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1.  Peptic ulcer and childhood adversities experienced by working-aged people 
AIM: To study the association between self-reported peptic ulcer and childhood adversities.
METHODS: The Health and Social Support Study (HeSSup) population consisted of a stratified random sample drawn from the Finnish Population Register in four age groups: 20-24, 30-34, 40-44 and 50-54. The survey was carried out by postal questionnaire during 1998, with a response rate of 40.0%. A follow-up questionnaire was sent during 2003 to all those who responded to the first. Altogether 19 626 individuals returned the follow-up questionnaire; a response rate of 75.8%. The subjects were asked whether a doctor had told them that they have or have had peptic ulcer. The analyses covered those who responded affirmatively to both the baseline and the follow-up enquiries (n = 718). Those not reporting a peptic ulcer in either of the two questionnaires (n = 17 677) were taken as controls. The subjects were further requested (through six questions) to think about their childhood adversities.
RESULTS: The most common adversities mentioned were long-lasting financial difficulties in the family, serious conflicts in the family, and a family member seriously or chronically ill. All the adversities reported, except parental divorce, were more common among peptic ulcer patients than among controls (P values varied between < 0.001 and 0.003). Age- and sex-adjusted odds ratios (OR) of childhood adversities in the multivariate logistic analysis for self-reported peptic ulcer varied between 1.45 and 2.01. Adjusting for smoking, heavy drinking, stress and nonsteroidal anti-inflammatory drug use had no further influence (ORs between 1.22 and 1.73).
CONCLUSION: Our findings suggest that childhood adversities maintain a connection with and have a predictive role in the development of peptic ulcer.
PMCID: PMC2712902  PMID: 19610142
Peptic ulcer; Working-aged; Childhood adversities; Stress factors; Predictive role
2.  Sense of coherence and intentions to retire early among Finnish women and men 
BMC Public Health  2010;10:22.
Previous studies have shown that age, physical and mental health status and working circumstances, along with different socio-economic and psychosocial factors affect the retirement process. However, the role of psychological resources, such as sense of coherence (SOC), on the retirement process is still poorly understood. This study investigated the associations between SOC and intentions to retire early and whether these associations were explained by socio-economic, psychosocial and work and health related factors.
The data were derived from the Finnish Health and Social Support (HeSSup) Study. The information was gathered from postal surveys in 1998 (baseline) and in 2003 (follow-up). The analyzed data consisted of 7409 women and 4866 men aged 30-54 at baseline. SOC and background factors including childhood circumstances, language, education, working circumstances, social support, health behaviour and somatic and mental health status were assessed at baseline. The intentions to retire early were assessed at follow-up using logistic regression analysis.
SOC was associated with intentions to retire early among both genders. Socio-economic, psychosocial and work and health behaviour related factors did not influence the association between SOC and intentions to retire early among women and men reporting somatic or mental illness. Further, the association between SOC and intentions to retire early remained among (somatically and mentally) healthy men. Among healthy women the association was weaker and statistically non-significant. Among unhealthy women, the odds ratios of SOC was 0.97 (CI 95% 0.96-0.98) and 0.97 among ill men (CI 95% 0.96-0.98), i.e., each additional SOC score reduced the risk of intentions by 3% among both genders.
Unhealthy employees with low SOC and low education were in the greatest risk to have reported intentions to retire early. SOC had an independent effect on intentions to retire early, and a strong SOC may have a potential to prevent early retirement in groups otherwise at risk. An important challenge would be to target the resources of SOC to the most vulnerable and design appropriate interventions in order to strengthen the level of SOC and hence prolong working years of the aging employees.
PMCID: PMC2831030  PMID: 20085637
3.  To Have or Not To Have a Pet for Better Health? 
PLoS ONE  2006;1(1):e109.
Pet ownership is thought to have health benefits, but not all scientific explorations have been founded on proper applications of representative samples or statistically correct methodologies. Databanks have been too small for proper statistical analyses; or, instead of a random sample, participation has been voluntary. The direction of causality has been evaluated incorrectly or control of relevant factors noted deficient. This study examined the associations of pet ownership with perceived health and disease indicators by taking into account socio-demographic background factors together with health risk factors, including exercise.
