Cited by 145Child Abuse and TraumaBirth, Development, and HealthHealth disparities and outcomes

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Childhood Adversities and Adult Cardiometabolic Health: Does the Quantity, Timing, and Type of Adversity Matter?

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Friedman, Esther M., Montez, Jennifer Karas, Sheehan, Connor McDevitt, Guenewald, Tara L., Seeman, Teresa E.·2015·Journal of Aging and Health

DOI 10.1177/0898264315580122PMC PMC4618269

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Abstract

Objective: Adverse events in childhood can indelibly influence adult health. While evidence for this association has mounted, a fundamental set of questions about how to operationalize adverse events has been understudied. Method: We used data from the National Survey of Midlife Development in the United States to examine how quantity, timing, and types of adverse events in childhood are associated with adult cardiometabolic health. Results: The best-fitting specification of quantity of events was a linear measure reflecting a dose–response relationship. Timing of event mattered less than repeated exposure to events. Regarding the type of event, academic interruptions and sexual/physical abuse were most important. Adverse childhood events elevated the risk of diabetes and obesity similarly for men and women but had a greater impact on women’s risk of heart disease. Discussion: Findings demonstrate the insights that can be gleaned about the early-life origins of adult health by examining operationalization of childhood exposures.

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“…preliminary research has not found a consistent trend regarding the relative impact of early versus late adversity; rather, it is the repeated exposure to adversity that appears to be the more important factor in harms to health and wellbeing (Friedman et al., 2015; Romero-Martínez et al., 2014).”
Background
Examining the prevalence of adverse childhood experiences (ACEs) among justice-involved youth in the U.S.: The importance of accounting for race/ethnicity, gender, and gendered racial/ethnic groups
Belisle, L. A., Pinchevsky, G. M., & Ortega, G. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2023.106514 · Cited by 15
Life Events and Adaptive Coping Approaches to Self-Management From the Perspectives of Hospitalized Cardiovascular Patients: A Qualitative Study
Qiu, R., Tang, L., Wang, X., & Ye, Z. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.692485 · Cited by 12
Status of injuries as a public health burden among children and adolescents in China
Wang, Z., Chen, H., Yu, T., Liu, S., & Hu, M. (2019) · Medicine · doi:10.1097/md.0000000000017671 · Cited by 12
The normalisation of sexual violence revictimisation in regional and rural areas: Our failure to respond
Corbett, E., Power, J., Theobald, J., Edmonds, L., Wright, K., & Hooker, L. (2023) · Australian Journal of Social Issues · doi:10.1002/ajs4.297 · Cited by 11
Associations between adverse childhood experiences and pain in middle-aged and older adults: findings from the China Health and Retirement Longitudinal Study
Luo, J., Ma, Y., Zhan, H.-W., Jia, W.-H., Zhang, J.-R., Xie, S.-Y., Yu, S.-Y., Hou, S.-L., Bi, X., & Wang, X. (2024) · BMC Public Health · doi:10.1186/s12889-024-19239-6 · Cited by 11
Education and Health Conditions Among the Currently Incarcerated and the Non-incarcerated Populations
Sheehan, C. M. (2018) · Population Research and Policy Review · doi:10.1007/s11113-018-9496-y · Cited by 11
Self-citation
Revictimization Is Associated With Higher Cardiometabolic Risk in Sexual Minority Women
Caceres, B. A., Wardecker, B. M., Anderson, J., & Hughes, T. L. (2021) · Women s Health Issues · doi:10.1016/j.whi.2021.02.004 · Cited by 11
Approaches for measuring cumulative childhood adversity: A study of youth from 5 sub-Saharan African countries
Gilbert, L. K., Matthews, S., Dube, S. R., & Annor, F. (2023) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2023.106542 · Cited by 11
“In this study, we compare three different models for operationalizing CCA, ACE score, ACE context, and ACE impact, following the approaches described above (Friedman et al., 2015; Heidinger & Willson, 2019; Schilling et al., 2008).”
BackgroundMethodResultInfluential
Measuring adversity in the ABCD® Study: systematic review and recommendations for best practices
Breslin, F. J., Ratliff, E. L., Cohen, Z. P., Croff, J., & Kerr, K. L. (2025) · BMC Medical Research Methodology · doi:10.1186/s12874-025-02521-5 · Cited by 9
