Background Childhood adversity strongly predicts adolescent multiple health risk behaviours (MRBs) such as alcohol/tobacco use, self-harm, and physical inactivity, and both adversities and MRBs are associated with premature mortality as well as several chronic health conditions that are among the leading causes of death in adults. It is therefore important to understand the relationship between adversities and MRBs and what could mediate any association. The aim of this study was to explore whether childhood psychopathology mediates associations between adversities and MRBs. Methods Participants were young people in the Avon Longitudinal Study of Parents and Children (ALSPAC) (N=5799). Using structural equation modelling, we explored the associations between adversities before 9 years and MRBs at age 16 years. We also explored potential mediating pathways through dimensional psychopathology measured by the Strength and Difficulties Questionnaire subscales at age 12 years. Results There were strong positive associations between adversities and MRBs (β 0.25, 95% CI 0.20, 0.31, p<0.001) suggesting that each additional adversity is associated with a 0.25 increase in number of MRBs out of 13 total risk behaviours. We found robust evidence of mediating pathways from adversities through conduct problems (β 0.05, 95% CI 0.03, 0.06, p<0.001), hyperactivity/inattention (β 0.02, 95% CI 0.01, 0.03, p<0.001) and peer relationship problems (β -0.02, 95% CI -0.03, -0.02, p<0.001) to MRBs. Conclusions Increased conduct problems and hyperactivity/inattention appear to partially explain the relationship between adversities and MRBs. Peer relationship problems also appear to reduce the association between adversities and MRBs and further research is needed to understand how to encourage peer connectivity without increasing risk of MRBs. These results suggest that interventions aimed at reducing MRBs among those exposed to childhood adversities could focus on prevention of behavioural problems.
Bibliographical noteFunding Information:
The UK Medical Research Council (MRC) and Wellcome (Grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. This publication is the work of the authors, and D.T. and C.W. will serve as guarantors for the contents of this paper. A comprehensive list of grants funding is available on the ALSPAC website ( http://www.bristol.ac.uk/alspac/external/documents/grant‐acknowledgements.pdf ). This research was specifically funded by the Wellcome Trust and the MRC (Grant refs: 076467/Z/05/Z & 092731). D.T. is currently funded by the NIHR School for Public Health Research Launching Fellowship and acknowledges past funding from the Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer) which received funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES‐590‐28‐0005), Medical Research Council, the Welsh Assembly Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration. C.W. is funded by a Cancer Research UK Population Research Postdoctoral Fellowship (C60153/A23895). A.R. was funded by the Medical Research Foundation and Medical Research Council Grant (MR/R004889/1). J.K. is funded by the NIHR’s School for Public Health Research. This publication presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. The authors have declared that they have no competing or potential conflicts of interest.
© 2021 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
- Adverse childhood experiences
- multiple health risk behaviours
- psychosocial attributes
- mediation analysis
- structural equation modelling
- UK birth cohort study