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Adverse childhood experiences associated with childhood obesity

Adverse childhood experiences (ACEs) are potentially traumatic events or environmental factors occurring during childhood that can disrupt a child’s sense of safety, stability, and bonding. ACEs include child abuse and maltreatment, family dysfunctions, and exposure to violence outside the family. Individuals impacted by ACEs are at greater risk of developing obesity in adulthood, however, few studies have prospectively measured ACEs and obesity during childhood. Associations with the adoption of obesogenic behaviours during childhood, which directly contribute to obesity are also understudied.

VISION researcher Dr Ladan Hashemi, along with colleagues from the University of Auckland, New Zealand, examined associations between individual and cumulative ACEs, obesity, and obesogenic behaviours during childhood (up to age 8). Using data from eight waves of the Growing Up in New Zealand study—the country’s largest birth cohort study—they developed an index to measure nine ACEs: child physical and psychological abuse, witnessing domestic violence against the mother, parental separation or divorce, parental incarceration, parental substance abuse, parental mental illness, peer bullying, and experiences of ethnic discrimination.  Their research, Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours, discovered that:

  • ACEs were prevalent among children in New Zealand with almost nine out of ten experiencing at least one ACE. Multiple adverse experiences were also prevalent, with one in three children experiencing at least three traumatic events.
  • Higher ACE scores and experience of each specific ACE were significantly more prevalent among those identified as Māori or Pacific, those living in food insecure households or in the most deprived areas.
  • Experience of two or more ACEs was associated with higher risk of adopting obesogenic behaviours such as excessive consumption of unhealthy foods and drinks, inadequate consumption of fruits and vegetables, inadequate sleep duration, excessive screen time, and physical inactivity. The risk increased as the number of ACEs increased.   
  • Six of nine assessed ACEs were associated with the development of childhood obesity. A dose-response pattern was observed, with obesity risk increasing as the number of ACEs increased.

Exposure to ACEs contributes to the population-level burden of childhood obesity, potentially influencing obesity outcomes through associations with unhealthy, obesogenic behaviours. The findings highlight the importance of a holistic understanding of the determinants of obesity, reinforcing calls for ACEs prevention and necessitating incorporation of ACEs-informed services into obesity reduction initiatives.

Recommendations

  • Childhood obesity reduction efforts may benefit from considering the role of ACEs. Understanding and addressing the social determinants of obesity, such as family and social environments, may be important in the context of traditional behavioural change interventions targeting nutrition, sleep, screen time, and physical activity
  • Interventions that reduce children’s exposure to violence could help reduce levels of obesity and associated ACEs
  • Violence reduction and family support should feature in the government’s Tackling Obesity strategy

To download the paper: Full article: Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours

To cite: Hashemi, L., Ghasemi, M., Mellar, B., Gulliver, P., Milne, B., Langridge, F., … Swinburn, B. (2025). Associations between specific and cumulative adverse childhood experiences, childhood obesity, and obesogenic behaviours. European Journal of Psychotraumatology, 16(1). https://doi.org/10.1080/20008066.2025.2451480

Or for further information, please contact Ladan at ladan.hashemi@city.ac.uk

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Adverse childhood experiences in firstborns associated with poor mental health of siblings

Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. First author Dr Shabeer Syed (UCL Great Ormond Street Institute of Child Health), VISION Director and Professor Gene Feder, and colleagues aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.

The first-of-its-kind study, published in The Lancet Public Health and funded by the National Institute for Health and Care Research Policy Research Programme, found that mothers whose firstborns had experienced adverse childhood experiences had a 71% increased risk of having children (aged five -18) with mental health problems, compared to mothers whose firstborn did not experience adversity.

This translates to 12 additional children with mental health problems for every 100 mothers whose firstborn experienced adversity.

These findings underscore the pervasive risk that early adversity can have on multiple children in the family, and the importance of early identification and sustained support for vulnerable families beyond the first 1,000 days of a child’s life.

