Childhood behavior problems and adverse economic outcomes: a 30-year population-based study of intergenerational income mobility.

BACKGROUND: The objectives of this study were to (a) assess the associations between early behavioral problems and intergenerational income mobility (i.e., the degree to which income status is transmitted from one generation to the next), (b) verify whether these associations are moderated by child sex, and (c) explore indirect effects of early behavioral problems on income mobility via high school graduation. METHODS: Data were drawn from the Quebec Longitudinal Study of Kindergarten Children (n = 3,020; 49.17% girls). Participants were followed from age 6 to 37 years. Measures included parents' and teachers' ratings of behavioral problems at age 6 years as well as participants' (ages 30-35 years) and their parents' (when participants were aged 10-19 years) income data obtained from tax return records. Regression models were used to predict upward and downward mobility (i.e., increased or decreased income status from one generation to the next) from attention-deficit/hyperactivity problems, conduct/opposition problems, depression/anxiety problems, prosociality, and the quality of children's relationship with their caregiver. Two-way interaction effects between behavioral problems and child sex were examined and indirect effect models including high school graduation as a mediator of these associations were conducted. RESULTS: Despite their higher educational attainment, females had lower incomes and experienced lower upward (but higher downward) income mobility than males. For both females and males, higher levels of attention-deficit/hyperactivity and conduct/opposition problems were associated with decreased odds of upward mobility, whereas higher levels of attention-deficit/hyperactivity were associated with increased odds of downward mobility. Attention-deficit/hyperactivity problems, conduct/opposition problems as well as low prosociality were associated with lower educational attainment (no high school diploma), which in turn was associated with increased odds of downward mobility. CONCLUSIONS: Results highlight the importance of providing intensive support to children with early behavioral problems as a means of improving educational attainment and intergenerational income mobility.

Mechanisms and pathways linking kindergarten behavior problems with mid-life employment earnings for males from low-income neighborhoods.

Childhood behavior problems are associated with reduced labor market participation and lower earnings in adulthood, but little is known about the pathways and mechanisms that explain these associations. Drawing on a 33-year prospective birth cohort of White males from low-income backgrounds (n = 1040), we conducted a path analysis linking participants' teacher-rated behavior problems at age 6 years-that is, inattention, hyperactivity, aggression-opposition, and low prosociality-to employment earnings at age 35-39 years obtained from tax records. We examined three psychosocial mediators at age 11-12 years (academic, behavioral, social) and two mediators at age 25 years (non-high school graduation, criminal convictions). Our findings support the notion that multiple psychosocial pathways-especially low education attainment-link kindergarten behavior problems to lower employment earnings decades later.

Childhood behavioral problems are associated with the intergenerational transmission of low education: a 16-year population-based study.

The intergenerational transmission of low educational attainment is well-documented, but little is known about how behavioral problems in childhood explain this association. Drawing upon a population-based cohort study (n = 3020) linked to administrative records, we investigated the extent to which inattentive, internalizing, externalizing, and prosocial behaviors at child ages 6-8 years accounted for associations between parental education and child's risk of failing to graduate from high school. We adjusted for economic, demographic, cognitive, and perinatal factors, as well as parental mental health. Using logistic regressions and the Karlson-Holm-Breen decomposition method, we found that childhood behaviors together explained 19.5% of the association between mother's education and child's high school graduation status at age 22/23, and 13.7% of the association between father's education and this same outcome. Inattentive behaviors were most strongly associated with failure to graduate from high school, while the role of other behaviors was modest or negligible. Inattentive behaviors may represent a mediational pathway between parental education and child education. Early interventions targeting inattentive behaviors could potentially enhance the prospects of intergenerational educational mobility.

Drinking behaviors of Chinese adolescents over the past three decades: A systematic review and meta-analysis.

