Do Adverse Childhood Experiences Modify the Association Between Disaster-Related Trauma and Cognitive Disability?

Identifying subpopulations that are particularly vulnerable to long-term adverse health consequences of disaster-related trauma is needed. We examined whether adverse childhood experiences (ACEs) potentiate the association between disaster-related trauma and subsequent cognitive disability among older adult disaster survivors. Data were from a prospective cohort study of older adults who survived the 2011 Great East Japan Earthquake. The baseline survey pre-dated the disaster by 7 months. We included participants who completed follow-up surveys (2013 and 2016) and did not have a cognitive disability before the disaster (n = 602). Disaster-related traumas (i.e., home loss, loss of friends or pets) and ACEs were retrospectively assessed in 2013. Cognitive disability levels in 2016 were objectively assessed. After adjusting for pre-disaster characteristics using a machine learning-based estimation approach, home loss (0.19, 95% confidence interval (CI): 0.09, 0.28) was, on average, associated with greater cognitive disability. Among individuals with ACEs, home loss was associated with even higher cognitive disability levels (0.64, 95% CI: 0.24, 1.03). Losses of friends (0.18, 95% CI: 0.05, 0.32) and pets (0.13, 95% CI: 0.02, 0.25) were associated with higher cognitive disability levels only among those with ACEs. Our findings suggest that individuals with a history of ACEs may be particularly vulnerable to adverse health consequences related to disasters.

Association of disaster-related damage with inflammatory diet among older survivors of the Great East Japan Earthquake and Tsunami.

Traumatic experiences from disasters have enduring effects on health, both directly and indirectly by influencing health behaviours. Among potential pathways, the impact of disaster-related trauma on dietary patterns has been understudied. This study investigated the relationship between disaster-related trauma and dietary inflammatory index (DII®), and how these relationships differed by gender and whether they prepare meal by themselves or not among older survivors of the 2011 Great East Japan Earthquake and Tsunami (n 1375). Dietary data were collected in 2020 using a brief-type self-administered diet history questionnaire, from which we derived a dietary inflammatory index (DII®) based on twenty-six food/nutrient items, where higher scores indicate pro-inflammatory (i.e. unhealthy) diet. We found that the experience of housing damage due to the earthquake and tsunami was associated with slightly higher DII scores (coef. = 0·38, 95 % CI -0·05, 0·81). Specifically, women who cooked by themselves tended to have higher DII when they experienced housing damage (coef. = 1·33, 95 %CI -0·63, 3·28). On the other hand, loss of friends was associated with a lower DII score (coef. = -0·28, 95 % CI -0·54, -0·01). These findings highlight the importance of providing support to groups who are at increased risk of deterioration in dietary quality in the aftermath of disasters.

Association of green tea consumption with prediabetes, diabetes and markers of glucose metabolism in rural Vietnam: a cross-sectional study.

The literature on green tea consumption and glucose metabolism has reported conflicting findings. This cross-sectional study examined the association of green tea consumption with abnormal glucose metabolism among 3000 rural residents aged 40-60 years in Khánh Hòa province in Vietnam. Multinomial logistic regression analysis was conducted to examine the association of green tea consumption (0, < 200, 200-< 400, 400-< 600 or ≥ 600 ml/d) with prediabetes and diabetes (based on the American Diabetes Association criteria). Linear regression analysis was performed to examine the association between green tea consumption and the log-transformed homeostatic model assessment of insulin resistance (HOMA-IR) (a marker of insulin resistance) and the log-transformed homeostatic model assessment of ß-cell function (HOMA-ß) (a marker of insulin secretion). The OR for prediabetes and diabetes among participants who consumed ≥ 600 ml/d v. those who did not consume green tea were 1·61 (95 % CI = 1·07, 2·42) and 2·04 (95 % CI = 1·07, 3·89), respectively. Higher green tea consumption was associated with a higher level of log-transformed HOMA-IR (Pfor trend = 0·04) but not with a lower level of log-transformed HOMA-ß (Pfor trend = 0·75). Higher green tea consumption was positively associated with the prevalence of prediabetes, diabetes and insulin resistance in rural Vietnam. The findings of this study indicated prompting the need for further research considering context in understanding the link between green tea consumption and glucose metabolism, especially in rural settings in low- and middle-income countries.

