Poor Health Outcomes In Adulthood Research Articles

Electrocortical Correlates of Emotion Processing and Resilience in Individuals with Adverse Childhood Experiences

AbstractChildhood trauma is associated with poor health outcomes in adulthood, largely due to the impact of chronic stress on the body. Fortunately, there are certain protective characteristics, such as constraint (i.e., impulse control, inhibition, and avoidance of unconventional behavior and risk) and cognitive reappraisal (i.e., reframing circumstances in a more positive light). In the present study, we investigated the interaction between childhood trauma, resilience, and neural correlates of emotion processing. Participants responded to survey questions regarding childhood trauma and resilient characteristics. They were later invited to passively view neutral, unpleasant, and pleasant images while their brain activity was recorded via electroencephalography (EEG). We analyzed two event-related potential (ERP) components of interest: the Early Posterior Negativity (EPN) and Late Positive Potential (LPP). We found that childhood trauma was associated with decreased constraint and reduced sensitivity to unpleasant images (i.e., decreased LPP amplitude differences between neutral and unpleasant images as compared to controls). Further, constraint predicted increased sensitivity to pleasant images. In a hierarchical linear regression analysis, we found that constraint moderated the relation between childhood trauma and emotion processing, such that it predicted increased sensitivity to unpleasant images for adults with childhood trauma in particular. Childhood trauma and cognitive reappraisal independently predicted decreased sensitivity to unpleasant images, (i.e., decreased LPP amplitude differences between neutral and unpleasant images). Our findings suggest that childhood trauma and resilient characteristics independently and interactively influence emotion processing.

Feeding Practices, Parent Perceptions, and Diet Diversity in a Sample of Children Aged 0-5 Years from Western Sydney, Australia: A Mixed Methods Study.

(1) Background: Sub-optimal feeding practices and dietary intakes in childhood are associated with poor health outcomes in adulthood. This mixed methods study aims to profile feeding practices, parent perceptions, and dietary diversity in a sample of children aged 0-5 years (n = 29) from Western Sydney, Australia. (2) Methods: In 2019, semi-structured interviews were conducted with parents, exploring their child's feeding practices. An online quantitative survey was used to assess children's feeding history. Nutrient intakes and dietary diversity scores were assessed using an online 24-h dietary recall. Quantitative data were analysed using descriptive statistics and one-way ANOVA, while qualitative data were analysed using inductive thematic analysis. (3) Results: The analysis showed that 27.6% of children were exclusively breastfed until 6 months of age and that 62.1% of children were introduced to solids before 6 months. Over 60% of children achieved minimum dietary diversity. The thematic analysis identified four themes, including mothers' feeding choices, mothers' perceptions of their children's diet, influences on feeding choices, and mothers' personal experiences. (4) Conclusions: The feeding history of over half the children in this sample indicated non-compliance with Australian and WHO infant feeding guidelines. The thematic analysis revealed various possible influences on parent feeding choices that can be used to inform targeted support.

Racial disparities in Alzheimer’s Disease and Related Dementias (ADRD): The association between early life adversity and ADRD

AbstractBackgroundAdverse childhood experiences (ACEs) are an important public health concern that predict neuroanatomical changes in development such as decreased prefrontal cortex and hippocampal volumes, and can lead to poor health outcomes in adulthood, including cognitive impairment. Alzheimer’s disease (AD) is the most common cause of dementia, and it disproportionately affects racial and ethnic minoritized (REM) individuals. Research demonstrates that some of the mechanisms underlying these racial disparities may include differences in exposure to specific types of ACEs (i.e. parental remarriage and/or death). A significant ACE burden can lead to disruption of the hypothalamic‐pituitary adrenal (HPA) axis, our fight‐or‐flight response system to environmental threats and stressors. Growing evidence has shown an association between ACEs and the development of cognitive impairment in older adulthood, including AD and related dementias (ADRD). We do not know, however, how biomarkers related to HPA axis dysregulation in association with ACEs are correlated to ADRD biomarkers (pathology) in a nationally representative, diverse cohort of individuals.MethodsA preliminary study is being conducted to evaluate the associations between early life adversity (measured retrospectively through surveys) and ADRD in several cohorts, including the Minority Aging in Research Study (MARS) from the Rush University Alzheimer’s Disease Research Center, the Stress and Resilience in Dementia (STRIDE) cohort from the University of Wisconsin, and the Duke University Medical Center clinics using DEDUCE, an on‐line query system in MaestroCare, Duke University Hospital’s electronic medical record system. Statistical analyses will be performed using R software.ResultsPending statistical analyses.ConclusionValidation of ACEs as independent risk factors for AD and contributors to the racial disparities seen in this condition will offer new potential therapeutic targets at the molecular level, new clinical screening modalities for specific ACEs instigating cognitive decline, and public policy insights to address a history of childhood trauma in patients with a clinical diagnosis of ADRD. This is especially for those REM individuals who have historically had a delayed or missed diagnosis and have been disproportionately impacted by ADRD.The research project described is supported by the National Institute On Aging of the National Institutes of Health under Award Number P30AG072958.

