Reichman Nancy E, Corman Hope, Noonan Kelly, Jiménez Manuel E
Department of Pediatrics and Child Health Institute of New Jersey, Rutgers University-Robert Wood Johnson Medical School, 89 French St., Room 3272, New Brunswick, NJ, 08903, USA.
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Matern Child Health J. 2018 Mar;22(3):318-326. doi: 10.1007/s10995-017-2418-5.
Objective To investigate the extent to which disabling infant health conditions are associated with adverse childhood experiences at age 5. Methods We conducted a secondary analysis of data from the Fragile Families and Child Wellbeing Study, a national urban birth cohort. We estimated logistic regression models of associations between the presence of a disabling infant health condition and the child's ACE exposures at age 5, controlling for factors that preceded the child's birth, including the mother's sociodemographic characteristics, physical health, mental illness, and substance abuse and the parents' criminal justice system involvement and domestic violence or sexual abuse. ACEs included 4 categories of child maltreatment (physical, sexual, psychological abuse, neglect) and 5 categories of household dysfunction (father absence, substance use, mental illness, caregiver treated violently, incarceration). Results 3.3% of the children were characterized as having a disabling health condition that was likely present at birth. Logistic regression estimates indicate that having a disabling infant health condition was associated with 83% higher odds of the child experiencing 2 or more ACEs (AOR 1.83, CI 1.14-2.94) and 73% higher odds of the child experiencing 3 or more ACEs (AOR 1.73, CI 1.07-2.77) at age 5. Conclusions for Practice The finding of strong links between disabling infant health conditions and ACEs at age 5 suggests that child health and ACEs play intertwining and mutually reinforcing roles during the early lifecourse and highlights the critical importance of investing in systems that simultaneously promote optimal child development and address childhood adversity.
目的 探讨致残性婴儿健康状况与5岁儿童不良童年经历之间的关联程度。方法 我们对“脆弱家庭与儿童福利研究”的数据进行了二次分析，该研究是一项全国性城市出生队列研究。我们估计了致残性婴儿健康状况与儿童5岁时不良童年经历暴露之间关联的逻辑回归模型，同时控制了儿童出生前的因素，包括母亲的社会人口学特征、身体健康状况、精神疾病、药物滥用以及父母与刑事司法系统的涉入情况、家庭暴力或性虐待。不良童年经历包括4类儿童虐待（身体虐待、性虐待、心理虐待、忽视）和5类家庭功能失调（父亲缺失、药物使用、精神疾病、照顾者遭受暴力、监禁）。结果 3.3%的儿童被判定患有可能在出生时就存在的致残性健康状况。逻辑回归估计表明，患有致残性婴儿健康状况与儿童在5岁时经历2次或更多不良童年经历的几率高83%（优势比1.83，置信区间1.14 - 2.94）以及经历3次或更多不良童年经历的几率高73%（优势比1.73，置信区间1.07 - 2.77）相关。实践结论 在5岁时致残性婴儿健康状况与不良童年经历之间存在紧密联系这一发现表明，儿童健康和不良童年经历在生命早期阶段相互交织且相互强化，突出了投资于同时促进儿童最佳发育和应对童年逆境的系统的至关重要性。
