Links between Adverse Childhood
Events and Obesity in Youth
Lori A. Francis, Ph.D. & Rhonda Belue, Ph.D.
Department of Biobehavioral Health
Department of Health Policy & Administration
Secular Trends in Childhood Obesity
NHANES 1971-2012
Adverse Childhood Events
• Stressful events that occur within/outside of the home
• Often chronic
• Significant impacts on child biopsychosocial
development
Kalmakis & Chandler, 2013
Early Adversity and Obesity
Unpredictability
• # house moves in infancy, linked with obesity mid-
childhood (age 9)1
• Food insecurity2
•
•
•
•
Feast-famine cycle
Dietary quality
Hunger3
School meal participation
1Giles
et al., 2013; 2Dinour et al., 2007; 3Metallinos-Katsaras et al., 2012
Early Adversity and Obesity
Parental Stress and Parenting
• Parental stress (serious life events, worries) linked
with obesity risk in youth1,2
• Harsh and neglectful parenting styles linked with
greater BMI gains from early childhood to
adolescence3
• Emotional support (sensitivity) linked with childhood
overweight and obesity4
1Parks
et al., 2012; 2Stenhammar et al., 2010; 3Connell & Francis, 2013; 4Strauss, 1999
Early Adversity and Obesity
• Poor parental mental and physical health linked with
obesity risk in youth1
•
2Maternal
•
•
•
•
•
•
reports of
intimate partner violence
food insecurity
housing insecurity
maternal depressive symptoms
maternal substance use
father's incarceration
1Garasky
et al., 2009; 2Suglia et al.,2012, 2013
Early Childhood Adversity &
Toxic Stress
Shonkoff J P et al. Pediatrics 2012;129:e232-e246
Objective
Exposure
to Early
Adversity
Obesity
2011-12 National Survey of
Children’s Health
• Random digit-dial survey to households with
children <18yrs
• Parent respondents
• 41,624 participants ages 10 to 17 yrs
Measures
• Adverse Childhood Events (6 indicators)





Death of a parent
Parent incarcerated after child’s birth
Witnessed parents/adults being physically violent
Victim of/witness to neighborhood violence
Lived with someone who was mentally ill, suicidal or
severely depressed
 Lived with someone who abused alcohol or drugs
Measures
• Overweight
- Based on age- and sex-specific body mass index
(BMI percentile > 85th)
• Covariates
- Frequency of financial hardship (covering basics)
- Neighborhood deprivation
- Neighborhood safety
Statistical Analysis
• Descriptives
• Sample characteristics
• Sample prevalence rates for ACEs
• Latent class analysis (PROC LCA in SAS)
used to form profiles based on exposure to
ACEs
• Examined relations between class
membership and overweight status
• Financial hardship and neighborhood vars as covariates
www.methodology.psu.edu; Lanza et al., 2011; Infant Development
Bivariate Approach
Risk 1
Obesity
Risk 1
Obesity
Risk n
Obesity
Mean Risk
Score
Obesity
Cumulative Risk Approach
Low Risk
High Risk
Risk for Obesity
Latent Class Approach
Class
4
Class 1
(low-risk)
Class
2
Class
3
Results
Sample Characteristics (n=41,624)
DEMOGRAPHICS
Male
51%
Non-Hispanic, White
56%
Hispanic
28%
Non-Hispanic, Black
13%
<HS Education
14%
Family Poverty
18%
Single, mother-headed
household
20%
HEALTH
Excellent/very good health
84%
Overweight/Obese
33%
Adverse Childhood Events
Total Sample Prevalence (%)
N=41,624
16
14.6
13.3
14
11.3
12
10
8.3
9.4
8
6
4.9
4
2
0
Parent Died
Parent
Incarcerated
Domestic
Violence
Neighborhood Mental Health Alcohol/Drug
Violence
Problems
Abuse
Class Membership
Adverse Event
Latent Class
(sample prevalence)
Low Risk
Alcohol/
Drugs
Violence
Mental Health
Multiple
Exposures
(63%)
(5%)
(21%)
(7%)
(4%)
Parent Died
Parent
Incarcerated
Witness Domestic
Violence
.03
.02
.13
.54
.07
.00
.08
.04
.18
.63
.02
.35
.30
.20
.92
Witness/Victim
Neighborhood
Violence
.00
.18
.82
.30
.98
Parent with
Mental
Illness/Suicidal
.03
.32
.02
.91
.58
Parent with
Alcohol/Drug
Problem
.03
.98
.00
.32
.77
Note: G2=397.0, AIC=246.4, BIC = 716.7
Predicting Class Membership
Family and Neighborhood Covariates
Neighborhood
Covariate
Low Risk
Financial
Hardship
Neighborhood
Deprivation
Neighborhood
Safety
Latent Class
(sample prevalence)
Alcohol/
Violence
Drugs
Mental Health
Multiple
Exposures
(63%)
(5%)
(21%)
(8%)
(4%)
1.0
2.81
0.27
1.43
3.05
1.0
4.49
2.41
0.86
1.46
1.0
5.51
1.05
0.91
0.88
Note: Estimates in bold are significant at p<.01. The low-risk class is used as the reference group.
Predicting Class Membership
Overweight
Low Risk
Overweight
Latent Class
(sample prevalence)
Alcohol/
Violence
Drugs
Mental Health
Multiple
Exposures
(63%)
(5%)
(21%)
(8%)
(4%)
1.0
2.2
2.5
1.5
1.7
Note: Estimates in bold are significant at p<.01. The low-risk class is used as the reference group.
Class Membership by Race/Ethnicity
Conclusions
• Increased risk of overweight with exposure
to specific constellations of risk
•
•
Exposure to violence conferred the greatest risk
for overweight
Living in a household with a parent with an
alcohol/drug problem also conferred unique risk
• The mechanisms by which these relations
exist should be explored
Limitations
• Few measures to understand mechanisms
• Programming limitations