Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences.

OBJECTIVES: To estimate the adult health burden and costs in California during 2013 associated with adults' prior Adverse Childhood Experiences (ACEs). METHODS: We analyzed five ACEs-linked conditions (asthma, arthritis, COPD, depression, and cardiovascular disease) and three health risk factors (lifetime smoking, heavy drinking, and obesity). We estimated ACEs-associated fractions of disease risk for people aged 18+ for these conditions by ACEs exposure using inputs from a companion study of California Behavioral Risk Factor Surveillance System data for 2008-2009, 2011, and 2013. We combined these estimates with published estimates of personal healthcare spending and Disability-Adjusted-Life-Years (DALYs) in the United States by condition during 2013. DALYs captured both the years of healthy life lost to disability and the years of life lost to deaths during 2013. We applied a published estimate of cost per DALY. RESULTS: Among adults in California, 61% reported ACEs. Those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 DALYs valued at approximately $102 billion dollars. During 2013, the estimated health burden per exposed adult included $589 in personal healthcare expenses and 0.0224 DALYs valued at $5,769. CONCLUSIONS: Estimates of the costs of childhood adversity are far greater than previously understood and provide a fiscal rationale for prevention efforts.

Weight Gain in Infancy and Overweight or Obesity in Childhood across the Gestational Spectrum: a Prospective Birth Cohort Study.

This study aimed to investigate the optimal degree of weight gain across the gestational spectrum in 1971 children enrolled at birth and followed up to age 7 years. Weight gain in infancy was categorized into four groups based on weight gain z-scores: slow (<-0.67), on track (-0.67 to 0.67), rapid (0.67 to 1.28), and extremely rapid (>1.28). Underweight and overweight or obesity (OWO) were defined as a body mass index ≤5(th) and ≥85(th) percentile, respectively, for age and gender. In our population, OWO was far more common than underweight (39.7% vs. 3.6%). Weight gain tracked strongly from age 4 to 24 months, and was positively associated with OWO and an unfavorable pattern of metabolic biomarkers, although the degree of weight gain for the risk was different across gestational categories. Extremely rapid weight gain led to a particularly high risk of OWO among children born early term and late preterm: odds ratio: 3.3 (95% confidence interval: 1.9 to 5.5) and 3.7 (1.8 to 7.5), respectively, as compared to those with on track weight gain. Our findings suggest that monitoring and ensuring optimal weight gain across the entire gestational spectrum beginning from birth represents a first step towards primary prevention of childhood obesity.

Salivary latent trait cortisol (LTC): Relation to lipids, blood pressure, and body composition in middle childhood.

Adversity experienced early in life has the potential to influence physical health later in life. The stress-health relation may be partially explained by stress-related effects on cardiovascular risk factors. This study explored links between individual differences in trait-like variation in the activity of the hypothalamic-pituitary-adrenal (HPA) axis with cardiovascular risk factors in children. 474 children (M age=9.22years; 54% female; 83% Caucasian) were included in this study, in which cardiovascular risk was assessed using the following indices - triglycerides (TG), HDL-cholesterol (HDL-C), glucose (Glu); resting systolic and diastolic blood pressure, body mass index (BMI), waist-to-hip ratio, and % fat. Saliva samples were measured 3 times a day (waking, 30min post-waking and bedtime) over 3days (later assayed for cortisol). A latent trait cortisol (LTC) factor explained 43% of the variance in cortisol levels within and across days. Confirmatory factor analysis identified three cardiovascular risk factors: lipids (i.e., TG and HDL-C), blood pressure (i.e., systolic and diastolic), and body composition (i.e., BMI, Waist-to-hip ratio, and % fat). Lower salivary LTC was associated with higher lipids, higher blood pressure, and higher body composition. The findings further support the internal and external validity of the LTC construct, and may also advance our understanding of the link between interindividual differences in HPA axis activity and cardiovascular risk in middle childhood.

Cardiovascular Risk Factors in Parents of Food-Allergic Children.

