkish sample. Three hundred forty-five infant-mother dyads participated in this study. Results of the research indicated that EAS adult scores were associated with maternal education and infant's diagnosis whereas child scores were associated with infant's age, diagnosis, and developmental level. Infants' involvement and responsiveness to the mother were lower in the group with ASD. Children with OPD, particularly when their mothers have lower education, might be at increased risk of having problems in parent-child interactions. Young ASD subjects with developmental delay are in greatest need of support to increase reactions toward their mother. These findings underscore the importance of using all of the EA dimensions rather than only one measure on children in high-risk populations.

Health lifestyles in early childhood

This study integrates two important developments, the concept of health lifestyles (which has focused on adults and adolescents) and the increased attention to early childhood. We introduce the concept of children's health lifestyles, identifying differences from adult health lifestyles and articulating intergenerational transmission and socialization processes shaping children's health lifestyles. Using the nationally representative Early Childhood Longitudinal Study-Birth Cohort (2001-2007; N ≈ 6,150), latent class analyses identify predominant health lifestyles among U.S. preschoolers. Five distinct empirical patterns representing health lifestyles emerge, two capturing low and medium levels of overall risk across domains and three capturing domain-specific risks. Social background predicts children's health lifestyles, but lower household resources often explain these relationships. Across kindergarten measures of cognition, behavior, and health, preschool health lifestyles predict children's development even after controlling for social disadvantage and concurrent household resources. Further research on health lifestyles throughout childhood is warranted.

The influence of parenting on early childhood health and health care utilization

OBJECTIVE

This study examined whether parenting, specifically parental support, structure, and behavioral control, predicted early childhood health care use and moderated the negative effects of socioeconomic disadvantage.

METHODS

A sample of 250 parent-child dyads from a longitudinal intergenerational research program participated.

RESULTS

Greater parental support was associated with increased rates of nonemergency care and a higher ratio of outpatient to emergency room (ER) services, a pattern reflecting better health and service use. Support also moderated the negative effects of disadvantaged family background. Greater behavioral control by parents predicted lower rates of both nonemergency care and ER visits. Structured parenting and behavioral control were associated with lower rates of respiratory illness.

CONCLUSIONS

This study highlights the importance of considering parenting practices when examining variations in early childhood health and health care, and the relevance of parental behavior in designing interventions for high-risk populations.

Distinguishing among disruptive behaviors to help predict high school graduation: does gender matter?

This study examined unique predictive associations of aggressive and hyperactive-inattentive behaviors in elementary school with high school graduation. The current study also investigated whether these associations were moderated by gender. At Time 1, 745 children in the 3rd through 5th grades completed peer ratings on their classmates' disruptive behaviors. At Time 2, school records were reviewed to determine whether students graduated within four years of entering high school. Results showed that gender and hyperactivity-inattention are uniquely associated with high school graduation, but childhood aggression is not. Results also indicated that gender moderated associations between hyperactivity-inattention and graduation. Among boys, hyperactive-inattentive behaviors were not significantly associated with graduation, above and beyond aggression. In contrast, among girls, hyperactive-inattentive behaviors in childhood were significantly associated with graduation even after controlling for aggression. These findings suggest that in middle childhood, hyperactive-inattentive behaviors may be a more meaningful predictor of high school graduation than other forms of early disruptive behavior (e.g., aggression), especially for girls. Such findings could have significant implications for prevention and intervention programs designed to target children at risk for dropping out of school.

Variables Associated with the Onset of Cigarette Smoking Among Adolescent Public Middle-School Students in Cartagena, Colombia