Uncovering Heterogeneous Associations Between Disaster-Related Trauma and Subsequent Functional Limitations: A Machine-Learning Approach.

This study examined heterogeneity in the association between disaster-related home loss and functional limitations of older adults, and identified characteristics of vulnerable subpopulations. Data were from a prospective cohort study of Japanese older survivors of the 2011 Japan Earthquake. Complete home loss was objectively assessed. Outcomes in 2013 (n = 3,350) and 2016 (n = 2,664) included certified physical disability levels, self-reported activities of daily living, and instrumental activities of daily living. We estimated population average associations between home loss and functional limitations via targeted maximum likelihood estimation with SuperLearning and its heterogeneity via the generalized random forest algorithm. We adjusted for 55 characteristics of survivors from the baseline survey conducted 7 months before the disaster. While home loss was consistently associated with increased functional limitations on average, there was evidence of effect heterogeneity for all outcomes. Comparing the most and least vulnerable groups, the most vulnerable group tended to be older, not married, living alone, and not working, with preexisting health problems before the disaster. Individuals who were less educated but had higher income also appeared vulnerable for some outcomes. Our inductive approach for effect heterogeneity using machine learning algorithm uncovered large and complex heterogeneity in postdisaster functional limitations among Japanese older survivors.

Parental absence during childhood and weight status in adulthood among middle-aged community dwellers in rural Vietnam.

OBJECTIVES: While adverse childhood experiences (ACEs) have been shown to be associated with adulthood obesity, less is known about their association with underweight. We examined the associations between parental absence (i.e., a major component of ACEs) and both underweight and excess weight among middle-aged rural community dwellers in Vietnam, where experiences of parental absence was not uncommon during and after the Vietnam War (1955-1975). METHODS: Data came from 3000 middle-aged adults who participated in the baseline survey of Khánh Hòa Cardiovascular Study. Parental absence was defined as parental absence due to death, divorce, or out-migration. Using information on the timing of such events, we categorized participants into those who experienced parental absence before the age of 3, between the ages of 3 and 15, and those without such experiences. BMI was calculated based on measured height and weight (kg/m2 ) and categorized into three groups: underweight <18.5; normal 18.5-24.9; excess weight ≥ 25. Multinomial logistic regression was then used to investigate the association between parental absence and adult weight status. RESULTS: Parental absence that occurred before the age of 3 was marginally significantly associated with underweight (relative risk ratio [RRR] = 1.44, 95% confidence interval [CI] 0.95, 2.20) but not with overweight/obesity. Parental divorce was associated with overweight/obesity (RRR = 2.48, 95% CI 1.28, 4.81), but not parental absence due to migratory work. CONCLUSIONS: While previous studies in Western settings focused almost exclusively on the risk of obesity in relation to exposure to ACEs, our findings point to the potential importance of considering the risk of underweight in low- and middle-income countries.

Early childhood adversity and late-life depressive symptoms: unpacking mediation and interaction by adult socioeconomic status.

PURPOSE: Adverse childhood experiences (ACEs) have been linked to diminished health achievement across the life course. However, few studies have rigorously investigated the role of adult socioeconomic status (SES) as a mediator and an effect modifier of the association between ACEs and late-life depression. We used a four-way decomposition analysis to examine the relative contributions of mediation and interaction by low adult SES to the association between ACEs and late-life depression. METHODS: Data came from two waves (2013 and 2016) of the Japan Gerontological Evaluation Study, a nationwide cohort of older people (n = 7271). ACEs were determined as ≥ 2 experiences of the following: parental loss, parental divorce, parental mental illness, domestic violence, physical abuse, psychological neglect, psychological abuse, and economic disadvantage. Low adult SES was defined as earning < 2 million yen of income and < 10 years of schooling. Depressive symptoms were assessed using the Geriatric Depression Scale. RESULTS: Controlled direct effect (coefficient 0.28; 95% CI 0.08-0.46) accounted for 69.1% of the total effect, which was greater than the other three estimates for the decomposed effects (reference interaction 20.8%, mediated interaction 5.7%, and pure indirect effect 4.4%). Adult SES accounted for 10.1% (via mediation) and 26.5% (via exposure-mediator interaction) of the total association between ACEs and depressive symptoms, respectively. CONCLUSION: ACEs appeared to be a strong and independent determinant of depressive symptoms in later life. Nonetheless, the interaction between ACEs and adult SES indicates that achieving high adult SES could mitigate the adverse effect of ACEs on late-life depression.

