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Positive experiences can mitigate negative effects in children with trauma

    Children with traumatic experiences in their early lives have a higher risk of obesity. But as new research from VISION researcher Dr Ladan Hashemi and colleagues at University of Auckland, New Zealand, demonstrate, this risk can be reduced through positive experiences.

    Their analysis of data from around 5,000 children in the Growing Up in New Zealand study revealed nine out of ten faced at least one significant source of trauma by the time they were eight years old. Multiple adverse experiences were also prevalent, with one in three children experiencing at least three traumatic events. Notably, certain traumatic experiences (including physical abuse and parental domestic violence) related more strongly to obesity than others. This highlights the strong connection between early-life adversity and physical health outcomes.

    Whilst researching the associations between obesity and childhood trauma, the team also explored the protective and mitigating effects of positive experiences. They defined positive experiences as:

    • mothers interacting well with their children
    • mothers involved in social groups
    • children engaged in enriching experiences and activities such as visiting libraries or museums and participating in sports and community events
    • children living in households with routines and rules, including those regulating bedtime, screen time and mealtimes
    • children attending effective early childhood education

    The findings were encouraging. Children with more positive experiences were significantly less likely to be obese by age eight. For example, those with five or six positive experiences were 60% less likely to be overweight or obese compared to children with zero or one positive experience. Even two positive experiences reduced the likelihood by a quarter.

    Among children exposed to multiple adversities, positive experiences can help mitigate the negative effects of childhood trauma. However, at least four positive experiences were required to significantly counteract the impact of adverse experiences.

    Recommendations

    • Traditional weight-loss programmes focused solely on changing behaviours are not enough to tackle childhood obesity. To create lasting change, children need positive social environments and life experiences as well as support to address the emotional scars of early trauma shaping their lives.
    • Fostering positive experiences is a vital part of this holistic approach. These experiences not only help protect children from the harmful effects of adversity but also promote their overall physical and mental wellbeing. This isn’t just about preventing obesity – it’s about giving children the foundation to thrive and reach their full potential.
    • Sure Start and providers of early childhood education and support for parents could help reduce the health inequalities resulting from exposure to violence.

    To download the paper: Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study | BMC Public Health

    To cite: Mellar, B.M., Ghasemi, M., Gulliver, P. et al. Identification of positive childhood experiences with the potential to mitigate childhood unhealthy weight status in children within the context of adverse childhood experiences: a prospective cohort study. BMC Public Health 25, 8 (2025). https://doi.org/10.1186/s12889-024-20727-y

    For further information on the research:

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

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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 seven ACEs: child physical and psychological abuse, witnessing domestic violence against the mother, 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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      The story so far: Co-production in Lambeth

        By Elizabeth Cook, Senior Lecturer in Criminology & Sociology at City St George’s, University of London

        As the VISION consortium approaches the end of its third year, work continues on consolidating the learning from various large datasets in crime and justice, health, and specialist services.

        What we know is that these datasets are structured in different ways, collected by different agencies, and curated for quite different purposes. They represent particular ways of knowing about violence and abuse: they can help to identify patterns (e.g., what determines whether victim-survivors of sexual violence and abuse access support), prevalence (e.g., of workplace bullying and harassment), trends over time, and associations (e.g., between intimate partner violence, suicidality, and self-harm). However, we also know that large datasets struggle to capture the complex, and sometimes messy, realities of violence and abuse experienced by communities, especially those that are marginalised and minoritised.

        Peer action research in Lambeth

        In Lambeth, working in collaboration with peer researchers has made visible the evidence gaps that emerge at the intersection of multiple systems of inequality, including racism and misogyny.

        We are lucky to be partnered with Lambeth Peer Action Collective (LPAC), High Trees and Partisan as part of a peer action research project. The aim of the project is to explore the role that trusted adults and trusted spaces can play in protecting young people from exposure to violence. Currently, there are 11 peer researchers that work as part of the LPAC: a collective of young people and youth organisations campaigning for change in their community. They are supported by High Trees, a Community Development Trust in Tulse Hill, eight partner youth organisations, and Partisan, a Black-led Community Interest Company providing culturally sensitive mental health support.

        What has been achieved so far?

        The project builds upon research conducted by the previous cohort of LPAC researchers conducted between December 2021 and August 2022. This project identified the impacts of violence on young people in Lambeth and the structural conditions of poverty, housing, education, urban regeneration, and public safety that were experienced unequally across the community.

        Developing these findings further, the second cohort of peer researchers have been participating in weekly research training sessions led by High Trees and supported by VISION. The group has been learning everything they need for the next stage: from safeguarding and finances, to developing research questions, critical thinking skills, and how to evaluate research methods. This month, the LPAC researchers are getting ready to put into practice the interview skills that they have been learning each week in preparation for the next stage of the project – recruitment.

        There has been amazing progress so far – not only in forming a research question and defining key concepts, but in developing a shared space for researchers to feel like change is possible and to collaborate with others who want the same.

        What have we learned?

        There are ongoing conversations about how peer action research can work to redress the imbalance between ‘researcher’ and ‘researched.’ These conversations seem even more relevant to research on violence and abuse, where the issue of power is central to both.

