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

Division of General Pediatrics, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2008; 122(5):961-70. DOI: 10.1542/peds.2007-3063
Source: PubMed


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.
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.
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 >or=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.
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.

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    • "Overall, it has been found that exposure to family conflict has the potential to affect a large range of negative outcomes, but internalising problems are most consistently represented (Harold and Conger 1997; Herrenkohl et al. 2009; Neighbors et al. 1997; Rice et al. 2006; Sheeber et al. 1996; Shelton and Harold 2008), particularly in adolescent depression (Garnefski and Doets 2000; Patton et al. 2008; Sallinen et al. 2004). Even though many studies have measured children and adolescent's exposure to conflict, one is unique in that it has addressed and reported on the specific levels of cumulative violence exposure necessary for negative health outcomes (Boynton-Jarrett et al. 2008). The finding that exposure to ≥5 types of violence leads to a 4.6-fold increase in the likelihood of poor health is a well-defined starting point that further research can use to establish a minimum level of perceived conflict that could induce harm in children or adolescents (Boynton-Jarrett et al. 2008). "
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