Renée Boynton-Jarrett

Cumulative Violence Exposure and Self-Rated Health: Longitudinal Study of Adolescents in the United States

OBJECTIVE. The goal was to determine whether cumulative exposure to violence in childhood and adolescence contributes to disparities in self-rated health among a nationally representative sample of US adolescents. METHODS. The National Longitudinal Survey of Youth 1997 is an ongoing, 8-year (1997–2004), longitudinal, cohort study of youths who were 12 to 18 years of age at baseline (N = 8224). Generalized estimating equations were constructed to investigate the relationship between cumulative exposure to violence and risk for poor health. RESULTS. At baseline, 75% of subjects reported excellent or very good health, 21.5% reported good health, and 4.5% reported fair or poor health. Cumulative violence exposures (witnessed gun violence, threat of violence, repeated bullying, perceived safety, and criminal victimization) were associated with a graded increase in risk for poor health and reduced the strength of the relationship between household income and poor health. In comparison with subjects with no violence exposure, risk for poor self-rated health was 4.6 times greater among subjects who reported ≥5 forms of cumulative exposure to violence, controlling for demographic features and household income. Trend analysis revealed that, for each additional violence exposure, the risk of poor health increased by 38%. Adjustment for alcohol use, drug use, smoking, depressive symptoms, and family and neighborhood environment reduced the strength of the relationships between household income and cumulative exposure to violence scores and poor self-rated health, which suggests partial mediation of the effects of socioeconomic status and cumulative exposure to violence by these factors. CONCLUSIONS. In this nationally representative sample, social inequality in risk for poor self-rated health during the transition from adolescence to adulthood was partially attributable to disparities in cumulative exposure to violence. A strong graded association was noted between cumulative exposure to violence and poor self-rated health in adolescence and young adulthood.

Cumulative Social Risk and Obesity in Early Childhood

OBJECTIVES: The goal of this study was to examine the relationship between cumulative social adversity and childhood obesity among preschool-aged children (N = 1605) in the Fragile Families and Child Wellbeing Study. METHODS: Maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and father’s incarceration were obtained when the child was 1 and 3 years of age. Two cumulative social risk scores were created by summing the 6 factors assessed at ages 1 and 3 years. Child height and weight were measured at 5 years of age. Logistic regression models stratified according to gender were used to estimate the association between cumulative social risk and obesity, adjusting for sociodemographic factors. RESULTS: Seventeen percent of children were obese at age 5 years, and 57% had at least 1 social risk factor. Adjusting for sociodemographic factors, girls experiencing high cumulative social risk (≥2 factors) at age 1 year only (odds ratio [OR]: 2.1 [95% confidence interval [CI]: 1.1–4.1]) or at 3 years only (OR: 2.2 [95% CI: 1.2–4.2]) were at increased odds of being obese compared with girls with no risk factors at either time point. Those experiencing high cumulative risk at age 1 and 3 years were not at statistically significant odds of being obese (OR: 1.9 [95% CI: 0.9–4.0]). No significant associations were noted among boys. CONCLUSIONS: There seems to be gender differences in the effects of cumulative social risk factors on the prevalence of obesity at 5 years of age. Understanding the social context of families could make for more effective preventive efforts to combat childhood obesity.

Child abuse and smoking among young women: the importance of severity, accumulation, and timing.

PURPOSE We examined the association between severity, accumulation, and timing of abuse in childhood and adolescence and smoking status among young women. METHODS Retrospective self-reported childhood abuse was ascertained with the modified Conflict Tactics Scale from 91,286 Nurses Health Study II participants in 2001 (68,505 returned; 75.0% response rate). Childhood abuse was categorized by severity (mile/moderate/severe), type (physical/sexual), and timing (childhood/adolescence). Smoking status during adolescence was reported at baseline (1989). Logistic regression was used to predict smoking initiation by age 14 and smoking status between the ages of 15 and 19. RESULTS A graded association between severity of abuse and early initiation of smoking (by age 14 years) was demonstrated (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.7-2.1 for severe physical violence). Young women with both physical and sexual abuse were two times more likely to start smoking by age 14 than were those reporting no abuse (OR = 2.0, 95% CI = 1.8-2.3). Although abuse during childhood increased risk for adolescent smoking (OR = 1.7, 95% CI = 1.8-2.1) for those with childhood physical and sexual abuse, inclusion of adolescent physical and sexual abuse (OR = 2.2, 95% CI 2.1-2.4) diminished the impact of childhood abuse (OR = 1.1, 95% CI 1.1-1.2). The degree of familial emotional support was protective against smoking, and reduced the impact of abuse by 40% among those with high emotional support versus those without (p < .0001). CONCLUSIONS A strong and graded association was observed between both severity and accumulation of abuse and the risk of early initiation of smoking among girls. Smoking status during late adolescence was more strongly associated with adolescent abuse than childhood abuse. Early smoking onset is associated with both heightened risk for disease in adolescence but also increased morbidity and mortality in adulthood. Identifying and intervening in potentially modifiable risk factors for smoking onset in young women, such as early-life physical and sexual abuse, and building familial strengths, such as emotional support, may have significant public health implications.

