儿童期不良经历与青少年饮酒的关联

张家帅; 左霞云; 余春艳; 廉启国; 钟向阳; 涂晓雯; 楼超华

doi:10.16835/j.cnki.1000-9817.2021.07.019

儿童期不良经历与青少年饮酒的关联

doi: 10.16835/j.cnki.1000-9817.2021.07.019

1.
复旦大学公共卫生学院, 上海 200032
2.
复旦大学生殖与发育研究院上海市计划生育科学研究所/国家卫生健康委员会计划生育药具重点实验室
3.
上海市静安区教育学院

基金项目:

国家卫生健康委员会计划生育药具重点实验室科技创新导向项目 CX2017-05

世界卫生组织项目 ERC0003027

上海市计划生育科学研究所青年创新基金 Q2018-1

详细信息

作者简介:
张家帅(1993-)，男，安徽阜阳人，在读博士，主要研究方向为青少年性与生殖健康

通讯作者:
楼超华，E-mail：louchaohua60@163.com

中图分类号: R179 G478
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- 文章访问数: 626
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- 被引次数: 0
出版历程
- 收稿日期: 2021-01-21
- 修回日期: 2021-02-25
- 网络出版日期: 2021-07-23
- 刊出日期: 2021-07-25

Association between adverse childhood experiences and adolescent alcohol use

1.
School of Public Health, Fudan University, Shanghai(200032), China

摘要

摘要: 目的探究儿童期不良经历(adverse childhood experiences, ACEs)与青少年饮酒的关联, 为青少年饮酒行为的防控提供指导。方法采用分层整群抽样的方法选取上海市某区3所公立初中六至八年级的1 550名学生, 于2017年和2018年11—12月开展2次匿名电子问卷调查。采用潜类别分析(latent class analysis, LCA)对ACEs进行分类, 利用多因素广义估计方程(generalized estimating equations, GEE)模型分析ACEs与青少年饮酒的关联。结果 LCA拟合结果表明, ACEs可分为3个潜类别, 分别定义为高暴露组(139名, 8.97%)、虐待忽视组(604名, 38.97%)和低暴露组(807名, 52.06%)。多因素GEE模型结果显示, 相较于低暴露组, 高暴露组(OR=2.65, 95%CI=1.72~4.07)和虐待忽视组(OR=1.50, 95%CI=1.14~1.96)研究对象的饮酒风险显著增加(P值均＜0.01)。结论不同潜类别的ACEs对饮酒的影响可能存在差异, 良好的儿童期成长环境可能有助于降低青少年饮酒风险。
- 生活变动事件 /
- 饮酒 /
- 精神卫生 /
- 问卷调查 /
- 青少年
Abstract: Objective To explore the association between adverse childhood experiences (ACEs) and adolescent alcohol use and to provide evidence for prevention and intervention. Methods A total of 1 550 students from grades 6 to 8 in three public middle schools in a district of Shanghai were selected by stratified cluster sampling method. The baseline and follow-up investigation were conducted by anonymous electronic questionnaire in mobile tablet from November to December in 2017 and 2018, respectively. The latent class analysis (LCA) was applied for the classification of ACEs, while the multivariate generalized estimating Equations (GEE) model was adopted to examine the association between ACEs and adolescent alcohol use. Results The ACEs was divided into 3 classes by LCA: high exposure (8.97%), abuse and neglect (38.97%), low exposure (52.06%). The multivariate GEE model indicates the risk of alcohol drinking among adolescents in high exposure and abuse and neglect classes were significantly higher than their counterparts in low exposure class (OR=2.65, 95%CI=1.72-4.07; OR=1.50, 95%CI=1.14-1.96, respectively). Conclusion The effect of ACEs on alcohol use may vary across different latent classes. Supportive childhood environment may contribute to decrease the risk of adolescent drinking behavior.
- Life change events /
- Alcohol drinking /
- Mental health /
- Questionnaires /
- Adolescent

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图 1 青少年ACEs三分类潜类别模型的条件概率分布

Figure 1. The distribution of conditional probability of 3-class LCA of ACEs

下载: 全尺寸图片幻灯片

表 1 青少年ACEs量表各条目回答情况构成(%, n=1 550)

