Effects of childhood maltreatment on violent injuries and premature death during young adulthood among urban high-risk men

摘要

Objectives: To assess childhood maltreatment as a risk factor for violent injuries and premature death in young adulthood and whether these associations are mediated by adolescent heavy drinking, hard drug use, hard drug selling, and violent offending. Design: Prospective longitudinal study of boys followed from childhood into young adulthood. Setting: Pittsburgh, Pennsylvania. Participants: A total of 1009 men from the Pittsburgh Youth Study. Main Exposure: Childhood maltreatment. Main Outcome Measures: Premature deaths between ages 18 and 38 years from the Social Security Death Index and self-reports of violent injuries inflicted by gunshot or knife between ages 18 and 28 years. Results: Young men who experienced childhood maltreatment, compared with their counterparts who did not experience it, had a greater risk of violent injuries (relative risk = 1.61; 95% CI, 1.10-2.35) and death (hazard ratio = 2.85; 95% CI, 1.37-5.93) during young adulthood. Adolescent violent offending and hard drug selling explained the association between childhood maltreatment and violent injuries, and violent offending partially accounted for the association between childhood maltreatment and premature death. Although adolescent violent offending predicted both outcomes, maltreated boys still had an increased risk of premature death (hazard ratio = 2.54; 95% CI, 1.21-5.34) after accounting for their adolescent violence. Conclusions: Childhood maltreatment significantly predicts premature death and violent injuries during young adulthood. These associations are partially explained by adolescent involvement in violence and drug dealing. Targeted interventions for maltreated boys to reduce their involvement in adolescent deviant behaviors may help decrease their risks for later serious injuries and premature death.