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1.  Self-reported drunkenness among adolescents in four sub-Saharan African countries: associations with adverse childhood experiences 
Consumption of alcohol is associated with acute and chronic adverse health outcomes. There is a paucity of studies that explore the determinants of alcohol use among adolescents in sub-Saharan Africa and, in particular, that examine the effects of adverse childhood experiences on alcohol use.
The paper draws on nationally-representative data from 9,819 adolescents aged 12-19 years from Burkina Faso, Ghana, Malawi, and Uganda. Logistic regression models were employed to identify correlates of self-reported past-year drunkenness. Exposure to four adverse childhood experiences comprised the primary independent variables: living in a food-insecure household, living with a problem drinker, having been physically abused, and having been coerced into having sex. We controlled for age, religiosity, current schooling status, the household head's sex, living arrangements, place of residence, marital status, and country of survey. All analyses were conducted separately for males and females.
At the bivariate level, all independent variables (except for coerced sex among males) were associated with the outcome variable. Overall, 9% of adolescents reported that they had been drunk in the 12 months preceding the survey. In general, respondents who had experienced an adverse event during childhood were more likely to report drunkenness. In the multivariate analysis, only two adverse childhood events emerged as significant predictors of self-reported past-year drunkenness among males: living in a household with a problem drinker before age 10, and being physically abused before age 10. For females, exposure to family-alcoholism, experience of physical abuse, and coerced sex increased the likelihood of reporting drunkenness in the last 12 months. The association between adverse events and reported drunkenness was more pronounced for females. For both males and females there was a graded relationship between the number of adverse events experienced and the proportion reporting drunkenness.
We find an association between experience of adverse childhood events and drunkenness among adolescents in four sub-Saharan African countries. The complex impacts of adverse childhood experiences on young people's development and behavior may have an important bearing on the effectiveness of interventions geared at reducing alcohol dependence among the youth.
PMCID: PMC2904276  PMID: 20569490
2.  Self-esteem and Mortality: Prospective Evidence from a Population-based Study 
Annals of epidemiology  2004;14(1):58-65.
Self-esteem is considered to be importantly associated with both psychosocial states such as depression as well as physical health. There are no population-based studies that examine the association between self-esteem and mortality. The objective of this study was to assess whether low self-esteem was prospectively associated with increased risk of death in a population-based sample of Finnish men.
A sample of 2682 male residents of Kuopio, Finland were interviewed and followed prospectively as part of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Characteristics of the KIHD sample at baseline included self-esteem, measured by the Rosenberg ten-item scale, socioeconomic factors, behavioral risk factors, other psychosocial characteristics, and prevalent diseases. Mortality was ascertained through linkage to the Finnish national death registry. We assessed the relationship between self-esteem and all-cause mortality using Cox proportional hazards models.
Low self-esteem was associated with a two-fold [hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.3–3.2] increase in age-adjusted mortality. This relationship was partially explained by behavioral and socioeconomic factors, and prevalent diseases, and fully explained by other psychosocial characteristics (hopelessness, depression, cynical hostility, and sullenness). When adjusted for hopelessness alone there was no increased risk associated with low self-esteem (HR = 1.3, 95% CI = 0.8–2.2).
This study found no association between self-esteem and all-cause mortality after adjustment for other psychosocial characteristics, primarily hopelessness. Our understanding of the observed relationships between some psychosocial factors and mortality may be improved by simultaneous measurement of multiple psychosocial domains, thus diminishing the potential for residual confounding.
PMCID: PMC3173508  PMID: 14664781
Self-esteem; Mortality; Psychosocial Factors; Socioeconomic Factors
3.  The Drunk in Court: Survey of Drunkenness Offenders from Two London Courts 
British Medical Journal  1968;4(5634):808-811.
A total of 151 men charged with drunkenness with or without aggravations were interviewed immediately after their appearance before the magistrates. The survey was conducted in two Metropolitan courts; one in an area frequented by vagrants, and the other in a mixed middle-class and working-class area.
Few of the offenders were casual roisterers and the majority had a serious drinking problem. Half the offenders showed evidence of chemical dependence on alcohol as determined by morning shakes, morning relief drinking, amnesias, inability to stop drinking, and hallucinatory experiences.
The majority of the offenders were suffering from gross social isolation.
Existing ways of dealing with such men seem inadequate. A rehabitation service is needed, with hostel accommodation, and particular attention should be paid to first offenders.