Adverse childhood experiences and food insecurity in emerging adulthood: findings from the EAT 2010-2018 study.

Low childhood socioeconomic status (SES) and adverse childhood experiences (ACEs) are associated with poor health outcomes in adulthood. Determining how ACEs may be linked to food insecurity among young people from socioeconomically diverse households can inform health-protective strategies. This study examined if ACEs are associated with food insecurity during the transition to adulthood, and investigated prevalence differences across SES strata. Participants were recruited from 20 secondary schools in Minneapolis-St. Paul, Minnesota. The analytic sample (n1,518) completed classroom surveys in 2009-2010 (mean age14.5 years) and follow-up surveys in 2017-2018 (mean age22.0 years). Past-year food insecurity was reported at both time points and ACEs were reported at follow-up. Logistic regression models were used to estimate emerging adult food insecurity prevalence by ACE exposure; models were stratified by childhood SES (low, middle, high). The adjusted prevalence of food insecurity was 45.3% among emerging adults who reported three or more ACEs compared to 23.6% among those with one or two ACEs, and 15.5% among those with no ACE (P<0.001). All forms of ACEs were related to an elevated prevalence of food insecurity in emerging adulthood. ACE-food insecurity associations were strongest for emerging adults from lower and middle SES households. Among emerging adults from low SES households, childhood experiences of emotional abuse and substance use by a household member were associated with the largest prevalence differences in food insecurity. Findings suggest a need for trauma-informed services within food assistance programs to better serve individuals with a history of ACEs.

Arrhythmia and COVID-19 in children.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection caused worldwide health problems, and coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. Cardiovascular complications of COVID-19 are not uncommon; among them, arrhythmia is considered a significant risk factor for poor health outcomes in adults. However, data are scarce on the arrhythmia of pediatric patients with SARS-CoV-2 infection, possibly due to their mild symptoms and low incidence of cardiovascular involvement. Multisystem inflammatory syndrome in children reportedly features increased cardiovascular involvement, but arrhythmic complications remain unidentified. Thus, here we review the epidemiology, manifestations, and outcomes of pediatric arrhythmia associated with COVID-19.

Proteome analysis of monocytes implicates altered mitochondrial biology in adults reporting adverse childhood experiences

The experience of adversity in childhood has been associated with poor health outcomes in adulthood. In search of the biological mechanisms underlying these effects, research so far focused on alterations of DNA methylation or shifts in transcriptomic profiles. The level of protein, however, has been largely neglected. We utilized mass spectrometry to investigate the proteome of CD14+ monocytes in healthy adults reporting childhood adversity and a control group before and after psychosocial stress exposure. Particular proteins involved in (i) immune processes, such as neutrophil-related proteins, (ii) protein metabolism, or (iii) proteins related to mitochondrial biology, such as those involved in energy production processes, were upregulated in participants reporting exposure to adversity in childhood. This functional triad was further corroborated by protein interaction- and co-expression analyses, was independent of stress exposure, i.e. observed at both pre- and post-stress time points, and became evident especially in females. In line with the mitochondrial allostatic load model, our findings provide evidence for the long-term effects of childhood adversity on mitochondrial biology.

Low birthweight is associated with epigenetic age acceleration in the first 3 years of life.