Adolescent drinking is a major worldwide public health challenge. China is home to the world's second largest youth population, but relatively little is known about adolescent drinking behaviors. This study examined (1) prevalence rates and sex and age differences in drinking behaviors among Chinese adolescents over the past three decades and (2) whether underage drinking declined following the enactment of a strict national underage drinking policy in 2006. Literature search was conducted in one Chinese and five English databases following the PRISMA guidelines. A total of 186 studies were included in the meta-analyses using random-effects models on nine measures (Ns range: 13,489-755,796, number of studies range: 12-110): lifetime, past month, past year, and weekly drinking; lifetime, past year, and past month drunkenness; past month binge drinking, and age at first drinking (≤ 13 years). Males reported higher prevalence on all drinking behaviors except for weekly drinking and past month drunkenness. High school students reported higher prevalence in lifetime drinking, past year drunkenness, and lifetime drunkenness, than middle school students. No measured drinking behavior showed a significant or reliable decline after 2006. The findings suggest that prevalence rates of drinking behaviors remain high among Chinese adolescents but are lower than among European or North American adolescents. The 2006 Chinese national policy to reduce underage drinking did not measurably alter patterns of underage drinking. Implications for prevention, research, and policy are discussed.

Behaviors in kindergarten are associated with trajectories of long-term welfare receipt: A 30-year population-based study.

This study examines the link between behavior in kindergarten and adult-life welfare receipt. Teacher-rated behavioral assessments were obtained for inattention, hyperactivity, aggression-opposition, anxiety, and prosociality when children (n=2960) were aged 5-6 years and linked to their tax return records from age 18-35 years. We used group-based based trajectory modeling to identify distinct trajectories of welfare receipt and multinomial logistic regression models to examine the association between behaviors and trajectory group membership. The child's sex, IQ, and family background were adjusted for. Four trajectories of welfare receipt were identified: low (n = 2,390, 80.7%), declining (n = 260, 8.8%), rising (n = 150, 5.2%), and chronic (n = 160, 5.4%). Relative to the low trajectory, inattention and aggression-opposition at age 6 years were associated with increased risk of following a declining, rising, and chronic trajectory of welfare receipt, independent of hyperactivity and anxiety. Prosocial behaviors were independently associated with a lower risk of following a chronic trajectory. This study shows that kindergarten children exhibiting high inattention and aggression-opposition and low prosocial behaviors may be at increased risk of long-term welfare receipt in adulthood. The implications for early screening, monitoring, and prevention are discussed.

Increased urban greenspace in childhood associated with lower inattention deficit among adolescents.

PURPOSE: There is a growing interest in assessing the benefits of exposure to urban greenspace on mental health due to the increased urbanization of youth and concerns for their mental health. We investigated the prospective associations of residential greenspace in childhood and mental health in adolescence. Use of a well-characterized birth cohort permitted adjustment for a range of potential confounding factors including family and neighborhood characteristics in addition to prior mental health problems, and exploration of moderation effects by sex and family socioeconomic status. METHODS: We analyzed longitudinal data collected from 742 urban-dwelling participants of the Quebec Longitudinal Study of Children Development. The Normalized Difference Vegetation Index (NDVI) within 250, 500, and 1000 m buffer zones surrounding the home residence was used to indicate childhood exposure to greenspace. Six self-reported mental health problems at 15/17 years were examined using the Mental Health and Social Inadaptation questionnaire: inattention, hyperactivity/impulsivity, conduct, depression, anxiety, and suicidal ideation. RESULTS: Childhood urban greenspace was associated with lower inattention problems in both females and males. We observed a 0.14 reduced standard deviation (SD) (ß = - 0.14, SE = 0.05, p < 0.01) in relation to an interquartile range (IQR) increase of NDVI (0.15) at the 250 m buffer zone, and similar results were found in 500 m and 1000 m buffer zones. These associations only slightly attenuated after adjustment for individual (sex, childhood mental health), family (family SES, maternal age at birth, parental mental health, family composition), and neighborhood (material and social deprivation) characteristics (ß = - 0.13, SE = 0.06, p = 0.03). No association was found for other mental health problems, and no moderation associations of sex or family socioeconomic status were observed. CONCLUSION:  These findings suggest that increasing residential greenspace in cities may be associated with modest benefits in attentional capacities in youth, necessitating further research to elucidate the underlying mechanisms.

