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

总结 美国近20%的年轻人在成年初期（18至25岁）变得肥胖， 在整个生命周期中健康状况不佳的过程。特别高的风险是1800万患有糖尿病的新兴成年人。 不良童年经历（ACE）的历史，一组9个发展破坏性的童年经历 例如虐待或父母精神疾病。有ACE病史的人体重增加加速， 成年后，导致肥胖的风险增加近40%。成年期的到来是一个至关重要的 这是一个干预以降低肥胖风险的时期，因为ACE相关的肥胖似乎出现在这个时期， 年龄，因为新兴的成年人不再是未成年人，可以独立于父母提供干预 (who可能导致了逆境）。现有的干预措施可以解决许多被认为是 在有ACE病史的人中，肥胖的原因是过度食用非常可口的“舒适”食物， 抚慰或麻木痛苦。因此，未来研究的一个有希望的焦点是确定以下各项的最佳组合： 这些干预成分，以减少ACE相关的肥胖。然而，在我们能够朝着这样的方向前进之前， 在干预研究中，我们首先需要回答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。重要问题包括： ACE暴露的组合与最大的肥胖风险相关？这些组合的不同之处在于 社会人口因素？ACE如何与提供洞察力的心理和行为因素相关联 转化为机制和干预目标？患有ACE和肥胖症的人认为什么样的干预措施 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 在2年和4年制学院和大学的新兴成人的问题。我们专注于学院和大学 因为他们为几乎一半的新兴成年人提供服务，他们为未来提供了一个可行的和令人兴奋的平台， 干预发展。在我们研究的定量阶段，我们将利用和建立一个独特的 以人口为基础的监测系统的2年和4年制学院和大学生，以确定（1） ACE和相关成人受害经历的集群与肥胖风险最密切相关 和（2）这些ACE簇与心理和 行为因素，可以提供洞察机制和干预目标。二是 定性探索ACE和体重行为之间的联系，在不同的超重/肥胖2年和4年， 有ACE病史的大学生我们将进行深入访谈，了解他们对 不健康的体重行为的原因，他们以前的体重管理经验，以及 他们认为最有帮助的体重管理支持。这种有效的形成性研究将填补关键 知识差距，为未来优化和调整干预措施的大规模工作奠定基础 降低患有ACE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