Coming of age in war: Early life adversity, age at menarche, and mental health.

Armed conflict and forced migration (ACFM) represent a set of extreme environments that are increasingly common for children and adolescents to experience. Adolescence may constitute a sensitive period (puberty and psychoneurological maturation) through which ACFM adversity leaves a lasting mark. Adolescence has become a focal point for analysis and intervention as it relates to the effects of early life adversity on puberty, linear growth, and mental health. Research in public health and psychological science suggests early life adversity (ELA) may accelerate puberty, heightening risks for mental health disorders. However, it is not well substantiated whether ACFM-derived adversities accelerate or delay relative pubertal timing. Secondly, ACFM provides salient context through which to probe the relationships between nutritional, psychosocial, and demographic changes and their respective impact on puberty and mental health. We conducted a narrative review which 1) examined constructions of early life adversity and their proposed influence on puberty 2) reviewed empirical findings (n = 29 studies, n = 36 samples) concerning effects of ACFM ELA on age at menarche and 3) discussed proposed relationships between early life adversity, puberty, and mental ill-health. Contrary to prior research, we found war-derived early life adversity was more consistently associated with pubertal delay than acceleration and may exert counterintuitive effects on mental health. We show that ELA cannot be operationalized in the same way across contexts and populations, especially in the presence of extreme forms of human stress and resilience. We further discuss the ethics of puberty research among conflict-affected youth.

Weathering within war: Somatic health complaints among Vietnamese older adults exposed to bombing and violence as adolescents in the American war.

OBJECTIVE: People living in war may experience deteriorating health via weathering (wear and tear) from long-term exposures to psychosocial and environmental stressors. Weathering embodied in somatic health complaints may illuminate the effects of war on health. METHODS: We investigate whether wartime stress exposures occurring during adolescence and early adulthood affect weathering in late adulthood via linear regression with data from the Vietnamese Health and Aging Study (VHAS). VHAS is a cross-sectional study wherein investigators surveyed 2447 adults aged 60+ in four districts of northern and central Vietnam in 2018. These same individuals ranged in age from seven to 52 in 1965, with most having been in adolescence or early adulthood at the peak of the American war in Vietnam (1965-1975). The sample used for this study (n = 2254) were participants in the first VHAS wave in 2018. RESULTS: We find older Vietnamese adults exposed to higher-intensity provincial bombing suffer more numerous somatic health complaints (unstandardized ß = 0.005, SE = 0.001, p = 0.001). Additionally, greater health complaints emerge among older adults whose most intense bombing exposures were at younger ages of adolescence (< age 15) as compared to those whose peak exposures were in older ages (19-25) (unstandardized ß = 0.62 95%, SE = 0.19, p = 0.01). CONCLUSION: Our findings suggest that age of exposure to armed conflict is a critical determinant of weathering across the life course.

War, forced displacement and growth in Laotian adults.

BACKGROUND: Evidence from several populations suggests that war negatively impacts civilian nutrition, physical growth and overall health. This effect is often enduring or permanent, particularly if experienced early in life. AIM: To assess whether the number of lifetime displacement experiences and being displaced in infancy were associated with adult height, sitting height, leg length and the sitting height ratio. SUBJECTS AND METHODS: Retrospective questionnaires on displacement and resettlement experiences and anthropometric data were collected from a sample of Laotian adult refugees (ethnic Hmong and Lao; n = 365). All were born in Laos or Thailand and had resettled in French Guiana or the US. Many had been displaced several times by military conflict in Laos. RESULTS: In bivariate analyses, being displaced in infancy and the number of lifetime displacement experiences one had were negatively associated with final adult height and leg length in both sexes. The association was stronger in females, particularly Hmong females. There was no significant association between total displacement experiences and the sitting height ratio. In multiple regression analyses, linear growth in males was negatively associated with being displaced in infancy; in females, the number of lifetime displacement experiences was a significant predictor. CONCLUSION: Forced displacement from war appears to have a lasting effect on final adult height, sitting height and leg length, although not necessarily on the sitting height ratio in this sample.

Socioeconomic correlates of current and regular smoking among college students in Rhode Island.

OBJECTIVE: The objective of this study was to determine how sociodemographic variables, in particular socioeconomic status, correlate with current and regular smoking among college students in Rhode Island. PARTICIPANTS AND METHODS: Over a 4-year period (academic year 2000--2001 to 2003--2004), the authors examined sociodemographic correlates of cigarette use among 3,984 students aged 17 to 24 years from 10 colleges and universities in Rhode Island. RESULTS: One-third of participants (32.0%) had smoked a cigarette in the 30 days preceding the questionnaire. Findings from a pair of logistic regression models indicated that participants from upper-income families were more likely to be current smokers--although not regular smokers--suggesting that the effect of socioeconomic status on smoking is partly dependent on the level of addiction. In addition, freshmen were more likely to be current and regular smokers than were upperclassmen, and white students were most likely to be regular smokers. CONCLUSIONS: The frequency of college students who reported that they first tried smoking and first smoked regularly while in college increased from freshman to senior year, indicating that the college years are a vulnerable period for smoking initiation and habituation.

Adiposity and height of adult Hmong refugees: relationship with war-related early malnutrition and later migration.

This study investigated whether historical proxies for poor nutrition early in life were associated with differences in body composition and height among adult Hmong refugees. Life history and anthropometric data were collected from a sample of 279 Hmong aged 18-51 years who were born in Laos or Thailand and resettled in French Guiana or the United States following the Second Indochina War. Overall, 30.5% were born in a war zone in Laos, while 38.8% were displaced as infants; these individuals were presumed to have experienced malnutrition in the perinatal and infant periods, respectively. Resettlement in urban areas in the US was utilized as a proxy for greater exposure to excessive energy balance, compared with Hmong who resettled in rural areas in French Guiana. In multiple linear regression models, being displaced in infancy was negatively associated with height after controlling for confounders, while being born in a war zone was associated with higher adiposity and centralized body fat distribution. Resettlement in the US was associated with a higher centralization of subcutaneous fat, but not overall adiposity. These findings may be of interest to the study of the developmental origins of obesity, in a population that has undergone early malnutrition followed by migration and rapid nutritional transition.

Methodological issues in the anthropometric assessment of Hmong children in the United States.

The effectiveness of the body mass index (BMI; kg/m2) in assessing overweight/obesity may be diminished in populations of short stature. In a sample (n = 79) of Hmong refugee children in the United States, of age 4-11 years, median z scores for height, BMI, and the triceps skinfold were -1.04z, +0.53z, and +0.18z, respectively. Further, 41.7% of children were above the NHANES 85th percentile for BMI-for-age, categorizing them as overweight/obese. Assessment of obesity by other established criteria for children, such as the triceps skinfold and body fat percentage, produced significantly lower estimates than did BMI. This is consistent with patterns found in other stunted populations, suggesting that BMI be employed in conjunction with other methods when assessing overweight/obesity in these groups. Finally, although stunting and overweight/obesity were both common in this study, at the individual level height z scores were positively correlated to z scores of various measures of adiposity.