Methodology/Principal Findings
The present study used baseline data from the 15-year Health and Social Support Study (the HeSSup Study). The Finnish Population Register Centre was used to draw population-based random samples stratified according to gender and four age groups (20–24, 30–34, 40–44, and 50–54 years). A total of 21,101 working-aged Finns responded to the baseline survey questionnaire of the 15-year HeSSup Study in 1998. Ordinal and binary logistic regression was used to analyze the cross-sectional data. Pet ownership was associated with poor rather than good perceived health. BMI surfaced as the risk factor most strongly associated with pet ownership.
Pet owners set in their ways and getting older were found to have a slightly higher BMI than the rest. Additional research is needed for the testing of hypotheses involving effects of pet ownership with various health dimensions within population groups that are composed of different kinds of background characteristics.
PMCID: PMC1762431  PMID: 17205113
4.  Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys 
The British Journal of Psychiatry  2010;197(5):378-385.
Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders.
To examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries.
Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI).
Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries.
Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.
PMCID: PMC2966503  PMID: 21037215
5.  Association between childhood adversities and adulthood depressive symptoms in South Korea: results from a nationally representative longitudinal study 
BMJ Open  2013;3(7):e002680.
To examine how childhood adversity (ie, parental death, parental divorce, suspension of school education due to financial strain or being raised in a relative's house due to financial strain) is associated with prevalence and incidence of adulthood depressive symptoms and whether this association differs by gender and by age in South Korea.
Prospective cohort design.
Nationally representative longitudinal survey in South Korea.
11 526 participants in South Korea.
Outcome measure
Prevalence and incidence of adulthood depressive symptoms were assessed as a dichotomous variable using the Centers for Epidemiologic Studies Depression (CES-D) Scale in 2006 and 2007.
In the prevalence analysis, each of the four childhood adversities was significantly associated with a higher prevalence of adulthood depressive symptoms. The higher incidence of depressive symptoms was associated with suspension of school education (OR 1.55, 95% CI 1.32 to 1.82) and parental divorce (OR 1.65, 95% CI 1.00 to 2.71). In the age-stratified analyses, prevalence of depressive symptoms was associated with all CAs across different adulthoods, except for parental divorce and late adulthood depressive symptoms. After being stratified by gender, the association was significant for parental divorce (OR 3.76, 95% CI 2.34 to 6.03) in the prevalence analysis and for being raised in a relative’s house (OR 1.89, 95% CI 1.21 to 2.94) in the incidence analysis only among women.
This study suggests that childhood adversity may increase prevalence and incidence of adulthood depressive symptoms, and the impact of parental divorce or being raised in a relative's house due to financial strain on adulthood depressive symptoms may differ by gender.
PMCID: PMC3717452  PMID: 23878171
Depression & mood disorders < PSYCHIATRY; Childhood adversity; Life-course epidemiology; South Korea
6.  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
7.  Childhood cognitive ability and adult mental health in the British 1946 birth cohort 
Social Science & Medicine (1982)  2007;64(11):2285-2296.
We examined whether childhood cognitive ability was associated with two mental health outcomes at age 53 years: the 28 item General Health Questionnaire (GHQ-28) as a measure of internalising symptoms of anxiety and depression, and the CAGE screen for potential alcohol abuse as an externalising disorder. A total of 1875 participants were included from the Medical Research Council National Survey of Health and Development, also known as the British 1946 birth cohort. The results indicated that higher childhood cognitive ability was associated with reporting fewer symptoms of anxiety and depression GHQ-28 scores in women, and increased risk of potential alcohol abuse in both men and women. Results were adjusted for educational attainment, early socioeconomic status (SES) and adverse circumstances, and adult SES, adverse circumstances, and negative health behaviours. After adjusting for childhood cognitive ability, greater educational attainment was associated with reporting greater symptoms of anxiety and depression on the GHQ-28. Although undoubtedly interrelated, our evidence on the diverging effects of childhood cognitive ability and educational attainment on anxiety and depression in mid-adulthood highlights the need for the two to be considered independently. While higher childhood cognitive ability is associated with fewer internalising symptoms of anxiety and depression in women, it places both men and women at higher risk for potential alcohol abuse. Further research is needed to examine possible psychosocial mechanisms that may be associated with both higher childhood cognitive ability and greater risk for alcohol abuse. In addition, the underlying mechanisms responsible for the gender-specific link between childhood cognitive ability and the risk of experiencing internalising disorders in mid-adulthood warrants further consideration.
