Pathways between childhood/adolescent adversity, adolescent socioeconomic status, and long-term cardiovascular disease risk in young adulthood

Jenalee R Doom, Susan M Mason, Shakira F Suglia, Cari Jo Clark, Jenalee R Doom, Susan M Mason, Shakira F Suglia, Cari Jo Clark

Abstract

Objective: The current study investigated mediators between childhood/adolescent adversities (e.g., dating violence, maltreatment, homelessness, and parental death), low socioeconomic status (SES) during adolescence, and cardiovascular disease (CVD) risk in young adulthood. The purpose of these analyses was to understand whether SES during adolescence and childhood/adolescent adversities affect CVD risk through similar pathways, including maternal relationship quality, health behaviors, financial stress, medical/dental care, educational attainment, sleep problems, and depressive symptoms.

Methods: Using the National Longitudinal Study of Adolescent to Adult Health (N = 14,493), which has followed US adolescents (Wave 1; M = 15.9 years) through early adulthood (Wave 4; M = 28.9 years), associations were examined between childhood/adolescent adversity and SES to 30-year CVD risk in young adulthood. The outcome was a Framingham-based prediction model of CVD risk that included age, sex, body mass index, smoking, systolic blood pressure, diabetes, and antihypertensive medication use at Wave 4. Path analysis was used to examine paths through the adolescent maternal relationship to young adult mediators of CVD risk.

Results: Childhood/adolescent adversity significantly predicted greater adult CVD risk through the following pathways: maternal relationship, health behaviors, financial stress, lack of medical/dental care, and educational attainment; but not through depressive symptoms or sleep problems. Lower SES during adolescence significantly predicted greater adult CVD risk through the following pathways: health behaviors, financial stress, lack of medical/dental care, and educational attainment, but not maternal relationship, depressive symptoms, or sleep problems.

Conclusions: Childhood/adolescent adversities and SES affected CVD risk in young adulthood through both similar and unique pathways that may inform interventions.

Keywords: Add Health; Adolescence; Adversity; CVD; Socioeconomic status; United States; Young adulthood.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Model tested in Mplus. Solid blue lines indicate direct paths between W1, W3, and W4 variables. Dashed red lines indicate direct paths that involve the addition of W1 maternal relationship as a mediator between SES → CVD risk and adversity → CVD risk. All direct and indirect paths from SES and adversity to CVD risk were tested. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Variables related to adult CVD risk with associated standardized estimates (β). This standardized estimate was the amount of change in Y per standard deviation unit of X. All paths reported were direct effects, *p < 0.05, **p < 0.01, ***p < 0.001. See online supplement for information on waves of data collection for childhood/adolescent adversities.

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