School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Department of Psychology, Hunter College, City University of New York, New York, NY, USA.
AIDS Behav. 2024 Sep;28(9):2887-2898. doi: 10.1007/s10461-024-04368-1. Epub 2024 Jun 22.
Adverse childhood experiences (ACEs) and financial hardship are associated with increased likelihood of heavier alcohol use and health challenges in adulthood among persons living with HIV (PWH). We examined whether retrospectively captured lifetime drinking trajectories are a pathway through which childhood hardships affect current health in a sample of 365 adult PWH. Childhood economic hardship and ACEs were used as main predictors. Measures of alcohol use included age at first drink and lifetime drinking trajectories. Health indicators included health-related quality of life, frailty, number of comorbidities, and symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD). Structural equation modeling (SEM) was applied to estimate both direct and indirect pathways between childhood hardship and physical and mental health. Participants were mostly male; Black (84%); and averaged 48 years of age. SEM results supported both direct and indirect pathways between childhood experiences and adult health. ACEs were connected to physical health directly and mental health both directly and indirectly through age at first drink and drinking heaviness during ages 10-20. Childhood economic hardship related to mental health indirectly through higher drinking levels during ages 10-20. Childhood adverse experiences, economic hardship, and early drinking patterns appear to accumulate, resulting in later life physical and mental health concerns for PWH. Findings support taking a life course approach to health. This includes considering individual trauma histories in HIV care engagement and taking preventative approaches which support the economic and social well-being of vulnerable children to improve health in subsequent decades.
不良的童年经历（ACEs）和经济困难与艾滋病毒感染者（PLWH）成年后更大量饮酒和健康挑战的可能性增加有关。我们研究了在 365 名成年 PLWH 样本中，是否可以通过回顾性捕获的终生饮酒轨迹来了解童年苦难对当前健康的影响，童年经济困难和 ACEs 用作主要预测因子。酒精使用的测量包括首次饮酒年龄和终生饮酒轨迹。健康指标包括与健康相关的生活质量、脆弱性、合并症数量以及焦虑、抑郁和创伤后应激障碍（PTSD）症状。结构方程模型（SEM）用于估计童年困难与身心健康之间的直接和间接途径。参与者主要为男性；黑人（84%）；平均年龄为 48 岁。SEM 结果支持童年困难与成人健康之间的直接和间接途径。ACEs 与身体健康直接相关，与心理健康也直接和间接相关，通过首次饮酒年龄和 10-20 岁期间的饮酒量来间接相关。童年经济困难与心理健康间接相关，因为在 10-20 岁期间的饮酒量更高。童年时期的不良经历、经济困难和早期饮酒模式似乎会积累，导致 PLWH 以后的生活出现身体和心理健康问题。研究结果支持采取生命历程方法来研究健康问题。这包括在 HIV 护理参与中考虑个体创伤史，并采取预防措施，支持弱势儿童的经济和社会福祉，以改善随后几十年的健康状况。