PMCID: PMC1912970  PMID: 5702297
4.  The relationship between parental socio-economic status and episodes of drunkenness among adolescents: findings from a cross-national survey 
BMC Public Health  2006;6:289.
Behavioral factors such as (excessive) alcohol consumption play a major role in the explanation of social inequalities in health. The unequal distribution of health risk behaviors among socio-economic groups has important consequences for both the current and future health status of the younger generation. However, little is known about socio-economic differences in unhealthy lifestyles during adolescence. The purpose of the present study is to investigate socio-economic differences in adolescent drinking behaviour among 11–15 year old adolescents in Europe and North America.
Data was obtained from the Health Behaviour in School-aged Children (HBSC) study 2001/02, a cross-national survey conducted in collaboration with the World Health Organization. The present analysis is based on 69249 male and 73619 female students from 28 countries. The effect of parental occupation and family affluence on episodes of drunkenness was assessed using separate logistic regression models controlling for age.
Socio-economic circumstances of the family had only a limited effect on repeated drunkenness in adolescence. For girls only in one out of 28 countries a significant association between family affluence and repeated drunkenness was observed, while boys from low and/or medium affluent families in nine countries faced a lower risk of drunkenness than boys from more affluent families. Regarding parental occupation, significant differences in episodes of drunkenness were found in nine countries for boys and in six countries for girls. Compared to family affluence, which was positively related to risk of drunkenness, a decreasing occupational status predicted an increasing risk of drunkenness. This pattern was identified within a number of countries, most noticeably for boys.
Parental socio-economic status is only of limited importance for episodes of drunkenness in early adolescence, and this very limited role seems to apply for girls more than for boys and for parental occupation more than family affluence. For future studies it might be important to look at the effects of socio-economic status within the context of other peer, family and school related factors in order to assess to what extent those factors might mediate the effects of social class background.
PMCID: PMC1693920  PMID: 17132161
5.  Drunken patients in the general hospital: their care and management 
Postgraduate Medical Journal  2005;81(953):161-166.
In Britain alcohol consumption is increasing, 1 in 4 men and 1 in 10 women drink hazardously, 1 in 3 young men, and 1 in 4 young women regularly binge drink. Mortality rates attributable to alcohol have doubled; with 1 in 5 male inpatients having an alcohol related problem. The increasing problem of managing drunken behaviour in accident and emergency departments is discussed. Although an alcohol history is recommended for all admissions, because of various reasons, hazardous drinkers continue to miss the opportunity of effective interventions. In addition to the more formal treatments for alcohol problems, there is a wealth of evidence reporting the effectiveness of brief interventions carried out by a range of health professionals can lead to long term reductions in alcohol consumption. This review discusses practical and legal issues of the assessment, screening tools, and management of intoxicated patients.
PMCID: PMC1743218  PMID: 15749791
6.  Women's childhood and adult adverse experiences, mental health, and binge drinking: The California Women's Health Survey 
This study examined sociodemographic, physical and mental health, and adult and childhood adverse experiences associated with binge drinking in a representative sample of women in the State of California.
Materials and methods
Data were from the 2003 to 2004 (response rates of 72% and 74%, respectively) California Women's Health Survey (CWHS), a population-based, random-digit-dial annual probability survey sponsored by the California Department of Health Services. The sample was 6,942 women aged 18 years or older.
The prevalence of binge drinking was 9.3%. Poor physical health, and poorer mental health (i.e., symptoms of PTSD, anxiety, and depression, feeling overwhelmed by stress), were associated with binge drinking when demographics were controlled, as were adverse experiences in adulthood (intimate partner violence, having been physically or sexually assaulted, or having experienced the death of someone close) and in childhood (living with someone abusing substances or mentally ill, or with a mother vicimized by violence, or having been physically or sexually assaulted). When adult mental health and adverse experiences were also controlled, having lived as a child with someone who abused substances or was mentally ill was associated with binge drinking. Associations between childhood adverse experiences and binge drinking could not be explained by women's poorer mental health status in adulthood.
Identifying characteristics of women who engage in binge drinking is a key step in prevention and intervention efforts. Binge drinking programs should consider comprehensive approaches that address women's mental health symptoms as well as circumstances in the childhood home.
PMCID: PMC2447829  PMID: 18538028
7.  Childhood adversities as a predictor of disability retirement 
There is a large body of research on adulthood risk factors for retirement due to disability, but studies on the effect of adverse childhood experiences are scarce.