The Developmental Origins of Health and Disease hypothesis posits that early life adversity is associated with poor adult health outcomes. Epidemiological evidence has supported this framework by linking low birthweight with adult health and mortality, but the mechanisms remain unclear. Accelerated epigenetic aging may be a pathway to connect early life experiences with adult health outcomes, based on associations of accelerated epigenetic aging with increased morbidity and mortality. Sixty-seven mother-infant dyads were recruited in the eastern Democratic Republic of Congo. Birthweight data were collected at birth, and blood samples were collected at birth and follow-up visits up to age 3. DNA methylation data were generated with the Illumina MethylationEPIC array and used to estimate epigenetic age. A multilevel model was used to test for associations between birthweight and epigenetic age acceleration. Chronological age was highly correlated with epigenetic age from birth to age 3 (r = 0.95, p < 2.2 × 10-16). Variation in epigenetic age acceleration increased over time. Birthweight, dichotomized around 2500 g, predicted epigenetic age acceleration over the first 3 years of life (b = -0.39, p = 0.005). Our longitudinal analysis provides the first evidence for accelerated epigenetic aging that emerges between birth and age 3 and associates with low birthweight. These results suggest that early life experiences, such as low birthweight, may shape the trajectory of epigenetic aging in early childhood. Furthermore, accelerated epigenetic aging may be a pathway that links low birthweight and poor adult health outcomes.

Adverse childhood experiences and resilience in childhood and adolescent and young adult cancer patients.

Childhood and adolescent and young adult (AYA) cancer survivors experience poor health outcomes in adulthood. Adverse childhood experiences (ACEs) also portend poor health outcomes for the general population. Resilience can mitigate effects of ACEs. We examined the feasibility of assessing ACEs and resilience in childhood and AYA cancer patients. We also described occurrences of ACEs, resilience, and poor health outcomes. Of 52 participants, most rated their study experience favorably, with privacy in answering sensitive questions. Half reported ACEs, and those with ACEs had lower resilience; X2 (3, N=52)=9.4, p=.02. Further investigations of ACEs and resilience in larger cohorts are warranted to delineate associations with long-term health outcomes.

The role of childhood unpredictability in adult health.

This research differentiated childhood unpredictability (i.e., perceptions of uncertainty or instability due to turbulent environmental changes) from other related constructs to identify its role in adult health. Study 1 (N = 441) showed that, beyond other childhood adversity variables (poverty and adverse childhood experiences or ACEs) and demographic characteristics, perceptions of unpredictability were associated with greater functional disability and worse health-related quality of life (assessed via the CDC's HRQOL Healthy Days measure and the RAND SF-36). Study 2 (N = 564) replicated those findings in a more racially diverse sample and showed that associations with childhood unpredictability held while also controlling for the Big 5 personality traits. Findings suggest that effects of unpredictability were especially pronounced among Hispanic (in Study 1), and Black/African American and low-income participants (in Study 2). Experiencing childhood environments that are perceived to be uncertain, unstable, or uncontrollable may put children on a path toward poor health outcomes in adulthood. Findings advance theories of child adversity and health and identify childhood unpredictability as a potentially valuable target for intervention.

Examining Childhood Adversities in Chinese Health Science Students Using the Simplified Chinese Version of the Adverse Childhood Experiences-International Questionnaire (SC-ACE-IQ).

Adverse childhood experiences (ACEs) are prevalent, costly, and associated with poor health outcomes in adults. Little is known about ACE prevalence rates or strategies for measuring ACEs among young adults in Mainland China. The aims of this study were to (a) translate the ACE-International Questionnaire (ACE-IQ) into Simplified Chinese, (b) assess the psychometric strength of the Simplified Chinese version of the ACE-IQ (SC-ACE-IQ), and (c) compare SC-ACE-IQ scores calculated using binary and frequency scoring methods. The ACE-IQ was translated from English to Simplified Chinese and evaluated for content validity, criterion validity, and test–retest reliability. Chinese young adults (n = 566) aged 18–38 years who were health science students were recruited in Shanghai, China from May to August 2020. ACE exposures were compared using binary and frequency scoring methods, as proposed by the World Health Organization (WHO). The SC-ACE-IQ has good content validity (S-CVI = 0.89) and test–retest reliability (ICC = 0.88). SC-ACE-IQ scores were associated with depressive (binary: r = 0.26, frequency: r = 0.29; p < 0.001) and anxiety (binary: r = 0.22, frequency: r = 0.24; p < 0.001) symptoms. Higher proportion of participants reported exposure to at least one ACE and four or more ACEs when using the binary scoring method compared to the frequency scoring method. The SC-ACE-IQ is a valid and reliable ACE measure for Chinese health science students. Using frequency methods may underestimate exposure to ACEs among this population. Researchers should carefully select scoring methods for different study populations and purposes.

