Childhood adversity and adult health: Evaluating intervening mechanisms
Childhood adversity and adult health: Evaluating intervening mechanisms
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DOI：
10.1016/j.socscimed.2016.02.026
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发表时间：
2016-05-01
影响因子：
5.4
通讯作者：
Brown, Tyson H.
中科院分区：
文献类型：
--
作者：
Turner, R. Jay;Thomas, Courtney S.;Brown, Tyson H.
大量的证据已经积累起来，支持童年逆境与几年甚至几十年后健康状况不佳的风险之间存在因果关系。对这一证据的一种解释是，这种联系在很大程度上或完全来自一个生物嵌入过程，而这个过程不能被随后的社会背景或经验所改变，这意味着童年也许是干预努力可能有效的唯一时间点。本文认为，这种长期的关联在多大程度上产生于社会背景和/或环境经验的干预差异-这一发现表明，儿童期后的预防工作也可能是有效的。基于这一论点，即选定的研究定义的成人健康状况可能会影响早期的不利成人健康联系，我们使用一个有代表性的社区样本的黑人和白色成人（N = 1252），以评估这种关系在三个健康指标：医生诊断的疾病，自我评价的健康，和非稳态负荷。结果一般表明，观察到的童年逆境和成年健康状况的尺寸之间的关系完全或几乎完全占成人社会经济地位（SEP）和成人压力暴露的变化。一个例外是童年的SEP-非稳态负荷协会，其中一个统计学上显着的关系仍然在成人的压力和SEP的背景下。这唯一的发现支持一个结论，即童年逆境的影响并不总是可以通过随后的经验来弥补。然而，总的来说，分析表明，在儿童期以后采取干预措施，以减少社会压力，提高社会和经济地位，可能是有用的。无论生物嵌入对成人健康的影响如何，它们似乎主要是通过成人的社会环境和接触产生的间接影响。(C)2016爱思唯尔有限公司版权所有。
Substantial evidence has accumulated supporting a causal link between childhood adversity and risk for poor health years and even decades later. One interpretation of this evidence is that this linkage arises largely or exclusively from a process of biological embedding that is not modifiable by subsequent social context or experience - implying childhood as perhaps the only point at which intervention efforts are likely to be effective. This paper considers the extent to which this long-term association arises from intervening differences in social context and/or environmental experiences - a finding that would suggest that post-childhood prevention efforts may also be effective. Based on the argument that the selected research definition of adult health status may have implications for the early adversity-adult health linkage, we use a representative community sample of black and white adults (N = 1252) to evaluate this relationship across three health indices: doctor diagnosed illnesses, self-rated health, and allostatic load. Results generally indicate that observed relationships between childhood adversity and dimensions of adult health status were totally or almost totally accounted for by variations in adult socioeconomic position (SEP) and adult stress exposure. One exception is the childhood SEP-allostatic load association, for which a statistically significant relationship remained in the context of adult stress and SEP. This lone finding supports a conclusion that the impact of childhood adversity is not always redeemable by subsequent experience. However, in general, analyses suggest the likely utility of interventions beyond childhood aimed at reducing exposure to social stress and improving social and economic standing. Whatever the effects on adult health that derive from biological embedding, they appear to be primarily indirect effects through adult social context and exposure. (C) 2016 Elsevier Ltd. All rights reserved.