As part of the study, researchers analysed linked GP and hospital health records from 333,048 first-time mothers and their 534,904 children (firstborns and siblings) born in England between 2002 and 2018. They focused on six different forms of adverse childhood experiences in the firstborn child recorded during their first 1,000 days of life (from conception up until the age of two).

These included: child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments (e.g. homelessness), and high-risk presentations of child maltreatment (e.g. unexplained child injuries).

Over a third (37.1%) of firstborn children had at least one recorded adverse childhood experience. The most common adverse childhood experiences were living with maternal mental health problems (21.6%), followed by adverse family environments (14.5%) such as parental criminality and housing instability.

Approximately one in five (19.8%) mothers had at least one child with a recorded mental health problem between the ages of 5 and 18.

The risk of mental health problems was consistent across all siblings, regardless of birth order (firstborn vs thirdborn), in families where the firstborn experienced adverse childhood experiences.

Lead author Dr Syed said: “Whilst previous research has focused on the impact of adverse childhood experiences on individual children, our study reveals a cascading health risk that extends beyond the individual, impacting on the health of siblings as well.

“This likely stems from the continuation of adverse childhood experiences within the family. When a child or parent presents with mental health concerns, violence or other forms of adversity, it’s essential to ask about the wider family context.”

As a result of their findings, the team are also calling for further research into the impact of early health visiting and primary care support.

Co-author, Professor Feder, said: “General practice teams have a key role in identifying first-born children experiencing adverse childhood experiences and in supporting first-time parents to help reduce the impact of adverse childhood experiences on the whole family, including subsequent children.

“We need further evidence for effective interventions to reduce that impact, particularly on mental health.”

Study limitations

The researchers could not investigate adverse childhood experiences related to fathers’ mental health or substance use as healthcare data from fathers could not be linked to their children.

The study found that adverse childhood experiences in firstborns were associated with mental health outcomes in the first and subsequent children, but this does not necessarily mean that adverse childhood experiences cause mental health problems.

Additionally, electronic health-care records underestimate intimate partner violence and child maltreatment due to non-disclosure and/or detection and under-recording by clinicians.

To download the paper: Adverse childhood experiences in firstborns and mental health risk and health-care use in siblings: a population-based birth cohort study of half a million children in England – The Lancet Public Health

Or for further information, please contact Shabeer at s.syed.16@ucl.ac.uk

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Cybercrime victimisation and the association with age, health and sociodemographic characteristics

By Ben Havers, PhD Candidate at the Dawes Centre for Future Crime, University College London

The UK has an ageing population; the Office for National Statistics (ONS, 2024) has predicted that the number of people aged 85 and over will increase from 1.6 million (2.5% of the total population) to 2.6 million (3.5%) over the next 15 years. Concerningly, a recent Age UK report (2024) revealed that more than one in three over 65s lack the basic skills to use the internet successfully. This would suggest that the number of older adults ill-equipped to deal with online threats is set to grow.

This blog describes a recent study conducted by Ben Havers (University College London) and colleagues, including Professor Sally McManus from VISION, exploring how cybercrime victimisation, repeat victimisation and financial impact are associated with age and other sociodemographic and health-related characteristics.

The authors analysed data from the 2019-2020 Crime Survey for England and Wales, an annual national crime victimisation survey carried out by the ONS. The survey is administered via face-to-face interviews with more than 35,000 adults across England and Wales. Participants are asked whether they have been a victim of crime in the past 12 months, and other personal information on topics such as housing, work and health.

