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Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. Here we test if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviours and lower mental well-being in adults.
Cross-sectional, face-to-face household surveys (aged 18–69 years, February-September 2015) examining ACEs suffered, always available adult (AAA) support from someone you trust in childhood and current diet, smoking, alcohol consumption and mental well-being were undertaken in four UK regions. Sampling used stratified random probability methods (n = 7,047). Analyses used chi squared, binary and multinomial logistic regression.
Adult prevalence of poor diet, daily smoking and heavier alcohol consumption increased with ACE count and decreased with AAA support in childhood. Prevalence of having any two such behaviours increased from 1.8% (0 ACEs, AAA support, most affluent quintile of residence) to 21.5% (≥4 ACEs, lacking AAA support, most deprived quintile). However, the increase was reduced to 7.1% with AAA support (≥4 ACEs, most deprived quintile). Lower mental well-being was 3.27 (95% CIs, 2.16–4.96) times more likely with ≥4 ACEs and AAA support from someone you trust in childhood (vs. 0 ACE, with AAA support) increasing to 8.32 (95% CIs, 6.53–10.61) times more likely with ≥4 ACEs but without AAA support in childhood. Multiple health-harming behaviours combined with lower mental well-being rose dramatically with ACE count and lack of AAA support in childhood (adjusted odds ratio 32.01, 95% CIs 18.31–55.98, ≥4 ACEs, without AAA support vs. 0 ACEs, with AAA support).
Adverse childhood experiences negatively impact mental and physical health across the life-course. Such impacts may be substantively mitigated by always having support from an adult you trust in childhood. Developing resilience in children as well as reducing childhood adversity are critical if low mental well-being, health-harming behaviours and their combined contribution to non-communicable disease are to be reduced.
Bellis MA, Hughes K, Leckenby N, Hardcastle KA, Perkins C, Lowey H. Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey. J Public Health. 2015;37:445–54. CrossRef
Bellis MA, Hughes K, Leckenby N, Perkins C, Lowey H. National household survey of adverse childhood experiences and their relationship with resilience to health-harming behaviors in England. BMC Med. 2014;12:1–10. CrossRef
Hughes K, Lowey H, Quigg Z, Bellis MA. Relationships between adverse childhood experiences and adult mental well-being: results from an English national household survey. BMC Public Health. 2016;16:1–11. CrossRef
Kelly-Irving M, Lepage B, Dedieu D, Lacey R, Cable N, Bartley M, et al. Childhood adversity as a risk for cancer: findings from the 1958 British birth cohort study. BMC Public Health. 2013;13:1–13. CrossRef
Su S, Jimenez MP, Roberts CTF, Loucks EB. The role of adverse childhood experiences in cardiovascular disease risk: a review with emphasis on plausible mechanisms. Curr Cardiol Rep. 2015;17:1–10. CrossRef
Bernard B. Fostering resilience in children. ERIC Clearinghouse on Elementary and Early Childhood Education: Urabana, IL; 1995.
Center on the Developing Child at Harvard University. Supportive relationships and active skill-building strengthen the foundations of resilience. In: Working paper 13. Cambridge MA: National Scientific Council on the Developing Child; 2015.
Zolkoski SM, Bullock LM. Resilience in children and youth: a review. Child Youth Serv Rev. 2012;34:2295–303. CrossRef
Marriott C, Hamilton-Giachritsis C, Harrop C. Factors promoting resilience following childhood sexual abuse: a structured, narrative review of the literature. Child Abuse Rev. 2014;23:17–34. CrossRef
Southwick SM, Vythilingam M, Charney DS. The psychobiology of depression and resilience to stress: implications for prevention and treatment. Annu Rev Clin Psychol. 2004;1:255–91. CrossRef
Drakopoulos SA, Lakioti E, Theodossiou I. Childhood socioeconomic deprivation and later adulthood health. Int J of Soc Econ. 2011;38:23–38. CrossRef
Wilkinson R, Marmot M. Social determinants of health: the solid facts. World Health Organization Regional Office for Europe: Copenhagen; 2003.
