Providence Center for Outcomes Research and Education, Portland, OR 97213, USA.
Int J Environ Res Public Health. 2022 Aug 25;19(17):10578. doi: 10.3390/ijerph191710578.
Adverse childhood experiences (ACEs) increase the risk of poor health and wellbeing in adulthood. In this study, we tested whether experiences in early adulthood-intimate partner violence (IPV), substance use, social isolation, and work instability-mediate the relationship between ACEs and poor physical health in later adulthood. Using data from a large-scale survey of Medicaid enrollees in the Portland metropolitan area, four separate mediation models were constructed to assess the indirect effects of each early adulthood experience and the proportion of the total effect on physical health accounted for by the pathway. Experiencing four or more ACEs increased the risk of poor adult physical health by 50% (RR 1.50). Considered in separate models, mediation by IPV accounted for 14.4% of the total effect; substance use mediated a similar proportion (14.0%). Social isolation was a less substantial mediator (7.6%). Work instability did not mediate the relationship between ACEs and adult physical health in our population. These findings provide evidence that IPV, substance use, and social isolation in early adulthood are part of the pathway between high ACEs and poor adult physical health. Intervening to prevent negative early adult experiences may mitigate some of the long-term effects of childhood trauma on health.
童年不良经历 (ACEs) 会增加成年后患不良健康和幸福感的风险。在这项研究中，我们测试了早期成年期的经历（亲密伴侣暴力 (IPV)、物质使用、社交孤立和工作不稳定）是否在 ACEs 和成年后身体健康不良之间起中介作用。使用波特兰大都市区医疗补助受保人大型调查的数据，构建了四个单独的中介模型，以评估每种早期成年期经历的间接影响以及该途径对身体健康总效应的比例。经历四种或更多 ACEs 会使成年后身体健康不良的风险增加 50%（RR 1.50）。在单独的模型中，IPV 的中介作用占总效应的 14.4%；物质使用也介导了类似比例的效应（14.0%）。社交孤立的中介作用较小（7.6%）。工作不稳定并不能在我们的人群中调节 ACEs 和成年后身体健康之间的关系。这些发现提供了证据表明，早期成年期的 IPV、物质使用和社交孤立是 ACEs 与成年后身体健康不良之间关系的一部分。干预以预防负面的早期成年经历可能会减轻童年创伤对健康的一些长期影响。
