Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Children who were punished physically had higher risks for
cardiovascular disease, arthritis, and obesity in adulthood, researchers found.
cardiovascular disease, arthritis, and obesity in adulthood, researchers found.
Compared with adults who were not punished physically as children, those who received harsh physical punishment in childhood were 24% more likely to be obese (95% CI 1.05-1.47) and 35% more likely to have arthritis (95% CI 1.10-1.69), according to Tracie Afifi, PhD, of the University of Manitoba in Winnipeg, Canada, and colleagues.
Children disciplined with physical punishment were also significantly more likely to have cardiovascular disease as adults (adjusted OR 1.38, 95% CI 1.08-1.76), though this association only approached significance after additional adjustment (aOR 1.28, 95% CI 1.00-1.64), they wrote online in the journal Pediatrics.
Prior research has established relationships between physical punishment -- such as pushing, grabbing, shoving, slapping, and hitting -- and mental disorders, aggression, delinquency, and physical injury. Additionally, other research has shown a link between long-term effects on health-related quality of life with physical abuse, sexual abuse, emotional abuse, intimate partner violence, and neglect. However, past studies have not explored long-term physical health consequences on adults who grew up receiving physical punishment.
The authors studied the effects of physical punishment on eight long-term health effects in a sample of 34,226 U.S. adults and compared with a representative sample of U.S. adults.
Data were collected through the National Epidemiologic Survey on Alcohol and Related Conditions for 2004 to 2005, which assessed physical punishment and childhood maltreatment.
Participants were considered to have received physical punishment as a child if they responded with 'sometimes or greater' to a question on how often they were pushed, grabbed, shoved, slapped, or hit by an adult in their home. The authors cautioned that some of those physical interactions may also be considered maltreatment or may have been coupled with other forms of abuse or maltreatment.
The study also assessed eight physical conditions and whether participants were afflicted by them in the past year, including arteriosclerosis or hypertension, hepatic disease, diabetes, cardiovascular disease, gastrointestinal disease, arthritis, and obesity. Obesity was categorized by the participant's reported height and weight, while the other conditions were diagnosed by a healthcare professional.
Covariates included gender, age, income, years of education, marital status, ethnicity, family history of household dysfunction, and Axis I and II mental disorders, which included major depression; dysthymia; mania; hypomania; social phobia; generalized anxiety disorder; panic disorder with or without agoraphobia; specific phobia; agoraphobia; posttraumatic stress disorder; alcohol abuse; drug abuse; and nicotine dependence, and antisocial; avoidant; dependent; borderline; histrionic; paranoid; schizoid; schizotypal; narcissistic; and obsessive-compulsive personality disorders.
The researchers adjusted odds ratios twice, including one model that adjusted for sociodemographic data, and another that added household dysfunction and Axis I and II disorders.
The prevalence of physical punishment was lower than that of child maltreatment (3.6% versus 38.1%).
In addition to associations between physical punishment and cardiovascular disease, arthritis, and obesity, there was a significant correlation with physical punishment and any physical condition (aOR 1.24, 95% CI 1.05-1.47).
Odds of a given condition were lower after adjustment for household dysfunction and mental disorders.
The authors also noted that when odds of participants being subject to any of the eight physical condition categories were compared, there was no significant difference in odds between those who had been maltreated or those who had experienced physical punishment as children.
They offered a number of potential mechanisms of action for these relations, such as dysregulation of the hypothalamus-pituitary adrenal axis, altered brain structure, and the relation between emotional and physical health seen in patients subject to maltreatment.
In an accompanying editorial, Rachel Brger, MD, of the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and Adam Zolotor, MD, of the the University of North Carolina School of Medicine, found the authors' conclusions about physical punishment to be lacking, particularly in their use of "harsh physical punishment" as the target in the association.
They cautioned that the study should have included non-harsh physical punishment in its measures, adding that "physical punishment which does not reach the level of being considered harsh is likely the most common type of discipline," though they did not define what constitutes non-harsh physical punishment.
The study was limited by a cross-sectional design, absent measures of lifetime outcomes for the eight physical conditions, and lack of confirmation of self-reported data. The authors also found the study was limited by retrospective data collection, retrospective recall of parental psychopathology, and missing data on parental physical health conditions.
The study was supported by an award from the Manitoba Medical Services Foundation, a Winnipeg Foundation award, an award from the Canadian Institutes of Health Research New Investigator, and an award from the Manitoba Health Research Council.
Primary source: Pediatrics
Source reference:
Afifi TO, et al "Harsh physical punishment in childhood and adult physical health" Pediatrics2013; DOI: 10.1542/peds.2013-4021.
Source reference:
Afifi TO, et al "Harsh physical punishment in childhood and adult physical health" Pediatrics2013; DOI: 10.1542/peds.2013-4021.
Additional source: Pediatrics
Source reference:
Berger RP, and Zolotor AJ "Is there an association between physical punishment in childhood and physical health in adulthood" Pediatrics 2013; DOI: 10.1542/peds.2013-1631
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Source reference:
Berger RP, and Zolotor AJ "Is there an association between physical punishment in childhood and physical health in adulthood" Pediatrics 2013; DOI: 10.1542/peds.2013-1631
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