Exposure to violence during adolescence and cardiovascular risk in young adulthood: Health behaviors as potential modifiers

Introduction: Early childhood trauma has been associated with increased cardiovascular risk in adulthood. However, the potential mediating role of specific health behaviors (tobacco, alcohol use and physical activity) has not been evaluated. Methods: We examined the mediating effect of adolescent health behaviors on the relationship between adolescent violence exposure and blood pressure (BP) in young adulthood in the National Longitudinal Study of Adolescent Health. Adolescents (mean age 15.5, n=10814) reported on their experiences of child abuse and neglect, witnessing and experiencing community violence and dating violence during waves 1 (1994-1995) and 2 (1996) of follow-up. A cumulative violence measure was created from these measures. Physical activity, alcohol and tobacco use were assessed by self-report. During wave 3 of follow-up (2001-2002), the presence/absence of having received a diagnosis of elevated BP was assessed by self-report. Results: In gender stratified analysis adjusting for socio-demographics, violence exposure was associated with elevated BP among both men and women (OR 1.3 95%CI 1.1, 1.6 and OR 1.2 95%CI 1.0, 1.4, respectively). Further adjustment for physical activity, alcohol and tobacco use did not change these effect estimates substantially, however a formal test of mediation revealed alcohol use and physical activity to be statistically significant mediators of the violence and BP relationship among both men and women. Conclusion: Violence exposure may directly affect cardiovascular health through activation of the stress pathway or indirectly by modifying health behaviors. Our findings suggest the effects of early violence exposure on cardiovascular risk may be partially mediated through early onset of negative health behaviors.