Journal of Behavioral Medicine

, Volume 41, Issue 4, pp 516–527 | Cite as

Screening for childhood adversity: the what and when of identifying individuals at risk for lifespan health disparities

  • Kate Ryan Kuhlman
  • Theodore F. Robles
  • Julienne E. Bower
  • Judith E. Carroll


Existing research on childhood adversity and health risk across the lifespan lacks specificity regarding which types of exposures to assess and when. The purpose of this study was to contribute to an empirically-supported framework to guide practitioners interested in identifying youth who may be at greatest risk for a lifelong trajectory of health disparities. We also sought to identify the point in childhood at which screening for adversity exposure would capture the largest group of at risk individuals for triage to prevention and intervention services. Participants (n = 4036) collected as part of the Midlife in the United States study reported their medical status and history including physical (cardiovascular disease, hypertension, obesity, diabetes, cancer) and mental health (depression, substance use problems, sleep problems). Participants indicated whether they were exposed to 7 adversities at any point in childhood and their age of exposure to 19 additional lifetime adversities before the age of 18. Parent drug abuse, dropping out or failing out of school, being fired from a job, and sexual assault during childhood exhibited the largest effect sizes on health in adulthood, which were comparable to the effects of childhood maltreatment. Childhood adversity screening in early adolescence may identify the largest proportion of youth at risk for negative health trajectories. The results of this descriptive analysis provide an empirical framework to guide screening for childhood adversity in pediatric populations. We discuss the implications of these observations in the context of prevention science and practice.


Child adversity Integrated primary care Health disparities Adolescence Academic problems Parent substance abuse Prevention science 



This study was funded by the John D. and Catherine T. MacArthur Foundation Research Network and the National Institute on Aging (P01-AG020166, U19-AG051426). Composition of this manuscript was supported by grants awarded to Dr. Kate Kuhlman by the National Institute of Mental Health (T32MH15750, K08MH112773).

Compliance with ethical standards

Conflict of interest

Kate Ryan Kuhlman, Theodore F. Robles, Julienne E. Bower, and Judith E. Carroll declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all individual participants included in the study.

Supplementary material

10865_2018_9921_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 30 kb)


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Authors and Affiliations

  1. 1.Department of Psychology and Social Behavior, School of Social EcologyUniversity of California IrvineIrvineUSA
  2. 2.Cousins Center for PsychoneuroimmunologySemel Institute for Neuroscience and Human Behavior, University of California Los AngelesLos AngelesUSA
  3. 3.Department of PsychologyUniversity of California Los AngelesLos AngelesUSA

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