Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study

Adjei, Nicholas Kofi; Schlüter, Daniela K; Straatmann, Viviane S.; Melis, Gabriella; Fleming, Kate; McGovern, Ruth; Howard, Louise M.; Kaner, Eileen; Wolfe, Ingrid; Taylor‐Robinson, David

doi:10.1016/j.lanepe.2021.100279

Cited by 29 publications

(25 citation statements)

References 37 publications

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“…Previous existing longitudinal studies have consistently shown that a range of adverse child and adolescent outcomes are patterned according to early childhood household income, with those growing up in the poorest families being much more likely to experience negative outcomes such as poor mental health, poor physical health, smoking, obesity, and poor academic achievement. [11][12][13][14][15][16][17][18][19][20][21][22] The examination of each of our five single adverse outcomes confirm these previous findings.…”

Section: Comparison To Previous Researchsupporting

confidence: 88%

“…Nor does our study identify and decipher the mechanisms and mediating pathways that link childhood household income and these adverse outcomes, as this is beyond the scope of this study. Recent studies have found that a substantial part of the relationship between socioeconomic conditions and adverse adolescent outcomes (about a fifth according to one recent study 11 ) can be explained (mediated) by adverse life experiences (ACEs), which include domestic violence and abuse, poor parental mental health, divorce and parental alcohol and substance use. 11 19 20 The clustering of multiple adverse outcomes across adolescents experiencing early life poverty, which we find, could also be influenced by ACEs and clustering of multiple ACEs across adolescents, and it is of interest for future research to explore this further.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…10 Existing literature on the effects of early childhood poverty examines single adverse outcomes in adolescence separately. [11][12][13][14][15][16][17][18][19][20][21][22] Further, studies of inequality in the cohort born after the Millennium (Generation Z) are sparse. In the present economic and welfare policy context, it is important to understand in detail the experience of those coming of age at present and to consider the implications for population health and policy in coming decades.…”

Section: Introductionmentioning

confidence: 99%

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Clustering of adverse health and educational outcomes in adolescence following early childhood poverty: implications for UK’s ‘levelling up’ agenda

Villadsen

Asaria

Skarda

et al. 2022

Preprint

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Background Early childhood poverty is associated with poorer health and educational outcomes in adolescence. However, there is limited evidence about the clustering of these adverse outcomes by income group. Methods We analysed five outcomes at age 17 known to limit life chances – psychological distress, self–assessed ill health, smoking, obesity, and poor educational achievement – using data from the longitudinal UK Millennium Cohort Study (N=15,245). We compared how single and multiple outcomes were distributed across quintiles of household income in early childhood (0-5 years) and modelled the maximum potential benefit of tackling the income gradient in these outcomes. Findings Children from the poorest households were 12.7(95% CI 6.4-25.1) times more likely than those from the richest to experience four or five adverse adolescent outcomes, with poor educational achievement and smoking showing the largest single risk ratios – 4.6(95% CI: 4.2-5.0) and 3.6(95% CI 3.0-4.2), respectively. We modelled hypothetical absolute and relative poverty elimination scenarios, as well as an income inequality elimination scenario, and found these would yield maximum reductions in multiple adolescent adversity of 5%, 30%, and 80% respectively. Interpretation Early childhood poverty is more strongly correlated with multiple adolescent adversity than any single adverse outcome. Reducing absolute poverty alone is not sufficient to eliminate the life-long burden of multiple adversity, which disproportionately impacts children across the bottom three-fifths of the income distribution. An ambitious levelling up agenda needs co-ordinated multi-agency action to tackle the complex interacting factors generating the steep social gradient in multiple adolescent adversity.

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Section: Comparison To Previous Researchsupporting

confidence: 88%

Section: Strengths and Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clustering of adverse health and educational outcomes in adolescence following early childhood poverty: implications for UK’s ‘levelling up’ agenda

Villadsen

Asaria

Skarda

et al. 2022

Preprint

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“…Adverse childhood experiences are potentially traumatic events that can have negative and persistent child and adult health outcomes (Felitti et al, 1998). In a recent study based on UK longitudinal data, Adjei et al (2022) found that poverty can amplify children's experiences of adversities and is strongly associated with adverse child outcomes later in adolescence, including poor mental health. This review also found that lived experiences of insecurity and adversity reportedly impacted children and young people emotionally and socially, with resulting mental health problems, stigma, isolation, and loneliness.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances

Muir

Adams

Evans³

et al. 2022

Trauma, Violence, & Abuse

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Parental substance use is highly prevalent worldwide, presenting major child safeguarding and public health concerns. Qualitative research enables in-depth understanding of how young people experience parental substance use and helps inform practice and policy through illustrative cases of experiences. This review aimed to synthesize published qualitative evidence exploring the lived experiences, perceived impact, and coping strategies of children and young people whose parents use substances. International literature databases including Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, International Bibliography of the Social Sciences, Social Science Database, Sociology Collection, and Scopus were searched from inception to 2022, alongside grey literature searching and relevant websites. Qualitative accounts were included, provided by participants aged below 25 years. No language, date, or geographical limits were applied. A thematic synthesis of 35 studies, across 49 papers, covering over 700 children and young people’s voices, identified five overarching themes. These themes included, (a) living with the unpredictable: insecurity within the family; (b) social and emotional impact of parental substance use; (c) controlling the uncontrollable: creating safety within the family; (d) coping with and resisting the emotional and social impacts; and (e) formal and informal support. The findings emphasize that children and young people who experience parental substance use are trying to manage and mitigate vulnerabilities and be resilient to unpredictable, adverse, and often stigmatizing experiences, usually without formal support in place. Further research is needed to coproduce child-centered interventions that promote children and young people’s social and emotional resilience.

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“…There are undoubtedly other ACE clusters that are important to consider, and other ACEs that could be considered in combination with parental DVA, MH, and SU. For example, recent work has demonstrated that poverty is an important risk factor influencing the expression of parental DVA, MH, and SU [154] and that upstream approaches to supporting families (e.g., financial support, housing, income supplementation) offer promise in reducing children's exposure to various ACEs [155]. Although we did not include poverty as an intervention target in our review, several studies targeted parents due to low-income and the majority of study samples displayed above average levels of low socio-economic status based on indicators of income, education, and unemployment.…”

Section: Strengths and Limitations Of The Reviewmentioning

confidence: 99%

Family focused interventions that address parental domestic violence and abuse, mental ill-health, and substance misuse in combination: A systematic review

et al. 2022

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Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) are three public health issues that tend to cluster within families, risking negative impacts for both parents and children. Despite this, service provision for these issues has been historically siloed, increasing the barriers families face to accessing support. Our review aimed to identify family focused interventions that have combined impacts on parental DVA, MH, and/or SU. We searched 10 databases (MEDLINE, PsycINFO, Embase, CINAHL, Education Research Information Centre, Sociological Abstracts, Applied Social Sciences Index & Abstracts, ProQuest Dissertations and Theses Global, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials) from inception to July 2021 for randomised controlled trials examining the effectiveness of family focused, psychosocial, preventive interventions targeting parents/carers at risk of, or experiencing, DVA, MH, and/or SU. Studies were included if they measured impacts on two or more of these issues. The Cochrane Risk of Bias Tool 2 was used to quality appraise studies, which were synthesised narratively, grouped in relation to the combination of DVA, MH, and/or SU outcomes measured. Harvest plots were used to illustrate the findings. Thirty-seven unique studies were identified for inclusion. Of these, none had a combined positive impact on all three outcomes and only one study demonstrated a combined positive impact on two outcomes. We also found studies that had combined adverse, mixed, or singular impacts. Most studies were based in the U.S., targeted mothers, and were rated as ‘some concerns’ or ‘high risk’ of bias. The results highlight the distinct lack of evidence for, and no ‘best bet’, family focused interventions targeting these often-clustered risks. This may, in part, be due to the ways interventions are currently conceptualised or designed to influence the relationships between DVA, MH, and/or SU. Trial registration: PROSPERO registration: CRD42020210350.

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Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study

Cited by 29 publications

References 37 publications

Clustering of adverse health and educational outcomes in adolescence following early childhood poverty: implications for UK’s ‘levelling up’ agenda

Clustering of adverse health and educational outcomes in adolescence following early childhood poverty: implications for UK’s ‘levelling up’ agenda

A Systematic Review of Qualitative Studies Exploring Lived Experiences, Perceived Impact, and Coping Strategies of Children and Young People Whose Parents Use Substances

Family focused interventions that address parental domestic violence and abuse, mental ill-health, and substance misuse in combination: A systematic review

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