Previous studies suggest that chronic stress may induce immune system malfunction and a broad range of adverse health outcomes; however, the underlying pathways for this relationship are unclear. Our study aimed to elucidate this question by examining the relationship between parental cardiovascular risk factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and waist-to-hip ratio (WHR) and maternal psychological stress score (MPSS) relative to the severity of the child's food allergy (FA) and number of affected children. SBP, DBP, BMI, and WHR were measured and calculated at the time of recruitment by trained nurses. MPSS was obtained based on self-report questionnaires covering lifestyle adjustments, perceived chronic stress, and quality of life. General linear models examined whether caregiver chronic stress was associated with FA. For mothers with children under age 5 years, SBP, DBP and number of affected children had strong and graded relationships with severity of the child's FA. MPSS was also significantly and positively associated with child FA severity (P < 0.001). However, no relationships were found between FA severity, BMI, or WHR for either parent. This was also the case for paternal SBP, DBP, and number of affected children of any age. There is a strong and graded link between cardiovascular risk and perceived stress in mothers of food-allergic children under age 5. Findings may have important implications for family-centered care of FA, may generalize to caregivers of children with chronic conditions, and extend the literature on allostatic load.

The Association of Maternal Obesity and Diabetes With Autism and Other Developmental Disabilities.

BACKGROUND: Obesity and diabetes are highly prevalent among pregnant women in the United States. No study has examined the independent and combined effects of maternal prepregnancy obesity and maternal diabetes on the risk of autism spectrum disorder (ASD) in parallel with other developmental disorders (DDs). METHODS: This study is based on 2734 children (including 102 ASD cases), a subset of the Boston Birth Cohort who completed at least 1 postnatal study visit at Boston Medical Center between 1998 and 2014. Child ASD and other DDs were based on physician diagnoses as documented in electronic medical records. Risks of ASD and other DDs were compared among 6 groups defined by maternal prepregnancy obesity and diabetes status by using Cox proportional hazard regression controlling for potential confounders. RESULTS: When examined individually, maternal prepregnancy obesity and pregestational diabetes (PGDM) were each associated with risk of ASD. When examined in combination, only mothers with obesity and PGDM (hazard ratio 3.91, 95% confidence interval 1.76-8.68) and those with obesity and gestational diabetes (hazard ratio 3.04, 95% confidence interval 1.21-7.63) had a significantly increased risk of offspring ASD. Intellectual disabilities (IDs), but not other DDs, showed a similar pattern of increased risk associated with combined obesity and PGDM. This pattern of risk was mostly accounted for by cases with co-occurring ASD and ID. CONCLUSIONS: Maternal prepregnancy obesity and maternal diabetes in combination were associated with increased risk for ASD and ID. ASD with ID may be etiologically distinct from ASD without ID.

Genome-wide association study identifies peanut allergy-specific loci and evidence of epigenetic mediation in US children.

Food allergy (FA) affects 2%-10% of US children and is a growing clinical and public health problem. Here we conduct the first genome-wide association study of well-defined FA, including specific subtypes (peanut, milk and egg) in 2,759 US participants (1,315 children and 1,444 parents) from the Chicago Food Allergy Study, and identify peanut allergy (PA)-specific loci in the HLA-DR and -DQ gene region at 6p21.32, tagged by rs7192 (P=5.5 × 10(-8)) and rs9275596 (P=6.8 × 10(-10)), in 2,197 participants of European ancestry. We replicate these associations in an independent sample of European ancestry. These associations are further supported by meta-analyses across the discovery and replication samples. Both single-nucleotide polymorphisms (SNPs) are associated with differential DNA methylation levels at multiple CpG sites (P<5 × 10(-8)), and differential DNA methylation of the HLA-DQB1 and HLA-DRB1 genes partially mediate the identified SNP-PA associations. This study suggests that the HLA-DR and -DQ gene region probably poses significant genetic risk for PA.

Body mass index and waist circumference rather than body adiposity index are better surrogates for body adiposity in a Chinese population.

BACKGROUND: Several studies have found that body adiposity index (BAI) is a better index of body adiposity than body mass index (BMI) in African and Mexican American adults. This study aims to evaluate the ability of BAI to predict body adiposity in Chinese children and adults. MATERIALS AND METHODS: In total, 2425 children and 5726 adults were recruited from rural China. All participants completed whole-body dual-energy X-ray absorptiometry (DXA) and anthropometric measures. The correlation of BMI, BAI, and waist circumference (WC) to DXA adiposity indexes was performed across sex-specific adult and age- and sex-specific child cohorts, using Spearman correlation and linear regression models, respectively. RESULTS: Both BMI and WC had a higher correlation with all adiposity indexes (whole body fat, percent body fat [Bfat%], trunk fat, and percent trunk fat [Tfat%]) measured by DXA than did BAI in both adults and children. Meanwhile, most of the linear regression model associations for BMI with Bfat% and Tfat% had a greater adjusted R(2) than those for BAI among both children and adults. CONCLUSION: This study indicates that BMI and WC are better tools than BAI for estimating whole body fat and central body fat in a Chinese population.