Native Hawaiian wellbeing and transdiagnostic trauma symptoms: The protective role of physical activity in dissociation

ObjectivesNative Hawaiians (NH) report higher rates of interpersonal trauma in childhood or adolescence (ITCA) as well as higher rates of chronic physical illness and psychopathology. Given that physical activity (PA) has positive impacts on physical and mental health, it may also serve as a protective factor in the development of poor health outcomes in adulthood following ITCA. The present study investigated what factors contribute to wellbeing and transdiagnostic posttraumatic sequelae for individuals with exposure to ITCA using a dataset from a longitudinal study cohort (n = 989) of ethnically diverse older individuals (mean age = 60) in Hawaiʻi. MethodsFive univariate general linear models were used to explore the unique effects of: PA; ITCA level; NH status; interactions with ITCA level; and interactions with NH status on the dependent variables: posttraumatic sequelae (i.e., dissociation, avoidance, interpersonal difficulty) and aspects of wellbeing (i.e., satisfaction with life [SWL], self-rated health). ResultsPA was a significant predictor of SWL, self-rated health, and dissociation, while exposure to ITCA predicted SWL. NH group status interacted with PA to uniquely predict dissociation. Exposure to ITCA differentially predicted SWL. ConclusionsFindings support prior evidence that processes in posttraumatic experience are significantly associated with poor health-promoting behaviors (e.g., PA). Additionally, for NHs, PA may reduce dissociation, or levels of dissociation already present in the NH group may play a role in disengagement from PA. Future research should consider whether PA holds benefits across trauma types (e.g., historical trauma), or if culturally based PA is differentially more protective.

Associations between Adverse Childhood Experiences and Emergency Department Utilization in an Adult Medicaid Population

Adverse childhood experiences (ACEs) are widely prevalent but unevenly distributed in the United States, with disadvantaged groups, especially those with low socioeconomic status, being more likely to experience them. ACEs have been linked to poor health outcomes in adulthood. In this study, we examined the association between ACEs and emergency department (ED) utilization using a cross-sectional life-course survey of low-income adults matched to Medicaid enrollment and claims data. Surveys were obtained from 2348 Medicaid-enrolled adults in the Portland, OR metropolitan area; 1133 were used in this analysis. We used a two-part regression model to estimate the association between ACE score and both ever using the ED and frequency of ED use in the year after survey completion. We also evaluated a set of potentially protective factors to see if they impacted the relationship between ED use and ACE score. We found that participants with a higher ACE score were more likely to obtain any emergency services care (odds ratio (OR) = 1.11, p = 0.011), but ACE score did not predict how frequently they would utilize those services. Close social relationships were found to be protective against high ED utilization for those with high ACE scores. Upstream prevention efforts that identify places to intervene in childhood and incorporate trauma-informed strategies into ED care in adulthood have the potential to decrease ED use.

Adolescent ethanol drinking promotes hyperalgesia, neuroinflammation and serotonergic deficits in mice that persist into adulthood

Adolescent alcohol use can permanently alter brain function and lead to poor health outcomes in adulthood. Emerging evidence suggests that alcohol use can predispose individuals to pain disorders or exacerbate existing pain conditions, but the underlying neural mechanisms are currently unknown. Here we report that mice exposed to adolescent intermittent access to ethanol (AIE) exhibit increased pain sensitivity and depressive-like behaviors that persist for several weeks after alcohol cessation and are accompanied by elevated CD68 expression in microglia and reduced numbers of serotonin (5-HT)-expressing neurons in the dorsal raphe nucleus (DRN). 5-HT expression was also reduced in the thalamus, anterior cingulate cortex (ACC) and amygdala as well as the lumbar dorsal horn of the spinal cord. We further demonstrate that chronic minocycline administration after AIE alleviated hyperalgesia and social deficits, while chemogenetic activation of microglia in the DRN of ethanol-naïve mice reproduced the effects of AIE on pain and social behavior. Chemogenetic activation of microglia also reduced tryptophan hydroxylase 2 (Tph2) expression and was negatively correlated with the number of 5-HT-immunoreactive cells in the DRN. Taken together, these results indicate that microglial activation in the DRN may be a primary driver of pain, negative affect, and 5-HT depletion after AIE.

