Laura Kestilä

Childhood adversities as risk factors for adult mental disorders : Results from the health 2000 study

BackgroundThe sex-specific role of stressful or traumatic childhood experiences and adverse circumstances in developing adulthood mental disorders is complex and still in need of comprehensive research.MethodsWithin the Health 2000 project in Finland, a representative sample of 4,076 subjects aged 30–64 years were investigated to examine associations between a set of retrospectively self-reported adverse environmental factors during childhood (0–16 years) and mental disorders diagnosed in the past 12 months by the Munich Composite International Diagnostic Interview.ResultsOf the 60% of adults reporting at least one childhood adversity, 17% had a current (past 12 months) mental disorder, compared to 10% of the non-reporters. A moderate dose–response relationship between the total number of adversities and current disorders was observed. Paternal mental health problems associated particularly strongly with male depressive disorders (OR 4.46), and maternal mental health problems with female depressive disorders (OR 3.20). Although seldom reported, maternal alcohol problems associated with alcohol use disorders in both sexes. Being bullied at school and childhood family discord predicted a variety of adulthood disorders in both sexes. All these four adversity items were more typical for depressive disorders with an earlier onset. Among females, more adversities were associated with mental disorders and their statistical significance was greater than among males.ConclusionsThere are marked sex differences and several diagnosis-related patterns in the associations between reported childhood experiences and environmental circumstances and adulthood mental disorders. The impact of adversities is probably composed of a wide range of factors from direct causal associations to complex, interacting environmental effects. Variations in the reported associations reflect the differing genetic and environmental transmission mechanisms of mental disorders.

The contribution of childhood circumstances, current circumstances and health behaviour to educational health differences in early adulthood

BackgroundThe life course approach emphasises the contribution of circumstances in childhood and youth to adult health inequalities. However, there is still a lot to know of the contribution of living conditions in childhood and youth to adult health inequalities and how later environmental and behavioural factors are connected with the effects of earlier circumstances. This study aims to assess a) how much childhood circumstances, current circumstances and health behaviour contribute to educational health differences and b) to which extent the effect of childhood circumstances on educational health differences is shared with the effects of later living conditions and health behaviour in young adults.MethodsThe data derived from the Health 2000 Survey represent the Finnish young adults aged 18–29 in 2000. The analyses were carried out on 68% (n = 1282) of the sample (N = 1894). The cross-sectional data based on interviews and questionnaires include retrospective information on childhood circumstances. The outcome measure was poor self-rated health.ResultsPoor self-rated health was much more common among subjects with primary education only than among those in the highest educational category (OR 4.69, 95% CI 2.63 to 8.62). Childhood circumstances contributed substantially (24%) to the health differences between these educational groups. Nearly two thirds (63%) of this contribution was shared with behavioural factors adopted by early adulthood, and 17% with current circumstances. Health behaviours, smoking especially, were strongly contributed to educational health differences.ConclusionTo develop means for avoiding undesirable trajectories along which poor health and health differences develop, it is necessary to understand the pathways to health inequalities and know how to improve the living conditions of families with children.

Do childhood social circumstances affect overweight and obesity in early adulthood

Aims: The aim of the study was to examine the association of childhood circumstances with overweight and obesity in early adulthood, to analyse whether the respondents education and current circumstances mediate these associations, and to explore whether the respondents health behaviour affects these associations. Design: This was a cross-sectional study with retrospective inquiries. Methods: The study was based on a representative two-stage cluster sample (N= 1894, participation rate 79%) of young adults aged 18—29 years in Finland in 2000. The outcome measure was three-class body mass index (BMI) (normal weight, overweight, and obesity). Multinomial logistic regression was used as the main statistical tool. Results: In women, childhood circumstances (low parental education (relative risk ratio (RRR) = 2.43), parental unemployment (RRR= 2.09) and single-parent family (RRR= 1.99)) increased the risk of overweight (25 ≤ BMI<30), but the effects were largely attenuated by other childhood factors and early adult circumstances. In men, no significant childhood predictors of overweight were found. Single-parent family (RRR=2.32), parental alcohol problem (RRR= 2.71), parental mental health problems (RRR=2.28) and being bullied at school (RRR=3.13) predicted obesity (BMI ≥ 30) in women in the age-adjusted models, and being bullied at school remained a significant predictor after adjusting for all childhood and current determinants. In both genders, the strong association between parental education and obesity remained significant after adjusting for all other determinants (for the lowest educational category, RRR= 3.56 in women, and RRR= 6.55 in men). Conclusions: Childhood factors predict overweight and obesity in early adulthood. This effect is stronger on obesity than on overweight and in women than in men, and it seems to be partly mediated by adult circumstances. The results emphasize the lasting effect of childhood socioeconomic position on adult obesity. When preventive policies are being planned, social circumstances in childhood should be addressed.