Intimate partner violence and cigarette smoking: Association between smoking risk and psychological abuse with and without co-occurrence of physical and sexual abuse.

OBJECTIVES We examined the association between psychological abuse in a current relationship and current cigarette smoking among women, with and without the co-occurrence of physical or sexual abuse. METHODS Womens experience of psychological abuse, experience of physical or sexual abuse, and smoking status were ascertained through a survey of female nurses. A score of 20 or more on the Womens Experience With Battering scale defined psychological abuse. We used logistic regression to predict current smoking, adjusting for demographic and social covariates. Analyses included women in a current relationship (n=54200). RESULTS Adjusted analyses demonstrated that women experiencing only psychological abuse alone were 33% (95% confidence interval [CI]=13%, 57%) more likely to smoke than nonabused women. Compared with nonabused women, psychologically abused womens risk of smoking was greater if they reported a single co-occurrence of physical or sexual abuse (odds ratio [OR]=1.5; 95% CI=1.3, 1.8) or multiple co-occurrences (OR=1.9; 95% CI=1.7, 2.3). CONCLUSIONS Psychological abuse in a current relationship was associated with an increased risk of smoking in this cohort of largely White, well-educated, and employed women. The co-occurrence of physical or sexual abuse enhanced that risk. Further research is needed to see if these associations hold for other groups.

Child and Adolescent Abuse in Relation to Obesity in Adulthood: The Black Women’s Health Study

OBJECTIVE: To investigate the association of physical and sexual abuse in childhood and adolescence with risk of adult obesity among black women in the United States. METHODS: Participants were women enrolled in the Black Women’s Health Study, an ongoing prospective cohort study begun in 1995. In 2005, 33 298 participants completed a self-administered questionnaire on early life experiences of abuse. Log-binomial regression models were used to derive risk ratios (RRs) and 95% confidence intervals (CIs) for the relation of child/teenager abuse with obesity (BMI ≥30) and central adiposity (waist circumference >35 inches) reported in 2005. RESULTS: The RR for BMI ≥30, a measure of overall obesity, was 1.29 (95% CI 1.20–1.38) for the highest severity of exposure to child/teenager physical and sexual abuse relative to no abuse. After controlling for postulated intermediates, including reproductive history, diet, physical activity, depressive symptoms, and socioeconomic status, the RR was 1.14 (95% CI 1.08–1.21). The RR for waist circumference >35 inches, which measures central obesity, for severe physical and sexual abuse relative to no abuse was 1.29 (95% CI 1.19–1.38) before adjustment for intermediates and 1.18 (95% CI 1.10–1.27) after adjustment. CONCLUSIONS: Early life sexual and physical abuse was associated with an increased risk of overall and central obesity in adulthood. Although the association between abuse and obesity was explained to some extent by health behaviors, reproductive history, and mental health, these factors did not fully account for the associations. Our data suggest that early life adversity is related to adult body size and weight distribution.

Avoiding the Unintended Consequences of Screening for Social Determinants of Health

Screening for social determinants of health, which are the health-related social circumstances (eg, food insecurity and inadequate or unstable housing) in which people live and work, has gained momentum as evidenced by the recent Centers for Medicare & Medicaid Services innovation initiative of

Association Between Maternal Intimate Partner Violence and Incident Obesity in Preschool-Aged Children Results From the Fragile Families and Child Well-being Study

157 million toward creation of accountable health communities.1 Funding will allow grantees to test a novel model of health care that includes identifying and addressing social determinants of health for Centers for Medicare & Medicaid Services beneficiaries. The initiative promotes collaboration between the clinical realm and the community through screening of beneficiaries to (1) identify unmet health-related social needs and (2) assist high-risk beneficiaries (ie, >2 emergency department visits and a health-related social need) with accessing available community services. Some health policy makers have embraced screening of social determinants as the next hope for achieving the triple aim of better health, improved health care delivery, and reduced costs because social and environmental factors are thought to contribute half

