Browsing by Subject "Adverse childhood experiences"

Background: Despite improved access to HIV testing and medication, AIDS remains a leading cause of death among youth living with HIV (YLWH) in Tanzania. YLWH are prone to worse HIV outcomes than other age groups, which may be caused or mediated by mental health, social determinants of health (SDH), and adverse childhood experiences (ACEs). In this study, the investigators sought to determine if ACEs were correlated with key health variables in hopes of better understanding the factors associated with negative HIV and mental health outcomes among Tanzanian youth. Additionally, the investigators aimed to observe longitudinal trends in virologic suppression to understand the extent to which undetectable = untransmittable or “U=U” messaging applies to the more volatile youth demographic. Finally, the investigators sought to identify patterns and predictors that could aid in understanding risk of virologic failure in this population. Methods: The investigators incorporated and merged secondary data from participants who were enrolled in both of two distinct studies to create a longitudinal database spanning from 2013 to 2020. Participant ACE scores were derived from trauma exposure questionnaires and were compared with data about mental health, stigma, SDH, sexual experiences, self-reported adherence and HIV RNA (viral load). Associations of ACEs and other key variables were performed using linear regression. Results: ACEs were common among YLWH, especially loss of a parent and physical abuse. ACEs were also correlated with both mental health outcomes and virologic failure. Of the 48 participants who were virologically suppressed at the beginning of the study, one third had subsequent virologic failure, which was often associated with changes in ACEs, medication regimen, and SDH. Conclusion: Understanding common ACEs in this vulnerable population has direct relevance for the design of targeted interventions to prevent and treat repercussions of childhood trauma and improve mental health and HIV outcomes. ACEs, experiences with suicide risk, and low social support are important correlates of virologic failure and should be an alert when considering repeat HIV RNA testing and eligibility for supportive services.

The life course perspective has long theorized that childhood is a sensitive period for mental, physical, and emotional development, meaning that negative experiences during childhood can have long-lasting impacts on health and wellbeing. Thus, adverse childhood experiences (ACEs), such as parental alcoholism, sexual abuse, and physical neglect, during this sensitive period of the life course may elicit poor mental health both in childhood and as children age into adulthood. Although research on the long term impact of childhood adversity is growing, this research has been somewhat limited in the measurement of childhood adversity, focusing on dichotomous measures (occurred/ did not occur) or the summation of such dichotomous measures. In doing so, this research fails to capture heterogeneity in adversity experience, such as the severity, duration, and context of childhood adversities as well as how specific types of adversities may co-occur, consequently underestimating the impact of negative experiences for those at greatest risk of poor mental health. In this dissertation, I explore how these sources of distinction pattern mental health trajectories, with consequences for mental health disparities across the life course. In broadening the definition of childhood adversity beyond the simple occurrence of negative events, this dissertation provides an analytic blueprint for future research assessing childhood adversity, contributing to stress, life course, and mental health studies. In Chapter 2, I focus on a single adverse experience, parental mental health problems in childhood, to showcase how differences in severity, duration, and context of an adversity correspond to different mental health patterns across adulthood. Using six waves of data from the Panel Study of Income Dynamics (PSID; 2007-2017) and applying growth curve methods I find that more severe and longer exposures to parental mental health problems in childhood correspond to even greater distress in adulthood. The gender of the parent afflicted does not predict differences in adult mental health, but those individuals exposed to both maternal and paternal poor mental health in childhood have the greatest distress in adulthood. Chapters 3 and 4 focus on two other sources of heterogeneity in childhood adversity experience: the number and type of childhood adverse events. These chapters employ latent class analysis (LCA) to capture latent subtypes who are similar in their responses to a set of indicators, essentially estimating adversity classes that capture both the number and type of adversities that co-occur. These classes are then used to predict mental health trajectories across the life course. Before assessing latent classes of childhood adversity, Chapter 3 sets the groundwork for the analytic strategy of predicting outcome trajectories by latent classes. To date, there are several methods for including a distal outcome in latent class models, with no clear analytic strategy for when the outcome of interest is a growth model. Therefore, in Chapter 3, I employ a simulation study assessing the performance of five different methods under 27 different data conditions. Results from this study suggest that a maximum-likelihood (ML) approach best captures the true parameter estimates while maintaining substantive clarity. Chapter 4 uses the identified method in Chapter 3 (ML approach) to assess how latent classes of childhood adversity relate to trajectories of mental health using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, Wave I-IV). Findings suggest that in addition to a class represented by low adversity experience, there are two classes with greater experiences of adversity. One adversity class, characterized by household dysfunction, has greater depressive symptoms than the low adversity class in early life, and this gap is maintained into mid-adulthood. The other adversity class, characterized by maltreatment, has both greater depressive symptoms than the low adversity class in early life and becomes increasingly more depressed than this group across the life course. Overall, this dissertation contributes both methodologically and substantively to the study of childhood adversity and life course mental health. Childhood adversity has the ability to shape one’s mental health outcomes for many years after childhood, but this relationship is conditional on the lived experiences of adversity. These findings underscore the importance of severity, duration, context, type, and number of adverse events for patterning which children are at greatest risk for mental health problems in adulthood. Future work should consider these elements in favor over an over-simplified measure that may obscure the life course impact of these negative experiences.

