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How do early-life adverse childhood experiences mediate the relationship between childhood socioeconomic conditions and adolescent health outcomes in the UK?
  1. Viviane S Straatmann1,2,
  2. Eric Lai1,
  3. Catherine Law3,
  4. Margaret Whitehead1,
  5. Katrine Strandberg-Larsen4,
  6. David Taylor-Robinson1
  1. 1 Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
  2. 2 NVS, Karolinska Institutet, Stockholm Universitet, Aging Research Center, Stockholm, Sweden
  3. 3 Population, Policy and Practice, Institute of Child Health, University College London, London, UK
  4. 4 Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
  1. Correspondence to Viviane S Straatmann, Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool L69 3GL, UK; v.schultz-straatmann{at}


Background Both adverse childhood experiences (ACEs) and adverse childhood socioeconomic conditions (SECs) in early life are associated with poor outcomes across the life course. However, the complex interrelationships between childhood SECs and ACEs are unclear, as are the consequences for health outcomes beyond childhood. We therefore assessed the extent to which early-life ACEs mediate the relationship between SECs and socioemotional behavioural problems, cognitive disability and overweight/obesity in adolescence.

Methods We used longitudinal data from the UK Millennium Cohort Study (MSC). Outcomes assessed at age 14 were socioemotional behavioural problems, cognitive disability and overweight/obesity. SECs at birth were measured by maternal education. Potentially mediating ACEs measured up to 5 years were verbal and physical maltreatment, parental drug use, domestic violence, parental divorce, maternal mental illness and high frequency of parental alcohol use. We used counterfactual mediation analysis to assess the extent to which ACEs mediate the association between SECs at birth and behavioural, cognitive and physical outcomes at age 14, estimating total (TE), natural direct and indirect effects, and mediated proportions.

Results Children with disadvantaged SECs were more likely to have socioemotional behavioural problems (relative risk (RR) 3.85, 95% CI 2.48 to 5.97), cognitive disability (RR 3.87, 95% CI 2.33 to 6.43) and overweight/obesity (RR 1.61, 95% CI 1.32 to 1.95), compared to those with more advantaged SECs. Overall, 18% of the TE of SECs on socioemotional behavioural problems was mediated through all ACEs investigated. For cognitive disability and overweight/obese, the proportions mediated were 13% and 19%, respectively.

Conclusion ACEs measured up to age 5 years in the MCS explained about one-sixth of inequalities in adolescents behavioural, cognitive and physical outcomes.

  • Health inequalities
  • cohort studies
  • child health
  • public health

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  • Contributors VSS carried out the statistical analyses (supported by EL), drafted the initial manuscript, reviewed and revised the manuscript. EL, KS-L, MW and CL participated in the drafting of the initial manuscript, reviewed and revised the manuscript. DT-R conceptualised and designed the study, coordinated, drafted the initial manuscript, reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This work was supported by the UK Public Health Research Consortium (PHRC). The PHRC is funded by the Department of Health and Social Care Policy Research Programme. Information about the wider programme of the PHRC is available from The views expressed in this paper are those of the authors and do not necessarily reflect those of the Department of Health and Social Care. DT-R is funded by the MRC on a Clinician Scientist Fellowship (MR/P008577/1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open-access repository. All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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