Some of the key findings of the study were:

  • People aged 75+ were most likely to experience repeat cybercrime victimisation and associated financial loss than younger demographics.
  • Men were more likely to experience victimisation and repeat victimisation than women. A plausible explanation is that men, who have been found to take more risks than women generally (Hudgens & Fatkin, 1985), may also engage in riskier behaviour or activities online, leaving them more vulnerable to malicious actors.
  • People of Black and mixed/multiple ethnicity were more likely to be cybercrime victims than participants of White ethnicity. Research on the drivers behind ethnic disparities in crime victimisation in the UK and abroad is limited. Salisbury and Upson’s ( 2004) crime survey analysis found that people of Black and minority ethnicity are more likely than White people to fall victim to crime in general. Future research might explore differing patterns and types of internet use, and systemic disadvantages, for example linguistic barriers to safe cyber navigation.
  • Worse cognitive, physical, mental and general health were associated with greater risk, across the ages. This relationship is likely to be bidirectional as poor health might increase the risk of cybercrime (Abdelhamid, 2020) and being a victim of cybercrime may worsen mental health (Rhoads, 2023).

The findings from this study indicate that future developments in online platform and process design, as well as multi-agency collaboration and information sharing, should focus on (a) empowering older adults to detect fraudulent activity before loss is incurred, and (b) removing barriers to reporting so that support can be provided before the individual is victimised a second or third time.

To read or download the article for free: Cybercrime victimisation among older adults: A probability sample survey in England and Wales | PLOS ONE

To cite: Havers, B., Tripathi, K., Burton, A., McManus, S., & Cooper, C. (2024). Cybercrime victimisation among older adults: A probability sample survey in England and Wales. PLOS ONE, 19(12), e0314380. https://doi.org/10.1371/journal.pone.0314380

Or for further information, please contact Ben at benjamin.havers.20@ucl.ac.uk

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Natural Language Processing: Interrogating free text in mental healthcare records to capture experiences of violence

Violence can be categorised in a variety of ways for example physical, sexual, emotional, and domestic but all cause significant physical and mental morbidity within general populations. Individuals with a severe mental illness have been found to be significantly more likely to experience domestic, physical, and sexual violence compared to the general population. For these individuals, experiences of violence are important risk factors however, this is not routinely collected by mental health services.

In general data on all forms of violence has been inadequately available from healthcare records. This is partly due to the lack of routine enquiry by professionals at points of clinical contact, and partly because instances of violence are difficult to identify in healthcare data in the absence of specific coding systems.

A general challenge for using health records data for research is that the most valuable and granular information is frequently contained in text fields (e.g., routine case notes, clinical correspondence) rather than in pre-structured fields; this includes mentions of violence whether experienced as a victim or perpetrated. Capturing violence experiences across mental healthcare settings can be challenging because most instances are likely to be recorded as unstructured text data. Therefore, natural language processing (NLP), is increasingly in use to extract information automatically from unstructured text in electronic health records, particularly in mental healthcare, on clinical entities.

Dr Ava Mason from Kings College London and VISION researchers Professor Robert Stewart, Dr Angus Roberts, Dr Lifang Li, and Dr Vishal Bhavsar worked with colleagues to apply NLP across different clinical samples to investigate mentions of violence. They ascertained recorded violence victimisation from the records of 60,021 patients receiving care from a large south London NHS mental healthcare provider during 2019. Descriptive and regression analyses were conducted to investigate variation by age, sex, ethnic group, and diagnostic category.

Results showed that patients with a mood disorder, personality disorder, schizophrenia spectrum disorder or PTSD had a significantly increased likelihood of victimisation compared to those with other mental health diagnoses. Additionally, patients from minority ethnic groups for Black and Asian had significantly higher likelihood of recorded violence victimisation compared to White groups. Males were significantly less likely to have reported recorded violence victimisation than females.

The researchers demonstrated the successful deployment of machine learning based NLP algorithms to ascertain important entities for outcome prediction in mental healthcare. The observed distributions highlight which sex, ethnicity and diagnostic groups had more records of violence victimisation. Further development of these algorithms could usefully capture broader experiences, such as differentiating more efficiently between witnessed, perpetrated and experienced violence and broader violence experiences like emotional abuse.