Preterm birth and random plasma insulin levels at birth and in early childhood.

IMPORTANCE: Although previous reports have linked preterm birth with insulin resistance in children and adults, it is not known whether altered insulin homeostasis is detectable at birth and tracks from birth through childhood. OBJECTIVE: To investigate whether preterm birth is associated with elevated plasma insulin levels at birth and whether this association persists into early childhood. DESIGN, SETTING, AND PARTICIPANTS: A prospective birth cohort of 1358 children recruited at birth from 1998 to 2010 and followed-up with prospectively from 2005 to 2012 at the Boston Medical Center in Massachusetts. MAIN OUTCOMES AND MEASURES: Random plasma insulin levels were measured at 2 time points: at birth (cord blood) and in early childhood (venous blood). The median age was 1.4 years (interquartile range [IQR], 0.8-3.3) among 4 gestational age groups: full term (≥39 wk), early term (37-38 wk), late preterm (34-36 wk), and early preterm (<34 wk). RESULTS: The geometric mean of insulin levels at birth were 9.2 µIU/mL (95% CI, 8.4-10.0) for full term; 10.3 µIU/mL (95% CI, 9.3-11.5) for early term; 13.2 µIU/mL (95% CI, 11.8-14.8) for late preterm; and 18.9 µIU/mL (95% CI, 16.6-21.4) for early preterm. In early childhood, these levels were 11.2 µIU/mL (95% CI, 10.3-12.0) for full term; 12.4 µIU/mL (95% CI, 11.3-13.6) for early term; 13.3 µIU/mL (95% CI, 11.9-14.8) for late preterm; and 14.6 µIU/mL (95% CI, 12.6-16.9) for early preterm. Insulin levels at birth were higher by 1.13-fold (95% CI, 0.97-1.28) for early term, 1.45-fold (95% CI, 1.25-1.65) for late preterm, and 2.05-fold (95% CI, 1.69-2.42) for early preterm than for those born full term. In early childhood, random plasma insulin levels were 1.12-fold (95% CI, 0.99-1.25) higher for early term, 1.19-fold (95% CI, 1.02-1.35) for late preterm, and 1.31-fold (95% CI, 1.10-1.52) for early preterm than those born full term. The association was attenuated after adjustment for postnatal weight gain and was not significant after adjustment for insulin levels at birth. Infants ranked in the top insulin tertile at birth were more likely to remain in the top tertile (41.2%) compared with children ranked in the lowest tertile (28.6%) in early childhood. CONCLUSIONS AND RELEVANCE: There was an inverse association between gestational age and elevated plasma insulin levels at birth and in early childhood. The implications for future development of insulin resistance and type 2 diabetes warrant further investigation.

Selecting an EBP to reduce long-term foster care: lessons from a university-child welfare agency partnership.

A growing implementation literature outlines broad evidence-based practice implementation principles and pitfalls. Less robust is knowledge about the real-world process by which a state or agency chooses an evidence-based practice to implement and evaluate. Using a major U.S. initiative to reduce long-term foster care as the case, this article describes three major aspects of the evidence-based practice selection process: defining a target population, selecting an evidence-based practice model and purveyor, and tailoring the model to the practice context. Use of implementation science guidelines and lessons learned from a unique private-public-university partnership are discussed.

The combined association of psychosocial stress and chronic hypertension with preeclampsia.

OBJECTIVE: This study aims to evaluate perceived lifetime stress, perceived stress during pregnancy, chronic hypertension, and their joint association with preeclampsia risk. STUDY DESIGN: This study includes 4314 women who delivered a singleton live birth at the Boston Medical Center from October 1998 through February 2008. Chronic hypertension was defined as hypertension diagnosed before pregnancy. Information regarding lifetime stress and perceived stress during pregnancy was collected by questionnaire. Preeclampsia was diagnosed by clinical criteria. RESULTS: Lifetime stress (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.9), perceived stress during pregnancy (OR, 1.7; 95% CI, 1.3-2.2), and chronic hypertension (OR, 10.4; 95% CI, 7.5-14.4) were each associated with an increased risk of preeclampsia. Compared to normotensive pregnancy with low lifetime stress, both normotensive pregnancy with high lifetime stress (OR, 2.1; 95% CI, 1.6-2.9) and pregnancy with chronic hypertension and low lifetime stress (OR, 10.2; 95% CI, 7.0-14.9) showed an increased risk of preeclampsia, while pregnancy with high lifetime stress and chronic hypertension yielded the highest risk of preeclampsia (OR, 21.3; 95% CI, 10.2-44.3). The joint association of perceived stress during pregnancy and chronic hypertension with preeclampsia was very similar to that of the joint association of lifetime stress and chronic hypertension with preeclampsia. CONCLUSION: This finding indicates that high psychosocial stress and chronic hypertension can act in combination to increase the risk of preeclampsia up to 20-fold. This finding underscores the importance of efforts to prevent, screen, and manage chronic hypertension, along with those to reduce psychosocial stress, particularly among women with chronic hypertension.

