Difficult childhood experiences — from bullying and neglect to physical and sexual abuse — are so prevalent that the American Heart Association is issuing its first scientific statement on their impact on cardiovascular health.
Fifty-nine percent of the U.S. population say they experienced at least one so-called adverse experience as a child or adolescent. The statement, published Monday in Circulation, asserts that substantial evidence links such adverse experiences to obesity, high blood pressure, Type 2 diabetes and cardiovascular disease in adulthood.
“Child maltreatment isn’t something we often talk about, and it’s a traumatic experience for children,” said Shakira Suglia, Sc.D., chair of the group that wrote the report and associate professor of epidemiology at Emory University’s Rollins School of Public Health in Atlanta.
While there’s a lack of agreement on exactly what constitutes childhood and adolescent adversity, the experiences are defined broadly as any threat to the safety of a child’s body, family and social structure. That can include dozens of specific threats, such as emotional abuse, the imprisonment of a parent, or parents getting divorced. Physical, sexual or emotional abuse and neglect are also types of childhood adversity and are known to disrupt normal development.
The general consensus is, the higher the number of adverse childhood experiences, the higher the health risks.
“I agree with pretty much everything in the statement,” said psychologist Karen Matthews, Ph.D., director of the Cardiovascular Behavioral Medicine Research Training Program at the University of Pittsburgh School of Medicine.
“Research certainly is pointing in the direction of what happens early in life has long-standing effect on cardiovascular health,” said Matthews, who was not involved in writing the new statement.
The report is intended to inform the public about what’s known about some of the health effects of difficult experiences early in life and present a road map for future research.
Cardiometabolic diseases such as Type 2 diabetes and cardiovascular diseases such as heart failure and stroke are among the leading causes of disease and death in the United States. Each year, heart disease is responsible for one in every four U.S. deaths — at least 610,000 people — and diabetes kills over 76,000 people.
Moreover, they create an escalating economic burden on society. Heart disease and stroke cost an estimated $316 billion and diagnosed diabetes costs an estimated $245 billion a year.
Three interrelated pathways — behavioral, mental health and biological — help explain how difficult experiences as a child increase cardiometabolic health risks, Suglia explained.
For example, childhood adversity is associated with coping behaviors such as smoking, overeating and inactivity, which increase the risk of obesity and cardiovascular disease. Being obese as a kid or teen is associated with a higher risk of cardiovascular disease as an adult.
Unhealthy childhood behaviors can also negatively affect mental health and increase the risk of mood and anxiety disorders, which can lead to cardiometabolic disease. And recent research suggests childhood adversity may even alter how genes behave, Suglia said.
Very young children may be particularly at risk. Research shows they are more vulnerable to the effect of maltreatment on their behavior, suggesting there are sensitive periods during childhood when exposure to negative experiences can be especially harmful to long-term health, Suglia said.
Other factors, such as gender, race, ethnicity, socioeconomic status and place of birth, also play a role.
“Gender differences come into play on which cardiovascular outcomes are important,” said Matthews, who has studied this in adolescents. “Literature hints that exposure to violence in childhood is more impactful on obesity and depression for girls and hypertension for boys.”
Most of the existing research is based on reports by adults of childhood events. The AHA statement notes the need for more research conducted during childhood that considers the influence of race, gender, socioeconomic status and immigration history.
To date, there are no national health care guidelines or recommendations for childhood adversity, the statement points out.
“We need to look at earlier time points as to when childhood and adolescent adversities start to impact health and how interventions impact the health of children,” Suglia said. “The how is certainly something we need to do more work on.”
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