        So far, the weekly sessions with peer researchers as well as our meetings with High Trees have taught us a lot about how power operates within institutions and the ways that it can be shared if there is a will to share it. This can be reflected in adequate resourcing, decision-making, access, and sharing skills and knowledge. The project has underlined the importance of respect in research: for different forms of expertise, within spaces, and within research relationships. The project has also challenged adult-centric assumptions about what we suppose that young people need to live better lives.

        As mentioned previously, this project highlights the evidence gaps that occur at the intersection of multiple inequalities. In doing so, peer action research can also shape how we utilise large datasets, recognising how different social realities are reflected within existing data (or not).

        In this sense, this collaboration has also made hyper-visible the question of: what and who is research for? As others have suggested, action research is not so much a methodology, but a way of thinking about research: it is a way of approaching a specific problem through community, participation, and curiosity. It is not necessarily driven by knowing more about something, but by wanting to change something with what you know.

        We hope that this research continues in that spirit!

        Further information

        Do check out the LPAC’s manifesto for change and their previous report!

         Photograph is copyrighted to Lambeth Peer Action Collective and not for use.

        A health perspective to the war in Israel and Palestine

          Gene Feder, VISION Director and Professor of Primary Care at the University of Bristol, has written an opinion piece with colleagues commenting on events in Israel and Gaza from a public health and primary care perspective. Responding to the war in Israel and Palestine was published in December in the online edition of the British Journal of General Practice.

          Gene and his colleagues are GPs working to further the development of family medicine in the occupied Palestinian territory, specifically in the West Bank, but with links to family medicine in Gaza through the United Nations Relief and Works Agency and through Medical Aid for Palestinians. They also have friends and family in Israel and Palestine.

          They have three responses to the current crisis as informed by their work as GPs and connection to Palestinian primary care:

          1. A plea for the protection of health care and health professionals amid the war
          2. A plea for the preservation of public health amid war
          3. A recognition that in the aftermath of October 7th and the invasion of Gaza, the widespread direct and vicarious trauma in Israeli and Palestinian populations will result in permanent physical and emotional damage: the former in the shape of orthopaedic, neurological, and gynaecological (as a result of rape) harm, the latter in the form of widespread anxiety, depression, and post-traumatic stress disorder which will also cascade down the generations.

          Given VISION’s commitment to developing evidence on violence prevention, we will be organising roundtable meetings bringing together researchers focusing on post-conflict violence reduction. This is an opportunity for dialogue, perhaps leading to new perspectives and research including systematic assessment of sustainable post-conflict interventions as well as further joint activities.

          For further information on the opinion piece, please see: Responding to the war in Israel and Palestine

          Photograph by Emad El Byed on Unsplash

          Cost effectiveness of primary care training & support programme for secondary prevention of DVA

            Recent research evaluated the cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK general practice sites.

            IRIS+ is a training and support programme for clinicians working in primary care to aid in their identification of those experiencing or perpetrating domestic violence / abuse (DVA).

            VISION Deputy Director, Dr Estela Capelas Barbosa and Director, Professor Gene Feder, worked with their University of Bristol colleagues to conduct a cost–utility analysis, a form of economic evaluation comparing cost with patient-centred outcome measures, as a means to measure the benefit obtained from the treatment or intervention.

            The specific cost-utility analysis they conducted assessed the potential cost-effectiveness of IRIS+ which assists primary care staff in identifying, documenting and referring not only women, but also men and children who may have experienced DVA as victims, perpetrators or both.

            The analysis showed that in practices that adopted the IRIS+ intervention, a savings of £92 per patient occurred. The incremental net monetary benefit was positive (£145) and the IRIS+ intervention was cost-effective in 55% of simulations (when the model is repeated with different assumptions).

            The research team therefore concluded that the IRIS+ intervention could be cost-effective in the UK from a societal perspective though there are large uncertainties. To resolve these the team will conduct a large trial with further economic analysis.

            For further information please see: Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model | BMJ Open

            Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

            Photo by Marcelo Leal on Unsplash

            Varying definitions and measurements of violence limit reduction strategies

              Violence reduction is a United Nations (UN) sustainable development goal (SDG) and is important to both the public health and criminology fields. The collaboration between the two has the potential to create and improve prevention strategies but has been hampered by the usage of different definitions and measurements.

              In this paper, VISION researchers Dr Niels Blom, Dr Anastasia Fadeeva and Dr Estela Capelas Barbosa explore the definitions and measurements of violence by the World Health Organization, UN, and Council of Europe to arrive at a harmonized framework aligned with the SDGs.

              Violence and abuse are defined by these organizations as intentional actions that (are likely to) lead to harm, irrespective of physicality or legality. When recording violence and abuse, health- and justice-based administrative systems use different codes which cannot directly be translated without resorting to broad overarching categories.

              The researchers propose a framework to record violence that includes individual and event identifiers, forms of violence and abuse (including physical, sexual, and psychological), harm, and individual and event characteristics.

              For further information please see: Social Sciences | Free Full-Text | The Concept and Measurement of Violence and Abuse in Health and Justice Fields: Toward a Framework Aligned with the UN Sustainable Development Goals (mdpi.com)

              Or contact Niels at Niels.Blom@city.ac.uk

              Photo by Parsa on Unsplash