Trajectories of adolescent poly-substance use and their long-term social and economic outcomes for males from low-income backgrounds.

Substance abuse is a significant public health concern that disproportionately burdens males and low-income communities. This study examined (1) longitudinal profiles of male adolescent poly-substance use and (2) their association with social and economic participation across early adulthood. Drawing on a cohort of males (n = 890) from low-income neighborhoods, we used group-based multi-trajectory modeling to identify profiles of poly-substance use (alcohol, tobacco, cannabis, illicit drugs) from age 13-17 years. Regression models were used to link substance use profiles to high school graduation, criminal convictions, personal and household earnings, welfare receipt and partnership from age 19-37 years, obtained from administrative records. Child IQ, family adversity and behavioral problems were adjusted for. Four poly-substance use profiles were identified: abstinent (n = 128, 14.4%), late-onset (n = 412, 46.5%), mid-onset (n = 249, 28.1%), and early-onset (n = 98, 11.1%). Relative to the late-onset (reference) group, participants in the early-onset profile were 3.0 times (95%CI = 1.68-5.53) more likely to have left school without a diploma, 2.7 times (95% CI = 1.56-4.68) more likely to have a criminal conviction by age 24 years, earned 10,185 USD less (95% CI = - 15,225- - 5144) per year at age 33-37 years and had 15,790 USD lower (95% CI = - 23,378- - 8218) household income at age 33-37 years, a 1.3 times (95%CI = 1.15-1.57) higher incidence of annual welfare receipt and a 24% (95% CI = 5-40) lower incidence of marriage/cohabitation from age 18-35 years. We show that adolescent-onset poly-substance use by age 13 is associated with poor social and economic outcomes. Delaying the onset of substance use and reducing exposure to additional substance classes has potential for high societal cost savings.

Long-term economic and social outcomes of youth suicide attempts.

BACKGROUND: Youth who attempt suicide are more at risk for later mental disorders and suicide. However, little is known about their long-term socioeconomic outcomes. AIMS: We investigated associations between youth suicide attempts and adult economic and social outcomes. METHOD: Participants were drawn from the Quebec Longitudinal Study of Kindergarten Children (n = 2140) and followed up from ages 6 to 37 years. Lifetime suicide attempt was assessed at 15 and 22 years. Economic (employment earnings, retirement savings, welfare support, bankruptcy) and social (romantic partnership, separation/divorce, number of children) outcomes were assessed through data linkage with government tax return records obtained from age 22 to 37 years (2002-2017). Generalised linear models were used to test the association between youth suicide attempt and outcomes adjusting for background characteristics, parental mental disorders and suicide, and youth concurrent mental disorders. RESULTS: By age 22, 210 youths (9.8%) had attempted suicide. In fully adjusted models, youth who attempted suicide had lower annual earnings (average last 5 years, US$ -4134, 95% CI -7950 to -317), retirement savings (average last 5 years, US$ -1387, 95% CI -2982 to 209), greater risk of receiving welfare support (risk ratio (RR) = 2.05, 95% CI 1.39 to 3.04) and were less likely to be married/cohabiting (RR = 0.82, 95% CI 0.73 to 0.93), compared with those who did not attempt suicide. Over a 40-year working career, the loss of individual earnings attributable to suicide attempts was estimated at US$98 384. CONCLUSIONS: Youth who attempt suicide are at risk of poor adult socioeconomic outcomes. Findings underscore the importance of psychosocial interventions for young people who have attempted suicide to prevent long-term social and economic disadvantage.

Behavior in childhood is associated with romantic partnering patterns in adulthood.