Childhood adversities, late-life stressors and the onset of depressive symptoms in community-dwelling older adults.

Objective: Depression is common in older individuals though many factors associated with its occurrence remain under-researched. We examined whether childhood adversities (CAs) and late-life stressors are associated with the onset of depressive symptoms in adults aged ≥ 65 and if these early- and late-life stressors interact in the prediction of depressive symptoms. Methods: Data came from the 2010 and 2013 waves of the Japan Gerontological Evaluation Study (JAGES) (N = 8701). The Geriatric Depression Scale (GDS-15) was used to assess the presence of depressive symptoms (GDS ≥ 5). A Poisson regression analysis was used to examine associations. Results: Both CAs (1 event: incidence rate ratio [IRR] = 1.59, 95% confidence interval [CI]: 1.41-1.79; ≥ 2 events: IRR = 2.36, 95% CI = 1.80-3.10) and late-life stressful events (1 event: IRR = 1.13, 95% CI: 1.02-1.25; ≥ 2 events: IRR = 1.25, 95% CI = 1.05-1.50) were significantly associated with the onset of depressive symptoms. Borderline significant interactions between CAs and late-life stressors (e.g. ≥ 2 CAs and ≥ 2 late-life events: IRR = 0.61, p = 0.087) suggest that late-life stressors may be important in predicting the onset of depressive symptoms especially among individuals with no or fewer CAs compared to those with ≥ 2 CAs. Conclusions: Stressful events in childhood and late adulthood were independently associated with the onset of depressive symptoms in older adults. In addition, stressful experiences in childhood might affect how individuals respond to stressful events in later life.

Chronic stress and age-related pattern of blood pressure: A cross-sectional study in rural China.

OBJECTIVE: Chronic stress is a risk factor for hypertension in adults. However, there is conflicting evidence for older adults. We hypothesized that age-related arterial stiffening, which leads to a lower blood pressure (especially diastolic blood pressure [DBP]), is more pronounced among older adults with high vs low stress. The objectives of this study were (a) to investigate age-related trends in systolic and DBPs among adults in rural Fujian, China, and (b) to examine differences in age-related blood pressure trends according to levels of stress by using Epstein-Barr virus (EBV) antibody titer as a marker of chronic stress status. METHODS: We collected cross-sectional data from 764 rural community-dwelling adults in rural Fujian, China (mean age = 59.4). Participants were categorized into high and low stress groups by median split of EBV antibody titer. A least-squares regression analysis was used to investigate the association between age and blood pressures. RESULTS: We observed an inverted U-shaped association between age and DBP, while there was a linear association between age and systolic blood pressure in the overall sample. When stratified by stress, the inverted U-shaped associations with age (both systolic and DBPs) were seen only among those with high stress; DBP peaked at the age of ~68 years, and the declining trend later in life was more clearly observed among those with high chronic stress. DISCUSSION: Decrease of DBP was more pronounced among older adults with high vs low chronic stress in rural China.

The association between family members' migration and Epstein-Barr virus antibody titers among people left behind in rural Fujian, China.