A systematic review of adherence to anticoagulation regimens in pediatric patients.

Thromboembolic disease rates are increasing in pediatric patients. Anticoagulation is prescribed for treatment and prevention of thromboembolic disease. While nonadherence to anticoagulation regimens predicts poor health outcomes in adults, data in anticoagulated pediatric patients are limited. We systematically reviewed the rates, outcomes, and predictors of anticoagulation nonadherence in the pediatric population. Out of a total of 3581 unique articles identified for review, 17 studies met inclusion criteria. These studies primarily evaluated patients with cardiac disease treated with vitamin K antagonists. Overall nonadherence rates varied from 3% to 42%, based upon population, definition of adherence, and measurement strategy. Patient age, goal international normalized ratio (INR), and number of concurrent potentially interacting medications correlated with nonadherence. Data examining the relationship between nonadherence and health outcomes were included in only two studies. Limitations of current literature, as well as critical knowledge gaps that require future study, are discussed.

School and Work Absences After Critical Care Hospitalization for Pediatric Acute Respiratory Failure

Patients who survive pediatric critical illness and their caregivers commonly experience physical, emotional, and cognitive sequelae. However, the rate and duration of school absence among patients and work absence among their caregivers are unknown. To determine the rates and duration of school absence among children who survived hospitalization with acute respiratory failure and work absence among their caregivers. The Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) cluster randomized trial included 2449 children from 31 sites to protocolized sedation (intervention) vs usual care (control) from June 6, 2009, to December 2, 2013. In total, 1360 children survived hospitalization and were selected for follow-up at 6 months after pediatric intensive care unit (PICU) discharge, which was completed from January 12, 2010, to April 13, 2015. This secondary analysis was conducted from July 1, 2020, to September 30, 2021. PICU hospitalization for acute respiratory failure, including invasive mechanical ventilation. Postdischarge assessments with caregivers of eligible participants at 6 months after PICU discharge, including questions about school and work absence. Risk factors associated with longer absence from school and work were identified. Postdischarge assessments were completed for 960 children who survived treatment for acute respiratory failure, of whom 443 (46.1%) were girls and 517 (53.9%) were boys; 509 of 957 (53.2%) were non-Hispanic White. Median age was 1.8 years (IQR, 0.4-7.9 years). In total, 399 children (41.6%) were enrolled in school, of whom 279 (69.9%) missed school after discharge. Median duration of postdischarge absence was 9.1 days (IQR, 0-27.9 days) among all children enrolled in school and 16.9 days (IQR, 7.9-43.9 days) among the 279 children with postdischarge absence. Among 960 primary caregivers, 506 (52.7%) were employed outside the home, of whom 277 (54.7%) missed work. Median duration of postdischarge work absence was 2 days (IQR, 0-10 days) among all employed primary caregivers, and 8 days (IQR, 4-20 days) among the 277 caregivers who missed work after discharge. The odds of postdischarge school absence and greater duration of absence increased for children 5 years or older (compared with 0-4 years, odds ratios [ORs] for 5-8 years, 3.20 [95% CI, 1.69-6.05] and 2.09 [95% CI, 1.30-3.37], respectively; ORs for 9-12 years, 2.49 [95% CI, 1.17-5.27] and 2.32 [95% CI, 1.30-4.14], respectively; and ORs for 13-18 years, 2.37 [95% CI, 1.20-4.66] and 1.89 [95% CI, 1.11-3.24], respectively) and those with a preexisting comorbidity (ORs, 1.90 [95% CI, 1.10-3.29] and 1.76 [95% CI, 1.14-2.69], respectively). In this secondary analysis of a cluster randomized trial, 2 in 3 children hospitalized for acute respiratory failure missed school after discharge, for a median duration of nearly 2 weeks. In addition, more than half of primary caregivers missed work after discharge. The magnitude of school absenteeism suggests that children may be at increased risk for lower educational achievement, economic hardship, and poor health outcomes in adulthood.

