Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: A prospective cohort study in the UK


Autoři: Lotte C. Houtepen aff001;  Jon Heron aff001;  Matthew J. Suderman aff001;  Abigail Fraser aff001;  Catherine R. Chittleborough aff002;  Laura D. Howe aff001
Působiště autorů: MRC Integrative Epidemiology Unit at the University of Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom aff001;  School of Public Health, Faculty of Health and Medical Sciences, and Robinson Research Institute, University of Adelaide, Adelaide, Australia aff002
Vyšlo v časopise: Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: A prospective cohort study in the UK. PLoS Med 17(3): e32767. doi:10.1371/journal.pmed.1003031
Kategorie: Research Article
doi: 10.1371/journal.pmed.1003031

Souhrn

Background

Experiencing multiple adverse childhood experiences (ACEs) is a risk factor for many adverse outcomes. We explore associations of ACEs with educational attainment and adolescent health and the role of family and socioeconomic factors in these associations.

Methods and findings

Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective cohort of children born in southwest England in 1991–1992, we assess associations of ACEs between birth and 16 years (sexual, physical, or emotional abuse; emotional neglect; parental substance abuse; parental mental illness or suicide attempt; violence between parents; parental separation; bullying; and parental criminal conviction, with data collected on multiple occasions between birth and age 16) with educational attainment at 16 years (n = 9,959) and health at age 17 years (depression, obesity, harmful alcohol use, smoking, and illicit drug use; n = 4,917). We explore the extent to which associations are robust to adjustment for family and socioeconomic factors (home ownership, mother and partner’s highest educational qualification, household social class, parity, child’s ethnicity, mother’s age, mother’s marital status, mother’s depression score at 18 and 32 weeks gestation, and mother’s partner’s depression score at 18 weeks gestation) and whether associations differ according to socioeconomic factors, and we estimate the proportion of adverse educational and health outcomes attributable to ACEs or family or socioeconomic measures. Among the 9,959 participants (49.5% female) included in analysis of educational outcomes, 84% reported at least one ACE, 24% reported 4 or more ACEs, and 54.5% received 5 or more General Certificates of Secondary Education (GCSEs) at grade C or above, including English and Maths. Among the 4,917 participants (50.1% female) included in analysis of health outcomes, 7.3% were obese, 8.7% had depression, 19.5% reported smoking, 16.1% reported drug use, and 10.9% reported harmful alcohol use. There were associations of ACEs with lower educational attainment and higher risk of depression, drug use, and smoking. For example, odds ratios (ORs) for 4+ ACEs compared with no ACEs after adjustment for confounders were depression, 2.4 (1.6–3.8, p < 0.001); drug use, 3.1 (2.1–4.4, p < 0.001); and smoking, 2.3 (1.7–3.1, p < 0.001). Associations with educational attainment attenuated after adjustment but remained strong; for example, the OR after adjustment for confounders for low educational attainment comparing 4+ ACEs with no ACEs was 2.0 (1.7–2.4, p < 0.001). Associations with depression, drug use, and smoking were not altered by adjustment. Associations of ACEs with harmful alcohol use and obesity were weak. For example, ORs for 4+ ACEs compared with no ACEs after adjustment for confounders were harmful alcohol use, 1.4 (0.9–2.0, p = 0.10) and obesity, 1.4 (0.9–2.2, p = 0.13) We found no evidence that socioeconomic factors modified the associations of ACEs with educational or health outcomes. Population attributable fractions (PAFs) for the adverse educational and health outcomes range from 5%–15% for 4+ ACEs and 1%–19% for low maternal education. Using data from multiple questionnaires across a long period of time enabled us to capture a detailed picture of the cohort members’ experience of ACEs; however, a limitation of our study is that this resulted in a high proportion of missing data, and our analyses assume data are missing at random.

Conclusions

This study demonstrates associations between ACEs and lower educational attainment and higher risks of depression, drug use, and smoking that remain after adjustment for family and socioeconomic factors. The low PAFs for both ACEs and socioeconomic factors imply that interventions that focus solely on ACEs or solely on socioeconomic deprivation, whilst beneficial, would miss most cases of adverse educational and health outcomes. This interpretation suggests that intervention strategies should target a wide range of relevant factors, including ACEs, socioeconomic deprivation, parental substance use, and mental health.

