Social Supports Prevent BMI Increases after Early Life Adversity Exposure: Pathways through Child Behavior

Background. Adversity exposure is multidimensional and complex, inclusive of Economic Hardship (EH) and Adverse Childhood Experiences (ACEs), which can have detrimental effects on child self-regulation, behaviors, and subsequent child obesity risk. However, mechanisms linking early life adversity to child obesity risk in low-resourced communities, including the social factors that may buffer effects of EH and ACEs, have yet to be empirically tested. This study examines 1) child behaviors as a mediator between EH/ACEs and child obesity risk, and 2) whether social supports buffer these effects.

Methods. Data were drawn from the Fragile Families and Child Wellbeing Study (n=4,898) when children were 1, 3, 5, 9, and 15-years old. Early life ACEs, EH, child behavioral problems, and social supports were assessed at child age 3 (Y3) years. The ACE index summed 13 past-year experiences (e.g., parental poor mental health, substance use, physical/emotional abuse). The EH index included 8 indicators of past-year hardship (e.g., family received free food/meals, was unable to pay rent/mortgage, could not pay bills). Child internalizing and externalizing behavioral problems were assessed by parent report using the Child Behavior Checklist. Social supports were assessed via parent report of a series of items indicating regular involvement in community groups and religious/spiritual groups over the past year. Height and weight were collected by trained researchers at Y3-Y9 and self-reported by youth at Y15 to generate sex-specific, age-adjusted BMI. Latent growth curve modelling was used to generate BMI slopes from Y3 through Y15. Structural equation modeling was used to test direct effects of Y3 EH/ACEs from the prior year on change in BMI from Y3-Y15, indirect effects of Y3 internalizing/externalizing behaviors as a mediator of the association, and moderating (i.e., buffering) effects of Y3 social supports. Models were adjusted for parent/child sociodemographics and baseline EH/ACEs.

Results. Internalizing (β=.01, p=.02) and externalizing (β=.02, p=.01) behaviors mediated associations between higher past-year ACEs and increasing BMI from Y3-15. Y3 externalizing (β=.01, p=.02), but not internalizing behaviors mediated the association between EH and BMI change. Effects of ACEs on internalizing but not externalizing behaviors were buffered by parent religious/spiritual involvement and community group involvement. Effects of EH on

externalizing behaviors were buffered by religious/spiritual involvement and community group involvement to a degree

Conclusion. ACEs and EH were differentially associated with child behaviors and trajectories of increasing BMI over 12 years. Mediation effects were buffered by social supports, which differed for ACEs and EH and by internalizing vs. externalizing behaviors. Study findings provide implications for alleviating some effects of early life adversity on BMI trajectories from early childhood through adolescence.