To examine whether adverse childhood experiences predict disability retirement.
Data were derived from the Health and Social Support Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow‐up questionnaire). The analysed data consisted of 8817 non‐retired respondents aged 40–54 years (5149 women, 3668 men). Negative childhood experiences, such as financial difficulties, serious conflicts and alcohol‐related problems, were assessed at baseline and disability retirement at follow‐up.
The risk of disability retirement increased in a dose–response manner with increasing number of childhood adversities. Respondents who had experienced multiple childhood adversities had a 3.46‐fold increased risk (95% CI 2.09 to 5.71) of disability retirement compared with those who reported no such adversities. Low socioeconomic status, depression (Beck Depression Inventory‐21), use of drugs for somatic diseases as well as health‐related risk behaviour, such as smoking, heavy alcohol consumption and obesity, were also predictors of disability retirement. After simultaneous adjustments for all these risk factors, the association between childhood adversities and the risk of disability retirement attenuated, but remained significant (OR 1.90, 95% CI 1.07 to 3.37).
Information on childhood conditions may increase our understanding of the determinants of early retirement, especially due to mental disorders. Childhood adversities should be taken into account when considering determinants of disability retirement and identifying groups at risk.
PMCID: PMC2465717  PMID: 17496255
8.  Alcohol Marketing, Drunkenness, and Problem Drinking among Zambian Youth: Findings from the 2004 Global School-Based Student Health Survey 
This study examines the associations between alcohol marketing strategies, alcohol education including knowledge about dangers of alcohol and refusal of alcohol, and drinking prevalence, problem drinking, and drunkenness. Analyses are based on the Global School-Based Student Health Survey (GSHS) conducted in Zambia (2004) of students primarily 11 to 16 years of age (N = 2257). Four statistical models were computed to test the associations between alcohol marketing and education and alcohol use, while controlling for possible confounding factors. Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR = 1.49; 95% CI: 1.09–2.02) and problem drinking (AOR = 1.41; 95% CI: 1.06–1.87) among youth after controlling for demographic characteristics, risky behaviors, and alcohol education. However, alcohol education was not associated with drunkenness or problem drinking. These findings underscore the importance of restricting alcohol marketing practices as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth.
PMCID: PMC3103909  PMID: 21647354
9.  Drunken Environments: A Survey of Bartenders Working in Pubs, Bars and Nightclubs 
There is evidence that bartenders play a key role in respect of the health and safety of patrons in nightlife environments. However, little is known of how bartenders themselves are affected by the environments in which they work, especially with regard to their exposure to violence, pressure to drink and stress. We used a cross-sectional survey to assess the experiences of bartenders (n = 424) working in pubs, bars and nightclubs in Denmark. 71% of the respondents reported drinking while working, 6% reported using other drugs than alcohol at work, and 33% reported drinking even when they did not feel like it because of pressure to drink at work. Verbal assaults and threats were common and associated with higher levels of perceived stress. Bartenders’ work environment poses a risk for the development of alcohol use disorders. The fact that many bartenders consume significant quantities of alcohol during their working hours may pose a risk not only to their own safety, but also to that of their colleagues and patrons.
PMCID: PMC3823323  PMID: 24157511
alcohol; violence; stress; drinking environments; prevention; work; bartenders
10.  Randomized Study of Combined Universal Family and School Preventive Interventions: Patterns of Long-Term Effects on Initiation, Regular Use, and Weekly Drunkenness 
This study reports findings on a combined family and school-based competency-training intervention from an in-school assessment 2.5 years past baseline, as a follow-up to an earlier study of substance initiation. Increased rates of observed alcohol use and an additional wave of data allowed evaluation of regular alcohol use and weekly drunkenness, with both point-in-time and growth curve analyses. Thirty-six rural schools were randomly assigned to (a) a combined family and school intervention condition, (b) a school-only condition, or (c) a control condition. The earlier significant outcome on a substance initiation index was replicated, and positive point-in-time results for weekly drunkenness were observed, but there were no statistically significant outcomes for regular alcohol use. Discussion focuses on factors relevant to the mix of significant longitudinal results within a consistent general pattern of positive intervention–control differences.
PMCID: PMC2409287  PMID: 16366809
universal prevention; family; school; substance use
11.  Alcohol marketing and drunkenness among students in the Philippines: findings from the nationally representative Global School-based Student Health Survey 
BMC Public Health  2013;13:1159.