PMCID: PMC3504659  PMID: 17397976
UK; Adult mental health; Prospective cohort; Childhood cognitive ability; Educational attainment; Gender
8.  Asthma and lung structure on CT: The MESA Lung Study 
The potential consequences of asthma in childhood and young adulthood on lung structure in older adults have not been studied in a large, population-based cohort.
The authors hypothesized that a history of asthma onset in childhood (age 18 or before) or young adulthood (age 19 to 45) was associated with altered lung structure on computed tomography (CT) in later life.
The Multi-Ethnic Study of Atherosclerosis Lung Study recruited 3,965 participants and assessed asthma history using standardized questionnaires, spirometry following guidelines, and segmental airway dimensions and percent low attenuation areas on CT scans.
Asthma with onset in childhood and young adulthood was associated with large decrements in the forced expiratory volume in one second among participants with a mean age of 66 years (−365 ml and −343 ml, respectively; P<0.001). Asthma with onset in childhood and young adulthood was associated with increased mean airway wall thickness standardized to an internal perimeter of 10 mm (Pi10) (0.1 mm, P<0.001 for both), predominantly from narrower segmental airway lumens (−0.39 mm and −0.34 mm, respectively; P<0.001). Asthma with onset in childhood and young adulthood also was associated with a greater percentage of low attenuation areas (1.69% and 4.30%, respectively; P<0.001). Findings were similar among never smokers except that differential percentage of low attenuation areas in child-onset asthma was not seen in them.
Asthma with onset in childhood or young adulthood, was associated with reduced lung function, narrower airways and, among asthmatics who smoked, greater percentage of low attenuation areas in later life.
PMCID: PMC3564253  PMID: 23374265
airway remodeling; airway structure; asthma; emphysema; epidemiology
9.  Breast feeding in infancy and social mobility: 60‐year follow‐up of the Boyd Orr cohort 
Archives of Disease in Childhood  2007;92(4):317-321.
To assess the association of having been breast fed with social class mobility between childhood and adulthood.
Historical cohort study with a 60‐year follow‐up from childhood into adulthood.
16 urban and rural centres in England and Scotland.
3182 original participants in the Boyd Orr Survey of Diet and Health in Pre‐War Britain (1937–39) were sent follow‐up questionnaires between 1997 and 1998. Analyses are based on 1414 (44%) responders with data on breast feeding measured in childhood and occupational social class in both childhood and adulthood.
Main outcome
Odds of moving from a lower to a higher social class between childhood and adulthood in those who were ever breast fed versus those who were bottle fed.
The prevalence of breast feeding varied by survey district (range 45–86%) but not with household income (p = 0.7), expenditure on food (p = 0.3), number of siblings (p = 0.7), birth order (p = 0.5) or social class (p = 0.4) in childhood. Participants who had been breast fed were 41% (95% CI 10% to 82%) more likely to move up a social class in adulthood (p = 0.007) than bottle‐fed infants. Longer breastfeeding duration was associated with greater odds of upward social mobility in fully adjusted models (p for trend = 0.003). Additionally controlling for survey district, household income and food expenditure in childhood, childhood height, birth order or number of siblings did not attenuate these associations. In an analysis comparing social mobility among children within families with discordant breastfeeding histories, the association was somewhat attenuated (OR 1.16; 95% CI 0.74 to 1.8).
Breast feeding was associated with upward social mobility. Confounding by other measured childhood predictors of social class in adulthood did not explain this effect, but we cannot exclude the possibility of residual or unmeasured confounding.