BACKGROUND: Most people will partner at some point during their lives. Yet little is known about the association between childhood behavior and patterns of long-term romantic partnering in adulthood. METHODS: In this population-based cohort study, behavioral ratings were prospectively obtained from teachers when children (n = 2,960) were aged 10-12 years - for inattention, hyperactivity, aggression-opposition, anxiety, and prosociality - and linked to their tax return records from age 18 to 35 years (1998-2015). We used group-based based trajectory modeling to estimate the probability of partnership (marriage/cohabitation) over time and multinomial logistic regression models to examine the association between childhood behavior and trajectory group membership. The child's sex and family socioeconomic background were adjusted for. RESULTS: Five distinct trajectories of partnering were identified: early-partnered (n = 420, 14.4%), mid-partnered (n = 620, 21.3%), late-partnered (n = 570, 19.2%), early-partnered-separated (n = 460, 15.5%), and delayed-or-unpartnered (n = 890, 30.0%). Participants in the early-partnered-separated and delayed-or-unpartnered trajectories were more likely to have left high school without a diploma and to have lower earnings and higher welfare receipt from age 18 to 35 years. After adjustment for sex and family background, inattention and aggression-opposition were uniquely and additively associated with increased likelihood of following an early-partnered-separated trajectory, while inattention and anxiety were associated with an increased likelihood of following a delayed-or-unpartnered trajectory. Childhood prosocial behaviors were consistently associated with earlier and more sustained patterns of partnership. CONCLUSIONS: Children with behavioral problems are more likely to separate or to be unpartnered across early adulthood. This may have consequences for their psychological health and wellbeing and that of their families.

Developmental profiles of childhood attention-deficit/hyperactivity disorder and irritability: association with adolescent mental health, functional impairment, and suicidal outcomes.

BACKGROUND: Irritability is frequently comorbid with ADHD. Although irritability alone has been linked to deleterious mental health and adaptive issues, the joint developmental course of ADHD and irritability symptoms during childhood as well as its association with later mental health and suicidal outcomes is not fully understood. We aimed to describe the developmental trajectories of childhood ADHD and irritability symptoms and to quantify their association with adolescent mental health and suicidal outcomes. METHODS: The Quebec Longitudinal Study of Child Development (QLSCD) included 1407 participants from the general population followed up from age 5 months to 17 years. We used a multitrajectory approach to identify developmental trajectories of childhood (6-12 years) ADHD and irritability symptoms. Outcome measures were adolescent (13-17 years) mental health (psychiatric symptoms/functional impairment) and suicidal outcomes. RESULTS: We identified distinct developmental profiles: combined absent or very low ADHD and absent or very low irritability (940 [66.8%]; reference group), moderately high irritability and low ADHD (158 [11.2%]), moderately high ADHD and low irritability (198 [14.1%]), and combined high ADHD and high irritability (111 [7.9%]). Multivariate modeling showed that, compared to children in the reference group, those in the combined high ADHD and high irritability profile showed higher levels of ADHD continuity (d ranges = 0.40-0.50), externalizing (d ranges = 0.25-0.59), internalizing (d ranges = 0.20-0.29), and functional impairments (d ranges = 0.17-0.48) and suicidal behaviors (odds ratio (OR) = 2.12, confidence interval (CI) = 1.47-3.06) in adolescence. CONCLUSIONS: The presence of persistently high levels of irritability along with ADHD symptoms during childhood significantly predicts adolescent ADHD continuity, externalizing, internalizing, and suicidal outcomes. Systematic consideration of irritability when assessing and treating ADHD may improve long-term mental health outcomes.

Inattention in boys from low-income backgrounds predicts welfare receipt: a 30-year prospective study.