A largely unaddressed issue in lower income countries and the Philippines, in particular, is the role of alcohol marketing and its potential link to early alcohol use among youth. This study examines the associations between exposures to alcohol marketing and Filipino youths’ drinking prevalence and drunkenness.
Cross-sectional analyses were used to examine the Global School-based Student Health Survey (GSHS) conducted in Philippines (2011). The self-administered questionnaires were completed by students primarily 13 to 16 years of age (N = 5290). Three statistical models were computed to test the associations between alcohol marketing and alcohol use, while controlling for possible confounding factors.
Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR: 1.84; 95% CI = 1.06–3.21) among youths after controlling for demographic and psychosocial characteristics, peer environment, and risky behaviors. In addition, seeing alcohol ads in newspapers and magazines (AOR: 1.65, 95% CI = 1.05–2.58) and seeing ads at sports events, concerts or fairs (AOR: 1.50, 95% CI = 1.06–2.12) were significantly associated with increased reports of drunkenness.
There are significant associations between alcohol marketing exposure and increased alcohol use and drunkenness among youth in the Philippines. These findings highlight the need to put policies into effect that restrict alcohol marketing practices as an important prevention strategy for reducing alcohol use and its dire consequences among vulnerable youth.
PMCID: PMC3890547  PMID: 24325264
Alcohol; Alcohol marketing; Drunkenness; Philippines; Survey
12.  Effects of legislative reform to reduce drunken driving and alcohol-related traffic fatalities. 
Public Health Reports  1988;103(6):659-667.
From 1980 through 1985, considerable progress was made across the Nation in reducing drunken driving and fatal automobile crashes. More than 400 chapters of local citizen groups concerned with reducing drunken driving were formed. New media coverage, measured in number of stories, increased fiftyfold from 1980 to 1984. More than 500 legislative reforms were passed. All States now have adopted a legal drinking age of 21. Many also adopted criminal and administrative per se laws and instituted penalty increases for drunken driving. By 1985, the total number of fatal crashes declined to 39,168, a decrease of 6,116, or 16 percent, from the 1980 level of 45,284. Single-vehicle fatal crashes occurring at night, those most likely to involve alcohol, declined by 20 percent, with 3,674 fewer crashes in 1985 than in 1980. Among teenage drivers, declines in fatal crashes were steeper: Fatal crashes decreased 26 percent, and single-vehicle night fatal crashes were down 34 percent. After 1984, however, the number of new citizen groups established and the number of stories appearing in the media began to decline. In 1986, after decreasing for several years, the number of fatal crashes rose 5 percent, and single-vehicle night fatal crashes rose 7 percent, up 1,060 from 1985. Among teenage drivers, the increase in single-vehicle night fatal crashes was even higher, up 17 percent. In 1987, single-vehicle night fatal crashes declined slightly but still remained higher than in 1983, 1984, or 1985.(ABSTRACT TRUNCATED AT 250 WORDS)
PMCID: PMC1478153  PMID: 3141962
13.  The Drunken Self: The Five-Factor Model as an Organizational Framework for Characterizing Perceptions of One’s Own Drunkenness 
Existing literature supports the use of the five-factor model (FFM) personality dimensions (i.e., Neuroticism, Extraversion, Agreeableness, Intellect, and Conscientiousness) as a comprehensive representation of mood, affect, and behavior. This study evaluated the use of the FFM as an organizational framework for understanding self-reported perceptions of drunkenness (i.e., mood, affect, and behavior associated with alcohol intoxication).
Cross-sectional data were obtained through an online survey of college student drinkers (N = 988; 50% male, 85% white, mean age = 18.2) in an Introductory Psychology course at a large, mid-western university. Participants reported on their perceptions of their sober and drunk “personalities” by rating items from Goldberg’s International Personality Item Pool.
Confirmatory factor analysis showed that sober and drunk personality structures fit the data equally well. On average, differences between perceived drunken and sober personality were pervasive; each of the 5 factors differed as a function of drunk versus sober state with perceived drunken personality associated with (in order of effect size) less conscientiousness, less intellect, less agreeableness, more extraversion, and less neuroticism. These general patterns varied by sex and drinking pattern.
Findings support the use of the FFM as a framework for organizing self-reported perceptions of global changes in “personality” that occur under intoxication.