PMCID: PMC2083668  PMID: 17301108
10.  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
11.  Asthma incidence and risk factors in a national longitudinal sample of adolescent Canadians: a prospective cohort study 
Estimates of asthma incidence and its possible determinants in adolescent populations have rarely been obtained using prospective designs. We sought to identify socio-demographic and other patterns in the incidence of asthma among Canadian adolescents and to examine possible behavioural and environmental determinants of asthma incidence using longitudinal analyses.
We used data from the National Population Health Survey (NPHS), a nationally representative longitudinal survey of Canadians. All persons aged 12–18 years without asthma at baseline were followed up to a maximum of 12 years. The outcome was a reported diagnosis of asthma during the follow-up period. Analyses were weighted to the population and bootstrapping procedures were used to estimate variances.
Participants (n = 956) represented 2,038,890 adolescents of whom 293,450 (14.4%) developed asthma over the 21,274,890 person-years of follow-up. Overall, the incidence of asthma was 10.2 per 1000 person-years. In adjusted Cox regression analysis, being female (HR = 2.13, 95% CI = 1.26-3.62, p = 0.005) and being exposed to passive smoking (HR = 2.06, 95% CI = 1.27-3.34, p = 0.003) were associated with the development of asthma while no statistically significant associations were identified for rural residence, being overweight, and other health behaviours. There was also an apparent cohort effect among girls where girls who were older at baseline reported being diagnosed with asthma more over the follow-up than their younger counterparts. This was not observed among males.
Asthma prevention initiatives for adolescents should target girls and focus on smoking exposures. The role that differential diagnostic patterns play in these observations should be investigated to more accurately assess the incidence of asthma.
PMCID: PMC3975456  PMID: 24666682
Asthma; Adolescents; Sex; Incidence; Urban–rural; Cohort effect; Environmental tobacco smoke
12.  Role of childhood health in the explanation of socioeconomic inequalities in early adult health 
STUDY OBJECTIVE: To examine the contribution of childhood health to the explanation of socioeconomic inequalities in health in early adult life. DESIGN: Retrospective data were used, which were obtained from a postal survey in the baseline of a prospective cohort study (the Longitudinal Study on Socio-Economic Health Differences in the Netherlands). Adult socioeconomic status was indicated by educational level, while health was indicated by perceived general health. Childhood health was measured by self reported periods of severe disease in childhood. Relations were analysed using logistic regression models. The reduction in odds ratios of "less than good" perceived general health for different educational groups after adjustment for childhood health was used to estimate the contribution of childhood health. SETTING: The population of the city of Eindhoven and surroundings in the south east of the Netherlands in 1991. PARTICIPANTS: 2511 respondents, aged 25-34 years, men and women, of Dutch nationality, were included in the analysis. MAIN RESULTS: There was a clear association between childhood health and adult health, as well as an association between childhood health and adult socioeconomic status. Approximately 5% to 10% of the increased risk of the lower socioeconomic groups of having a "less than good" perceived general health can be explained by childhood health. CONCLUSIONS: Childhood health contributes to the explanation of socioeconomic inequalities in early adult health. Although this contribution is not very large, it cannot be ignored and has to be interpreted largely in terms of selection on health.
PMCID: PMC1756612  PMID: 9604036
13.  Comorbid Major Depression and Generalized Anxiety Disorders in the National Comorbidity Survey follow-up 
Psychological medicine  2007;38(3):365-374.
Although generalized anxiety disorder (GAD) and major depressive episode (MDE) are known to be highly comorbid, little prospective research has examined whether these two disorders predict the subsequent first onset or persistence of the other or the extent to which other predictors explain the time-lagged associations between GAD and MDE.
Data were analyzed from the nationally representative two-wave panel sample of 5001 respondents who participated in the 1990-2 National Comorbidity Survey (NCS) and the 2001-03 NCS follow-up survey. Both surveys assessed GAD and MDE. The baseline NCS also assessed three sets of risk factors that are considered here: childhood adversities, parental history of mental-substance disorders, and respondent personality.