Childhood adversities and the comorbidity between mood and general medical disorders in adults: Results from the WHO World Mental Health Survey Portugal

ObjectiveChildhood adversities have been linked to poor health outcomes in adults, including both mood and general medical disorders. Here we tested the hypothesis that childhood adversities specifically increase the risk of comorbidity between mood and general medical disorders, rather than increasing the risk of either one independently. MethodsMood disorders (DSM-IV major depressive, dysthymic and bipolar disorders), childhood adversities and general medical disorders were assessed in 2060 adults in the WHO World Mental Health Survey Portugal. Discrete-time survival analyses were used to investigate the association between mood disorders and subsequent first-onset general medical disorders and between general medical disorders and subsequent first-onset mood disorders, in adults. Discrete-time survival and multinomial regression analyses were used to test the influence of childhood adversities on the comorbidity between mood disorders and general medical disorders. Anxiety disorders were used as a psychiatric control. ResultsAdult-onset mood disorders were found to precede the onset of diabetes (OR:1.8; 95% CI:1.2–2.9), arthritis (OR:1.6; 95% CI:1.1–2.3) and seasonal allergies (OR:1.6; 95% CI:1.1–2.5) while adult-onset hypertension was found to precede the onset of mood disorders (OR:1.7; 95% CI:1.2–2.6). Maladaptive family functioning (abuse, neglect and parental maladjustment), was associated with mood disorders (OR:1.5; 95% CI:1.2–1.9), hypertension (OR:1.4; 95% CI:1.1–1.7), arthritis (OR:1.3; 95% CI:1.0–1.6) and seasonal allergies (OR:1.5; 95% CI:1.1–2.0) in adulthood. Finally, the effect of maladaptive family functioning in predicting comorbid mood disorders and arthritis significantly differed from its effect in predicting only arthritis (p ​= ​0.01), which was not observed for other comorbidities. Maladaptive family functioning further predicted comorbid anxiety disorders and hypertension. ConclusionChildhood adversities may be a specific risk factor for comorbid mood disorders and arthritis in adults.

Associations Between Adverse Childhood Experiences and Adult Health Outcomes: Exploring Gender Differences

Objectives: This study aimed to (1) understand the associations between Adverse Childhood Experiences (ACEs) and poor adult health outcomes, specifically looking at both physical and mental health indicators, and (2) examine gender differences in ACEs’ impact on adult health outcomes.Methods: Data were obtained from the 2012 Korean General Social Survey. The study sample comprised 1,396 individuals aged ≥ 18 years who answered the ACE questionnaire. Controlling for sociodemographic factors, linear regression models were run to estimate the relationships between ACEs and adult physical (self-rated poor physical health status) and mental health indicators (depressive symptoms). Furthermore, the Chow test was carried out to ascertain whether there were any gender differences in ACEs’ impact on both adult physical and mental health outcomes.Results: Higher numbers of ACEs were significantly and positively associated with worse adult physical and mental health outcomes, such as poorer physical health status and higher levels of depressive symptoms compared with individuals who reported no adversities during childhood. In addition, gender differences were identified in ACEs’ impact on both health indicators, suggesting that females were at a higher risk of depression, while males were more likely to experience poor physical health.Conclusion: Adults reporting multiple adversities during childhood are more likely to experience poorer physical and mental health, demonstrating a strong, graded dose-response relationship between the number of ACEs and a range of negative adult health outcomes. Gender differences also exist in ACEs’ impact on adult physical and mental health, thus suggesting the need for gender-based intervention strategies to address ACEs in the adult population.

Childhood loneliness as a specific risk factor for adult psychiatric disorders.

