Gloria Hu

Importance: Childhood adversity has been linked to many indicators of shorter healthy lifespan, including earlier onset of disease and disability as well as early mortality. These observations suggest the hypothesis that childhood maltreatment may accelerate aging. We tested this hypothesis in a prospective cohort of individuals with documented childhood maltreatment and controls matched on demographic and socioeconomic factors. Objective: To characterize the relationship between childhood maltreatment and accelerated biological aging in a prospective cohort of documented cases of childhood maltreatment and matched controls.Design: Prospective cohort study Setting: Cases were drawn from juvenile and adult court records from the years 1967 through 1971 in a large Midwest metropolitan geographic area. Controls were selected from the same schools and hospitals of birth and matched on age, sex, race, and approximate socioeconomic status. Participants: 357 individuals with documented cases of childhood maltreatment and 250 matched controlsExposure: Court-substantiated cases of childhood physical or sexual abuse, or neglect occurring at age 11 or youngerOutcome: Biological aging quantified using two blood-chemistry algorithms, the Klemera-Doubal method Biological Age (KDM BA) and the PhenoAge, developed and validated in data from the National Health and Nutrition Examination Surveys (NHANES) using published methods and publicly available software. Results: Participants (55% women, 49% non-White) had mean age of 41 years (SD=4). Those with court substantiated childhood maltreatment history exhibited more advanced biological aging as compared with matched controls, although this difference was statistically different for only the KDM BA measure (KDM BA Cohen’s D=0.20, 95% CI=[0.03,0.36], p=0.02; PhenoAge Cohen’s D=0.09 95% CI=[-0.08,0.25], p=0.296). In subgroup analyses, maltreatment effect sizes were larger for women as compared to men and for White participants as compared to non-White participants, although these differences were not statistically significant at the α=0.05 level.Conclusions and Relevance: As of midlife, effects of childhood maltreatment on biological aging are small in magnitude but discernible. Interventions to treat psychological and behavioral sequelae of exposure to childhood maltreatment, including in midlife adults, have potential to protect survivors from excess burden of disease, disability, and mortality in later life.

In the United States (U.S.), the HIV infection rate is disproportionately high among incarcerated individuals. HIV-infected individuals typically receive antiretroviral therapy (ART) to suppress HIV and reduce the threat of transmission. Although HIV-infected individuals are generally ART-adherent while incarcerated, the public health benefits experienced during incarceration are often lost as HIV-infected individuals struggle to maintain optimal adherence post-incarceration. While the importance of maintaining adherence in the post-incarceration period has been acknowledged, research on barriers to ART adherence during this period is limited. To better understand post-release barriers to ART adherence, we conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City; we also followed up with 18 (90%) participants after three months to explore whether their adherence challenges changed over time. Viral load testing results from their most recent physician visit were also recorded at each interview. Interviews were transcribed using transcription software and reviewed for accuracy by a researcher. Thematic coding based on discussion guide prompts were then used to identify commonly mentioned barriers to adherence. The results identified four overarching themes that affected study participants’ efforts to adhere to their ART regimen: medication burden, forgetfulness, mental health and emotional difficulties, and perceived conflict between substance use and medication adherence. These barriers were the most commonly cited and largely persisted at three-month follow-up. The results suggest that interventions addressing these challenges are essential for promoting ART adherence among HIV-infected formerly incarcerated individuals. Effective interventions may include mobile-based text messaging reminders and those that facilitate patient-provider communication. Additionally, interventions or programs that integrate substance use and mental health treatment into HIV-related care, along with other types of behavioral health support, may also be beneficial for this population. Such interventions should be a routine part of discharge planning and support for incarcerated individuals returning to the community.

Background: In the U.S., approximately one in seven HIV-infected individuals experience incarceration at least once in their lifetime. While HIV-infected individuals experience positive health outcomes during periods of incarceration, they tend to experience treatment disruption as they return to their community after custody which results in poor health outcomes. The purpose of this study was to explore the transitional support received from the Department of Corrections during the reentry period. Methods: We conducted in-depth interviews with 20 HIV-infected formerly incarcerated individuals in New York City. Interviews were audio recorded and transcribed. Three researchers performed line-by-line reading of the transcripts to identify dominant codes and themes that emerged. A mixture of deductive and inductive techniques was used to identify patterns that emerged in the data. Results: Most of the participants were male and racial and ethnic minorities. There were five dominant themes that emerged during our analysis: 1) variations in the quantity of antiretroviral medication received during transition; 2) linkages to community-based physical health care providers was not well-coordinated; 3) insufficient housing and social resources; 4) structural and social challenges to post-release well-being; and 5) family as a source of resilience. Conclusions: Discharge support planning should include sufficient medication to prevent treatment disruption and a more comprehensive approach to linkage to community-based healthcare services. Such planning should also include thorough pre-release assessments to identify appropriate levels of support needed, including employment and housing assistance, which will be useful for resource allocation. Broadening public health partnerships may also increase availability and promote accessibility to the most appropriate healthcare services and programs, which may provide better opportunities to receive coordinated care and ensure continuity of care. Finally, ties to family members and other loved ones should be leveraged to help facilitate the achievement of optimal health outcomes among this population.