PMCID: PMC3768252  PMID: 22458428
Alcohol Involvement; Five-Factor Personality; Drunken Comportment
14.  Historical measures of social context in life course studies: retrospective linkage of addresses to decennial censuses 
There is evidence of a contribution of early life socioeconomic exposures to the risk of chronic diseases in adulthood. However, extant studies investigating the impact of the neighborhood social environment on health tend to characterize only the current social environment. This in part may be due to complexities involved in obtaining and geocoding historical addresses. The Life Course Socioeconomic Status, Social Context, and Cardiovascular Disease Study collected information on childhood (1930–1950) and early adulthood (1960–1980) place of residence from 12,681 black and white middle-aged and older men and women from four U.S. communities to link participants with census-based socioeconomic indicators over the life course.
Most (99%) participants were linked to 1930–50 county level socioeconomic census data (the smallest level of aggregation universally available during this time period) corresponding to childhood place of residence. Linkage did not vary by race, gender, birth cohort, or level of educational attainment. A commercial geocoding vendor processed participants' self-reported street addresses for ages 30, 40, and 50. For 1970 and 1980 censuses, spatial coordinates were overlaid onto shape files containing census tract boundaries; for 1960 no shape files existed and comparability files were used. Several methods were tested for accuracy and to increase linkage. Successful linkage to historical census tracts varied by census (66% for 1960, 76% for 1970, 85% for 1980). This compares to linkage rates of 94% for current addresses provided by participants over the course of the ARIC examinations.
There are complexities and limitations in characterizing the past social context. However, our results suggest that it is feasible to characterize the earlier social environment with known levels of measurement error and that such an approach should be considered in future studies.
PMCID: PMC538253  PMID: 15548332
15.  Associations between binge and heavy drinking and health behaviors in a nationally representative sample 
Addictive behaviors  2011;36(12):1240-1245.
Binge and heavy drinking are noted in the literature for their relatively high prevalence and adverse health-related effects.
Design and participants
We used data from the 2006 Behavioral Risk Factor Surveillance Survey (BRFSS) to determine the associations between binge and heavy drinking and a wide range of health-related variables, including positive and negative health behaviors, preventive care practices, and quality of life indices in a nationally representative sample of 344,793 adults.
Rates of binge and heavy drinking in the current sample were 15% and 5%, respectively. Binge and heavy drinking were more common among men, younger adults, and individuals with higher incomes and at least some college education. After controlling for relevant demographic variables, binge and heavy drinking were associated with a number of adverse health-related and preventive care behaviors (e.g., smoking, failing to receive a mammogram), as well as less life satisfaction and a greater number of poor mental health days than those who did not engage in these drinking behaviors. Interestingly, binge and heavy drinking were also associated with some positive health-related variables (e.g., recent physical activity, positive perceptions of one’s own health).
The current study findings provide additional information regarding the relations between health-related attitudes and behaviors and binge and heavy drinking in the U.S. population. Implications of study findings are discussed.
PMCID: PMC3459671  PMID: 21868171
Binge drinking; Heavy drinking; Health behaviors; Preventive care; BRFSS
16.  Childhood Trauma and Chronic Illness in Adulthood: Mental Health and Socioeconomic Status as Explanatory Factors and Buffers 
Experiences of traumatic events in childhood have been shown to have long-term consequences for health in adulthood. With data from the 2005 Canadian Community Health Survey we take a life course perspective of cumulative disadvantage and examine the potential role of mental health and socioeconomic status in adulthood as multiple mediators of the link between childhood trauma and chronic illness in adulthood. Mental health and socioeconomic status are also tested as buffers against the typically adverse consequences of childhood trauma. The results suggest mental health and socioeconomic status partially explain the association of childhood trauma with chronic illness in adulthood, with mental health showing a stronger effect. In addition, an analysis of the interactions suggested higher socioeconomic status is a potential protective factor for those with a history of trauma. Results also suggest cumulative disadvantage following trauma may lead to chronic illness and suggest the need for public health expenditures on resources such as counseling and income supports to prevent or reduce psychological harm and chronic illness resulting from traumatic events.
PMCID: PMC3153850  PMID: 21833299
childhood trauma; chronic illness; mental health; socioeconomic status; cumulative disadvantage
17.  Details for Manuscript Number SSM-D-07-00371R2 "The impact of cumulative childhood adversity on young adult mental health: Measures, models, and interpretations" 
Social science & medicine (1982)  2008;66(5):1140-1151.