To download the paper: Frontiers | Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis

To cite: Mason AJC, Bhavsar V, Botelle R, Chandran D, Li L, Mascio A, Sanyal J, Kadra-Scalzo G, Roberts A, Williams M, Stewart R. Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis. Frontiers in Psychiatry 2024 Sep 10. doi:103389/fpsyt.2024.1181739

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Domestic abuse in cancer care: Improving the identification and support

Although few studies have explored people’s experiences of domestic abuse and cancer, we know the two co-occur. The few studies we do have show that cancer can trigger an escalation of abuse. But there are no published domestic abuse interventions in the cancer setting.

In an attempt to plug that gap, Sandi Dheensa, University of Bristol researcher, and colleagues, including VISION Deputy Director Estela Capelas Barbosa, have conducted a service evaluation on a domestic abuse intervention for hospital-based cancer professionals. Their study, Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention – European Journal of Oncology Nursing, is the first to evaluate a DA training (and support) intervention for cancer professionals in England.

The key findings demonstrate that cancer and DA frequently co-occur, and that training and support intervention of hospital-based cancer staff increased the rate of DA identifications. There is an appetite for DA and cancer training amongst hospital-based cancer staff.

The evaluation contributes further evidence of the benefit of hospital-based domestic abuse coordinator roles and contributes new evidence for the feasibility of adapting the role for a specific context.

To read the article or download the paper free of charge:

Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention – European Journal of Oncology Nursing

To cite:

Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention. Dheensa, Sandi et al. European Journal of Oncology Nursing, Volume 0, Issue 0, 102724

Or for further information, please contact Sandi at sandi.dheensa@bristol.ac.uk

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Prior homelessness and associations with health and violent victimisation

By Dr Natasha Chilman, Research Associate, UKRI Population Health Improvement (PHI-UK), Population Mental Health Consortium, Kings College London

In the United Kingdom, we have the highest rate of homelessness compared to other high-income countries. For many people homelessness is a temporary, although often very impactful, experience in their lives. However, there is a paucity of research and data looking at people who are formerly homeless and living in private households (i.e., rented or owned accommodation).

This blog describes a new study which fills this gap, conducted by Dr Natasha Chilman from King’s College London and colleagues, including Professor Sally McManus from VISION.

The study authors analysed data from the Adult Psychiatric Morbidity Surveys, which is a nationally representative survey of adults living in private households in 2007 and 2014. Out of 13,859 people, 535 people reported previous experience of homelessness.

Some of the key findings of the study were:

  • A staggering 40% of people who formerly experienced homelessness had experienced violence in their homes at some point in their lives, compared to 7% of people who had never been homeless.
  • A quarter (24%) of people who formerly experienced homelessness reported experience of sexual abuse, compared to less than 5% of people who had never experienced homelessness.
  • Almost half (45%) of the formerly homeless group were currently experiencing depression or anxiety, compared to just 15% of people who had never experienced homelessness. People who formerly experienced homelessness were also experiencing more severe symptoms of these common mental disorders.
  • There were strong associations between former homelessness and health conditions, across common mental disorders, physical health conditions, alcohol/substance dependence, and multimorbidities. These associations persisted even after adjusting for a range of potential confounders, including indicators of socio-economic position and smoking.
  • Adjusting for adverse experiences including violence and abuse attenuated associations between former homelessness and alcohol/substance dependence related health outcomes, but not mental/physical health.

The findings from this study highlight the urgent need for long-term integrated healthcare support for people who are formerly homeless to continue after they have secured private housing. There were severe inequalities in experiences of violence and sexual abuse for people who have experienced homelessness, underscoring the importance of both violence and homelessness prevention, and of trauma-informed approaches to support.

To read the article or download the paper free of charge:

The public health significance of prior homelessness: findings on multimorbidity and mental health from a nationally representative survey | Epidemiology and Psychiatric Sciences | Cambridge Core

To cite:

Chilman N, Schofield P, McManus S, Ronaldson A, Stagg A, Das-Munshi J. The public health significance of prior homelessness: findings on multimorbidity and mental health from a nationally representative survey. Epidemiology and Psychiatric Sciences. 2024;33:e63. doi:10.1017/S2045796024000659

Or for further information, please contact Natasha at natasha.chilman@kcl.ac.uk

Workplace bullying and harassment harms health

Workplace bullying and harassment (WBH) is bad for people’s health, and this negative health impact can manifest in a variety of ways and be long-lasting.