Epigenetics and early life origins of chronic noncommunicable diseases.

In light of the increasing threats of chronic noncommunicable diseases in developing countries, the growing recognition of the early life origins of chronic disease, and innovative breakthroughs in biomedical research and technology, it is imperative that we harness cutting-edge data to improve health promotion and maintenance. It is well recognized that chronic diseases are complex traits affected by a wide range of environmental and genetic factors; however, the role of epigenetic factors, particularly with regard to early life origins, remains largely unexplored. Given the unique properties of the epigenome-functionality during critical time windows, such as the intrauterine period, heritability, and reversibility-enhancing our understanding of epigenetic mechanisms may offer new opportunities for the development of novel early prediction and prevention paradigms. This may present an unparalleled opportunity to offer maternal and child health professionals important tools with the translational value to predict, detect, and prevent disease at an early age, long before its clinical occurrence, and as such, break lifelong and transgenerational cycles of disease. In doing so, modern technology can be leveraged to make great contributions to population health, quality of life, and reducing the burdensome economic costs of noncommunicable diseases in developing countries.

Defining a target population at high risk of long-term foster care: barriers to permanency for families of children with serious emotional disturbances.

Long-term foster care (LTFC) is an enduring problem that lacks evidence of effective strategies for practice or policy. This article describes initial activities of a statewide project of the national Permanency Innovations Initiative. The authors sought to: (1) verify the relevance of children's mental health as a predictor of LTFC, (2) describe critical barriers encountered by parents of children with serious emotional disturbances, and (3) identify systems barriers that hinder permanency for this target population.

Nature, nurture and academic achievement: a twin study of teacher assessments of 7-year-olds.

BACKGROUND: Twin research has consistently shown substantial genetic influence on individual differences in cognitive ability; however, much less is known about the genetic and environmental aetiologies of school achievement. AIMS: Our goal is to test the hypotheses that teacher-assessed achievement in the early school years shows substantial genetic influence but only modest shared environmental influence when children are assessed by the same teachers and by different teachers. SAMPLE: 1,189 monozygotic (MZ) and dizygotic (DZ) twin pairs born in 1994 in England and Wales. METHODS: Teachers evaluated academic achievement for 7-year-olds in Mathematics and English. Results were based on the twin method, which compares the similarity between identical and fraternal twins. RESULTS: Suggested substantial genetic influence in that identical twins were almost twice as similar as fraternal twins when compared on teacher assessments for Mathematics, English and a total score. CONCLUSIONS: The results confirm prior research suggesting that teacher assessments of academic achievement are substantially influenced by genetics. This finding holds even when twins are assessed independently by different teachers.

Genetics and educational psychology.

BACKGROUND: Molecular genetics, one of the most energetic and exciting areas of science, is slowly but surely coming to educational psychology. AIMS: We review recent molecular genetic research on learning disabilities as a sign of things to come in educational psychology. We also consider some misconceptions about genetics that have slowed the acceptance of genetics in educational psychology. SAMPLES: Diverse samples of children with learning disabilities have been studied, primarily in the UK and the USA. METHODS: Linkage analysis can detect genes that have large effects on learning disabilities. Association analysis can detect genes of much smaller effect size, which is important because common disorders such as learning disabilities are likely to be influenced by many genes as well as by many environmental factors. RESULTS: For reading disability, replicated linkages have been identified on chromosomes 6, 15 and 18. A gene responsible for a rare type of language impairment has recently been identified. For common language impairment, linkages on chromosomes 16 and 19 have recently been reported. More than 200 genetic disorders, most extremely rare, include mental retardation among their symptoms, and chromosomal abnormalities are a major cause of mental retardation. CONCLUSIONS: Although finding specific genes associated with learning disabilities is unlikely to have much of a direct application for teachers in the classroom, such findings will have far-reaching implications for diagnosis, treatment and prevention of learning disabilities and for research in educational psychology. Educational psychology has been slower to accept evidence for the importance of genetics than other areas of psychology in part because of misconceptions about what it means to say that genetics is important for common complex disorders such as learning disabilities.