Research studies investigating the impact of childhood cumulative adversity on adult mental health have proliferated in recent years. In general, little attention has been paid to the operationalization of cumulative adversity, with most studies operationalizing this as the simple sum of the number of occurrences of distinct events experienced. In addition, the possibility that the mathematical relationship of cumulative childhood adversity to some mental health dimensions may be more complex than a basic linear association has not often been considered. This study explores these issues with 2 waves of data drawn from an economically and racially diverse sample transitioning to adulthood in Boston, USA. A diverse set of childhood adversities were reported in high school and 3 mental health outcomes--depressed mood, drug use, and antisocial behavior--were reported 2 years later during the transition to adulthood
Our results suggest that both operationalization and statistical modeling are important and interrelated and, as such, they have the potential to influence substantive interpretation of the effect of cumulative childhood adversity on adult mental health. In our data, total cumulative childhood adversity was related to depressive symptoms, drug use, and antisocial behavior in a positive curvilinear manner with incremental impact increasing as adversities accumulate, but further analysis revealed that this curvilinear effect was an artifact of the confounding of high cumulative adversity scores with the experience of more severe events. Thus, respondents with higher cumulative adversity had disproportionately poorer mental health because of the severity of the adversities they were exposed to, not the cumulative number of different types of adversities experienced. These results indicate that public health efforts targeting prevention of childhood adversities would best be aimed at the most severe adversities in order to have greatest benefit to mental health in young adulthood.
PMCID: PMC2362506  PMID: 18177989
USA; cumulative adversity; transition to adulthood; depression; drug use; antisocial behavior; adolescents; mental health
18.  Incarceration of a Household Member and Hispanic Health Disparities: Childhood Exposure and Adult Chronic Disease Risk Behaviors 
Incarceration of a household member has been linked to poor mental and behavioral health outcomes in children, but less is known about the health behaviors of these children once they reach adulthood.
We analyzed data from 81,910 respondents to the 2009–2010 Behavioral Risk Factor Surveillance System to identify associations between the childhood experience of having a household member incarcerated and adult smoking status, weight status, physical activity, and drinking patterns. We used multivariable logistic regression to control for sex, age, education, and additional adverse childhood events in the whole population and in separate models for Hispanic, non-Hispanic white, and non-Hispanic black adults. We also assessed for having multiple risk behaviors.
People who lived with an incarcerated household member during childhood were more likely as adults than those who did not to engage in smoking (adjusted odds ratio [AOR] 1.50; 95% confidence interval [CI], 1.27–1.77) and heavy drinking (AOR 1.39; 95% CI, 1.03–1.87), after controlling for demographics and additional adverse childhood events. Exposure to incarceration in the household as a child among Hispanic adults was associated with being a smoker, being a heavy drinker, and having multiple risk behaviors and among white adults was associated with being a smoker and having multiple risk behaviors; among black adults there were no significant associations.
Incarceration of a household member during childhood is associated with adult risk behaviors, and race/ethnicity may be a factor in this association.
PMCID: PMC3652716  PMID: 23639764
19.  Effects of childhood socioeconomic position on subjective health and health behaviours in adulthood: how much is mediated by adult socioeconomic position? 
BMC Public Health  2011;11:269.
Adult socioeconomic position (SEP) is one of the most frequently hypothesised indirect pathways between childhood SEP and adult health. However, few studies that explore the indirect associations between childhood SEP and adult health systematically investigate the mediating role of multiple individual measures of adult SEP for different health outcomes. We examine the potential mediating role of individual measures of adult SEP in the associations of childhood SEP with self-rated health, self-reported mental health, current smoking status and binge drinking in adulthood.
Data came from 10,010 adults aged 25-64 years at Wave 3 of the Survey of Family, Income and Employment in New Zealand. The associations between childhood SEP (assessed using retrospective information on parental occupation) and self-rated health, self-reported psychological distress, current smoking status and binge drinking were determined using logistic regression. Models were adjusted individually for the mediating effects of education, household income, labour market activity and area deprivation.
Respondents from a lower childhood SEP had a greater odds of being a current smoker (OR 1.70 95% CI 1.42-2.03), reporting poorer health (OR 1.82 95% CI 1.39-2.38) or higher psychological distress (OR 1.60 95% CI 1.20-2.14) compared to those from a higher childhood SEP. Two-thirds to three quarters of the association of childhood SEP with current smoking (78%), and psychological distress (66%) and over half the association with poor self-rated health (55%) was explained by educational attainment. Other adult socioeconomic measures had much smaller mediating effects.
