Does socioeconomic adversity in childhood explain the association between neighborhood disadvantage and health behaviors?

摘要

Background Early life socioeconomic adversities may play a role in the associations observed between neighbourhood characteristics and health. However, few studies have examined whether childhood adversity is a confounder or modifier in the associations between neighbourhood socioeconomic disadvantage and health behaviours. Aims We examined the role of self-reported childhood adversity in the association between neighbourhood disadvantage and co-occurrence of behavioural risk factors (sum of smoking, moderate/heavy alcohol use and physical inactivity) among 31 271 Finnish public sector employees. Methods The analyses were run using multilevel cumulative logistic regression with adjustments first for age, and then also for sex, marital status, individual socioeconomic characteristics (occupational position, residence size and housing tenure), and population density in the area. Results Childhood adversity was associated with co-occurrence of behavioural risk factors with age-adjusted cumulative odds ratio (COR) of 1.32 (95% CI: 1.25-1.40, for 3-6 vs. 0 adversities). However, adversity had no effect on the association between neighbourhood disadvantage and the sum of risk factors; this age-adjusted COR was 1.52 (95% CI: 1.43-1.62) in the highest vs. lowest disadvantage quartile when not including adversity, and 1.50 (95% CI: 1.40-1.60) when adjusting for childhood adversity. Additional adjustments attenuated both associations (COR 1.20, 95% CI: 1.12-1.29 for the highest vs. lowest quartile of disadvantage, and COR 1.25, 95% CI: 1.18-1.33 for 3-6 vs. 0 adversities). In adversity-stratified analyses those reporting 3-6 adversities had higher likelihood of co-occurrence of health risk behaviours than those with 2,1, or 0 adversities (test for interaction p=0.07). Conclusions Childhood adversity has no effect on the associations between neighbourhood disadvantage and co-occurrence of behavioural risk factors in these data. However, those with more adverse childhood experiences may be susceptible for the socioeconomic effects of neighbourhoods.