Cumulative Violence Exposure and Self-Rated Health: Longitudinal Study of Adolescents in the United States

被引:113
作者
Boynton-Jarrett, Renee [1 ]
Ryan, Louise M. [2 ]
Berkman, Lisa F. [3 ]
Wright, Rosalind J. [4 ,5 ]
机构
[1] Boston Univ, Sch Med, Div Gen Pediat, Boston, MA 02118 USA
[2] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[3] Harvard Univ, Sch Publ Hlth, Dept Soc Human Dev & Hlth, Boston, MA 02115 USA
[4] Harvard Univ, Sch Med, Boston, MA USA
[5] Brigham & Womens Hosp, Dept Med, Channing Lab, Boston, MA USA
基金
美国国家卫生研究院;
关键词
longitudinal study; socioeconomic status; self-rated health; adolescents; exposure to violence;
D O I
10.1542/peds.2007-3063
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
OBJECTIVE. The goal was to determine whether cumulative exposure to violence in childhood and adolescence contributes to disparities in self-rated health among a nationally representative sample of US adolescents. METHODS. The National Longitudinal Survey of Youth 1997 is an ongoing, 8-year (1997-2004), longitudinal, cohort study of youths who were 12 to 18 years of age at baseline (N = 8224). Generalized estimating equations were constructed to investigate the relationship between cumulative exposure to violence and risk for poor health. RESULTS. At baseline, 75% of subjects reported excellent or very good health, 21.5% reported good health, and 4.5% reported fair or poor health. Cumulative violence exposures (witnessed gun violence, threat of violence, repeated bullying, perceived safety, and criminal victimization) were associated with a graded increase in risk for poor health and reduced the strength of the relationship between household income and poor health. In comparison with subjects with no violence exposure, risk for poor self-rated health was 4.6 times greater among subjects who reported >= 5 forms of cumulative exposure to violence, controlling for demographic features and household income. Trend analysis revealed that, for each additional violence exposure, the risk of poor health increased by 38%. Adjustment for alcohol use, drug use, smoking, depressive symptoms, and family and neighborhood environment reduced the strength of the relationships between household income and cumulative exposure to violence scores and poor self-rated health, which suggests partial mediation of the effects of socioeconomic status and cumulative exposure to violence by these factors. CONCLUSIONS. In this nationally representative sample, social inequality in risk for poor self-rated health during the transition from adolescence to adulthood was partially attributable to disparities in cumulative exposure to violence. A strong graded association was noted between cumulative exposure to violence and poor self-rated health in adolescence and young adulthood. Pediatrics 2008; 122: 961-970
引用
收藏
页码:961 / 970
页数:10
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