آیا نژاد، بی توجهی، و فقر دوران کودکی سلامت جسمی در دوران بزرگسالی را پیش بینی می کند؟ تجزیه و تحلیل چند سطحی نگر

Childhood neglect and poverty often co-occur and both have been linked to poor physical health outcomes. In addition, Blacks have higher rates of childhood poverty and tend to have worse health than Whites. This paper examines the unique and interacting effects of childhood neglect, race, and family and neighborhood poverty on adult physical health outcomes. This prospective cohort design study uses a sample (N = 675) of court-substantiated cases of childhood neglect and matched controls followed into adulthood (Mage = 41). Health indicators (C-Reactive Protein [CRP], hypertension, and pulmonary functioning) were assessed through blood collection and measurements by a registered nurse. Data were analyzed using hierarchical linear models to control for clustering of participants in childhood neighborhoods. Main effects showed that growing up Black predicted CRP and hypertension elevations, despite controlling for neglect and childhood family and neighborhood poverty and their interactions. Multivariate results showed that race and childhood adversities interacted to predict adult health outcomes. Childhood family poverty predicted increased risk for hypertension for Blacks, not Whites. In contrast, among Whites, childhood neglect predicted elevated CRP. Childhood neighborhood poverty interacted with childhood family poverty to predict pulmonary functioning in adulthood. Gender differences in health indicators were also observed. The effects of childhood neglect, childhood poverty, and growing up Black in the United States are manifest in physical health outcomes assessed 30 years later. Implications are discussed.

In the United States, childhood neglect is the most common form of maltreatment and accounts for over 60% of cases reported to child protective services. In 2011, 541,000 children in the United States were estimated to be victims of neglect (U.S. Department of Health and Human Services, 2012). Studies have also reported associations between childhood neglect and childhood poverty (Berger, 2005, Drake and Pandey, 1996 and Theodore et al., 2007) with estimated rates of neglect of 2.2 children per 1,000 in middle- and upper-socioeconomic status (SES) families compared to 16.1 per 1,000 children in low-SES families (Sedlak et al., 2010). Furthermore, both neglect and poverty in childhood are associated with a range of negative sequelae, including poor physical health in adulthood (Conroy et al., 2010, Danese et al., 2009 and Lanier et al., 2009). However, few studies have examined physical health consequences of neglect (Wegman & Stetler, 2009). In this study, we focus on cases of childhood neglect that represent judgments that caregivers failed to provide food, shelter, clothing, and/or attend to the medical needs of the child beyond acceptable community standards at the time.