BACKGROUND: Childhood disruptive behaviors are highly prevalent and associated with adverse long-term social and economic outcomes. Trajectories of welfare receipt in early adulthood and the association of childhood behaviors with high welfare receipt trajectories have not been examined. METHODS: Boys (n = 1000) from low socioeconomic backgrounds were assessed by kindergarten teachers for inattention, hyperactivity, aggression, opposition, and prosociality, and prospectively followed up for 30 years. We used group-base trajectory modeling to estimate trajectories of welfare receipt from age 19-36 years using government tax return records, then examined the association between teacher-rated behaviors and trajectory group membership using mixed effects multinomial regression models. RESULTS: Three trajectories of welfare receipt were identified: low (70.8%), declining (19.9%), and chronic (9.3%). The mean annual personal employment earnings (US$) for the three groups at age 35/36 years was $36 500 (s.d. = $24 000), $15 600 (s.d. = $16 275), and $1700 (s.d. = $4800), respectively. Relative to the low welfare receipt group, a unit increase in inattention (mean = 2.64; s.d. = 2.32, range = 0-8) at age 6 was associated with an increased risk of being in the chronic group (relative risk ratio; RRR = 1.16, 95% CI 1.03-1.31) and in the declining group (RRR = 1.13, 95% CI 1.03-1.23), after adjustment for child IQ and family adversity, and independent of other behaviors. Family adversity was more strongly associated with trajectories of welfare receipt than any behavior. CONCLUSIONS: Boys from disadvantaged backgrounds exhibiting high inattention in kindergarten are at elevated risk of chronic welfare receipt during adulthood. Screening and support for inattentive behaviors beginning in kindergarten could have long-term social and economic benefits for individuals and society.

Applying the triple bottom line of sustainability to healthcare research-a feasibility study.

OBJECTIVE: The triple bottom line (TBL) of sustainability is an important emerging conceptual framework which considers the combined economic, environmental and social impacts of an activity. Despite its clear relevance to the healthcare context, it has not yet been applied to the evaluation of a healthcare intervention. The aim of this study was to demonstrate whether doing so is feasible and useful. DESIGN: Secondary data analysis of a 12-month randomized controlled trial. SETTING: Community based mental health care. PARTICIPANTS: Patients with chronic psychotic illnesses (n = 333). INTERVENTION(S): Community treatment orders. MAIN OUTCOME MEASURE(S): Financial and environmental (CO2 equivalent) costs of care, obtained from healthcare service use data, were calculated using publicly available standard costs; social sustainability was assessed using standardized social outcome measures included in the trial data. RESULTS: Standardized costing and CO2e emissions figures were successfully obtained from publicly available data, and social outcomes were available directly from the trial data. CONCLUSIONS: This study demonstrates that TBL assessment can be retrospectively calculated for a healthcare intervention to provide a more complete assessment of the true costs of an intervention. A basic methodology was advanced to demonstrate the feasibility of the approach, although considerable further conceptual and methodological work is needed to develop a generalizable methodology that enables prospective inclusion of a TBL assessment in healthcare evaluations. If achieved, this would represent a significant milestone in the development of more sustainable healthcare services. If increasing the sustainability of healthcare is a priority, then the TBL approach may be a promising way forward.

Multi-rater developmental trajectories of hyperactivity-impulsivity and inattention symptoms from 1.5 to 17 years: a population-based birth cohort study.

The developmental course of hyperactivity-impulsivity and inattention symptoms from infancy to adolescence has not been documented in a population sample. The aim of this study was to describe the developmental course of hyperactivity-impulsivity and inattention symptoms from 1.5 to 17 years using multiple informants, and to identify perinatal risk factors associated with following elevated (high-risk) trajectories. Using a population-based birth cohort (n = 1374), symptom ratings from mothers (1.5-8 years), teachers (6-13 years) and participant self-reports (10-17 years) were combined using group-based multi-trajectory modeling to identify informants' convergence in identifying high-symptom trajectories of hyperactivity-impulsivity and inattention over time. Perinatal risk factors associated with high-symptom trajectories were identified using stepwise logistic regression. The study found that symptoms of hyperactivity-impulsivity broadly declined from 1.5 to 17 years while symptoms of inattention remained constant. 21.4% of participants followed elevated trajectories of hyperactivity-impulsivity and 20.2% followed elevated trajectories of inattention; 11.6% followed elevated trajectories of both types of symptoms concurrently. Risk factors for high-risk trajectories of hyperactivity-impulsivity were low maternal education, prenatal alcohol exposure, non-intact family, maternal depression, and low child IQ; for high-risk inattention they were prenatal street drug exposure, early motherhood, low maternal education, maternal depression and low child IQ. Risk factors for trajectories of high-risk hyperactivity-impulsivity and inattention concurrently were low maternal education, maternal depression, and low child IQ. The combination of longitudinal assessments from multiple informants (i.e., mother, teacher, participant-reports) provides a new way to characterize hyperactivity-impulsivity and inattention phenotypes over time.