This study suggests that the association between childhood SEP and self-rated health, psychological distress and current smoking in adulthood is largely explained through an indirect socioeconomic pathway involving education. However, household income, area deprivation and labour market activity are still likely to be important as they are intermediaries in turn, in the socioeconomic pathway between education and health.
PMCID: PMC3110570  PMID: 21527039
20.  A Life Course Model of Education and Alcohol Use* 
Working from a life course perspective, this study examined the paradoxical association between academic status and drinking across the transition to young adulthood with multilevel modeling and a nationally representative sample of young people from the Add Health data project (n = 6,308). Taking academically advanced courses in high school was associated with lower rates of current drinking and binge drinking during high school (grades 9–12) but higher rates of both after high school (age range: 20–26). This positive longitudinal association between academic status and drinking was explained partly, but not completely, by educational, family, and work circumstances in young adulthood. The association was less likely to occur among students who attended high schools in which high achievement was the norm. Thus, the association between academic status and drinking behavior reverses across the transition to young adulthood, especially in certain types of peer environments within the educational system.
PMCID: PMC2843392  PMID: 17982868
21.  Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study 
BMC Public Health  2010;10:20.
Strong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood.
Baseline survey data on health behaviours, health status and exposure to adverse childhood experiences (ACEs) were collected from 17,337 adults during 1995-1997. ACEs included abuse (emotional, physical, sexual), witnessing domestic violence, parental separation or divorce, or growing up in a household where members with mentally ill, substance abusers, or sent to prison. We used the ACE score (an integer count of the 8 categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. Two methods of case ascertainment were used to identify incident lung cancer through 2005 follow-up: 1) hospital discharge records and 2) mortality records obtained from the National Death Index.
The ACE score showed a graded relationship to smoking behaviors. We identified 64 cases of lung cancer through hospital discharge records (age-standardized risk = 201 × 100,000-1 population) and 111 cases of lung cancer through mortality records (age-standardized mortality rate = 31.1 × 100,000-1 person-years). The ACE score also showed a graded relationship to the incidence of lung cancer for cases identified through hospital discharge (P = 0.0004), mortality (P = 0.025), and both methods combined (P = 0.001). Compared to persons without ACEs, the risk of lung cancer for those with ≥ 6 ACEs was increased approximately 3-fold (hospital records: RR = 3.18, 95%CI = 0.71-14.15; mortality records: RR = 3.55, 95%CI = 1.25-10.09; hospital or mortality records: RR = 2.70, 95%CI = 0.94-7.72). After a priori consideration of a causal pathway (i.e., ACEs → smoking → lung cancer), risk ratios were attenuated toward the null, although not completely. For lung cancer identified through hospital or mortality records, persons with ≥ 6 ACEs were roughly 13 years younger on average at presentation than those without ACEs.
Adverse childhood experiences may be associated with an increased risk of lung cancer, particularly premature death from lung cancer. The increase in risk may only be partly explained by smoking suggesting other possible mechanisms by which ACEs may contribute to the occurrence of lung cancer.
PMCID: PMC2826284  PMID: 20085623
22.  Childhood adversities and adult-onset asthma: a cohort study 
BMJ Open  2012;2(5):e001625.
Childhood adversities may be important determinants of later illnesses and poor health behaviour. However, large-scale prospective studies on the associations between childhood adversities and the onset of asthma in adulthood are lacking.
Prospective cohort study with 7-year follow-up.
Nationally representative study. Data were collected from the Health and Social Support (HeSSup) survey and national registers.
The participants represent the Finnish population from the following age groups: 20–24, 30–34, 40–44, and 50–54 years at baseline in 1998 (24 057 survey participants formed the final cohort of this study). The occurrence of childhood adversities was assessed at baseline with a six-item survey scale. The analyses were adjusted for sociodemographic characteristics, behavioural health risks and common mental disorders.
Primary and secondary outcomes
The survey data were linked to data from national health registers on incident asthma during a 7-year follow-up to define new-onset asthma cases with verified diagnoses.