OBJECTIVES: In contrast to the health of migrants, which has been extensively studied, little attention has been paid to the health of adults left behind by family members who out-migrated to other locations. This study was performed to investigate the association between being left behind and the Epstein-Barr virus (EBV) antibody titer, which is an indicator of cellular immune functioning previously shown to be associated with psychological stress. METHODS: A cross-sectional survey was conducted in rural communities in Fujian, China, in 2015. Questionnaire data and dried blood spot samples were collected from 748 adults. A mixed effect regression analysis was conducted to investigate the association. RESULTS: Results indicated that the EBV antibody titers were higher among people who had been left behind compared with those who had not. CONCLUSIONS: Our findings suggest that, in rural Fujian, China, family separation following the out-migration of family members is an important determinant of psychological stress.

Association between parental visitation and depressive symptoms among institutionalized children in Japan: a cross-sectional study.

BACKGROUND: Mental health problems are an important issue among institutionalized children. Although positive communication with parents is essential for children's well-being, it has not been sufficiently verified how interactions with parents affect mental health among institutionalized children, who have experienced childhood adversity and likely lack secure attachment formation with their parents. The objectives of this study were to investigate the association between parental visitation and depressive symptoms among institutionalized children in Japan, and to explore whether the established security of attachment interacts with that association. METHODS: A cross-sectional data from 399 institutionalized children aged 9 to 18 in Japan was used for the analysis. A mixed effects regression analysis was conducted to investigate the associations. RESULTS: Institutionalized children who had parental visitation showed higher depressive symptoms than those who did not. In particular, father's visitations were significantly associated with higher depressive symptoms. There was a significant interaction with score of secure attachment; children with low scores on secure attachment showed higher levels of depression with their father's visitation, whereas children with high scores on secure attachment did not. CONCLUSIONS: Findings suggested that parental visitation and the frequency of visitation were not actually associated with better psychological status, but that instead, father's visitations were associated with higher depressive symptoms among institutionalized children. It should be noted that our cross-sectional results cannot infer any causal relationship and do not emphasize that parental visitation should be avoided. However, it may be important to conduct careful assessment before starting parental visitation, especially when children seem to have problems with attachment formation.

Association between early parental deprivation and cellular immune function among adults in rural Fujian, China.

This study investigated the role of childhood parental deprivation in the association between quality of life (QOL) and the Epstein-Barr virus (EBV) antibody titer, a marker of cellular immune functioning, using data from 734 adults living in seven communities in rural Fujian, China. Parental deprivation was defined if either of their parents had died, divorced, or left them for migratory work for more than 1 year before they turned (a) 16 years of age (childhood and adolescence), or (b) 3 years of age (early childhood). A mixed-effects regression analysis with a random effects model revealed that parental deprivation during early childhood was positively associated with the EBV antibody titer (coefficient = 0.33, p = 0.007), whereas parental deprivation during the first 16 years was not. Further analysis incorporating an interaction term between QOL and parental deprivation revealed a significant interaction between QOL and parental deprivation during early childhood; a significant association between QOL and the EBV antibody titer was found only among those who reported parental deprivation during early childhood. This study suggests that parental deprivation during the period of immune system development may be linked with physiological responses to stressors later in life.

Epstein-Barr virus antibody titer as a stress biomarker and its association with social capital in rural Fujian communities, China.

OBJECTIVES: There has been little research on the association between social capital and psychological stress measured by a biomarker, particularly in developing countries. Our objective was to investigate the association between Epstein-Barr virus (EBV) antibody titer, an indicator of cellular immune function previously shown to be associated with psychological stress, and social capital among rural community dwellers in Fujian Province, China. METHODS: We conducted a cross-sectional survey in seven rural communities in Fujian in 2015. We used questionnaire data and dried blood spot samples for the measurement of biomarkers collected from 734 local residents for the analysis. We conducted a mixed effects regression analysis to investigate the association between EBV antibody titer and four social capital variables, which included cognitive and structural social capital assessed both at individual and community levels. RESULTS: Community-level structural social capital was inversely associated with psychological stress (coefficient = -0.96, 95% confidence interval [CI] = -1.91, -0.01) while individual-level structural social capital was positively associated with it (coefficient = 0.21, 95% CI = 0.07, 0.36). Neither individual- nor community-level cognitive social capital was associated with psychological stress status. CONCLUSIONS: In rural Fujian, China, social capital seemed to be an important determinant of psychological health. While living in a community with active social interaction may benefit the residents psychologically, social interaction in the form of strongly bonded relationships may be a source of psychological stress at the individual level due to the potential demands and obligations that may be associated with such connections.

