The Health Consequences of Childhood Maltreatment and Foster Care From Adolescence Into Mid-Life

PROJECT SUMMARY Child abuse and neglect are common among US children and consequential for later-life health and wellbeing, including hypertension, obesity, cardiovascular functioning, substance use, and depression. Foster care placement, which is an important strategy through which Child Protective Services (CPS) remedy the risk of future harm, is also associated with myriad deleterious outcomes. Because each of these experiences—child maltreatment and foster care placement—are unevenly distributed by race and socio-economic status, they may contribute to health inequalities. Unfortunately, prior research on the effects of both of these childhood experiences is generally limited to the study of health in adolescence or early adulthood and does not differentiate health consequences due to maltreatment from health consequences due to foster care placement. Indeed, few studies consider the potentially moderating effects of maltreatment dosage on health outcomes or control for well-established determinants of health, such as genetic disposition, personal behavior, and environmental contexts. These limitations significantly diminish knowledge about the potentially heterogeneous effects of childhood traumatic events on health and wellbeing, the persistence of those effects throughout the life-course, and the potentially remedial or additive effects of important state interventions in family life. This in turn constricts the ability to design policies that reduce long-term health disadvantages among vulnerable children without introducing new sources of social vulnerability. Our project closes this knowledge gap by leveraging the unique advantages of the National Longitudinal Study of Adolescent to Adult Health (Add Health), which tracks a national cohort from childhood into mid-life and includes detailed measures of childhood victimization as well as unique biomarker data and information on core social determinants of health. The project uses these data to (1) extend the scope of existing associational studies of health outcomes from early adulthood until mid-life, (2) study the persistence of health disadvantages among maltreated and fostered children, (3) disaggregate the effects of maltreatment and foster care on health outcomes, and (4) assess how such effects differ across socio-demographic categories and the dosage of childhood abuse and neglect.