Childhood and Current Determinants of Heavy Drinking in Early Adulthood

AIMS To explore the association of parental education, childhood living conditions and several adversities with heavy drinking in early adulthood, and to analyze the effect of the respondents current circumstances on these associations. METHOD The analyses were conducted in a sample of 1234 adults aged 18-29 years participating in the Finnish Health 2000 Survey (65% of the original representative two-stage cluster sample, N = 1894). The outcome measure was heavy drinking measured by g/week for pure alcohol (for men >or=280 g/week and for women >or=140 g/week). RESULTS 8% of young adult men and 5% of women were heavy drinkers. In both genders, parental alcohol problems and other childhood adversities, poor own education, and unemployment status increased the risk of heavy drinking. The impact of childhood on heavy drinking was partly independent and partly mediated by adult characteristics, in particular, for both genders, low level of education. CONCLUSIONS Childhood adversities are associated with heavy drinking in early adulthood among both genders. Childhood social circumstances as well as low educational level and unemployment should be taken into account in planning preventive policies to tackle the harms caused by excessive alcohol use at the individual and population level.

Employee, Partner, and Mother: Woman's Three Roles and Their Implications for Health

A large number of Western women today occupy the roles of an employee, a partner, and a mother. The three life spheres may spell contradictory expectations, demands, and rewards. The aim of this article is to examine self-rated health (SRH) and psychological distress of Finnish women aged 30 to 49 years. In addition to the number of roles the respondent occupies, the quality and the characteristics of each role are analyzed. The employee role is most strongly associated with SRH, whereas job control (jc) is the most important work characteristic. The partner role and, in more detail, support from partner determines psychological distress most significantly. Multiple-role occupancy is associated with good SRH. This, however, appears to be a cumulative effect of the individual roles and mostly not due to interactions between the roles the women occupy.

A 26-year follow-up study of heavy drinking trajectories from adolescence to mid-adulthood and adult disadvantage

AIMS The aim of the study was to identify heavy drinking trajectories from age 16 to 42 years and to examine their associations with health, social, employment and economic disadvantage in mid-adulthood. METHODS Finnish cohort studys participants who were 16 years old in 1983 were followed up at age 22, 32 and 42 (n = 1334). Heavy drinking was assessed at every study phase and based on these measurements trajectories of heavy drinking were identified. The trajectory groups were then examined as predictors of disadvantage at age 42. RESULTS Five distinct heavy drinking trajectories were identified: moderate (35%), steady low (22%), decreasing (9%), increasing (11%) and steady high (23%). Frequencies of the trajectory groups differed by gender. Using the moderate trajectory as a reference category, women in the steady high trajectory had an increased risk of experiencing almost all disadvantages at age 42. In men, increasing and steady high groups had an increased risk for experiencing health and economic disadvantage. CONCLUSION Steady high female drinkers and steady high and increasing male drinkers had the highest risk for disadvantage in mid-adulthood. By identifying heavy drinking trajectories from adolescence to mid-adulthood we can better predict long-term consequences of heavy alcohol use and plan prevention and intervention programmes.