Table 1. The questionnaire of ACEs and the responses of eligible participants(%, n=1 550)

ACEs量表维度	具体条目	从来没有	有时	经常
虐待
情感虐待	有没有因为大人们辱骂，对你说恶毒的话，或说不想要你之类的话而感到害怕或情绪极为糟糕	47.48	38.26	14.26
躯体虐待	有没有因为父母或其他大人要狠狠地揍你感到害怕	64.06	26.90	9.03
性虐待	大人碰过你的隐私部位吗(排除父母帮你洗澡)	92.13	6.90	0.97
	大人强迫与你发生性行为吗	98.45	0.58	0.97
忽视
情感忽视	有没有过觉得自己不被爱或不被关心的感觉	58.39	31.03	10.58
	有没有过觉得没人会保护你的感觉	59.74	27.35	12.90
躯体忽视	有没有较长时间地经历过一段完全只能靠自己照顾自己的生活	65.10	27.74	7.16
家庭功能不良
父母物质滥用	父母/监护人有没有因为酗酒或滥用毒品回家后虐待你或你的家人	96.58	2.45	0.97
父母精神异常	有没有看见过自己妈妈或爸爸太过悲伤以至于不能照顾你的情形	91.55	7.61	0.84
母亲遭遇家庭暴力	有没有看见过自己的妈妈被人打或被威胁的情形	95.10	4.45	0.45
父母犯罪	父母中有人坐过牢吗	97.68	1.81	0.52
家庭经济不稳定	有没有经历过一段因为太穷家里食物不够吃的情形	98.06	1.48	0.45
	家人有被迫离开家的情况吗	93.94	5.42	0.65
父母离异	父母目前的婚姻状况是	-	-	-
注：以上条目(“父母离异”除外)在回答之前，系统会提示研究对象“请回忆你童年时的经历”。

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表 2 ACEs不同潜类别模型拟合结果

Table 2. The results of latent class analysis of ACEs with different class

模型	AIC值	BIC值	aBIC值	Entropy值	LMR值	BLRT值	各类别人数
1	13 500.20	13 559.01	13 524.06	—	—	—	1 550
2	12 435.23	12 558.19	12 485.13	0.71	＜0.01	＜0.01	765/785
3	12 227.53	12 414.64	12 303.46	0.73	＜0.01	＜0.01	139/807/604
4	12 211.02	12 462.28	12 312.98	0.76	0.19	＜0.01	798/26/138/588
5	12 204.37	12 519.79	12 332.36	0.70	0.16	0.05	30/132/219/571/598
6	12 203.31	12 582.87	12 357.32	0.72	0.56	0.33	30/70/220/57/598/575

下载: 导出CSV

表 3 ACEs与青少年饮酒的多因素广义估计方程模型拟合结果(n=1 550)

Table 3. The association between ACEs and adolescent alcohol use: results of multivariate generalized estimating equations model(n=1 550)

效应	β值	标准误	OR值(OR值95%CI)	P值
时间1	0	-	-	-
时间2	0.02	0.11	1.02(0.82~1.27)	0.87
潜类别3	0	-	-	-
潜类别1	0.97	0.22	2.65(1.72~4.07)	＜0.01
潜类别2	0.40	0.14	1.50(1.14~1.96)	＜0.01
潜类别1×时间2	-0.53	0.25	0.59(0.36~0.97)	0.04
潜类别2×时间2	-0.29	0.16	0.75(0.55~1.02)	0.07
潜类别3×时间2	0	-	-	-
潜类别1×时间1	0	-	-	-
潜类别2×时间1	0	-	-	-
潜类别3×时间1	0	-	-	-
注：潜类别1~3分别代表高暴露组、虐待忽视组和低暴露组；时间1代表基线调查，2代表随访调查；多因素广义估计方程模型同时纳入的协变量有年龄、性别、朋友物质使用情况(抽烟、饮酒)、学校里成年人关心程度、抑郁量表评分、自我行动能力量表评分、每天上网时间(使用社交媒体、打游戏或其他网络活动)。

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