Loneliness is a major risk factor for both psychological disturbance and poor health outcomes in adults. This study aimed to assess whether childhood loneliness is associated with a long-term disruption in mental health that extends into adulthood. This study is based on the longitudinal, community-representative Great Smoky Mountains Study of 1420 participants. Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview up to eight times in childhood (ages 9-16; 6674 observations; 1993-2000) for childhood loneliness, associated psychiatric comorbidities and childhood adversities. Participants were followed up four times in adulthood (ages 19, 21, 25, and 30; 4556 observations of 1334 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric anxiety, depression, and substance use outcomes. Both self and parent-reported childhood loneliness were associated with adult self-reported anxiety and depressive outcomes. The associations remained significant when childhood adversities and psychiatric comorbidities were accounted for. There was no evidence for an association of childhood loneliness with adult substance use disorders. More associations were found between childhood loneliness and adult psychiatric symptoms than with adult diagnostic status. Childhood loneliness is associated with anxiety and depressive disorders in young adults, suggesting that loneliness - even in childhood - might have long-term costs in terms of mental health. This study underscores the importance of intervening early to prevent loneliness and its sequelae over time.

Parental Childhood Feeding Experiences and Complementary Feeding Practices in Urban Households of Nigeria

ABSTRACT Background Poor complementary feeding practices can expose young children to increased burdens of undernutrition, morbidity, and poor health outcomes in adulthood. Parents and caregivers, who feed the children, are shaped by socio-cultural beliefs and pervasive socioeconomic realities. Also, parental values are influenced by their perceptions and childhood feeding experiences among others. This study, therefore, explored the role of parental childhood feeding experiences and changing socioeconomic realities on complementary feeding practices in urban households of Aba, Nigeria. Method Twenty-eight in-depth interviews and eight focus group discussions were held with parents of young children aged 6–23 months attending postnatal care clinics in selected healthcare facilities in Aba city, Nigeria. Aba city is one of the sprawling urban centers in South-East Nigeria. Data were thematically analyzed using Atlas.ti software. Results Complementary feeding practices in the Aba urban households of South-East Nigeria did not meet the recommended feeding guidelines on timely complementary feeding and dietary diversity. Consumption of processed foods and sweetened beverages was prevalent. Data suggest this feeding pattern was affected by two factors: parental feeding experiences in early life and changing socioeconomic realities. Parents who lacked satisfactory feeding experiences in their childhood but achieved some socioeconomic success in later life exhibited poor complementary feeding practices. Also, certain food types were associated with affluence notwithstanding their nutritional values. Poor complementary feeding was also linked to the parental desire to not reliving their poor childhood feeding experiences. Conclusion The parental perceived poor childhood feeding experience has led many to adopt the consumption of processed foods and sweetened beverages. This may expose children to risks of undernutrition, obesity, and overall poor health outcomes in later adulthood. More effort should be made to educate parents on healthful eating patterns and the dangers of poor complementary feeding practices in children's overall health well-being in later life.

599 Associations between adverse childhood experiences and obstetrical outcomes in an urban underserved population

Adverse childhood experiences (ACEs) such as abuse, neglect, and household dysfunction are strongly associated with poor adult health outcomes in a dose-dependent manner. Less is known about the impact of ACEs on pregnancy, especially in vulnerable populations. The objective of this study was to examine the relationship between ACEs and obstetric outcomes. This is a single-center retrospective cohort study of pregnant women referred to a mental health care coordinator due to elevated psychosocial risks and/or behavioral concerns. Women younger than age 18 and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the ACE questionnaire. Medical charts were reviewed for obstetric outcomes. The associations between ACE score and adverse obstetric outcomes including preterm birth (<37 weeks), low birth weight (<2500 g), and hypertensive disorders of pregnancy (gestational hypertension and preeclampsia), were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at p< 0.1 in bivariate analysis). Our cohort included 92 women of whom 49% had elevated cumulative ACE score ≥ 4 and 26% had a cumulative ACE score ≥ 6. Women with elevated ACE score were significantly more likely to have chronic hypertension; otherwise there were no differences on demographic characteristics or potential obstetric confounds between groups (Table 1). In univariate analysis, ACE score ≥ 4 was not associated with adverse obstetric outcomes, however a score ≥ 6 was associated with an increased risk of preterm birth (OR 3.7, 95% CI 1.2-11.4) and low birth weight (OR 4.9, 95% CI 1.4-17.2). This association did not remain statistically significant after controlling for chronic hypertension. A high level of childhood adversity was associated with chronic hypertension and both prematurity and low birth weight. Future studies should examine whether chronic illnesses help account for poor obstetric outcomes in pregnant women with high childhood adversity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)