Over a decade ago the UK government initiated the Fair Treatment at Work survey, aiming to ‘place the issue of bullying at work on employers’ agendas’, yet there has been no major initiative since.

Using data from the 2014 Adult Psychiatric Morbidity Survey, VISION researchers Annie Bunce, Ladan Hashemi and Sally McManus, along with Carrie Myers and Charlotte Clark from City St George’s, University of London and Stephen Stansfeld from Queen Mary, University of London, examined the prevalence and nature of WBH among workers in England, and associations with mental health.

A clear picture of the severity of the problem of WBH in England is painted by four key findings.

  1. One in ten people in paid work reported having experienced WBH in the past year. This is likely to be an underestimate due to underreporting for various reasons;
  2. Those who reported bullying were more likely to be in a financially disadvantaged position;
  3. Over half of people who reported having been bullied at work identified the perpetrator as a line manager; and
  4. Clinically diagnosed common mental disorder was more than twice as likely in employees with experience of WBH compared with those without, and those exposed to WBH were also twice as likely as others in paid work to screen positive for PTSD.

Taken together these findings demonstrate that WBH is common in UK workplaces, it may be driven and exacerbated by issues of inequality, power and hierarchical organisational structures, and it is associated with depressive and anxiety disorders severe enough to warrant health service intervention and treatment.

This power dynamic should not be forgotten when addressing issues in the workplace, but the complexity of workplace environments creates challenges for identifying, understanding and addressing bullying. Reports of WBH can coincide with performance concerns from managers, and, whilst behaviours intended as legitimate performance management activities might be misinterpreted as bullying by the employee, it is also possible that HR practitioners attribute managerial bullying behaviours to legitimate performance management practice to exonerate mangers and protect the organisation.

This links to a recently published piece for The Conversation by Sally McManus and Kat Ford (Bangor University), which sets out how companies can influence and perpetuate violence in society, including via employment practices that conceal the extent of bullying, sexual harassment and other forms of workplace violence (for further information see Six ways companies fuel violence (theconversation.com).

Also, structural issues in the workplace can create pressure for managers which they then take out on those they manage, managers can be victims of WBH themselves, and organisational culture may perpetuate WBH.

Given such complex power dynamics, it is recommended that organisations involve employees at all levels in the development of policies, and collaboratively review the implementation and performance of policies regularly to ensure they are working for the people they are intended to protect. Rather than prescribed ‘tick box’ policies and responses, creative methods incorporating employees’ perspectives may more likely lead to meaningful change.

Crucially, managers and HRs might not be the most approachable people for victims of WBH. For example, other VISION research has found this to be the case for victims of intimate partner violence and abuse (see VISION Policy Series: The impact of intimate partner violence on job loss and time off work in the UK – City Vision).  Therefore, alternative sources of support need to be available within organisations, such as unions and counselling services.

For further information please see the full paper available at: Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey | BMC Public Health (springer.com)

Or please contact Dr Annie Bunce at annie.bunce@city.ac.uk

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VISION researchers presenting at UK Data Service Health Studies Conference 2024

This event is in the past.

Two researchers of the VISION consortium project presented at the Health Studies Conference in July.

Dr Elizabeth Cook, Senior Lecturer at City, University of London, presented Indirect victims of violence: mental health and the close relatives of serious assault victims in England.

Dr Annie Bunce, Research Fellow at City, University of London, presented Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

The free event was on 1 July at University College London (UCL) and organised by the UK Data Service in collaboration with UCL and the National Centre for Social Research. The conference provided updates from the data producers of key UK social surveys with health-related content, such as the Health Survey for England, Understanding Society and the English Longitudinal Study of Ageing. There were also presentations by researchers who conducted analyses using health data.

Register for the event

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