The association between economic development, lifestyle differentiation, and C-reactive protein concentration within rural communities in Hainan Island, China.

OBJECTIVE: Earlier fieldwork in rural areas of Hainan Island, China, demonstrated that during the course of economic development increasing differences had emerged in lifestyles within communities. It is possible that these variations might have stratified residents into subpopulations with different health attributes. This study examined the association between C-reactive protein (CRP) concentration, a biomarker of future cardiovascular events, and personal lifestyle parameters and the degree of community-level economic development among rural communities. METHODS: A cross-sectional field survey was undertaken in 19 rural communities in Hainan. Convenience sampling was used to recruit 1,744 participants. Dried blood spot samples were collected to measure high-sensitivity CRP concentration. Sex-stratified multilevel regression analyses were conducted to identify factors associated with CRP concentration among the participants. RESULTS: While CRP concentration was negatively associated with being married and (more) education among men, for women CRP concentration was associated with the frequency of poultry consumption (P = 0.014) and the experience of migratory work in the previous year (P = 0.009). In addition, for females, living in communities with a greater degree of inequality, as indexed by the Gini coefficient, was also associated with increased CRP concentration (P = 0.003). CONCLUSION: Given that CRP concentration is a marker of future CVD risk, this study suggests that within these previously homogenous rural communities, economic development might have stratified people into population subgroups with a different CVD risk.

Epstein-Barr virus antibody titer and its association with the domain scores from the World Health Organization's Quality of Life questionnaire: Findings from Rural Hainan Province, China.

OBJECTIVE: Epstein-Barr virus (EBV) antibody titer has recently been used as a biomarker of psychological stress. This is the first study to investigate the association between EBV antibody titer and perceived quality of life (QOL) in Hainan Island, China. METHODS: Participants from two regions of Hainan Island, recruited into a larger study investigating the health impact of rapid economic development among rural residents, were stratified by age, sex, and region; 15 people were randomly selected from each of the 16 subgroups, to give a total sample size of 240. EBV antibody titer in dried blood spot samples was measured by enzyme-linked immunosorbent assay. The abbreviated version of the World Health Organization's Quality of Life questionnaire was used to gather information on six categories of QOL. Multiple linear regression analysis was used to examine the relationship between EBV antibody titer and QOL. RESULTS: After adjusting for the effects of age, sex, region and C-reactive protein concentration, EBV antibody titer was negatively associated with the physical (P = 0.044) and psychological QOL domains (P = 0.039). CONCLUSION: This study suggests that among individuals living in an environment in the initial stages of economic development EBV antibody titer, a biomarker of psychological stress, is not only associated with the psychological aspects of QOL but is also linked to physical problems.

Impact of lifestyle changes on stress in a modernizing rural population in Hainan Island, China.

OBJECTIVE: Little is known about inter-individual variation in psychological stress in modernizing rural populations in developing countries. The objective of this study was to investigate the association between Epstein-Barr virus (EBV) antibody titer, a biomarker of psychological stress, and lifestyle parameters in rural communities in Hainan Island, China. METHODS: EBV antibody titer was measured in dried blood spot (DBS) samples collected from 240 adults living in rural communities in Hainan Island. Measures of two major lifestyle changes in rural areas of Hainan Island, i.e., diet and commercial goods possession, were examined by using information on the weekly frequency of pork consumption and monthly mobile phone fees. Both parameters were standardized to create two composite scores: a total affluence index (TAI--the sum of these scores), and an investment tendency index (ITI--the difference between them). Least-squares regression analysis was used to investigate the association between EBV antibody titer and these lifestyle parameters. RESULTS: A positive association was found between the frequency f pork consumption and EBV antibody titer (P = 0.040), whereas a negative association was found between mobile phone fees and EBV antibody titer (P = 0.028). A negative association was also observed between ITI and EBV antibody titer (P = 0.002) after adjusting for the effect of TAI. CONCLUSION: Psychological stress among local residents was linked to the type of lifestyle changes they had experienced, where the adoption of a more market-oriented lifestyle, irrespective of current affluence, was associated with less psychological stress.