“Indeed, ELA has lasting effects on physical and mental health evident in adulthood [4, 5].”
Evaluating the Cumulative Impact of Childhood Misfortune: A Structural Equation Modeling Approach
Mustillo, S., Li, M., & Ferraro, K. F. (2019) · Sociological Methods & Research · doi:10.1177/0049124119875957 · Cited by 11
Investigating the associations between childhood trauma and cardiovascular health in midlife
Caceres, B. A., Britton, L. E., Cortés, Y. I., Makarem, N., & Suglia, S. F. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22752 · Cited by 11
“Investigators have found that both men and women with a history of childhood trauma have a higher prevalence of diabetes and obesity, but onlywomen demonstrate a significantly higher prevalence of CVD (Friedman et al., 2015).”
Application of life course trajectory methods to public health data: A comparison of sequence analysis and group-based multi-trajectory modeling for modelling childhood adversity trajectories
Elsenburg, L. K., Rieckmann, A., Bengtsson, J., Jensen, A. K., & Rod, N. H. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116449 · Cited by 10
Specifying the psychosocial pathways whereby child and adolescent adversity shape adult health outcomes
Lei, M., Berg, M. T., Simons, R. L., & Beach, S. R. H. (2022) · Psychological Medicine · doi:10.1017/s003329172200318x · Cited by 11
Does the duration of childhood starvation affect life at age 45 or older in China? The mediating role of socioeconomic and health statuses
Liu, Y., Zhao, Y., Tian, Y., & Xu, L. (2020) · Journal of Health Psychology · doi:10.1177/1359105320914364 · Cited by 10
“In addition, miserable experiences, from low birth weight to abuse or economic deprivation, lead to negative effects on adult health (Friedman et al., 2015; Levine et al., 2015).”
Background
Assessing Cardiometabolic Health Risk Among U.S. Children Living in Grandparent-Headed Households
Song, M., Hayman, L. L., Lyons, K. S., Dieckmann, N. F., & Musil, C. M. (2021) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2021.09.003 · Cited by 9
Revictimisation of Women in Non-Urban Areas: A Scoping Review
Corbett, E., Theobald, J., Billett, P., Hooker, L., Edmonds, L., & Fisher, C. (2022) · Trauma Violence & Abuse · doi:10.1177/15248380221094317 · Cited by 10
Alcohol's Collateral Damage: Childhood Exposure to Problem Drinkers and Subsequent Adult Mortality Risk
Rogers, R. G., Lawrence, E., & Montez, J. K. (2016) · Social Forces · doi:10.1093/sf/sow074 · Cited by 9
“…could be valuable, the effects of parental alcohol abuse on children’s health and well-being in adulthood persist even when controlling for childhood SES (e.g., Christoffersen and Soothill 2003; Danese and Tan 2014; Fisher et al. 2010; Friedman et al. 2015; Thomas, Hyppönen, and Power 2008).”
BackgroundSelf-citation
Childhood adversity and women’s cardiometabolic health in adulthood: associations with health behaviors, psychological distress, mood symptoms, and personality
van Dammen, L., Bush, N. R., de Rooij, S. R., Mol, B. W. J., Groen, H., Hoek, A., & Roseboom, T. J. (2019) · BMC Women's Health · doi:10.1186/s12905-019-0797-z · Cited by 9
Learning Disabilities
Hostutler, C. A., Gormley, M. J., Laracy, S. D., & Winterhalter, M. (2018) · Springer eBooks · doi:10.1007/978-3-030-00791-1_15 · Cited by 9
The lasting imprint of childhood disadvantage: cumulative histories of exposure to childhood adversity and trajectories of psychological distress in adulthood
Heidinger, L. S., & Willson, A. E. (2021) · Longitudinal and Life Course Studies · doi:10.1332/175795921x16223516066150 · Cited by 8
Childhood food insufficiency and adulthood cardiometabolic health conditions among a population-based sample of older adults in Puerto Rico
McClain, A. C., Cory, H. J., & Mattei, J. (2022) · SSM - Population Health · doi:10.1016/j.ssmph.2022.101066 · Cited by 9
Effects of early life factors on the health and quality of life of older adults
Yılmaz, F., & Tekin, R. N. (2017) · Psychogeriatrics · doi:10.1111/psyg.12278 · Cited by 8
Childhood maltreatment associated with adolescent peer networks: Withdrawal, avoidance, and fragmentation
Kamis, C., & Copeland, M. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.107125 · Cited by 10
Cumulative environmental stress and emerging cardiometabolic risk during childhood
Kunin‐Batson, A., Haapala, J. L., Crain, A. L., Gunnar, M. R., Kharbanda, E. O., Kelly, A. S., Seburg, E. M., Sherwood, N. E., & French, S. A. (2024) · Pediatric Obesity · doi:10.1111/ijpo.13116 · Cited by 8