Objetivo: determinar la prevalencia y las variables asociadas al inicio del consumo de cigarrillo en adolescentes de media vocacional de Cartagena, Colombia. Materiales y método: estudio analítico observacional transversal con 1.100 estudiantes de básica secundaria de las instituciones educativas oficiales de la ciudad de Cartagena, matriculados durante el año 2012; la información se recolectó a través de la ficha demográfica, el inventario de consumo de cigarrillo y actitudes frente al mismo de la Encuesta Mundial Sobre Tabaquismo en jóvenes (Emta_Joven), la escala Apgar familiar, Rosenberg para autoestima y la escala de Zung de ansiedad. Se realizó análisis estadístico univariado, bivariado y multivariado. Resultados: participaron 1.090 estudiantes (de los 1.100 fueron descartados 10 por estar mal diligenciados) con edades entre 10 y 18 años, media = 12,3; 565 (51,8 %) estudiantes fueron de sexo masculino y 525 (48,2 %) de sexo femenino. El consumo de cigarrillo alguna vez en la vida se asoció a edades entre 13 y 18 años (OR = 2,86; IC95 %: 1,96-4,18), ser de sexo masculino (OR = 2,40; IC95 %: 1,63-3,56) y a alta intención de consumo de sustancias (cigarrillo, alcohol y marihuana) (OR = 3,18; IC95 %: 2,18-4,64). Conclusión: el consumo de cigarrillo alguna vez en la vida en estudiantes de media vocacional de Cartagena, Colombia, se asoció a tener alta intención de consumo de sustancias, ser adolescente y ser de sexo masculino.

Long-term consequences of adolescent gang membership for adult functioning

OBJECTIVES

We examined the possible public health consequences of adolescent gang membership for adult functioning.

METHODS

Data were drawn from the Seattle Social Development Project, a longitudinal study focusing on the development of positive and problem outcomes. Using propensity score matching and logistic regression analyses, we assessed the effects of adolescent gang membership on illegal behavior, educational and occupational attainment, and physical and mental health at the ages of 27, 30, and 33 years.

RESULTS

In comparison with their nongang peers, who had been matched on 23 confounding risk variables known to be related to selection into gang membership, those who had joined a gang in adolescence had poorer outcomes in multiple areas of adult functioning, including higher rates of self-reported crime, receipt of illegal income, incarceration, drug abuse or dependence, poor general health, and welfare receipt and lower rates of high school graduation.

CONCLUSIONS

The finding that adolescent gang membership has significant consequences in adulthood beyond criminal behavior indicates the public health importance of the development of effective gang prevention programs.

Possible genetic association between vasopressin receptor 1B and child aggression

BACKGROUND

Studies on animal models have implicated arginine vasopressin signalling pathway in aggressive behaviour. The role of arginine vasopressin in childhood onset aggression is unclear.

METHODS

We investigated 11 single-nucleotide polymorphisms in the genes coding for arginine vasopressin and its receptors in our sample of 177 aggressive child cases paired with adult controls matched for sex and ethnicity.

RESULTS

We found the non-synonymous polymorphism AVPR1B_rs35369693 to be associated with child aggression in our sample (P=0.007). We also found two-marker haplotype window containing AVPR1B_rs35369693 and AVPR1B_rs28676508 to be associated (P=0.003). The haplotype findings survived multiple-testing adjusted significance threshold of 0.0063.

CONCLUSIONS

This is the first report of a genetic association between vasopressin receptor 1B and child aggression. Replication in independent samples are required to confirm these findings.

Poverty during pregnancy: Its effects on child health outcomes

It is estimated that nearly 100,000 children are born into poverty each year in Canada. During pregnancy, their mothers are likely to face multiple stressful life events, including lone-mother and teenage pregnancies, unemployment, more crowded or polluted physical environments, and far fewer resources to deal with these exposures. The early child health consequences of poverty and pregnancy are multiple, and often set a newborn child on a life-long course of disparities in health outcomes. Included are greatly increased risks for preterm birth, intrauterine growth restriction, and neonatal or infant death. Poverty has consistently been found to be a powerful determinant of delayed cognitive development and poor school performance. Behaviour problems among young children and adolescents are strongly associated with maternal poverty. Sound evidence in support of policies and programs to reduce these disparities among the poor, including the role of health practitioners, is difficult to find. This is partly because many interventions and programs targeting the poor are not properly evaluated or critically appraised.

