童年/青少年逆境、青少年社会经济地位与青年期长期心血管疾病风险之间的关联。
Pathways between childhood/adolescent adversity, adolescent socioeconomic status, and long-term cardiovascular disease risk in young adulthood.
机构信息
Center for Human Growth & Development, University of Michigan, 300 N. Ingalls Street, Ann Arbor, MI, 48109-5406, USA.
Division of Epidemiology and Community Health, University of Minnesota, 1300 S. Second Street, Suite 300, Minneapolis, MN, 55454, USA.
出版信息
Soc Sci Med. 2017 Sep;188:166-175. doi: 10.1016/j.socscimed.2017.06.044. Epub 2017 Jul 24.
OBJECTIVE
The current study investigated mediators between childhood/adolescent adversities (e.g., dating violence, maltreatment, homelessness, and parental death), low socioeconomic status (SES) during adolescence, and cardiovascular disease (CVD) risk in young adulthood. The purpose of these analyses was to understand whether SES during adolescence and childhood/adolescent adversities affect CVD risk through similar pathways, including maternal relationship quality, health behaviors, financial stress, medical/dental care, educational attainment, sleep problems, and depressive symptoms.
METHODS
Using the National Longitudinal Study of Adolescent to Adult Health (N = 14,493), which has followed US adolescents (Wave 1; M = 15.9 years) through early adulthood (Wave 4; M = 28.9 years), associations were examined between childhood/adolescent adversity and SES to 30-year CVD risk in young adulthood. The outcome was a Framingham-based prediction model of CVD risk that included age, sex, body mass index, smoking, systolic blood pressure, diabetes, and antihypertensive medication use at Wave 4. Path analysis was used to examine paths through the adolescent maternal relationship to young adult mediators of CVD risk.
RESULTS
Childhood/adolescent adversity significantly predicted greater adult CVD risk through the following pathways: maternal relationship, health behaviors, financial stress, lack of medical/dental care, and educational attainment; but not through depressive symptoms or sleep problems. Lower SES during adolescence significantly predicted greater adult CVD risk through the following pathways: health behaviors, financial stress, lack of medical/dental care, and educational attainment, but not maternal relationship, depressive symptoms, or sleep problems.
CONCLUSIONS
Childhood/adolescent adversities and SES affected CVD risk in young adulthood through both similar and unique pathways that may inform interventions.
目的
本研究调查了儿童/青少年期逆境（例如，约会暴力、虐待、无家可归和父母死亡）、青少年时期低社会经济地位（SES）与青年期心血管疾病（CVD）风险之间的中介因素。这些分析的目的是了解青少年时期的 SES 和儿童/青少年期逆境是否通过类似的途径影响 CVD 风险，包括母婴关系质量、健康行为、经济压力、医疗/牙科保健、教育程度、睡眠问题和抑郁症状。
方法
使用国家青少年到成人健康纵向研究（N=14493），该研究通过早期成年期（波 4；M=28.9 岁）跟踪美国青少年（波 1；M=15.9 岁），检查了儿童/青少年期逆境与 SES 与青年期 30 年 CVD 风险之间的关联。结果是一个基于弗雷明汉的 CVD 风险预测模型，该模型包括年龄、性别、体重指数、吸烟、收缩压、糖尿病和波 4 时使用的降压药物。路径分析用于检验青少年期母婴关系对 CVD 风险成年中介因素的途径。
结果
儿童/青少年期逆境通过以下途径显著预测更大的成年 CVD 风险：母婴关系、健康行为、经济压力、缺乏医疗/牙科保健和教育程度；但不包括抑郁症状或睡眠问题。青少年时期较低的 SES 通过以下途径显著预测更大的成年 CVD 风险：健康行为、经济压力、缺乏医疗/牙科保健和教育程度，但不包括母婴关系、抑郁症状或睡眠问题。
结论
儿童/青少年期逆境和 SES 通过相似和独特的途径影响青年期的 CVD 风险，这些途径可能为干预措施提供信息。
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