Friedli L. Mental health, resilience and inequalities. World Health Organization Regional Office for Europe: Copenhagen; 2009.
Bynum L, Griffin T, Riding DL, Wynkoop KS, Anda E, et al. Adverse childhood experiences reported by adults - five states, 2009. MMWR Morb Mortal Wkly Rep. 2010;59:609–13.
Tuyns AJ, Esteve J, Raymond L, Berrino F, Benhamou E, Blanchet F, et al. Cancer of the larynx/hypopharynx, tobacco and alcohol: Iarc international case-control study in Turin and Varese (Italy), Zaragoza and Navarra (Spain), Geneva (Switzerland) and Calvados (France). Int J Cancer. 1988;41:483–91. CrossRefPubMed
Bellis MA, Hughes K, Nicholls J, Sheron N, Gilmore I, Jones L. The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals. BMC Public Health. 2016;16:1–10. CrossRef
Stewart-Brown S, Tennant A, Tennant R, Platt S, Parkinson J, Weich S. Internal construct validity of the Warwick-Edinburgh mental well-being scale (WEMWBS): a rasch analysis using data from the Scottish health education population survey. Health Qual Life Outcomes. 2009;7:1–8. CrossRef
Royal Mail. Postcode Address File (PAF). http://www.royalmail.com/business/services/marketing/data-optimisation/paf. Accessed 20 July 2016.
Bates A. Methodology used for producing ONS's small area population estimates. Popul Trends. 2006;125:30–6.
Public Health England. Adjusted IMD 2010 scores for 2011 LSOAs. http://www.apho.org.uk/resource/item.aspx?RID=125887. Accessed 20 July 2016.
Office of National Statistics. Welsh Index of Multiple Deprivation (WIMD). http://gov.wales/statistics-and-research/welsh-index-multiple-deprivation/?lang=en. Accessed 1 December 2015.
Office for National Statistics. Similarities and differences between the indices of deprivation across the UK. 2016. http://www.neighbourhood.statistics.gov.uk/HTMLDocs/analysisandguidance/analysisarticles/indices-of-deprivation.htm. Accessed 8 July 2016.
IBM. IBM SPSS advanced statistics 22. Armonk, NY: IBM Corporation; 2013.
National Statistics. Health survey for England. 2014. http://content.digital.nhs.uk/catalogue/PUB19295. Accessed 10th November 2016.
Lovato C, Watts A, Stead LF. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst Rev. 2011;5:CD003439.
Lawrence D, Mitrou F, Zubrick SR. Non-specific psychological distress, smoking status and smoking cessation: United States National Health Interview Survey 2005. BMC Public Health. 2011;11:1–13. CrossRef
United Nations. Transforming our World: The 2030 agenda for sustainable development. https://sustainabledevelopment.un.org/post2015/transformingourworld. Accessed 10th November 2016.
Sixty-seventh World Health Assembly. Strengthening the role of the health system in addressing violence, in particular against women and girls, and against children. EB 138. R3. 24-5-2014.
Sethi D, Bellis M, Hughes K, Gilbert R, Mitits F, Galea G. European report on preventing child maltreatment. World Health Organization Regional Office for Europe: Copenhagen; 2013.
Center on the Developing child at Harvard University. Building the brain's "air traffic control" system: how early experiences shapre the development of executive function. In: Working paper no. 11. Cambridge MA: National Scientific Council on the Developing Child; 2011.
Khanlou N, Wray R. A Whole community approach toward child and youth resilience promotion: a review of resilience literature. Int J Mental Health Addict. 2014;12:64–79. CrossRef
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the global burden of disease study. Lancet. 2010;380:2095–128. CrossRef
Smith LA, Foxcroft DR. The effect of alcohol advertising, marketing and portrayal on drinking behaviour in young people: systematic review of prospective cohort studies. BMC Public Health. 2009;9:1–11. CrossRef
- Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being
Mark A. Bellis
- BioMed Central