The quality of the mother-child relationship in high-risk dyads: application of the Emotional Availability Scales in an intergenerational, longitudinal study

The present research examined how family psychosocial risk may be associated with emotional availability (EA) across age and time in two longitudinal, intergenerational studies with high-risk, disadvantaged mother-child dyads. Study 1 examined dyads during preschool and middle childhood. Study 2 examined a different sample of dyads, tested intensively at five time points (6, 12, and 18 months; preschool; and school age). Across studies, maternal childhood histories of aggression and social withdrawal predicted negative EA (higher levels of maternal hostility) during mother-child interactions at preschool age. In Study 1, mothers with higher levels of social withdrawal during childhood had preschoolers who were less appropriately responsive to and involving of their mothers during interactions. In Study 2, higher levels of observed appropriate maternal structuring predicted child responsiveness while observed maternal sensitivity (and structuring) predicted observed child involvement. More maternal social support and better home environment combined with lower stress predicted better mother-child relationship quality. Findings contribute to the burgeoning literature on EA by focusing on a high-risk community sample across time and generations. Results are interpreted in light of the developmental psychopathology framework, and have implications for a broader understanding of how EA is related to parental history and personal characteristics, as well as ongoing family and environmental context.

A three-generational study of risk factors for childhood externalizing behavior among African Americans and Puerto Ricans

This is the first prospective study to examine the precursors of child externalizing behavior across three generations of African Americans and Puerto Ricans. Participants comprised a community cohort of male and female African Americans and Puerto Ricans (N = 366, X⁻ age = 29.4 years), who are part of an ongoing study of drug use and problem behaviors, and who had a child. Data were collected at four time waves, spanning the participants' adolescence to adulthood. Questionnaires were initially self-administered in schools in East Harlem, NY, USA (time 1). Subsequently, structured interviews were conducted by trained interviewers (times 2 and 3), and self-administered via mail (time 4). The independent variables consisted of the participants' prospective reports of their (a) relationships with their parents during adolescence, (b) depressive mood and drug use (adolescence to adulthood), (c) relationship with their oldest child between the ages of 6-13, and (d) perceptions of neighborhood crime and deterioration (in adulthood). The dependent variable was externalizing behavior in the participant's oldest child (X⁻ age = 9.6 years; SD = 2.0). Structural equation modeling showed that the parent-child relationship during participants' adolescence was linked with the participants' depressive mood and drug use which, in turn, were associated with the participants' relationship with their own child, as well as with neighborhood crime and deterioration when participants were adults. The participants' depressive mood, and relationship with their own child, as well as neighborhood crime and deterioration, each had a direct pathway to externalizing behavior in the participant's child. Findings suggest that intervention programs and public policy should address parental attributes, neighborhood factors, and, especially, parenting skills, to reduce risk factors for the intergenerational transmission of externalizing behavior.

Smoking in pregnancy and parenting stress: maternal psychological symptoms and socioeconomic status as potential mediating variables

INTRODUCTION

The purpose of this study was to examine the impact of smoking in pregnancy on parenting stress. Maternal psychological symptoms and socioeconomic status (SES) were evaluated as potential mediating factors between prenatal cigarette use and later parenting stress.

METHOD

The sample included 218 mothers who were recruited at the hospital after birth and completed a 6-month visit with their infants at a university laboratory. Based on the mothers' responses to interviews at the hospital on tobacco use during pregnancy, the sample included 77 nonsmokers and 141 smokers. Information on sociodemographic variables, prenatal care, and other substance use during pregnancy was collected at the hospital interview. At the 6-month visit, the mothers completed measures of parenting stress and psychological symptoms. Cotinine levels were assessed at both timepoints.

RESULTS

Regression analysis showed that maternal smoking during pregnancy predicted parenting stress in infancy. Maternal symptoms of psychological distress and SES were evaluated simultaneously to determine whether they functioned as mediating variables between smoking in pregnancy and parenting stress. A multiple mediation analysis (Preacher & Hayes, 2008a) showed that maternal psychological symptoms functioned as a mediating variable but that SES did not.

CONCLUSIONS

Results suggest that mothers who smoke in pregnancy are likely to experience higher levels of psychological symptoms, which, in turn, predict higher levels of parenting stress. Smoking in pregnancy may be a marker for symptoms of psychological distress in mothers.

Morbidity and mortality risk among the "forgotten few": why are girls in the justice system in such poor health?

The present study assessed the physical health of a population of girls sentenced to custody in a large US State via medical examinations and clinical assessments in adolescence and young adulthood. Findings indicated that injuries, obesity, and sexually transmitted diseases were the norm, with over 50% of the population meeting criteria for each of these health problems. A dose-response relationship was documented between childhood victimization and injuries and injury risk in adolescence and self-harm, HIV risk, physical health symptoms, and hospitalizations in young adulthood. The relationship between childhood victimization and poor adult physical health was fully mediated by health-risk behaviors in adolescence. Clinical and policy implications of the high mortality and morbidity risk among female juvenile offenders are discussed.