Socioeconomic disparities in mammography screening in the United States from 2012 to 2020.

The potential impact of the COVID-19 pandemic on socioeconomic disparities in mammography uptake remain poorly understood. We used repeated cross-sectional data from the 2012, 2014, 2016, 2018, and 2020 waves of the Behavioral Risk Factor Surveillance System, focusing on the U.S. women aged 50-74 years and investigated the relationships of educational attainment, employment status, and household income with a missed mammogram in the past two years. We ran Poisson regression analyses accounting for survey weights. The sample numbers were 139,761 in 2012, 137,916 in 2014, 140,000 in 2016, 116,756 in 2018, and 102,774 in 2020, respectively. Women with the lower educational attainment and lower household incomes reported higher proportions of missed mammography screening. Self-employed women were most likely to miss a mammogram. Accounting for other covariates, there was an increase in the adjusted prevalence ratio (PR) of missed mammography from 2018 to 2020 (pre-pandemic versus post pandemic onset) for self-employed women compared to women in waged work. Non-Hispanic Black women who were self-employed (PR = 0.28, 95% CI: 0.16, 0.51) and employed for wages (PR = 0.58, 95% CI: 0.47, 0.73) were at lower risks of missing a mammogram compared to non-Hispanic White women in the same categories. The findings suggest that disparities for mammography uptake widened after the pandemic onset, especially for employment status, which varied by race/ethnicity.

Association between workplace social capital and systolic blood pressure among 23 173 workers at 367 small-sized and medium-sized enterprises in Japan: a cross-sectional study.

OBJECTIVES: Social capital (SC) has been shown to be inversely associated with elevated blood pressure. While SC in the workplace may also be associated with blood pressure, it has not been extensively studied. We aimed to investigate the association between workplace SC and systolic blood pressure (SBP). DESIGN: A cross-sectional study. SETTING: 367 small-sized and medium-sized companies in Japan. PARTICIPANTS: A total of 23 173 participants (15 991 males and 7182 females) aged ≥18 years. EXPOSURE OF INTEREST: SC was assessed using individual responses to eight 4-point Likert questions used in the Brief Job Stress Questionnaire. Workplace SC was assessed as the mean of individual-level responses to the SC questions from those working in the same company. OUTCOME MEASURE: Systolic blood pressure (SBP) RESULTS: A multilevel linear regression model revealed that higher workplace-level SC was linked with lower SBP (coef.=-0.53 per 1SD increment in workplace SC, 95% CI=-1.02 to -0.05) among females in the age-adjusted model, which remained statistically significant after adjusting for other covariates. After adjusting for individual-level SC, this association was attenuated and became non-significant (coef.=-0.41, 95% CI=-0.87 to 0.05), while individual-level SC was inversely associated with SBP (coef.=-0.43, 95% CI=-0.73 to -0.13). Among males, we did not find any evidence of significant inverse associations either in relation to workplace SC (coef.=-0.12, 95% CI=-0.46 to 0.21) or individual-level SC (coef.=0.19, 95% CI=-0.01 to 0.39). CONCLUSIONS: Our study findings suggested that workplace-level SC can affect SBP differently by sex.

Bidirectional associations between post-traumatic stress symptoms and sleep quality among older survivors of the 2011 Great East Japan Earthquake and Tsunami.

