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

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

doi:10.1016/j.lanepe.2021.100279

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

ORACLE consortium, Nicholas Kofi Adjei^*, Daniela K. Schlüter, Viviane S. Straatmann, Gabriella Melis, Kate M. Fleming, Ruth McGovern, Louise M. Howard, Eileen Kaner, Ingrid Wolfe, David C. Taylor-Robinson

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

39 Citations (Scopus)

Abstract

Background: Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes. Methods: We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders. Findings: Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 – 8·3), cognitive disability (aOR 2·1; CI 1·5 – 2·8), drug experimentation (aOR 2·8; CI 1·8 – 4·2) and obesity (aOR 1·8; CI 1·3 – 2·5). Interpretation: In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health. Funding: The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London (ARC South London) at King's College Hospital NHS Foundation Trust and the Medical Research Council (MRC).

Original language	English
Article number	100279
Journal	The Lancet Regional Health - Europe
Volume	13
Early online date	4 Feb 2022
DOIs	https://doi.org/10.1016/j.lanepe.2021.100279
Publication status	Published - Feb 2022

Keywords

child health
child poverty
cohort
family adversity
multi-trajectory analysis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.lanepe.2021.100279Licence: CC BY

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ORACLE consortium, Adjei, N. K., Schlüter, D. K., Straatmann, V. S., Melis, G., Fleming, K. M., McGovern, R., Howard, L. M., Kaner, E., Wolfe, I., & Taylor-Robinson, D. C. (2022). Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study. The Lancet Regional Health - Europe, 13, Article 100279. https://doi.org/10.1016/j.lanepe.2021.100279

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

abstract = "Background: Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes. Methods: We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders. Findings: Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 – 8·3), cognitive disability (aOR 2·1; CI 1·5 – 2·8), drug experimentation (aOR 2·8; CI 1·8 – 4·2) and obesity (aOR 1·8; CI 1·3 – 2·5). Interpretation: In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health. Funding: The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London (ARC South London) at King's College Hospital NHS Foundation Trust and the Medical Research Council (MRC).",

keywords = "child health, child poverty, cohort, family adversity, multi-trajectory analysis",

author = "{ORACLE consortium} and Adjei, {Nicholas Kofi} and Schl{\"u}ter, {Daniela K.} and Straatmann, {Viviane S.} and Gabriella Melis and Fleming, {Kate M.} and Ruth McGovern and Howard, {Louise M.} and Eileen Kaner and Ingrid Wolfe and Taylor-Robinson, {David C.}",

note = "Funding Information: Millennium Cohort Study is available via the UK Data Archive. Further information about the study is found at https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/. The STATA codes we used for the Group Based Multi-trajectory is available at https://github.com/NicholasAdjei/Multi-Trajectory-models-/blob/main/STATA%20Codes_GBTM.do. This work is a collaboration with the Institute of Women's and Children's Health (IWCH), part of King's Health Partners. We would like to thank Ms. Lara Christianson for selecting appropriate databases and compiling search items for this study. We also appreciate the help and support from Dr. Miheretu M. Kebede, Dr. Andreas Rieckmann and Dr. Florence Samkange-Zeeb. Funding Information: This work was funded by the National Institute for Health Research (NIHR) Policy Research Programme (ORACLE: OveRcoming Adverse ChiLdhood Experiences, Grant reference number NIHR200717); and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. DTR is supported by the NIHR School for Public Health Research, the NIHR Public Health Policy Research and by the Medical Research Council (MRC) on a Clinician Scientist Fellowship (MR/P008577/1). VSS is supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE) [2016-07148; 2020-00274]. DKS is supported by the FORTE [2020-00274] and the NIHR Public Health Policy Research Unit. Professors Kaner and Howard are supported by NIHR Senior Investigator awards and Prof Kaner is Director of the NIHR Applied Research Collaboration for the North East and North Cumbria. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, MRC or FORTE. All authors declare no competing interests. Publisher Copyright: {\textcopyright} 2021 The Author(s)",

year = "2022",

month = feb,

doi = "10.1016/j.lanepe.2021.100279",

language = "English",

volume = "13",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier Ltd",

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ORACLE consortium, Adjei, NK, Schlüter, DK, Straatmann, VS, Melis, G, Fleming, KM, McGovern, R, Howard, LM, Kaner, E, Wolfe, I & Taylor-Robinson, DC 2022, 'Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study', The Lancet Regional Health - Europe, vol. 13, 100279. https://doi.org/10.1016/j.lanepe.2021.100279

