Child Adversity, Adult Intimate Partner Violence and Inflammation in Young Adults

Negative childhood experiences and adult intimate partner violence may leave individuals vulnerable to poor mental and physical health in adulthood. Victims of emotional abuse and intimate partner violence have a higher risk of developing chronic medical conditions in adult life, including cardiovascular disease. Similarly, adults who lived in poverty as children have higher risk of cardiovascular disease. The immune system releases acute-phase proteins such as C-reactive protein (CRP) not only in response to infections but also in response to exposure to traumatic experiences. CRP has been linked to the incidence and progression of atherosclerosis, a precursor for cardiovascular disease. To understand potential pathways that link emotional abuse, intimate partner violence and exposure to poverty to chronic medical conditions in adulthood, this dissertation first investigates the association between emotional abuse and elevations in CRP. Second it examines the relationship between adult intimate partner violence and CRP. For emotional abuse and intimate partner violence gender interactions are tested. Lastly, the dissertation tests for an effect of poverty status in childhood and/or adulthood on CRP and investigates the extent to which poverty may compound the effects of emotional abuse and intimate partner violence on CRP.This dissertation uses data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a prospective observational study of a nationally representative sample of U.S adolescents enrolled in grades seven to twelve in the 1994-1995academic year. Funded by the National Institute of Child Health and Development (NICHD), the study is overseen by the Carolina Population Center at the University of North Caroline at Chapel Hill (UNC) (Harris, 2008). Add Health focuses on social factors that influence adolescent and young adult family and peer networks, health behaviors and health status. This dissertation uses data from three of the four waves of data: Wave I data was collected during 1994-1995 when respondents were enrolled in grades seven to twelve; Wave III data was collected from original Wave 1 respondents in 2001-2002 when these young adults were between the ages of 18 and 26 and Wave IV data was again collected from original Wave I respondents were between the ages 24 and 32 now settling into young adulthood. At Wave IV respondents provided blood samples in the form of dried blood spots (DBS), which were later analyzed for a variety of biological markers including C-reactive protein. All analyses for this dissertation used statistical methods adjusted for the complex sampling design of Add Health. Repeated exposure to emotional abuse was significantly associated with CRP in fully adjusted models, although there was no evidence of a gender interaction. Similarly, experiencing chronic intimate partner violence in adulthood was significantly associated with elevated CRP levels in fully adjusted models. Young adults who lived in poverty as children had significantly higher CRP levels after adjusting for parents’ education, young adults’ own education level, demographic characteristics and known risk factors for CRP including smoking, BMI and depressive symptoms. Respondents who lived in poverty as children and remained in poverty as adults also had significantly higher CRP levels, and the association appears to be mediated by BMI.This dissertation finds support for the enduring effects of early life adversity and adult traumatic experiences on inflammation—a risk factor for cardiovascular disease. These findings also mirror population level disparities in the incidence of cardiovascular disease. Public health implications include health education efforts to increase knowledge about the physiologic consequences of emotional abuse and intimate partner violence. Secondary prevention efforts include routine screenings for exposure to emotional abuse, intimate partner violence and material adversity in primary care settings as well as increasing referrals to community based programs designed to help families cope with adversity