A total of 12 126 (59%) participants reported that they encountered a childhood adversity. Of them 3677 (18% of all) endured three to six adversities. During a follow-up of 7 years, 593 (2.9%) participants were diagnosed with incident asthma. Those who reported three or more childhood adversities had a 1.6-fold (95% CI 1.31 to 2.01) greater risk of asthma compared to those without childhood adversities. This hazard attenuated but remained statistically significant after adjustment for conventional risk factors (HR 1.33; 95% CI 1.06 to 1.67).
Adults who report having encountered adversities in childhood may have an increased risk of developing asthma.
PMCID: PMC3488721  PMID: 23069774
Psychiatry; Epidemiology
23.  The effects on children and adolescents of parents' excessive drinking: an international review. 
Public Health Reports  1989;104(5):433-442.
The effects during childhood, adolescence, and adulthood of having a parent with a drinking problem has interested researchers in several countries. The greatest number of reports related to this subject have appeared in the U.S. literature and in the literature from countries of Eastern Europe. This review encompasses the findings of researchers in these countries as well as workers in Western Europe, Latin America, and Japan. This review does not include biological, physiological, or neurological data. The epidemiologic evidence from several countries shows significant points of agreement. Problem drinking by a parent markedly increases health risks to children and adolescents. Such risks include diminished intellectual capacity and development, increased neuroticism, and a wide range of psychological and behavioral disorders. Parents who drink excessively are also likely to have children who experience long-term adverse consequences. These include heavy and problem-causing psychoactive substance use, criminality, suicide, depression, personality disorders, and psychological and behavioral disturbances. Parents who drink heavily are also especially likely to produce children who subsequently abstain from alcohol or drink only lightly.
PMCID: PMC1579958  PMID: 2508172
24.  Prenatal and Childhood Growth, and Hospitalization for Alcohol Use Disorders in Adulthood: The Helsinki Birth Cohort Study 
PLoS ONE  2014;9(1):e87404.
Small birth size - an indicator of a sub-optimal prenatal environment - and variation in growth after birth have been associated with non-communicable diseases in later life. We tested whether birth size or growth in childhood associated with the risk of hospital admission for alcohol use disorders (AUDs) from early to late adulthood.
The sample comprised 6544 men and 6050 women born between 1934 and 1944 in Helsinki, Finland. Data on anthropometric measures were extracted from medical records and diagnoses of AUD from the Finnish Hospital Discharge Register and Causes of Death Register covering a 40-year period from 1969 to 2008.
Altogether 171 women (2.8%) and 657 men (10.0%) were diagnosed at a hospital with AUD. After adjusting for major confounders, shorter length at birth, shorter height up to two years of age, and lower weight at two years associated with hospitalization for AUD in women. In men, slower growth in height, particularly from 2 to 7 years, and slower weight gain from 7 to 11 years as well as shorter height and lower weight at 7 and 11 years associated with a diagnosis of AUD in men.
Pre- and postnatal growth associates with the risk for AUD later in life differently in women than in men: the fetal period and infancy seem to be the sensitive periods for women, whereas those for men the occur from toddlerhood onwards.
PMCID: PMC3906150  PMID: 24489908
25.  Adverse Childhood Experiences and Adult Criminality: How Long Must We Live before We Possess Our Own Lives? 
The Permanente Journal  2013;17(2):44-48.
Subjects (151) from 4 different offender groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) referred for treatment at an outpatient clinic in San Diego, CA, after conviction in criminal court, completed the ACE Questionnaire. The offender group reported nearly 4 times as many adverse events in childhood than an adult male normative sample. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types.
Empirical research associated with the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study has demonstrated that ACE are associated with a range of negative outcomes in adulthood, including physical and mental health disorders and aggressive behavior.
Subjects from 4 different offender groups (N = 151) who were referred for treatment at an outpatient clinic in San Diego, CA, subsequent to conviction in criminal court, completed the ACE Questionnaire. Groups (nonsexual child abusers, domestic violence offenders, sexual offenders, and stalkers) were compared on the incidence of ACE, and comparisons were made between the group offenders and a normative sample.
Results indicated that the offender group reported nearly four times as many adverse events in childhood than an adult male normative sample. Eight of ten events were found at significantly higher levels among the criminal population. In addition, convicted sexual offenders and child abusers were more likely to report experiencing sexual abuse in childhood than other offender types.
On the basis of a review of the literature and current findings, criminal behavior can be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with adult criminality. We suggest that to decrease criminal recidivism, treatment interventions must focus on the effects of early life experiences.
PMCID: PMC3662280  PMID: 23704843

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