英格兰全国儿童不良经历及其与对有害健康行为的复原力关系的家庭调查。
National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England.
作者信息
Bellis Mark A, Hughes Karen, Leckenby Nicola, Perkins Clare, Lowey Helen
机构信息
Centre for Public Health, World Health Organization Collaborating Centre for Violence Prevention, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
出版信息
BMC Med. 2014 May 2;12:72. doi: 10.1186/1741-7015-12-72.
BACKGROUND
Epidemiological and biomedical evidence link adverse childhood experiences (ACEs) with health-harming behaviors and the development of non-communicable disease in adults. Investment in interventions to improve early life experiences requires empirical evidence on levels of childhood adversity and the proportion of HHBs potentially avoided should such adversity be addressed.
METHODS
A nationally representative survey of English residents aged 18 to 69 (n = 3,885) was undertaken during the period April to July 2013. Individuals were categorized according to the number of ACEs experienced. Modeling identified the proportions of HHBs (early sexual initiation, unintended teenage pregnancy, smoking, binge drinking, drug use, violence victimization, violence perpetration, incarceration, poor diet, low levels of physical exercise) independently associated with ACEs at national population levels.
RESULTS
Almost half (47%) of individuals experienced at least one of the nine ACEs. Prevalence of childhood sexual, physical, and verbal abuse was 6.3%, 14.8%, and 18.2% respectively (population-adjusted). After correcting for sociodemographics, ACE counts predicted all HHBs, e.g. (0 versus 4+ ACEs, adjusted odds ratios (95% confidence intervals)): smoking 3.29 (2.54 to 4.27); violence perpetration 7.71 (4.90 to 12.14); unintended teenage pregnancy 5.86 (3.93 to 8.74). Modeling suggested that 11.9% of binge drinking, 13.6% of poor diet, 22.7% of smoking, 52.0% of violence perpetration, 58.7% of heroin/crack cocaine use, and 37.6% of unintended teenage pregnancy prevalence nationally could be attributed to ACEs.
CONCLUSIONS
Stable and protective childhoods are critical factors in the development of resilience to health-harming behaviors in England. Interventions to reduce ACEs are available and sustainable, with nurturing childhoods supporting the adoption of health-benefiting behaviors and ultimately the provision of positive childhood environments for future generations.
背景
流行病学和生物医学证据表明，儿童期不良经历（ACEs）与有害健康行为以及成人非传染性疾病的发生有关。投资于改善早期生活经历的干预措施需要关于儿童期逆境水平以及若解决此类逆境可能避免的有害健康行为比例的实证证据。
方法
2013年4月至7月期间，对18至69岁的英国居民进行了一项具有全国代表性的调查（n = 3885）。根据经历的ACEs数量对个体进行分类。建模确定了在全国人口水平上与ACEs独立相关的有害健康行为（过早开始性行为、意外少女怀孕、吸烟、酗酒、吸毒、暴力受害、暴力 perpetration、监禁、不良饮食、低体育锻炼水平）的比例。
结果
近一半（47%）的个体经历了九种ACEs中的至少一种。儿童期性虐待、身体虐待和言语虐待的患病率分别为6.3%、14.8%和18.2%（经人口调整）。在对社会人口统计学进行校正后，ACEs计数可预测所有有害健康行为，例如（0种与4种及以上ACEs相比，调整后的优势比（95%置信区间））：吸烟3.29（2.54至4.27）；暴力 perpetration 7.71（4.90至12.14）；意外少女怀孕5.86（3.93至8.74）。建模表明，全国范围内11.9%的酗酒、13.6%的不良饮食、22.7%的吸烟、52.0%的暴力 perpetration、58.7%的海洛因/快克可卡因使用以及37.6%的意外少女怀孕患病率可归因于ACEs。
结论
稳定且具保护性的童年是英国培养抵御有害健康行为能力的关键因素。减少ACEs的干预措施是可行且可持续的，培养性的童年有助于养成有益健康的行为，并最终为子孙后代提供积极的童年环境。
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