Elsevier

The Journal of Pediatrics

Volume 164, Issue 3, March 2014, Pages 631-638.e2
The Journal of Pediatrics

Original Article
Cumulative Adversity in Childhood and Emergent Risk Factors for Long-Term Health

https://doi.org/10.1016/j.jpeds.2013.11.003Get rights and content

Objective

To examine whether and when effects of cumulative adversity in the first 7 years of life are evident in relation to 3 childhood markers of risk for poor adult physical health.

Study design

The study data are from an English birth cohort. Parental reports of 8 social risk factors were obtained during the child's first 7 years, and scores were created to reflect cumulative adversity at 4 developmental periods. At age 7 and 11 years, weight, height, and blood pressure (BP) were measured by clinic staff, and caregivers reported behavior problems. Linear regression was used to estimate associations of cumulative adversity with each outcome (n = 4361) and changes in these outcomes between 7 and 11 years (n = 3348).

Results

At age 7 years, mean adversity and chronic exposure to high adversity were associated with elevated body mass index (BMI) and internalizing and externalizing symptoms (P < .05), but not elevated BP. Adversity in all developmental periods was associated with elevated numbers of internalizing and externalizing symptoms (P < .0001), but associations were less robust for BMI. Adversity did not predict change in BMI or BP between age 7 and 11 years, however, it predicted increases in internalizing and externalizing symptoms (P < .0001).

Conclusion

Cumulative adversity was associated with BMI and behavior problems at age 7 years, and our data indicate that timing and chronicity of exposure to adversity differentially influence diverse indicators of long-term health risk commonly measured in childhood. This research suggests the hypothesis that interventions to address adversity could reduce the development of multiple chronic disease risk factors and limit their effects on health.

Section snippets

Methods

Study participants were members of the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective investigation of children born to mothers living in Avon County with estimated delivery dates between April 1991 and December 1992.15 The ALSPAC was designed to study how biological, social, and environmental factors influence pregnancy outcomes and child development. Approximately 85% of eligible pregnant women agreed to participate (n = 14 541), and 13 988 children who were alive at

Results

Characteristics of the study sample, including mean and proportional values of the outcomes, predictors, and covariates, are presented in Table II. The sample had a similar proportion of girls and boys and was almost entirely white (consistent with the regional population), and there was variation in maternal education. The number of children exposed to each risk factor ranged across the cumulative adversity scores at each developmental period: maternal psychopathology, 417-478; 1 adult in the

Discussion

At age 7 years, mean cumulative adversity and chronic exposure to high adversity were associated with elevated BMI and internalizing and externalizing symptoms, but not with elevated BP. Adversity scores for all 4 developmental periods were associated with elevated internalizing and externalizing symptomatology, whereas these associations for BMI were less robust. Cumulative adversity at age 1.5-3 years was the sole assessment associated with a change in BMI z-score between 7 and 11 years, and

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    Funded by a postdoctoral fellowship from the Robert Wood Johnson Foundation to support the Early Childhood Innovation Project based at the Center on the Developing Child at Harvard University (to N.S.). ALSPAC supported by the UK Medical Research Council the Wellcome Trust (092731) and the University of Bristol. The authors declare no conflicts of interest.

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