Background Adverse childhood experiences (ACEs) are a measure of childhood adversity, reflecting exposures to abuse, neglect, and household dysfunction prior to the age of 18. They have consistently been associated with worse adult health outcomes, as caused by psychological stress. Although these outcomes include metabolic disease, few studies have been able to examine the association of ACEs directly with adult stress eating. Thus, we examined the association of ACEs and frequent adult stress eating in a largely low-income and racially diverse population in the southern US. Methods Among 32,209 Southern Community Cohort Study participants primarily recruited from clinics that serve the un- and under-insured in 12 southeastern states, we used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of ACEs with frequent adult stress eating, adjusted for age, sex, and income. As a secondary analysis, we calculated ORs further adjusted for adult mental and emotional well-being. Results Individuals with any ACE were more likely to report frequent stress eating as an adult compared to those without ACEs (OR 1.47; 95% CI 1.38, 1.56). By number of ACEs, there was a significant dose-response trend, with ORs rising from 1.16 (95% CI 1.07, 1.25) for 1 ACE to 1.93 (95% CI 1.78, 2.09) for 4 or more ACEs (p for trend <0.0001) for the likelihood of frequent adult stress eating. These findings remained significant after further adjusting for mental and emotional well-being. Conclusions With the finding that ACEs are associated with adult stress eating across populations, even beyond the impact of depression and other mental-emotional well-being factors, research is needed to explore whether trauma intervention strategies can mitigate adult stress eating behavior and related poor health outcomes.
Sydney Aquilina, M. Shrubsole, J. Butt et al.· Research Square· 0 citations
Purpose Higher SES is associated with lower mortality among colorectal cancer (CRC) survivors. We performed a mediation analysis to identify factors that mediate the association between household income and CRC mortality. Methods Data arise from 1038 participants of the prospective Southern Community Cohort Study (SCCS) who developed incident CRC after enrollment (2002-2009); 73% self-identify as Black. Fifty-nine percent self-reported household income <$15,000/year. Mortality outcomes were determined via the National Death Index. Proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality by income level. Mediation analysis was used to estimate indirect effects of stage, healthcare-access and use, comorbidities and health behaviors on mortality. Results Higher income was associated with lower risk for all-cause mortality (≥$15,000 vs. <$15,000/year: HR = 0.70, 95%CI:0.58-0.84) and CRC-specific mortality (HR = 0.75, 95%CI:0.59-0.94). Differences in stage and surgical resection together explained 33% of the association with CRC-specific mortality and 16% for all-cause mortality. Smoking history explained 11% of the association with all-cause mortality and 9% for CRC-specific mortality. Diet explained 9% of the association with each outcome. Adjustment for all potential mediators explained 26% and 44% of the associations with all-cause and CRC-specific mortality, respectively. Associations between income and mortality were similar for participants with local/regional tumors only. Conclusions Differences in early detection and surgical resection are the strongest mediators of the association between income and mortality. SES-targeted health policies and patient navigation will improve CRC outcomes. Additionally, health policies to address smoking cessation and food availability will create opportunities for interventions to promote health equity.
Thomas P. Lawler, Oluwatoyosi Ogunmuyiwa, Rida A Khatri et al.· SSM: Population Health· 0 citations