Sun Jing, Knowles Molly, Patel Falguni, Frank Deborah A, Heeren Timothy C, Chilton Mariana
Department of Epidemiology, Drexel University School of Public Health, Philadelphia, Pennsylvania.
Department of Health Management and Policy, Drexel University School of Public Health, Philadelphia, Pennsylvania.
Am J Prev Med. 2016 May;50(5):561-572. doi: 10.1016/j.amepre.2015.09.024. Epub 2015 Nov 16.
Exposure to childhood adversity, including abuse, neglect, and household dysfunction, is associated with negative long-term health and economic outcomes. Little is known about how adversity exposure in parents' early lives may be related to later food insecurity for parents and their children. This study investigated the association between female caregivers' adverse childhood experiences (ACEs) and household and child food insecurity, taking into account depressive symptoms.
This study used cross-sectional data from 1,255 female caregivers of children aged <4 years surveyed in an urban clinical setting from March 2012 through June 2014. Measures included sociodemographic characteristics; caregivers' ACEs, including abuse, neglect, and household dysfunction; depressive symptoms; and household and child food insecurity. Multinomial and logistic regression analyses assessed the relationship among ACEs, depressive symptoms, and household and child food security status.
Caregiver depressive symptoms modified associations between ACEs and food insecurity level. After adjusting for covariates, caregivers reporting both depressive symptoms and four or more ACEs were 12.3 times as likely to report low food security (95% CI=6.2, 24.7); 28.8 times as likely to report very low food security (95% CI=12.8, 64.8); and 17.6 times as likely to report child food insecurity (95% CI=7.3, 42.6) compared with those reporting no depressive symptoms and no ACEs.
Depressive symptoms and ACEs were independently associated with household and child food insecurity, and depressive symptoms modified the association between ACEs and household and child food insecurity. Comprehensive policy interventions incorporating nutrition assistance and behavioral health may address intergenerational transmission of disadvantage.
童年时期遭受逆境，包括虐待、忽视和家庭功能失调，与长期负面的健康和经济后果相关。关于父母早年所经历的逆境如何与他们及其子女后来的粮食不安全状况相关，我们知之甚少。本研究调查了女性照料者童年不良经历（ACEs）与家庭及儿童粮食不安全之间的关联，并考虑了抑郁症状。
本研究使用了2012年3月至2014年6月在城市临床环境中对1255名4岁以下儿童的女性照料者进行调查的横断面数据。测量指标包括社会人口学特征；照料者的ACEs，包括虐待、忽视和家庭功能失调；抑郁症状；以及家庭和儿童粮食不安全状况。多项和逻辑回归分析评估了ACEs、抑郁症状与家庭及儿童粮食安全状况之间的关系。
照料者的抑郁症状改变了ACEs与粮食不安全水平之间的关联。在调整协变量后，报告有抑郁症状且有四种或更多ACEs的照料者报告粮食安全水平低的可能性是报告无抑郁症状且无ACEs者的12.3倍（95%置信区间=6.2, 24.7）；报告粮食安全水平极低的可能性是其28.8倍（95%置信区间=12.8, 64.8）；报告儿童粮食不安全的可能性是其17.6倍（95%置信区间=7.3, 42.6）。
抑郁症状和ACEs与家庭及儿童粮食不安全独立相关，且抑郁症状改变了ACEs与家庭及儿童粮食不安全之间的关联。纳入营养援助和行为健康的综合政策干预措施可能有助于解决劣势的代际传递问题。