Expanding the Construct Validity of the Relationship Profile Test: Associations With Physical Health and Anaclitic and Introjective Traits

The authors examined the construct validity of the Relationship Profile Test (RPT) with respect to measures of two related constructs—physical health and well-being (functional health status), and depression-linked personality type (anaclitic vs. introjective). In Study 1, the authors administered the RPT, Depressive Experiences Questionnaire (DEQ), and Medical Outcomes Study Short Form (MOS SF-20) to 116 undergraduate students. In Study 2, the RPT, DEQ, and MOS SF-20 were administered to 110, mostly African American female, primary care outpatients. Destructive Overdependence was positively correlated with anaclitic and introjective trait scores in both samples. Dysfunctional Detachment was positively correlated with introjective scores in both samples and with anaclitic scores in the primary care sample. Healthy Dependency was negatively correlated with introjective scores in both samples and with anaclitic scores in the primary care sample. These studies support the construct validity of the RPT in ethnically diverse nonclinical and clinical samples, and extend previous findings documenting links between RPT subscale scores and scores on measures of other theoretically related constructs.

Risk factors for young adult substance use among women who were teenage mothers

Teenage mothers may not "mature out" of substance use during young adulthood, and this non-normative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range=12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n=292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use, peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Chronic stress and stressful life events in the offspring of parents with bipolar disorder

BACKGROUND

The stress generation theory suggests that depressed individuals and children of depressed mothers are prone to create stressors that are interpersonal and dependent on their own behaviour. Exposure to "self-generated" stress is believed to increase the risk for onset and recurrence of depression. Much less is known about stress in the offspring of parents with bipolar disorder (OBD).

METHODS

As part of a longitudinal study, 37 OBD and 33 offspring of parents with no affective disorder (13 to 26 years old) were interviewed using the UCLA Life Stress Interview, assessing their current life circumstances (chronic stress) and recent negative life events (episodic stress).

RESULTS

The OBD reported more difficulties in interpersonal and non-interpersonal domains of chronic stress than controls. The group differences remained significant after controlling for the presence of affective disorders, indicating that the effect of risk status on chronic stress is independent of the problems associated with having a disorder. With respect to episodic stress, the OBD were 3.9 times more likely to have experienced a moderate to severe interpersonal stressor compared to the control group. There was no group difference for dependent events, but the OBD experienced more severe independent events than controls.

LIMITATIONS

Methodological limitations include a small sample size, large age range, and the absence of parent-reported stress and symptomatology.

CONCLUSIONS

Although the findings do not support the stress generation theory, they suggest that elevated levels of episodic and chronic stress may be important markers of risk for affective disorders in high-risk participants.

Marijuana use and sexually transmitted infections in young women who were teenage mothers

PURPOSE

Teenage pregnancy and marijuana use are associated with higher risk of contracting sexually transmitted infections (STIs). In this study, we examined the role of early and current marijuana use as it related to STI risk in a sample of young women who were pregnant teenagers, using a variety of statistical models.

METHODS

We recruited 279 pregnant adolescents, ages 12-18, from an urban prenatal clinic as part of a study that was developed to evaluate the long-term effects of prenatal substance exposure. Six years later, they were asked about their substance use and sexual history. The association of early and late marijuana use to lifetime sexual partners and STIs was examined, and then structural equation modeling (SEM) was used to illustrate the associations among marijuana use, number of sexual partners, and STIs.

RESULTS

Bivariate analyses revealed a dose-response effect of early and current marijuana use on STIs in young adulthood. Early and current marijuana use also predicted a higher number of lifetime sexual partners. However, the effect of early marijuana use on STIs was mediated by lifetime number of sexual partners in the SEM, whereas African-American race, more externalizing problems, and a greater number of sexual partners were directly related to more STIs.

CONCLUSIONS

Adolescent pregnancy, early marijuana use, mental health problems, and African-American race were significant risk factors for STIs in young adult women who had become mothers during adolescence. Pregnant teenage girls should be screened for early drug use and mental health problems, because they may benefit the most from the implementation of STI screening and skill-based prevention programs.