Klíčová slova:

Educational attainment – Health education and awareness – Human families – Obesity – Pregnancy – Recreational drug use – Social stratification – Socioeconomic aspects of health


Zdroje

1. Jaffee SR, Ambler A, Merrick M, Goldman-Mellor S, Odgers CL, Fisher HL, et al. Childhood Maltreatment Predicts Poor Economic and Educational Outcomes in the Transition to Adulthood. Am J Public Health. 2018;108:1142–7. doi: 10.2105/AJPH.2018.304587 30088989

2. Romano E, Babchishin L, Marquis R, Frechette S. Childhood Maltreatment and Educational Outcomes. Trauma Violence Abuse. 2015;16:418–37. doi: 10.1177/1524838014537908 24920354

3. Pinto Pereira SM, Li L, Power C. Child Maltreatment and Adult Living Standards at 50 Years. Pediatrics. 2017;139:e20161595. doi: 10.1542/peds.2016-1595 27994115

4. Khambati N, Mahedy L, Heron J, Emond A. Educational and emotional health outcomes in adolescence following maltreatment in early childhood: A population-based study of protective factors. Child Abuse Negl. 2018;81:343–53. doi: 10.1016/j.chiabu.2018.05.008 29793149

5. Metzler M, Merrick MT, Klevens J, Ports KA, Ford DC. Adverse childhood experiences and life opportunities: Shifting the narrative. Child Youth Serv Rev. 2017;72:141–9.

6. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2:e356–e66. doi: 10.1016/S2468-2667(17)30118-4 29253477

7. Kinner SA, Borschmann R. Inequality and intergenerational transmission of complex adversity. Lancet Public Health. 2017;2:e342–e3. doi: 10.1016/S2468-2667(17)30139-1 29253468

8. Smith L. Adverse childhood experiences (ACEs): educational interventions. ESSS outline. Glasgow, Scotland: Iriss; 2018 [cited 10 April 2019]. Available from: https://www.iriss.org.uk/resources/esss-outlines/aces.

9. ACE Aware Wales. ACE Aware Wales. Internet. 2018 [cited 10 April 2019]. Available from: https://www.aceawarewales.com/about/.

10. ACE-Aware Scotland. Increasing awareness of adverse childhood experiences. Internet. 2018 [cited 10 April 2019]. Available from: http://aceawarescotland.com/.

11. Finkelhor D, Shattuck A, Turner H, Hamby S. Improving the adverse childhood experiences study scale. JAMA Pediatr. 2013;167:70–5. doi: 10.1001/jamapediatrics.2013.420 23403625

12. Houtepen LC, Heron J, Suderman M, Tilling K, Howe LD. Adverse childhood experiences in the children of the Avon Longitudinal Study of Parents and Children (ALSPAC). Wellcome Open Res. 2018;3:106. doi: 10.12688/wellcomeopenres.14716.1 30569020

13. Pelton LH. Child abuse and neglect: the myth of classlessness. Am J Orthopsychiatry. 1978;48:608–17. doi: 10.1111/j.1939-0025.1978.tb02565.x 707612

14. Freisthler B, Merritt DH, LaScala EA. Understanding the ecology of child maltreatment: a review of the literature and directions for future research. Child Maltreat. 2006;11:263–80. doi: 10.1177/1077559506289524 16816324

15. Halfon N, Larson K, Son J, Lu M, Bethell C. Income Inequality and the Differential Effect of Adverse Childhood Experiences in US Children. Acad Pediatr. 2017;17:S70–s8. doi: 10.1016/j.acap.2016.11.007 28865663

16. Hughes M, Tucker W. Poverty as an Adverse Childhood Experience. N C Med J. 2018;79:124–6. doi: 10.18043/ncm.79.2.124 29563312

17. Treanor M. Poverty and adverse childhood experiences. Children 1st. Internet. 2018 [cited 10 April 2019]. Available from: https://www.children1st.org.uk/blog/poverty-and-adverse-childhood-experiences-aces/.