Baseline MDE significantly predicted subsequent GAD onset but not persistence. Baseline GAD significantly predicted subsequent MDE onset and persistence. The associations of each disorder with the subsequent onset of the other attenuated with time since onset of the temporally primary disorder, but remained significant for over a decade after this onset. The risk factors predicted onset more than persistence. Meaningful variation was found in the strength and consistency of associations between risk factors and the two disorders. Controls for risk factors did not substantially reduce the net cross-lagged associations of the disorders with each other
The existence of differences in risk factors for GAD and MDE argues against the view that the two disorders are merely different manifestations of a single underlying internalizing syndrome or that GAD is merely a prodrome, residual, or severity marker of MDE.
PMCID: PMC2745899  PMID: 18047766
14.  The association of childhood adversities and early onset mental disorders with adult onset chronic physical conditions 
Archives of General Psychiatry  2011;68(8):838-844.
The physical health consequences of childhood psychosocial adversities may be as substantial as the mental health consequences but whether this is the case remains unclear because much prior research has involved unrepresentative samples and a selective focus on particular adversities or physical outcomes. The association between early onset mental disorders and subsequent poor physical health in adulthood has not been investigated.
To investigate whether childhood adversities and early onset mental disorders are independently associated with increased risk of a range of adult onset chronic physical conditions in culturally diverse samples spanning the full adult age range.
Cross-sectional community surveys of adults in ten countries.
General population.
Adults (>= 18 years; n = 18,303), with diagnostic assessment and determination of age of onset of DSM-IV mental disorders; assessment of childhood familial adversities; and age of diagnosis/onset of chronic physical conditions.
Main Outcome Measures
Risk (hazard ratios) of adult onset (> age 20) heart disease, asthma, diabetes, arthritis, chronic spinal pain, and chronic headache as a function of specific childhood adversities and early onset (< age 21) DSM-IV depressive and anxiety disorders, with mutual adjustment.
A history of three or more childhood adversities was independently associated with onset of all six physical conditions (hazard ratios from 1.44–2.19). Controlling for current mental disorder made little difference to these associations. Early onset mental disorders were independently associated with onset of five physical conditions (hazard ratios from 1.43–1.66).
These results are consistent with the hypothesis that childhood adversities and early onset mental disorders have independent, broad spectrum effects that increase risks of diverse chronic physical conditions in later life. They require confirmation in a prospective design. The long time course of these associations has theoretical and research implications.
PMCID: PMC3402030  PMID: 21810647
15.  Harsh physical punishment as a specific childhood adversity linked to adult drinking consequences: Evidence from China 
Addiction (Abingdon, England)  2010;105(12):2097-2105.
The aim of the current study is to estimate the association between childhood physical punishment (CPP) and level of alcohol use disorder (AUD), using two different approaches to take other childhood adversities into account.
Design and Setting
Population survey using face-to-face interviews to a representative sample of non-institutionalized adult residents of Beijing and Shanghai, China.
A total of 5201 participants aged 18 to 70 years old.
A version of the World Mental Health Composite International Diagnostic Interview was used. Standardized assessments covered early life experiences of childhood physical punishment, other childhood adversities, parental drinking problems, childhood conduct problems, and clinical features of AUD.
A robust association linking CPP and level of AUD was found, holding other childhood adversities constant (probit coefficient=0.70, 95% CI=1.40, 1.00) via covariate terms in Structural Equations Modeling. Furthermore, there was evidence that CPP might exert an additional influence on level of AUD over and above a generally noxious family environment (probit coefficient=0.20, 95% CI=0.02, 0.38).
There appears to be a robust association between reports of harsh punishment in childhood and alcohol dependence in adulthood adjusting for a range of possible confounding factors. Whether the association is causal or whether both are related to a common underlying factor or recall bias needs to be investigated further.
PMCID: PMC2975861  PMID: 20854335
16.  Abuse during Childhood and Adolescence and Risk of Adult-Onset Asthma in African American Women 
Experiences of violence contribute to the occurrence of childhood asthma but there is little information on the effect of early life abuse on adult-onset asthma.
We prospectively assessed the relation between physical and sexual abuse during childhood and adolescence and the incidence of adult-onset asthma in the Black Women’s Health Study.