Family structure and health, how companionship acts as a buffer against ill health

Background

Health and well-being are the result of synergistic interactions among a variety of determinants. Family structure and composition are social determinants that may also affect health behaviours and outcomes. This study was performed to examine the associations between family structure and health and to determine the protective effects of support mechanisms to improve quality of health outcome.

Methods

Six hundred people, selected by multistage sampling to obtain a representative population of men and women aged 20–60 living in communities in Japan, were included in this study. Data regarding subjective views of one's own health, family structure, lifestyle and social support were collected through structured face-to-face interviews on home visits. Systolic and diastolic blood pressures, height and weight were measured by trained examiners. The associations between family structure and health after controlling for demographics, lifestyle and social support were examined using logistic and linear regression analyses.

Results

Subjects living alone were significantly more likely to be in ill health, as determined using the General Health Questionnaire, in comparison to those in extended families (OR = 3.14). Subjects living alone or as couples were significantly more likely to suffer from severe hypertension in comparison to those living in extended families (OR = 8.25, OR = 4.90). These associations remained after controlling for the influence of lifestyle. Subjects living only with spouse or in nuclear family had higher probabilities of mental ill health in the absence than in the presence of people showing concern for their well-being.

Conclusion

The results of this study infers that a support mechanism consisting of companionship and the presence of family or other people concerned for one's well being acts as a buffer against deleterious influence of living in small family that will lead to improved quality of health outcome.

Cardiovascular disease risk factors in adolescents: do negative emotions and hypothalamic-pituitary-adrenal axis function play a role?

PURPOSE OF REVIEW

Negative emotions such as depression and hostility/anger are important risk factors for cardiovascular disease in adults, but are often neglected in treatment or prevention programs. Adolescence is a stage of life when negative emotions often first become problematic and is also a time when the pathogenesis of cardiovascular disease appears to accelerate. The literature on negative emotions and cardiovascular disease risk factors in adolescents is reviewed here.

RECENT FINDINGS

Research indicates that negative emotions are associated with cardiovascular disease risk factors in adolescence. Negative emotions are also associated with several types of hypothalamic-pituitary-adrenal axis dysregulation. Such dysregulation appears to have a facilitatory effect on cardiovascular disease development and progression in adults. Thus, it is possible that negative emotions in adolescents may be risk factors for the development of cardiovascular disease via dysregulation of the hypothalamic-pituitary-adrenal axis. Although this hypothesis has not been directly tested, some studies indirectly support the hypothesis.

SUMMARY

Negative emotions are associated with cardiovascular disease risk factors in adolescents; it is possible that hypothalamic-pituitary-adrenal axis dysregulation is an important mechanism. This hypothesis merits further research. If the hypothesis is valid, it has significant implications for early prevention of cardiovascular disease.

Maternal and child health problems: the inter-generational consequences of early maternal aggression and withdrawal

The purpose of this study was to determine the impact of childhood aggression and social withdrawal on adult health, and to examine the transfer of health-risk to offspring. Previous studies have linked aggression to poor health habits, whereas social withdrawal has been linked to increased symptom reporting. Little research has attempted to examine the effects of parents' childhood behaviour problems on health in the next generation. Seventy-four parents from disadvantaged neighbourhoods in Montreal (roughly half of whom were identified in childhood as being highly aggressive and/or withdrawn) and their offspring aged 9-11-years old participated in this prospective, longitudinal study. Health histories of mothers and target children were taken during structured home interviews. Regression analyses tested the relationship between parents' behaviour problems in childhood and subsequent health outcomes in both generations. Mothers who were high on both aggression and withdrawal in childhood showed the earliest signs of health problems. Maternal childhood aggression predicted lower self-rated health and some current health problems, whereas maternal childhood withdrawal predicted more somatizing symptoms such as frequent headaches. Offspring of socially withdrawn mothers or fathers were more likely to be prescribed medication for respiratory problems and Ritalin, despite no matching maternal reports of higher incidence of behavior or respiratory problems. In summary, there were distinct health patterns for families of individuals who are highly aggressive and socially withdrawn in childhood, with implications for transfer of poor health habits to the next generation.