Black females experience disparate rates of hypertension and earlier decline in cardiovascular health (CVH) than other females in the U.S. To date, much of research has focused on health behaviors, but more research is needed to understand how adversities early in life and in the social environment may contribute to premature decline in CVH among young Black women. Studies show that early life stress in the form of adverse childhood experiences (ACEs), like family dysfunction and child maltreatment, are reported in higher numbers by women, and historically minoritized populations, and experiencing four or more adversities in childhood may independently double the odds of CVD. In addition, social adversities like racial discrimination, housing insecurity, and social isolation in young adulthood may also contribute to inequities in CVH. Many health behaviors, such as cigarette use and dietary intake, are used as a stress coping measure, further highlighting the importance of understanding the stressors and adversities that are commonly experienced by young adult Black women. However, much of research has focused on CVD as a disease of middle and older adults, but less is known about the CVH of young adult Black women.

Young adulthood is an important developmental period when women are busy launching careers, and establishing social roles such as intimate partnerships and parenting, and forming new health behavior patterns to accommodate these changes. Per the developmental origins of health and disease hypothesis, stress, adversity, and health behaviors in young adulthood not only affect the individual, but also that of future generations. Improving the CVH of young adult Black women is essential to reducing and eliminating health inequities, and requires an appreciation of the heterogeneity among Black women, and the use of innovative approaches to identify subgroups of women who are doing well.

This dissertation includes a systematic review of the published literature on ACEs and blood pressure among women in the United States, and a secondary analysis of The National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine how adverse childhood and social experiences relate to the cardiovascular health (CVH) health of young adult Black women. The systematic search of three databases identified 1,640 articles, and ten met all established inclusion criteria. In our review ACEs were positively associated with blood pressure in six of the ten articles reviewed. The inconsistency in results may be related to self-report vs objective assessment of blood pressure. Racial and ethnic diversity was limited, with half of the articles consisting of samples that were majority White. Future research should incorporate diverse, population representative samples, with consideration for sex-or-race specific stressors, such as racism, and its potential impact on blood pressure and CVH.

Data presented in the remaining three chapters of the dissertation study are an observational, cross-sectional analysis of data from Black females, ages 24-32 who participated in the Add Health study at wave four. The first data based chapter examines if social adversities and sleep characteristics are indicators of increased risk of hypertension among young adult Black women. Of the five social adversities (social isolation, discrimination, high perceived stress, low subjective social status, child abuse) and four sleep characteristics examined (delayed sleep onset, poor sleep continuity, short sleep, long sleep, and snoring), only discrimination and poor sleep continuity were positively associated with higher odds of hypertension, adjusting for age and BMI. Since social adversities often co-exist, the next chapter examined patterns or latent classes of social adversity. Three latent classes were identified: (1) low stress, (2) high violence, and (3) high stress. In analyses adjusted for age, income, education and depression, the subclasses of social adversity were related to diet, and physical activity, but were not related to overall ideal CVH. Whereas chapters 3 and 4 both focused on stressors in young adulthood as predictors of CVH, chapter 5 added an additional life course perspective by considering the impact of adverse childhood experiences on CVH. This chapter also sought to advance the literature by examining the maternal relationship and religion and spirituality in adolescence and young adulthood as potential protective factors that may buffer the stress of childhood adversity. The results in chapter five suggest that a strong religious and spiritual connection in adolescence or young adulthood may promote CVH among young Black women, but it’s impact on CVH is diminished after taking into account other factors such as severity of ACEs, socioeconomic status, and mental health. The second proposed protective factor, maternal relationship, did not have a significant direct influence on CVH.

This study may be the first to explore CVH in a within-group, population-representative sample of young adult Black women in the United States. The present findings suggest there are critical differences in how social contributors influence health, and in fact, many of the social constructs measured had little influence on health. This suggests that the factors measured may not accurately reflect the underlying construct for different subpopulations. Moreover, there may be other social factors that are not well captured in existing scientific research that likely are impacting the health of Black women and need to be explored, to advance the American Heart Association’s goal of equitable improvements in CVH.