We followed 28,456 women from 1995 through 2011 with biennial mailed questionnaires. Experiences of physical and sexual abuse that occurred during childhood and adolescence were obtained in 2005. Cox regression models were used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI).
During 417,931 person-years of follow-up, 1160 participants reported physician diagnosed asthma and concurrent use of asthma medication. Compared with women who experienced no abuse during childhood or adolescence, the multivariable IRR for any childhood abuse was 1.24 (95% CI 1.06–1.45) and for any adolescent abuse it was 1.10 (95% CI 0.88–1.36). The IRR was higher for childhood physical abuse (IRR=1.29, 95% CI 1.07–1.49) than for childhood sexual abuse (IRR=1.15, 95% CI 0.88–1.49). IRRs for physical and sexual abuse during adolescence were compatible with 1.0. The association between childhood abuse and asthma incidence was stronger in older compared with younger women.
In this large cohort of African American women, there was a positive association between adult-onset asthma and childhood physical abuse, and weaker associations for childhood sexual abuse and any abuse during adolescence. Given the high prevalence of asthma and of childhood abuse, the association is of public health importance.
PMCID: PMC3615035  PMID: 23219171
Asthma; child abuse; adolescent abuse; incidence; longitudinal studies; cohort studies; African Americans; women
17.  Child Physical Abuse and Adult Mental Health: A National Study 
Journal of traumatic stress  2012;25(4):384-392.
This study characterizes adults who report being physically abused during childhood, and examines associations of reported type and frequency of abuse with adult mental health. Data were derived from the 2000–2001 and 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions, a large cross-sectional survey of a representative sample (N = 43,093) of the U.S. population. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between child physical abuse and adult psychiatric disorders adjusted for sociodemographic characteristics, other childhood adversities, and comorbid psychiatric disorders. Child physical abuse was reported by 8% of the sample and was frequently accompanied by other childhood adversities. Child physical abuse was associated with significantly increased adjusted odds ratios (AORs) of a broad range of DSM-IV psychiatric disorders (AOR = 1.16–2.28), especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder. A dose-response relationship was observed between frequency of abuse and several adult psychiatric disorder groups; higher frequencies of assault were significantly associated with increasing adjusted odds. The long-lasting deleterious effects of child physical abuse underscore the urgency of developing public health policies aimed at early recognition and prevention.
PMCID: PMC3805363  PMID: 22806701
18.  Helicobacter pylori colonization is inversely associated with childhood asthma 
The Journal of infectious diseases  2008;198(4):553-560.
Asthma, a serious health problem worldwide, is growing more common. The colonization of Helicobacter pylori, a major human indigenous (commensal) microbe that is present early in life may be relevant to childhood asthma risk.
We conducted cross-sectional analyses using data from 7,412 participants in the National Health and Nutrition Survey (NHANES) 1999–2000 to assess the association between H. pylori and childhood asthma.
H. pylori seropositivity was inversely associated with early-onset asthma (onset age < 5 years) and current asthma in children 3–13 years. Among participants 3–19 years of age, the presence of H. pylori was inversely related to ever having asthma (OR = 0.69; 95% CI = 0.45–1.06), and the inverse association with early childhood-onset (
This study is the first to report an inverse association of H. pylori with asthma in children. The findings indicate new directions for research and asthma prevention.
PMCID: PMC3902975  PMID: 18598192
Helicobacter pylori; epidemiology; asthma; cross-sectional study
PLoS ONE  2009;4(9):e7146.
Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics
Subjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998–2002, as part of the European Community Respiratory Health Survey (ECRHS). All participants to follow-up with current asthma at baseline were eligible for the analysis. To assess change over the follow-up, asthma severity at the two surveys was defined using standardized data on respiratory symptoms, lung function and medication according to the Global Initiative for Asthma (GINA) Guidelines. Another quantitative score (Ronchetti) further considering hospitalizations was also analysed.
