Trauma and Instability Dimensions of Adversity Contribute to Youth Health Behaviors and Outcomes

Background and Purpose. Childhood adversity plays a fundamental role in predicting youth health outcomes. However, our understanding of how adverse experiences in childhood should best be conceptualized remains elusive and interventions are presently unable to target specific adversities that confer risk. Adversity is typically defined as a unidimensional construct, but is likely more complex, inclusive of traumatic events (e.g., crime victim, loss of parent) and instabilities (e.g., divorce, food insecurity, moving), which may have differential effects on child health. This study tests whether trauma and instability differentially associate with child health behaviors and outcomes known to increase risk of long-term chronic disease.

Method. This prospective study, part of a larger randomized control trial, includes 360 youth-parent dyads recruited from urban Cleveland schools as youth entered 6th grade (T1). Those with a BMI >85th percentile were eligible and followed annually for 3 years (T2-T4). Trauma was assessed based on the Children’s Life Events Inventory. Youth reported six traumatic experiences: 1) badly hurt or sick, 2) arrested, 3) victim of a crime, 4) experienced death of parent, 5) sibling, or 6) close friend. Instability was assessed via parent and youth report of six items: 1) marital separation, 2) divorce, 3) change of schools, 4) change of residence, 5) food insecurity with hunger, and 6) fear of crime in neighborhood. Summed index scores were calculated for trauma, instability, and the cumulative score of trauma and instability measured at T1, reflecting adversity experienced in the past year. Multiple regression was used to assess effects of adversity dimensions at T1 (trauma/instability/cumulative risk) on health behaviors (caloric intake, physical activity, sedentary behaviors, sleep, stress) and outcomes (change in BMI, blood pressure, cholesterol [HDL], blood glucose) over 3 years. Models were adjusted for household education, child age, sex, and child BMI.

Results. Youth were primarily female (57.8%) and non-Hispanic Black (76.7%). At T1, mean BMI percentile was 95.69 (SD=3.72). Youth had an average of 0.44 (SD=0.82) traumatic experiences and 0.82 (SD=0.90) experiences of instability over the past year. Trauma (b=2.71, p=.04) and instability (b=2.95, p = .01) predicted poorer sleep quality at T1. Instability, but not trauma, was predictive of higher stress at T1 (b=1.09, p=.004) and T2 (b=1.25, p=.002), decline in HDL from T1-T4 (b=-.44, p=.02), and increase in BMI from T1-T4 (b=0.31, p<.001). Cumulative trauma and instability scores predicted poorer sleep quality at T1 (b=2.84, p<.001), higher stress at T2 (b=.76, p=.006) and T2 (b=1.03, p<.001), and decline in HDL (b=-.28, p=.04) and increase in BMI (b=0.24, p<.001) from T1-T4.

Conclusions and Implications. Although exposures to both trauma and instability similarly predicted poorer sleep quality, instability distinctly increased risk for increases in BMI and decreases in HDL over a four-year period, as well as higher levels perceived stress over 2 years. Experiences with trauma and instability may co-occur, yet have distinct impacts for youth health among lower-income overweight and obese youth. Future research should explore mechanisms that link adversity dimensions to adolescent health and interventions should consider tailoring supports specific to trauma and instability.