Social and behavioral risk factors for obesity in early childhood

OBJECTIVE To examine the impact of chronicity of maternal intimate partner violence (IPV) on obesity risk among preschool-aged children. DESIGN Prospective cohort study. SETTING Several large US cities. PARTICIPANTS A subsample of the Fragile Families and Child Well-being Study participants (n = 1595), who were children born between 1998 and 2000 and their parents interviewed at baseline and at 12, 36, and 60 months. MAIN EXPOSURE Maternal report of restrictive, sexual, and physical abuse from an intimate partner. Chronic IPV was defined as any maternal IPV exposure during both pregnancy or infancy (0-12 months) and early childhood (36-60 months). MAIN OUTCOME MEASURE Repeated measures of child body mass index. RESULTS Among the 1595 children, 16.5% were obese at age 5 years and 49.4% of the mothers reported some form of IPV. Compared with those who had no IPV exposure, children whose mothers reported chronic IPV had an elevated risk for obesity at age 5 years (adjusted odds ratio = 1.80; 95% confidence interval, 1.24-2.61). Stratified analyses indicated increased risk for obesity among girls with a maternal history of chronic IPV (adjusted odds ratio = 2.21; 95% confidence interval, 1.30-3.75) compared with boys (adjusted odds ratio = 1.66; 95% confidence interval, 0.94-2.93) and a larger effect of any maternal IPV on obesity among children living in less safe neighborhoods (adjusted odds ratio = 1.56; 95% confidence interval, 1.03-2.36). CONCLUSIONS Chronic maternal IPV is associated with increased risk of obesity among preschool-aged children. Preventing family violence and improving community safety may help reduce childhood obesity.

Childhood Hardship, Maternal Smoking, and Birth Outcomes: A Prospective Cohort Study

Objective: Although multiple social and behavioral risk factors associated with obesity co-occur among young children, most studies have examined them separately. The purpose of this study was to examine the relationship between social risk factors, behavioral problems, health behaviors, and obesity among preschoolers in the Fragile Families and Child Wellbeing Study (N = 1589). Methods: A cumulative social risk score was created by summing maternal reports of intimate partner violence, food insecurity, housing insecurity, maternal depressive symptoms, maternal substance use, and fathers incarceration, obtained when the child was 3 years old. Mothers reported on the childs internalizing and externalizing behaviors with the Child Behavior Checklist at age 5 years. Mothers also reported on hours the child spent watching television and sleeping as well as servings of soda or juice drinks the child consumed per day. Child height and weight were measured at age 5 years. Obesity was defined as body mass index ≥95th percentile. Results: In regression analyses adjusted for health behaviors, behavioral problems, and sociodemographic factors, cumulative social risk was associated with obesity among girls. Externalizing behavioral problems were associated with obesity among girls (prevalence ratios [PRs], 1.5; 95% confidence interval [CI], 1.2–1.7) and boys (PR, 1.3; 95% CI, 1.1–1.6). Short sleep duration was also associated with obesity among girls (PR, 1.2; 95% CI, 1.0–1.4) and boys (PR, 1.3; 95% CI, 1.1–1.5) even after adjusting for behavioral problems and social risk factors. Watching more than 2 hours of television per day was associated with obesity among boys (PR 1.5; 95% CI, 1.2 to 1.9) but not girls. Conclusion: Co-occurring social and behavioral risk factors are associated with obesity among 5-year-old children.

Prenatal environmental factors influencing IgE levels, atopy and early asthma.

OBJECTIVE To determine the association between type, chronicity, and severity of childhood hardships and smoking status during pregnancy, preterm birth (PTB), and low birth weight (LBW). DESIGN Prospective cohort study. SETTING The National Child Development Study, a nationally representative study of births in Great Britain in 1958. PARTICIPANTS Four thousand eight-hundred sixty-five women with at least 1 singleton live birth. MAIN EXPOSURES Hardship during childhood, indicated by several variables, including financial/structural hardship, lack of parental interest in education, family dysfunction, violence/mental health issues, and family structure. MAIN OUTCOME MEASURES Smoking in pregnancy, LBW, and PTB. RESULTS A consistent and graded association was seen between all types of childhood hardships and smoking status during pregnancy (odds ratio [OR] for 4 or more hardships, 2.02; 95% confidence interval [CI], 1.58-2.58; P < .001 for all comparisons). Most hardships were also associated with risk of LBW and PTB, with associations between number of hardships and both outcomes persisting after controlling for smoking status and adult social class (for LBW, OR, 1.51; 95% CI, 1.10-2.06; for PTB, OR, 1.44; 95% CI, 1.08-1.92). CONCLUSION Childhood hardships have an enduring impact on future pregnancy outcomes, in part through their association with smoking during pregnancy and adult socioeconomic position.