Psychometric validation of a multi-dimensional capability instrument for outcome measurement in mental health research (OxCAP-MH).

BACKGROUND: Patient reported outcome measures (PROMs) are widely used in mental healthcare research for quality of life assessment but most fail to capture the breadth of health and non-health domains that can be impacted. We report the psychometric validation of a novel, multi-dimensional instrument based on Amartya Sen's capability approach intended for use as an outcome measure in mental health research. METHODS: The Oxford Capabilities Questionnaire for Mental Health (OxCAP-MH) is a 16-item self-complete capability measure that covers multiple domains of functioning and welfare. Data for validation of the instrument were collected through a national randomised controlled trial of community treatment orders for patients with psychosis. Complete OxCAP-MH data were available for 172 participants. Internal consistency was established with Cronbach's alpha; an interclass correlation coefficient was used to assess test-retest reliability in a sub-sample (N = 50) tested one week apart. Construct validity was established by comparing OxCAP-MH total scores with established instruments of illness severity and functioning: EuroQol (EQ-5D), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) and Objective Social Outcomes Index (SIX). Sensitivity was established by calculating standard error of measurement using distributional methods. RESULTS: The OxCAP-MH showed good internal consistency (Cronbach's alpha 0.79) and test-retest reliability (ICC = 0.86). Convergent validity was evidenced by strong correlations with the EQ-5D (VAS 0.52, p < .001) (Utility 0.45, p < .001), and divergent validity through more modest associations with the BPRS (-0.41, p < .001), GAF (0.24, p < .001) and SIX (0.12, p = ns). A change of 9.2 points on a 0-100 scale was found to be meaningful on statistical grounds. CONCLUSIONS: The OxCAP-MH has demonstrable reliability and construct validity and represents a promising multi-dimensional alternative to existing patient-reported outcome measures for quality of life used in mental health research.

Community treatment orders and social outcomes for patients with psychosis: a 48-month follow-up study.

PURPOSE: Community treatment orders (CTOs) are widely used internationally despite a lack of evidence supporting their effectiveness. Most effectiveness studies are relatively short (12-months or less) and focus on clinical symptoms and service data, while a little attention is given to patients' social outcomes and broader welfare. We tested the association between the duration of CTO intervention and patients' long-term social outcomes. METHODS: A sub-sample (n = 114) of community-based patients from the Oxford Community Treatment Order Evaluation Trial (OCTET) were interviewed 48 months after randomisation. Multivariate regression models were used to examine the association between the duration of the CTO intervention and social outcomes as measured by the social network schedule, Objective Social Outcomes Index, Euro-Qol EQ-5D-3L (EQ-5D), and Oxford Capabilities Questionnaire for Mental Health. RESULTS: No significant association was found between the duration of CTO intervention and social network size (IRR = 0.996, p = .63), objective social outcomes (B = -0.003, p = .77), health-related quality of life (B = 0.001, p = .77), and capabilities (B = 0.046, p = .41). There were no between-group differences in social outcomes when outcomes were stratified by original arm of randomisation. Patients had a mean of 10.2 (SD = 5.9) contacts in their social networks, 42% of whom were relatives. CONCLUSIONS: CTO duration was not associated with improvements in patients' social outcomes even over the long term. This study adds to growing concerns about CTO effectiveness and the justification for their continued use.