Effects of childhood socio-economic conditions on educational differences in leisure-time physical activity

BACKGROUND Our purpose was to assess the direct and indirect contribution of childhood socio-economic conditions to educational differences in leisure-time physical activity among women and men. METHODS Population-based data were derived from a representative sample of Finns aged >or=30 years (N = 7112) as part of Health 2000 Survey. Multinomial logistic regression analysis was applied. Leisure-time physical activity was divided into inactivity, moderate and high activity. RESULTS Childhood socio-economic conditions had both a direct and indirect effect through adulthood socio-economic conditions on educational differences in leisure-time physical activity. The direct effect of childhood socio-economic conditions on educational differences in inactivity was stronger than its indirect effects through adulthood socio-economic conditions and other health behaviours and related factors. Adulthood socio-economic conditions had a considerable indirect effect on educational differences in leisure-time physical activity through other adulthood health behaviours and related factors among men. CONCLUSIONS In order to narrow educational differences in leisure-time physical activity, we should secure a childhood environment that enables a physically active lifestyle, support leisure-time physical activity in diverse occupational groups, guarantee equal physical activity possibilities across different educational careers and support those with insufficient material resources.

Leisure time physical activity in a 22-year follow-up among Finnish adults

BackgroundThe aim of this study was to explore long-term predictors of leisure time physical activity in the general population.MethodsThis study comprised 718 men and women who participated in the national Mini-Finland Health Survey from 1978–1980 and were re-examined in 2001. Participants were aged 30–80 at baseline. Measurements included interviews, health examinations, and self-administered questionnaires, with information on socioeconomic position, occupational and leisure time physical activity, physical fitness, body mass index, smoking, alcohol consumption, and physical functional capacity. Analyses included persons who were working and had no limitations in functional capacity at baseline.ResultsThe strongest predictor of being physically active at the follow-up was participation in physical activity at baseline, with an OR 13.82 (95%CI 5.50-34.70) for 3 or more types of regular activity, OR 2.33 (95%CI 1.22-4.47) for 1–2 types of regular activity, and OR 3.26 (95%CI 2.07-5.15) for irregular activity, as compared to no activity. Other determinants for being physically active were moving upwards in occupational status, a high level of baseline occupational physical activity and remaining healthy weight during the follow-up.ConclusionsTo prevent physical inactivity among older adults, it is important to promote physical activity already in young adulthood and in middle age and to emphasize the importance of participating in many types of physical activity.

Socio-demographic and behavioral variation in barriers to leisure-time physical activity.

Introduction: We examined the socio-demographic and behavioral determinants of perceived barriers to leisure-time physical activity (LTPA) in a population-based sample of working-aged adults. Methods: Data comprised the National FINRISK 2002 Study, a population-based health examination study. Analyses were restricted to those aged 25–64 years and who perceived that their amount of LTPA did not reach sufficient levels. They reported barriers to LTPA, defined as a lack of time, motivation and lack of companionship to be active with, as well as high expenses. Age, education, household income, employment status, family type, physical activity, smoking and body mass index (BMI) were included as explanatory variables. Results: Lack of time was the most frequent barrier. Each barrier was explained by a different set of factors that also varied between genders. The strongest and most systematic associations with the barriers were found for age, employment status and family type. Lack of time was less often reported as a barrier among the unemployed, singles without children and older people. Lacking motivation as a barrier was most common among singles without children. High expenses as a barrier was more often reported by the unemployed, and less often reported in the highest income group. Conclusions: When considering actions to promote LTPA, there is not one single solution, because the perceived barriers vary by population subgroups.

Childhood Adversities and Socioeconomic Position as Predictors of Leisure-Time Physical Inactivity in Early Adulthood

BACKGROUND Limited knowledge exists on how childhood social, health-related and economic circumstances predict adult physical inactivity. Our aim was a) to examine how various childhood adversities and living conditions predict leisure-time physical inactivity in early adulthood and b) to find out whether these associations are mediated through the respondents own education. METHODS Young adults aged 18-29 were used from the Health 2000 Study of the Finnish. The cross-sectional data were based on interviews and questionnaires including retrospective information on childhood circumstances. The analyses were carried out on 68% of the original sample (N = 1894). The outcome measure was leisure-time physical inactivity. RESULTS Only a few of the 11 childhood adversities were related with physical activity in early adulthood. Having been bullied at school was associated with physical inactivity independently of the other childhood circumstances and the respondents own education. Low parental education predicted leisure-time physical inactivity in men and the association was mediated by the respondents own education. Respondents with only primary or vocational education were more likely to be physically inactive during leisure-time compared with those with secondary or higher education. CONCLUSIONS There is some evidence that few specific childhood adversities, especially bullying at school, have long-lasting effects on physical activity levels.