“…childhood stressors and later health outcomes have measured psychosocial stress at only a single point in time, 1,8,16 relied on adult retrospective reports of childhood experiences, 7,9,11,17 or examined a limited array of potential stressors 6,10,18 and health outcomes (predominantly obesity).”
Background
Adverse childhood experiences and incident coronary heart disease: a counterfactual analysis in the Whitehall II prospective cohort study
Akasaki, M., Nicholas, O., Abell, J. G., Valencia‐Hernández, C. A., Hardy, R., & Steptoe, A. (2021) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2021.100220 · Cited by 7
The relationship of childhood adversity with diurnal cortisol patterns and C-reactive protein at 60–64 years of age in the 1946 National Survey of Health and Development
Robson, E., Norris, T., Hamer, M., Costa, S., Hardy, R., & Johnson, W. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105362 · Cited by 7
“For example, Lob et al. (2020) using the English Longitudinal Study of Ageing (ELSA) found no strong evidence that cumulative retrospectively reported ACEs were related to hair cortisol in a sample of older adults (N= 2,600, aged 49-69 years).”
MethodInfluential
The impact of the send-down experience on the health of elderly Chinese women: Evidence from the China family panel studies
Liang, Y., & Dong, J. (2021) · International Review of Economics & Finance · doi:10.1016/j.iref.2021.12.017 · Cited by 7
Age- and sex-specific associations between risk scores for schizophrenia and self-reported health in the general population
Paquin, V., Pries, L.-K., ten Have, M., Bak, M., Günther, N., de Graaf, R., van Dorsselaer, S., Lin, B. D., van Eijk, K. R., Kenis, G., et al. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02346-3 · Cited by 7
Childhood adversity trajectories and weight status in young adult men: a register-based study including 359,783 Danish men
Wimmelmann, C. L., Sejling, C., Clarke, R. B., Elsenburg, L. K., Sørensen, T. I. A., & Rod, N. H. (2024) · International Journal of Obesity · doi:10.1038/s41366-024-01540-4 · Cited by 7
Maternal Education in Early Life and Risk of Metabolic Syndrome in Young Adult American Females and Males
Huang, J. Y., Gariépy, G., Gavin, A. R., Rowhani‐Rahbar, A., Siscovick, D. S., & Enquobahrie, D. A. (2019) · Epidemiology · doi:10.1097/ede.0000000000001068 · Cited by 7
Early-Life Adversity Predicting The Incidence of Multisite Chronic Pain in The General Population
Rouch, I., Strippoli, M. F., Dorey, J., Laurent, B., Ranjbar, S., Marques-Vidal, P. M., Berna, C., Suter, M. R., Vaucher, J., von Gunten, A., et al. (2024) · European Psychiatry · doi:10.1192/j.eurpsy.2024.1753 · Cited by 6
“According to the suggestion by Friedman et al. [37], exposure to early-life adversity was also quantified by the sum of reported events.”
Women's Help-Seeking and Service Experiences: Sexual Revictimization in Regional and Rural Areas
Corbett, E., Power, J., Theobald, J., Wright, K., & Hooker, L. (2025) · Violence Against Women · doi:10.1177/10778012251348432 · Cited by 7
“…disorders and higher levels of suicide ideation (Edwards & Banyard, 2022), post-traumatic stress disorder (PTSD; Ullman & Peter-Hagene, 2016), complex PTSD (Cloitre et al., 2009) and physical conditions such as cardiovascular diseases (Friedman et al., 2015) and endometriosis (Harris et al., 2018).”
Exploring the Association Between Trauma, Instability, and Youth Cardiometabolic Health Outcomes Over Three Years
Schuler, B. R., Gardenhire, R., Jones, S., Spilsbury, J. C., Moore, S. M., & Borawski, E. A. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.08.049 · Cited by 7
“Due to potential sex/gender differences in risk exposure, with increased risk for females [39], interaction effects of trauma and instability with child sex on CMR outcomes were examined.”
Background
Adverse Childhood Experiences and Risk of Abnormal Body Mass Index: A Global Systematic Review and Meta-Analysis
Amiri, S., Mahmood, N., Yusuf, R., Ghenimi, N., Javaid, S. F., & Khan, M. A. (2024) · Children · doi:10.3390/children11081015 · Cited by 8
Symptom structure of complex posttraumatic stress disorder among de facto unattended children in China: A network analysis
Liang, Y., Sun, Y., Hong, J., & Xi, J. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.107170 · Cited by 5
The Mediating Effects of Chronic Diseases in the Relationship Between Adverse Childhood Experiences and Trajectories of Depressive Symptoms in Later Life: A Nationwide Longitudinal Study
Dai, Q., Li, M., Wang, Z., Xu, Q., Zhang, X., & Tao, L. (2024) · Healthcare · doi:10.3390/healthcare12242539 · Cited by 5