Association of childhood externalizing, internalizing, comorbid problems with criminal convictions by early adulthood.

Childhood externalizing problems have been linked with adult criminality. However, little is known about criminal outcomes among children with comorbid externalizing and internalizing problems. We examined the associations between profiles of behavioral problems during childhood (i.e., externalizing, internalizing, and comorbid) and criminality by early adulthood. Participants were N = 3017 children from the population-based Quebec Longitudinal Study of Kindergarten Children followed up from age 6-25. Multitrajectory modeling of teacher-rated externalizing and internalizing problems from age 6-12 years identified four distinct profiles: no/low, externalizing, internalizing, and comorbid problems. Juvenile (age 13-17) and adult (age 18-25) criminal convictions were extracted from official records. Compared to children in the no/low profile, those in the externalizing and comorbid profiles were at higher risk of having a criminal conviction, while no association was found for children in the internalizing profile. Children with comorbid externalizing and internalizing problems were most at risk of having a criminal conviction by adulthood, with a significantly higher risk when compared to children with externalizing or internalizing problems only. Similar results were found when violent and non-violent crimes were investigated separately. Specific interventions targeting early comorbid behavioral problems could reduce long-term criminality.

Exploring early self-referential memory effects through ownership.

The self-reference effect (SRE) is the reliable memory advantage for information encoded about self over material encoded about other people. The developmental pathway of the SRE has proved difficult to chart, because the standard SRE task is unsuitable for young children. The current inquiry was designed to address this issue using an ownership paradigm, as encoding objects in the context of self-ownership have been shown to elicit self-referential memory advantages in adults. Pairs of 4- to 6-year-old children (n = 64) sorted toy pictures into self- and other-owned sets. A surprise recognition memory test revealed a significant advantage for toys owned by self, which decreased with age. Neither verbal ability nor theory of mind attainment predicted the size of the memory advantage for self-owned items. This finding suggests that contrary to some previous reports, memory in early childhood can be shaped by the same self-referential biases that pervade adult cognition.

Climate Change and Substance-Use Behaviors: A Risk-Pathways Framework.

Climate change is undermining the mental and physical health of global populations, but the question of how it is affecting substance-use behaviors has not been systematically examined. In this narrative synthesis, we find that climate change could increase harmful substance use worldwide through at least five pathways: psychosocial stress arising from the destabilization of social, environmental, economic, and geopolitical support systems; increased rates of mental disorders; increased physical-health burden; incremental harmful changes to established behavior patterns; and worry about the dangers of unchecked climate change. These pathways could operate independently, additively, interactively, and cumulatively to increase substance-use vulnerability. Young people face disproportionate risks because of their high vulnerability to mental-health problems and substance-use disorders and greater number of life years ahead in which to be exposed to current and worsening climate change. We suggest that systems thinking and developmental life-course approaches provide practical frameworks for conceptualizing this relationship. Further conceptual, methodological, and empirical work is urgently needed to evaluate the nature and scope of this burden so that effective adaptive and preventive action can be taken.

Childhood Abuse, Intimate Partner Violence in Young Adulthood, and Welfare Receipt by Midlife.

