Adverse Childhood Experiences and Obesity in Emerging Adults: Mixed Methods Study

摘要 在美国，近20%的年轻人在成年初期(18至25岁)变得肥胖， 一生中健康状况不佳的过程。风险特别高的是1800万患有 不良童年经历史(ACE)，一组9种发展受阻的童年经历 例如虐待或父母精神疾病。有ACE病史的人在以下情况下体重增加加速 进入成年期，导致肥胖风险增加近40%。刚成年是一个至关重要的因素 为降低肥胖风险而进行干预的时期，因为ACE相关的肥胖似乎出现在 年龄，因为新兴成年人不再是未成年人，可以独立于父母提供干预 (他可能对这场逆境做出了贡献)。现有的干预措施可以解决许多被认为是 导致那些有ACE病史的人肥胖，例如过度消费非常可口的“舒适”食物来 抚慰或麻木痛苦。因此，未来研究的一个有前景的重点是确定 这些干预成分有助于减少血管紧张素转换酶相关肥胖。然而，在我们能够向这样的方向前进之前 在干预研究中，我们首先需要回答关于谁应该接受干预的基本问题 以及应该解决的心理和行为因素。重要的问题包括：什么 ACE暴露的组合与最大的肥胖风险有关？这些组合是否有以下不同 社会人口因素？A级与提供洞察力的心理和行为因素有何关联 转变为机制和干预目标？患有ACEs和肥胖症的人认为有哪些类型的干预措施 会有帮助吗？拟议的研究将使用创新的混合方法来回答这些问题 两年制和四年制学院和大学中的新兴成年人的问题。我们专注于学院和大学 因为他们服务于几乎一半的新兴成年人，他们为未来提供了一个可行和令人兴奋的平台 干预性发展。在我们研究的量化阶段，我们将利用并建立一个独特的 二、四年制大学生人群监测系统(1) 与肥胖风险最密切相关的A级和相关成人受害经历集群 跨人口群体和(2)这些ACE集群与心理和心理集群的关联 可提供对干预机制和目标的洞察的行为因素。第二，我们将 定性地探讨2岁和4岁不同超重/肥胖儿童的ACE和体重行为之间的联系 有ACE病史的大学生。我们将对他们进行深入访谈，了解他们对 不健康体重行为的原因，他们以前的体重管理经验，以及 他们认为体重管理支持将是最有帮助的。这种高效的形成性研究将填补关键 知识差距，为今后优化和量身定制干预措施的大规模工作奠定基础 降低患有ACEs的新兴成年人的肥胖风险

Summary Almost 20% of young people in the US become obese during emerging adulthood (age 18 to 25 years), setting the course for poor health across the life span. At particularly high risk are the 18 million emerging adults with a history of Adverse Childhood Experiences (ACEs), a set of 9 developmentally disruptive childhood experiences such as abuse or parental mental illness. People with ACE histories experience accelerated weight gain in emerging adulthood, leading to an almost 40% increased risk of obesity. Emerging adulthood is a crucial period in which to intervene to reduce obesity risk both because ACE-related obesity appears to emerge at this age and because emerging adults are no longer minors and can be offered intervention independent of parents (who may have contributed to the adversity). Existing interventions can address many of the factors thought to contribute to obesity in those with ACE histories, such as overconsumption of highly palatable “comfort” food to soothe or numb distress. Thus a promising focus of future research is identifying the optimal combination of these intervention components to reduce ACE-related obesity. However, before we can advance toward such intervention studies, we first need to answer fundamental questions about who should receive interventions and the psychological and behavioral factors that should be addressed. Important questions include: What combinations of ACE exposures are associated with the greatest obesity risk? Do these combinations differ by sociodemographic factors? How are ACEs associated with psychological and behavior factors that offer insight into mechanisms and intervention targets? What types of interventions do those with ACEs and obesity think would be helpful? The proposed study will use an innovative mixed methods approach to answer these questions in emerging adults in 2- and 4-year colleges and universities. We focus on colleges and universities because they serve almost half of all emerging adults, and they offer a feasible and exciting platform for future intervention development. In the quantitative phase of our study, we will leverage and build upon a unique population-based surveillance system of 2- and 4-year college and university students to identify (1) the clusters of ACEs and related adult victimization experiences that are most strongly associated with obesity risk across population groups and (2) associations of these ACE clusters with clusters of psychological and behavior factors that can provide insight into mechanisms and targets for intervention. Second, we will qualitatively explore the links between ACEs and weight behaviors in diverse overweight/obese 2- and 4-year college students with ACE histories. We will conduct in-depth interviews regarding their perception of the reasons for unhealthy weight behaviors, their prior experiences with weight management, and the types of weight management supports they think would be most helpful. This efficient formative study will fill critical gaps in knowledge, providing a foundation for future large-scale work that will optimize and tailor interventions to reduce obesity risk in emerging adults with ACEs