TY - JOUR

T1 - Impact of poverty and family adversity on adolescent health

T2 - a multi-trajectory analysis using the UK Millennium Cohort Study

AU - ORACLE consortium

AU - Adjei, Nicholas Kofi

AU - Schlüter, Daniela K.

AU - Straatmann, Viviane S.

AU - Melis, Gabriella

AU - Fleming, Kate M.

AU - McGovern, Ruth

AU - Howard, Louise M.

AU - Kaner, Eileen

AU - Wolfe, Ingrid

AU - Taylor-Robinson, David C.

N1 - Funding Information: Millennium Cohort Study is available via the UK Data Archive. Further information about the study is found at https://cls.ucl.ac.uk/cls-studies/millennium-cohort-study/. The STATA codes we used for the Group Based Multi-trajectory is available at https://github.com/NicholasAdjei/Multi-Trajectory-models-/blob/main/STATA%20Codes_GBTM.do. This work is a collaboration with the Institute of Women's and Children's Health (IWCH), part of King's Health Partners. We would like to thank Ms. Lara Christianson for selecting appropriate databases and compiling search items for this study. We also appreciate the help and support from Dr. Miheretu M. Kebede, Dr. Andreas Rieckmann and Dr. Florence Samkange-Zeeb. Funding Information: This work was funded by the National Institute for Health Research (NIHR) Policy Research Programme (ORACLE: OveRcoming Adverse ChiLdhood Experiences, Grant reference number NIHR200717); and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King's College Hospital NHS Foundation Trust. DTR is supported by the NIHR School for Public Health Research, the NIHR Public Health Policy Research and by the Medical Research Council (MRC) on a Clinician Scientist Fellowship (MR/P008577/1). VSS is supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE) [2016-07148; 2020-00274]. DKS is supported by the FORTE [2020-00274] and the NIHR Public Health Policy Research Unit. Professors Kaner and Howard are supported by NIHR Senior Investigator awards and Prof Kaner is Director of the NIHR Applied Research Collaboration for the North East and North Cumbria. The views expressed in this publication are those of the authors and not necessarily those of the NIHR, MRC or FORTE. All authors declare no competing interests. Publisher Copyright: © 2021 The Author(s)

PY - 2022/2

Y1 - 2022/2

N2 - Background: Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes. Methods: We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders. Findings: Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 – 8·3), cognitive disability (aOR 2·1; CI 1·5 – 2·8), drug experimentation (aOR 2·8; CI 1·8 – 4·2) and obesity (aOR 1·8; CI 1·3 – 2·5). Interpretation: In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health. Funding: The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London (ARC South London) at King's College Hospital NHS Foundation Trust and the Medical Research Council (MRC).

AB - Background: Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes. Methods: We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders. Findings: Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 – 8·3), cognitive disability (aOR 2·1; CI 1·5 – 2·8), drug experimentation (aOR 2·8; CI 1·8 – 4·2) and obesity (aOR 1·8; CI 1·3 – 2·5). Interpretation: In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health. Funding: The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London (ARC South London) at King's College Hospital NHS Foundation Trust and the Medical Research Council (MRC).

KW - child health

KW - child poverty

KW - cohort

KW - family adversity

KW - multi-trajectory analysis

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U2 - 10.1016/j.lanepe.2021.100279

DO - 10.1016/j.lanepe.2021.100279

M3 - Article

AN - SCOPUS:85123019210

SN - 2666-7762

VL - 13

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 100279

ER -

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

Abstract

Keywords

UN SDGs

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