STUDY OBJECTIVES: We sought to examine the bidirectional associations between post-traumatic stress symptoms (PTSS) and sleep quality in a sample of older disaster survivors. METHODS: We used 4 waves (2010, 2013, 2016, and 2020) of the Iwanuma Study, which included pre-disaster information and 9 years of follow-up data among older survivors of the 2011 Great East Japan Earthquake and Tsunami. Poisson regression analysis was used to examine the bidirectional associations between sleep problems and PTSS. RESULTS: Individuals reporting sleep problems before the disaster were more likely to develop PTSS after exposure to disaster trauma, while there was no effect modification, i.e. prevalence ratio for sleep problems did not differ by the magnitude of disaster damages. Individuals reporting sleep problems after the disaster were less likely to recover from PTSS, and more likely to develop the delayed onset of PTSS 5 years after the disaster. While individuals who recovered from PTSS 9 years after the disaster were still at slightly higher risk of having sleep problems compared to those who never had PTSS, none of the sleeping problems were found to be significantly prevalent after the Bonferroni correction. CONCLUSIONS: Pre-disaster sleep problems predicted PTSS onset independently of experiences of disaster trauma. The association between PTSS and sleep problems was bidirectional. Intervening to mitigate lingering sleep problems may benefit the recovery of disaster survivors from post-traumatic symptoms.

Residential instability during adolescence and health and wellbeing in adulthood: A longitudinal outcome-wide study.

Although prior research suggests that residential instability during adolescence can have long-term impacts on health and wellbeing, few studies have identified a robust comparison group and considered a broad set of outcomes. To address these knowledge gaps, we examined the associations between residential instability during adolescence and a wide range of adult health and wellbeing outcomes using an outcome-wide design in the National Longitudinal Study of Adolescent to Adult Health. We defined residential instability as two or more moves between Waves I and II (ages 13-18 years). We assessed outcomes at ages 33-43 years (Wave V) in nine domains: biomarkers, physical health, health behaviors, psychological distress, psychological wellbeing, social behaviors, social wellbeing, trauma/victimization, and socioeconomic attainment. Results of doubly-robust targeted maximum likelihood estimation, adjusting for pre-exposure values of the outcome variables and cofounders (Wave I), showed little evidence of an association for certain outcomes, all of which disappeared after accounting for multiple comparisons. Our results suggest that residential instability in adolescence does not lead to worse health and wellbeing in adulthood, but rather, outcome differences between groups are due to pre-existing differences prior to residential instability in adolescence.

Parent-child separation and cardiometabolic outcomes and risk factors in adulthood: A systematic review.

BACKGROUND: Parent-child separation has been associated with negative mental health across childhood and adulthood, yet little is known about the long-term impacts for cardiovascular health. This systematic review synthesized and evaluated the quality of the literature examining the association between exposures to parent-child separation and cardiometabolic outcomes in adulthood. METHODS: Following a registered protocol, online databases (Pubmed, PsycInfo, and Web of Science) were searched for relevant studies. Studies were included if they (a) defined the exposure before age 18 as institutionalization, foster care placement, parental incarceration, separation due to parents migrating for economic reasons, or asylum and war; and (b) quantified the association between parent-child separation and cardiometabolic events and diagnoses (e.g., coronary heart disease, diabetes) and risk factors (e.g., body mass index, fat distribution, serum-based metabolic markers, inflammatory markers in adulthood (≥ age 18). Studies lacking an unexposed comparison group were excluded. The risk for bias in each study was assessed with a modified Newcastle-Ottawa Scale. RESULTS: Of the 1938 studies identified, 13 met our inclusion criteria. Two of the four studies examining associations between parent-child separation and cardiometabolic events and diagnoses found positive associations with coronary heart disease and diabetes. Amongst the 13 studies examining associations with any type of adult cardiometabolic risk factors, eight studies reported at least one positive association. Sub-analyses considering separate reasons for parent-child separation provided clearer insights: War evacuation was associated with hypertension and high blood pressure across four studies from the same cohort; out-of home care experiences largely evidenced null results across five different studies, and two studies on parental incarceration suggested positive associations with elevated inflammation, BMI and blood pressure. CONCLUSIONS: The connections between parent-child separation and adult cardiometabolic outcomes and risk factors are currently inconsistent. The results may depend on the reason for separation, age of assessment, analytic differences and other psychosocial variables that are often unmeasured in this literature.