The study included 685 subjects with asthma followed-up over a mean period of 8.65 yr (min 4.3-max 11.7). At baseline, asthma severity according to GINA was distributed as intermittent: 40.7%, 31.7% as mild persistent, 14% as moderate persistent, and 13.5% as severe persistent. Using the Ronchetti score derived classification, the distribution of asthma severity was 58% mild, (intermittent and mild persistent), 25.8% moderate, and 15.4% severe. Whatever the classification, there was no significant difference in the severity distribution between men and women. There was also no gender difference in the severity distribution among incident cases which developed asthma between the two surveys. Men with moderate-to-severe asthma at baseline were more likely than women to have moderate-to-severe asthma at follow-up. Using GINA, 69.2% of men vs. 53.1% of women (p = 0.09) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. Using Ronchetti score, 53.3% of men vs. 36.2% of women (p = 0.03) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up.
There was no gender difference in asthma severity at the two surveys. However, our findings suggest that asthma severity might be less stable in women than in men.
PMCID: PMC2745579  PMID: 19779616
Although many studies have indicated that psychosocial factors contribute to hypertension, and that early childhood adversity is associated with long-term adverse mental and physical health sequelae, the association between early adversity and later hypertension is not well studied.
Data from 10 countries participating in the World Health Organization (WHO) World Mental Health (WHM) Surveys (N = 18,630) were analyzed to assess the relationship between childhood adversity and adult-onset hypertension, as ascertained by self-report. The potentially mediating effect of early-onset depression-anxiety disorders, as assessed by the WHM Survey version of the International Diagnostic Interview (WMH-CIDI), on the relationship between early adversity and hypertension was also examined.
Two or more early childhood adversities, as well as early-onset depression-anxiety, were significantly associated with hypertension. A range of specific childhood adversities, as well as early-onset social phobia and panic/agoraphobia, were significantly associated with hypertension. In multivariate analyses, the presence of 3 or more childhood adversities was associated with hypertension, even when early-onset depression-anxiety or current depression-anxiety was included in the model.
Although caution is required in the interpretation of self-report data on adult-onset hypertension, the results of this study further strengthen the evidence base regarding the role of psychosocial factors in the pathogenesis of hypertension.
PMCID: PMC3486699  PMID: 20196979
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
STUDY OBJECTIVE--To report the prevalence of physical disability in a national sample of 43 year old men and women, and examine the relationship between disability and the consumption of hospital care. To assess the contribution of childhood health and social circumstances to the risk of adult disability, and the socioeconomic consequences of disability. DESIGN--The assessment of disabilities of physical movement was based on criteria developed by OPCS for their national survey of disability. The analysis used data on socioeconomic circumstances from childhood to 43 years and on serious illness in the first 25 years of life collected prospectively on members of the MRC National Survey of Health and Development, the 1946 birth cohort study. SETTING--England, Wales, and Scotland. PARTICIPANTS--A general population sample of 3235 men and women aged 43 years. MAIN RESULTS--Seven per cent of cohort survivors at 43 years were physically disabled and a further 3% reported difficulties although they were not assessed as disabled according to OPCS criteria. The prevalence of severe disability at this age was similar to that derived from the OPCS survey but the prevalence of mild disability was substantially greater. Disability was associated with a greater use of hospital care in recent years and throughout life. Those who had experienced a serious illness in earlier life were over twice as likely to be disabled; certain conditions, such as polio, were associated with a particularly high relative risk. Those who had had a socially disadvantaged start to life were more likely to be physically disabled at 43 years but the strength of this relationship was considerably weakened by adjustment for later social factors, suggesting that social disadvantage throughout life, or during adult life, increased the risk of disability. Taking these results into account the relative impact of disability on income and employment was found to be greatest for those from the unskilled and semi-skilled classes. CONCLUSIONS--The prevalence of physical disability among those in early middle age may be greater than previously estimated. The strong links between childhood ill health and adult disability and its association with high levels of hospital care support longstanding recommendations for better coordination between child and adult health services. Social disadvantages affects the risk of disability and its financial and employment consequences.
PMCID: PMC1059957  PMID: 8051525
This study evaluates associations of commonly co-occurring childhood adversities with physical violence in dating relationships to identify potential strategies for refining and targeting dating violence prevention programmes.
