| ObjectivesThe study aims to describe the relationship between different dimensions of early life adversity and pubertal timing and tempo as well as the gender differences,and to further explore the specific effects of threat-and deprivation-related adversitie on pubertal development and its potential mechanisms by combining the dimensional model of adversity and psychopathology.MethodsUsing data of pubertal development cohort of children,2288 students of grade 1-3 with an average age of(8.11 ±0.87)years old were randomly selected through clustering convenience sampling method from 2 nine-year schools of Bengbu,Anhui Province,China,in 2013(baseline,T0).Participants were followed up for four waves(2015,T1;2017,T2;2018,T3 and 2019,T4)across 6 years.At baseline,adolescent demographic information,parental education,family income,sleep duration,physical activities and psychopathological symptom were evaluated by using parental questionnaire.Based on the original Kaiser-CDC ACE Study and the synthesis literatures on ACEs,early life adversities were evaluated by parents reporting whether children had experienced peer bullying,physical abuse,emotional abuse,sexual abuse,physical neglect and emotional neglect at grade 1 to 3 or younger.Cronbach’s alpha(α=0.733)showed the questionnaire in our study to reach acceptable validity and reliability.At follow-up surveys,information on other types of early life adversity,such as witnessing domestic violence,lack of parental warmth and parental divorce,was obtained using student questionnaires.Threat-related adversities included 5 specific adversities: peer bullying,physical abuse,emotional abuse,sexual abuse and witnessing domestic violence;Deprivation-related adversities included 6 specific adversities: emotional neglect,physical neglect,parental divorce,low parental educational,low family income,and lack of parental warmth.From baseline,physical examination and secondary sexual development evaluation were evaluated biennially.Height and weight was measured by trained interviewers using standardized instruments,from which we calculated BMI.Breast tanner stage in girls were evaluated by visual inspection and palpation.Testicular volume in boys was estimated by a trained male pediatric endocrinologist through palpation using a Prader orchidometer.Based on pubertal development data from five surveys,SAS 9.4 PROC NLMIXED was used to fit nonlinear growth model to evaluate pubertal timing and tempo.Timing is estimated at mid puberty(Tanner stage Ⅲ),and tempo is estimated as instantaneous rate of change at that point.Linear regression model was used to examine the association between different dimensions of early life adversity and pubertal timing and tempo,and to explore the dose-response relationship between cumulative threatand deprivation-related adversities and pubertal timing and tempo among boys and girls,separately.All analyses adjusted for age,BMI,psychopathological symptoms,sleep duration and physical activities at baseline.ResultsOf the 2288 children participating at baseline,1956 had participated in five rounds of surveys,with a 6-year missing rate of 14.51%.Finally,1765 participants had complete data of early life adversity,pubertal development and related covariates,with a mean(SD)age of(8.15±0.88)years.Compared with the follow-up sample,the proportion of boys in the lost follow-up sample was significantly higher and the age was significantl older(P< 0.05).There were no significant differences in pubertal development,BMI and maternal education level at baseline between adolescents lost to follow-up and the sample follow-up(P>0.05).Threat-related adversities included peer bullying(25.95%),physical abuse(33.54%),emotional abuse(39.09%),sexual abuse(3.00%)and witnessing domestic violence(15.07%).The cumulative threat score was 0~5,with an average of(1.17±1.10).Among them,scores of threat-related adversities of boys(1.26±1.12)was significantly higher than girls(1.06±1.07).Deprivation-related adversities included emotional neglect(36.54%),physical neglect(19.09%),parental divorce(10.02%),low parental education level(21.81%),low family income(4.41%)and lack of parental warmth(14.67%).The cumulative deprivation score was 0~6,with an average of(1.07±1.11).Among them,scores of deprivation-related adversities of boys(1.14 ±1.12)was significantly higher than girls(0.99 ±1.09).Compared to children without threat-related adversity,experiencing 3 or more threat-related adversities was associated with earliest pubertal timing(boys: 12.84±0.75 vs.12.55±0.76;girls: 11.40±0.76 vs.10.89±0.75)and the slowest pubertal tempo(boys: 1.30±0.37 vs.1.15±0.38;girls: 1.68±0.41 vs.1.52±0.41);Compared to children without deprivation-related adversity,there was no significant difference in pubertal timing(boys: 12.73±0.75 vs.12.73±0.76;girls: 11.34±0.75 vs.11.24±0.77)and tempo(boys: 1.28±0.38 vs.1.25±0.38;girls: 1.59±0.41 vs.1.65±0.42)among children who experienced 3 or more deprivation-related adversities.In a multivariate linear regression model that included both cumulative threat-and deprivation-related adversities scores,and adjusted for age,BMI,psychopathological symptoms,sleep duration,and physical activity at baseline,we found that the cumulative threat-related adversities were related to earlier pubertal timing and slower pubertal tempo.The cumulative threat-related adversities score ≥3 was most strongly associated with early pubertal timing(boys: β=-0.30,95%CI:-0.48~-0.13,P=0.001;girls: β=-0.43,95%CI:-0.65~-0.21,P<0.001)and slow pubertal tempo(boys: β=-0.16,95%CI:-0.25~-0.08,P < 0.001;girls: β=-0.27,95%CI:-0.42~-0.12,P<0.001).However,there was no significant association between cumulative deprivation-related adversities and pubertal timing and tempo(P>0.05).ConclusionThe effects of different dimensions of early life adversities on pubertal development are specific: threat-related adversities are related to early pubertal timing and slow pubertal tempo in a dose-response manner,while deprivation-related adversities are not significantly related to pubertal timing and tempo.Understanding the specific association between threat-and deprivation-related adversities and pubertal timing and tempo may contribute to elucidate potential mechanisms for the association between early life adversity and later pubertal development,and to provide empirical basis for early screening for early pubertal development and reducing the potential harms of early life adversity... |
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