OBJECTIVE: To investigate prospective associations between type of child abuse (physical, sexual, both), timing (childhood, young adulthood, both), and welfare receipt into middle-age. METHODS: Database linkage study using the Quebec Longitudinal Study of Kindergarten Children cohort born in 1980 and government administrative databases (N = 3020). We assessed parental tax returns, family and personal background characteristics (1982-1987). At age 22 years, participants answered retrospective questionnaires on experienced childhood abuse (physical, sexual abuse < age 18 years) and intimate partner violence (IPV) (ages 18-22). Main outcome was years on social assistance, on the basis of participant tax returns (ages 23-37 years). Analysis included weights for population representativeness. RESULTS: Of 1690 participants (54.4% females) with available data, 22.4% reported childhood abuse only, 14.5% IPV only, and 18.5% both. Prevalence of childhood physical, sexual, and both was 20.4%, 12.2%, and 8.3%, respectively. Adjusting for socioeconomic background and individual characteristics, we found that childhood physical abuse alone and physical or sexual abuse combined were associated with a two-fold risk of welfare receipt, as compared to never-abused (adjusted incidence risk ratio 2.43, 95% confidence interval [CI], 1.65-3.58; and adjusted incidence risk ratio 2.04, 95% CI, 1.29-3.23, respectively). Repeated abuse (childhood abuse combined with adult IPV) had a three-fold risk (adjusted incidence ratio 3.59, 95% CI, 2.39-5.37). CONCLUSIONS: Abuse across several developmental periods (childhood and young adulthood) is associated with increased risks of long-term welfare receipt, independently of socioeconomic background. Results indicate a dose-response association. Early prevention and targeted identification are crucial to preventing economic adversity that may potentially lead to intergenerational poverty.

Association of Childhood Externalizing, Internalizing, and Comorbid Symptoms With Long-term Economic and Social Outcomes.

Importance: Little is known about the long-term economic and social outcomes for children with longitudinally assessed comorbid externalizing and internalizing symptoms, especially compared with children with externalizing symptoms or internalizing symptoms only. Objective: To examine the association between childhood trajectories of externalizing, internalizing, and comorbid symptoms and long-term economic and social outcomes. Design, Setting, and Participants: A 32-year prospective cohort study linked with administrative data was conducted in school-aged participants aged 6 to 12 years in the Québec Longitudinal Study of Kindergarten Children (N = 3017) followed up from 1985 to 2017. Data analysis was conducted between August 1, 2021, and March 31, 2022. Exposures: Teacher-rated behavioral symptoms were used to categorize children from age 6 to 12 years into developmental profiles using group-based trajectory modeling. Main Outcomes and Measures: Multivariable regression models were used to test the association between childhood symptom profile group and adult employment earnings, welfare receipt, intimate partnership status, and having children living in the household. Participant sex, IQ, and socioeconomic background were adjusted for. Results: Of 3017 participants in this sample, 1594 (52.8%) were male and 1423 (47.2%) were female. Per confidentiality rules established by Statistics Canada, income variables were rounded to base 100 and count variables were rounded to base 10; the mean (SD) age was 37 (0.29) years at follow-up. Four symptom profiles were identified: no/low (n = 1369 [45.4%]), high externalizing (882 [29.2%]), high internalizing (354 [11.7%]), and comorbid (412 [13.7%]) symptoms. Compared with the no/low symptom profile, participants in the high externalizing-only profile earned $5904 (95% CI, -$7988 to -$3821) less per year and had 2.0 (95% CI, 1.58-2.53) times higher incidence of welfare receipt, while participants in the high internalizing group earned $8473 (95% CI, -$11 228 to -$5717) less per year, had a 2.07 (95% CI, 1.51-2.83) higher incidence of welfare receipt, and had a lower incidence of intimate partnership (incident rate ratio [IRR], 0.89; 95% CI, 0.80-0.99). Participants in the comorbid profile fared especially poorly: they earned $15 031 (95% CI, -$18 030 to -$12 031) less per year, had a 3.79 (95% CI, 2.75-5.23) times higher incidence of annual welfare receipt, and were less likely to have an intimate partner (IRR, 0.71; 95% CI, 0.63-0.79) and children living in the household (IRR, 0.86; 95% CI, 0.80-0.92). Estimated lost earnings over a 40-year working career were $140 515 for the high externalizing, $201 657 for the high internalizing, and $357 737 for the comorbid profiles. Conclusions and Relevance: In this cohort study, children exhibiting sustained childhood high externalizing, high internalizing, or comorbid symptoms were at increased risk of poor economic and social outcomes into middle age. These findings suggest that children exhibiting comorbid problems were especially vulnerable and that early detection and support are indicated.