Authors: Friedman, E. M., Montez, J. K., Sheehan, C. M., Guenewald, T. L., & Seeman, T. E.
Affiliations: RAND Corporation (US)
Syracuse University (US)
The University of Texas at Austin (US)
University of Southern California (US)
University of California, Los Angeles (US)
Corresponding author: Friedman, Esther M.
ORCID: Friedman, Esther M.
Montez, Jennifer Karas
Sheehan, Connor McDevitt
Seeman, Teresa E.
Venue: Journal of Aging and Health
Publisher: SAGE Publications
Published: 2015-04-22
Volume: 27
Issue: 8
Pages: 1311-1338
ISSN: 0898-2643 (ISSN-L)
1552-6887
DOI: 10.1177/0898264315580122
PMC: PMC4618269
OpenAlex: W1975221687
Cited by: 145
References: 69
Citations by year: 2026: 9 · 2025: 11 · 2024: 17 · 2023: 10 · 2022: 14 · 2021: 18 · 2020: 14 · 2019: 18 · 2018: 18 · 2017: 10 · 2016: 4 · 2015: 2
FWCI: 14.05
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Journal of Aging and Health (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
eScholarship (California Digital Library) (submittedVersion)
Funders: National Institutes of Health (2t32hd007545-21)
National Institute on Aging (P30AG028748, P01AG020166, U19AG051426)
National Center for Research Resources (M01RR000865)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32-HD007545, R24HD042849, T32HD007081)
Topics: Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Social Sciences › Health › Health disparities and outcomes
Keywords: adverse childhood experiences, cardiometabolic health, diabetes risk, obesity risk, heart disease risk, sexual abuse, physical abuse, dose-response relationship, sex differences
MeSH terms: Adult Survivors of Child Adverse Events, Adult, Aged, Diabetes Mellitus, Female, Heart Diseases, Humans, Male, Middle Aged, Obesity, Risk, Time Factors, United States

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Childhood Adversities and Adult Cardiometabolic Health: Does the Quantity, Timing, and Type of Adversity Matter?

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