Data on 5130 adult respondents to a nationally representative survey with at least one dating relationship before the age of 21 years were analysed. Logistic regression models assessed associations between 12 childhood adversities and physical dating violence (PDV).
Adjusting for the number of co-occurring adversities, 10 of the 12 childhood adversities were significantly associated with PDV perpetration or victimisation (OR 1.5–2.8). The population attributable risk proportion of PDV due to all 12 childhood adversities was 53.4%. Childhood adversities with the highest attributable risk proportions were sexual abuse (13.8%), interparental violence (11.6%) and parent mental illness (10.7%). Multivariate prediction equations ranked respondents by their childhood adversity risk profiles; 46.4% of PDV cases occurred in the top two risk deciles.
Assessment of a broad range of childhood exposures to familial adversities may help to identify adolescents at particularly high risk of PDV and to guide prevention efforts.
PMCID: PMC3686487  PMID: 21321063
Thorax  2000;55(5):383-387.
BACKGROUND—The prevalence of asthma and allergic diseases in children and young adults is inversely associated with family size. It has been suggested that more frequent exposure to infections in a large family group, particularly those spread by the faecal-oral route, may protect against atopic diseases, although not all published data support this hypothesis. Whether similar considerations apply to adult onset wheeze is unknown. The relationship between adult onset wheezing and atopy measured in adulthood and childhood exposure to a range of infections was investigated.
METHODS—A nested case control study of participants in a 30 year follow up survey was conducted. Questionnaire data on childhood infections had been obtained in a 1964 survey. In 1995 a further questionnaire on respiratory symptoms and other risk factors for wheezing illness was administered, total IgE, skin and RAST tests were performed, and serum was stored. In 1999 serological tests for hepatitis A, Helicobacter pylori, and Toxoplasma gondii were performed on the stored samples. Information from the 1964 questionnaires was available for 97 cases and 208 controls and serological tests were obtained for 85 cases and 190 controls. The potential risk factors were examined for all cases, those who reported doctor diagnosed asthma, those who described persistent cough and phlegm with wheeze, and subjects stratified by atopic status.
RESULTS—The sibship structure was similar in cases and controls. In univariate analysis of all cases, childhood infections reported by parents as acquired either before or after the age of three years did not influence case:control or atopic status. Seropositivity was also similar for all cases and controls, but cases in the subgroup with chronic cough and phlegm were more likely to be seropositive for hepatitis A and H pylori. Seropositivity was unrelated to atopic status. In multivariate analyses both the effect of having two or more younger siblings (OR 0.1, 95% CI 0.03 to 0.8) and of acquiring measles up to the age of three (OR 0.2, CI 0.03 to 0.8) were significantly related to a lower risk of doctor diagnosed asthma.
CONCLUSIONS—In these well characterised subjects, exposure to infections as measured by parental reports obtained at age 10-14 years and by serological tests obtained in adulthood did not influence the development of wheezing symptoms or atopic status in adulthood. However, early exposure to measles and family size may be associated with a lower risk of adult onset doctor diagnosed asthma.

PMCID: PMC1745751  PMID: 10770819
BMJ Open  2013;3(3):e002057.
To assess how much the association between migraine and depression may be explained by various measures of stress.
National Population Health Survey is a prospective cohort study representative of the Canadian population. Eight years of follow-up time were used in the present analyses.
Canadian adult population ages 18–64.
9288 participants.
Incident migraine and major depression.
Adjusting for sex and age, depression was predictive of incident migraine (HR: 1.62; 95% CI 1.03 to 2.53) and migraine was predictive of incident depression (HR: 1.55; 95% CI 1.15 to 2.08). However, adjusting for each assessed stressor (childhood trauma, recent marital problems, recent unemployment, recent household financial problems, work stress, chronic stress and change in social support) decreased this association, with chronic stress being a particularly strong predictor of outcomes. When adjusting for all stressors simultaneously, both associations were largely attenuated (depression–migraine HR: 1.30; 95% CI 0.80 to 2.10; migraine–depression HR: 1.19; 95% CI 0.86 to 1.66).
Much of the apparent association between migraine and depression may be explained by stress.
PMCID: PMC3612807  PMID: 23474788

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