摘要：Objectives. We examined the relationship between childhood abuse and adult health risk behaviors, and we explored whether adult health risk behaviors or mental health problems mediated the relationship between childhood abuse and adult health problems and health care utilization. Methods. We used logistic regression to analyze data from the Mental Health Supplement of the Ontario Health Survey, a representative population sample (N = 8116) of respondents aged 15 to 64 years. Results. We found relationships between childhood sexual abuse and smoking (odds ratio [OR] = 1.52; 95% confidence interval [CI] = 1.16, 1.99), alcohol problems (OR = 2.44; 95% CI = 1.74, 3.44), obesity (OR = 1.61; 95% CI = 1.14, 2.27), having more than 1 sexual partner in the previous year (OR = 2.34; 95% CI = 1.44, 3.80), and mental health problems (OR = 2.26; 95% CI = 1.78. 2.87). We also found relationships between these factors (with the exception of obesity) and childhood physical abuse. Mediation analysis suggested that health risk behaviors and particularly mental health problems are partial mediators of the relationship between childhood abuse and adult health. Conclusions. Public health approaches that aim to decrease child abuse by supporting positive parent–child relationships, reducing the development of health risk behaviors, and addressing children's mental health are likely to improve long-term population health. Recent studies have suggested a link between childhood abuse and adult health. Researchers have reported associations between childhood abuse and higher rates of medical problems, poor self-rated health, pain symptoms, and functional disability. 1 – 6 A history of childhood maltreatment is also associated with higher health care utilization (more physician visits, surgeries, and hospitalizations, as well as higher annual health costs) in adulthood. 7 – 9 There is limited understanding of the mechanisms linking childhood abuse and adult health. Childhood maltreatment may have an adverse effect on adult health as a result of biological and psychosocial factors. Physiological research demonstrates that childhood maltreatment can have negative effects on the nervous, immune, and endocrine systems. 10 – 13 Kuh et al. suggest that children's environments can influence their attitudes, beliefs, academic achievements, and development of health behaviors. 14 Parents can inadvertently promote poor health habits and lack of autonomy in children by failing to teach important skills, by communicating poor attitudes, and by providing negative role models. Health risk behaviors and mental health problems may be mediators in the relationship between childhood abuse and adult health. Considerable evidence supports an association between childhood abuse and health risk behaviors such as smoking, poor nutrition, sedentary lifestyle, high alcohol consumption, and higher-risk sexual practices. 6 , 15 – 18 Childhood abuse appears to have negative effects on self-esteem and is associated with high levels of anxiety, depression, and anger. 19 – 21 These mental health problems may play a role in the development of health risk behaviors 22 , 23 and may also influence long-term health by causing troubled relationships, poor school achievement, premature parenthood, and unemployment. 24 The Adverse Childhood Experiences (ACE) Study, based on data from health maintenance organizations, reported that health risk behaviors and depression mediated the relationship between adverse childhood experiences and ischemic heart disease 25 and liver disease, 26 providing evidence that health risk behaviors and mental health problems may be part of a causal chain linking childhood abuse to adult health problems. Given the high prevalence rates of childhood abuse and its long-term effects on health, it is crucial to understand the mechanisms connecting one to the other, to facilitate the development of public health strategies to address these problems. To the best of our knowledge, no previous population-based studies have examined whether health risk behaviors and mental health problems may be mediating factors in the relationship between childhood abuse and adult health. Population studies are important because clinical samples are not representative of the population and are prone to selection biases that may give inaccurate estimates. In addition, studying a broader scope of health indicators may be more informative for population health applications. Our goal was to use population-based cross-sectional data to examine the association between childhood physical and sexual abuse and adult health risk behaviors (smoking, alcohol problems, physical inactivity, obesity, and risky sexual behaviors). We also explored whether health risk behaviors or mental health problems mediated the relationship between childhood abuse and adult health problems and health care utilization.
