Cumulative Violence Exposure and Self-Rated Health: Longitudinal Study of Adolescents in the United States
Cumulative Violence Exposure and Self-Rated Health: Longitudinal Study of Adolescents in the United States
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DOI：
10.1542/peds.2007-3063
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发表时间：
2008-11-01
期刊：
影响因子：
8
通讯作者：
Wright, Rosalind J.
中科院分区：
文献类型：
--
作者：
Boynton-Jarrett, Renee;Ryan, Louise M.;Wright, Rosalind J.
目标。目的是确定儿童期和青春期暴力的累积暴露是否会导致美国青少年自评健康水平的差异。1997年全国青年纵向调查是一项持续8年（1997-2004）的纵向队列研究，研究对象是基线年龄为12至18岁的青少年（N = 8224）。建立了广义估计方程，以探讨累积暴力暴露与健康不良风险之间的关系。在基线时，75%的受试者报告良好或非常健康，21.5%报告良好健康，4.5%报告一般或较差健康。累积的暴力暴露（目睹枪支暴力、暴力威胁、反复欺凌、安全感和犯罪受害）与健康状况不佳的风险逐级增加有关，并降低了家庭收入与健康状况不佳之间的关系的强度。与没有暴力接触的受试者相比，在控制人口特征和家庭收入的情况下，报告有bb0 = 5种形式的累计暴力接触的受试者自我评估健康状况不佳的风险是没有暴力接触的受试者的4.6倍。趋势分析显示，每增加一次暴力接触，健康状况不佳的风险就增加38%。酒精使用、药物使用、吸烟、抑郁症状以及家庭和邻里环境的调整降低了家庭收入与暴力累积暴露得分和不良自评健康之间的关系强度，这表明这些因素部分调解了社会经济地位和暴力累积暴露的影响。在这一具有全国代表性的样本中，从青春期过渡到成年期自评健康状况不佳风险方面的社会不平等，部分可归因于累积接触暴力的差异。注意到，在青少年和青年时期，累积接触暴力与自我评价健康状况不佳之间存在强烈的等级关联。儿科2008;122: 961 - 970
OBJECTIVE. The goal was to determine whether cumulative exposure to violence in childhood and adolescence contributes to disparities in self-rated health among a nationally representative sample of US adolescents.METHODS. The National Longitudinal Survey of Youth 1997 is an ongoing, 8-year (1997-2004), longitudinal, cohort study of youths who were 12 to 18 years of age at baseline (N = 8224). Generalized estimating equations were constructed to investigate the relationship between cumulative exposure to violence and risk for poor health.RESULTS. At baseline, 75% of subjects reported excellent or very good health, 21.5% reported good health, and 4.5% reported fair or poor health. Cumulative violence exposures (witnessed gun violence, threat of violence, repeated bullying, perceived safety, and criminal victimization) were associated with a graded increase in risk for poor health and reduced the strength of the relationship between household income and poor health. In comparison with subjects with no violence exposure, risk for poor self-rated health was 4.6 times greater among subjects who reported >= 5 forms of cumulative exposure to violence, controlling for demographic features and household income. Trend analysis revealed that, for each additional violence exposure, the risk of poor health increased by 38%. Adjustment for alcohol use, drug use, smoking, depressive symptoms, and family and neighborhood environment reduced the strength of the relationships between household income and cumulative exposure to violence scores and poor self-rated health, which suggests partial mediation of the effects of socioeconomic status and cumulative exposure to violence by these factors.CONCLUSIONS. In this nationally representative sample, social inequality in risk for poor self-rated health during the transition from adolescence to adulthood was partially attributable to disparities in cumulative exposure to violence. A strong graded association was noted between cumulative exposure to violence and poor self-rated health in adolescence and young adulthood. Pediatrics 2008; 122: 961-970