18. Taylor-Robinson DC, Straatmann VS, Whitehead M. Adverse childhood experiences or adverse childhood socioeconomic conditions? Lancet Public Health. 2018;3:e262–e3. doi: 10.1016/S2468-2667(18)30094-X 29776799

19. Traub F, Boynton-Jarrett R. Modifiable Resilience Factors to Childhood Adversity for Clinical Pediatric Practice. Pediatrics. 2017;139:e20162569. doi: 10.1542/peds.2016-2569 28557726

20. Klika JB, Herrenkohl TI. A review of developmental research on resilience in maltreated children. Trauma Violence Abuse. 2013;14:222–34. doi: 10.1177/1524838013487808 23666947

21. Cicchetti D. Annual Research Review: Resilient functioning in maltreated children—past, present, and future perspectives. J Child Psychol Psychiatry. 2013;54:402–22. doi: 10.1111/j.1469-7610.2012.02608.x 22928717

22. Boyd A, Golding J, Macleod J, Lawlor DA, Fraser A, Henderson J, et al. Cohort Profile: The 'Children of the 90s'—the index offspring of the Avon Longitudinal Study of Parents and Children. Int J Epidemiol. 2012;42:111–27. doi: 10.1093/ije/dys064 22507743

23. Fraser A, Macdonald-Wallis C, Tilling K, Boyd A, Golding J, Davey SG, et al. Cohort Profile: The Avon Longitudinal Study of Parents and Children: ALSPAC mothers cohort. Int J Epidemiol. 2012;42:97–110. doi: 10.1093/ije/dys066 22507742

24. World Health Organization. Adverse Childhood Experiences International Questionnaire (ACE-IQ). Geneva: WHO; 2018 [cited 10 April 2019]. Available from: https://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/en/.

25. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT. The Alcohol Use Disorders Identification Test. Guidelines for use in primary care. Second Edition. Geneva: World Health Organization, 2001.

26. Lewis G. Assessing psychiatric disorder with a human interviewer or a computer. J Epidemiol Community Health. 1994;48:207–10. doi: 10.1136/jech.48.2.207 8189180

27. Legleye S, Karila L, Beck F, Reynaud M. Validation of the CAST, a general population Cannabis Abuse Screening Test. J Subst Use. 2007;12:233–42.

28. Enders CK. Applied missing data analysis. In: Little TD, editor. Methodology in the Social Sciences. New York: Guilford Press; 2010.

29. van Buuren S, Groothuis-Oudshoorn K. mice: Multivariate Imputation by Chained Equations in R. J Stat Softw. 2011;45:i03.

30. Meng XL, Rubin DB. Performing likelihood ratio tests with multiply-imputed data sets. Biometrika. 1992;79:103–11.

31. Howe LD, Tilling K, Galobardes B, Lawlor DA. Loss to follow-up in cohort studies: bias in estimates of socioeconomic inequalities. Epidemiology. 2013;24:1–9. doi: 10.1097/EDE.0b013e31827623b1 23211345

32. Copeland WE, Shanahan L, Hinesley J, Chan RF, Aberg KA, Fairbank JA, et al. Association of Childhood Trauma Exposure With Adult Psychiatric Disorders and Functional Outcomes. JAMA Netw Open. 2018;1:e184493. doi: 10.1001/jamanetworkopen.2018.4493 30646356

33. Bjorkenstam E, Hjern A, Mittendorfer-Rutz E, Vinnerljung B, Hallqvist J, Ljung R. Multi-exposure and clustering of adverse childhood experiences, socioeconomic differences and psychotropic medication in young adults. PLoS ONE. 2013;8:e53551. doi: 10.1371/journal.pone.0053551 23341951

34. Bellis MA, Ashton K, Hughes K, Ford K, Bishop J, Paranjothy S. Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population. Cardiff: Public Health Wales, 2015.

35. Newbury JB, Arseneault L, Moffitt TE, Caspi A, Danese A, Baldwin JR, et al. Measuring childhood maltreatment to predict early-adult psychopathology: Comparison of prospective informant-reports and retrospective self-reports. J Psychiatr Res. 2018;96:57–64. doi: 10.1016/j.jpsychires.2017.09.020 28965006

36. Baldwin JR, Reuben A, Newbury JB, Danese A. Agreement Between Prospective and Retrospective Measures of Childhood Maltreatment: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(6):584–593. doi: 10.1001/jamapsychiatry.2019.0097 30892562

37. Howe LD, Tilling K, Lawlor DA. Studying the life course health consequences of childhood adversity: challenges and opportunities. Circulation. 2015;131:1645–7. doi: 10.1161/CIRCULATIONAHA.115.016251 25858195

38. Caleyachetty R, Hardy R, Cooper R, Richards M, Howe LD, Anderson E, et al. Modeling Exposure to Multiple Childhood Social Risk Factors and Physical Capability and Common Affective Symptoms in Later Life. J Aging Health. 2018;30:386–407. doi: 10.1177/0898264316680434 28553793


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