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The experience of childhood trauma is known to predict health-relevant outcomes across the lifespan. Previous reviews summarize existing knowledge of the implications of childhood trauma for health in young adults and adults more generally. The current theoretical review aims to integrate the existing literature on the relationship between childhood trauma and health-relevant outcomes specifically in college students, consolidating findings across specific health domains. Further, the following theoretical review highlights the need for more research in this area and discusses how college campuses may use the knowledge in this area of work to develop targeted interventions aimed at improving the health of college students who experienced trauma in childhood.

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Diane P. Calello reports receipt of honoraria from St. Peter’s University Hospital (New Jersey) for Pediatric Grand Rounds presentation, payment from the District Attorney of New York for expert testimony in a criminal case, support to Poison Center to defray costs of professional conference travel from the New Jersey Department of Health, and membership on the American College of Medical Toxicology Board of Trustees (through January 2023). Howard A. Greller reports receipt of honoraria from UpToDate for authored content and reimbursement from the Department of Emergency Medicine, Rutgers University, for travel to meetings. Alex J. Krotulski reports funding from the National Institute of Justice, U.S. Department of Justice, for sample analysis and salary. Trevor A. Cerbini reports receipt of reimbursement for travel expenses and conference fees from Rutgers University. No other potential conflicts of interest were disclosed.

Objective: To investigate whether use of cognitive reappraisal and expressive suppression interact with childhood trauma burden to predict alcohol problems in a sample of American Indian adults., Methods: Four hundred and twenty-nine American Indian adults (Mean age = 37.62, 59.5 % male) completed an online survey to measure childhood trauma exposure, perceived impact of childhood trauma, trait use of expressive suppression, and alcohol problems in adulthood., Results: Trait use of cognitive reappraisal and expressive suppression interacted with childhood trauma burden to predict alcohol problems in adulthood. American Indian adults who reported high levels of childhood trauma burden who also reported frequent use of both cognitive reappraisal and expressive suppression had significantly more alcohol problems compared to individuals who reported similarly high levels of childhood trauma burden who reported low use of these emotion regulation strategies., Conclusions: These findings provide initial evidence that emotion regulation interventions which focus on different emotion regulation strategies could be an effective way to offset the risk for alcohol problems associated with childhood trauma., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2023. Published by Elsevier B.V.)

Life events, such as the Coronavirus disease 2019 (COVID-19) pandemic, elicit increases in psychological stress and symptoms of anxiety and depression. In turn, these outcomes have negative implications for mental health. Emotion regulation strategies and prior adversity may moderate the degree to which life events affect outcomes that are linked to mental health. The purpose of the current study was to evaluate whether childhood adversity and emotion regulation strategy use interactively informed changes in outcomes linked to mental health following the onset of the pandemic in American Indian (AI) adults. AI adults ( N = 210) reported levels of childhood adversity, emotion regulation strategy use, symptoms of anxiety and depression, and psychological stress 1 month prior to the onset of the COVID-19 pandemic. One month following the declaration of the pandemic, they reported on their stress, symptoms of anxiety and depression once again. The interaction between expressive suppression and childhood adversity predicted changes in psychological stress and symptoms of depression ( B = .26, t (198) = 4.43 p < .001, R ² change = .06) and ( B = .23 t (199) = 4.14, p < .001, R ² change = .05) respectively. The findings indicate that expressive suppression may be a maladaptive emotion regulation strategy for AI adults who experienced high levels of childhood adversity. This work represents a first step in understanding the role of emotion regulation strategy use in predicting mental health-relevant outcomes in the context of a life event, in a community that is disproportionately affected by chronic mental health conditions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Investigate whether psychosocial risk in the childhood family environment moderates the relationship between childhood socioeconomic status (SES) and sleep, and the relationship between childhood SES and ambulatory blood pressure (ABP) in college students, two factors that are linked to future risk for cardiovascular disease. Participants: 124 American college students. Methods: Childhood SES and psychosocial risk in childhood family environments were measured by self-report instruments. Sleep was measured with self-report and actigraphy (over 5 days) and ABP over a 2-day period. Results: Linear regressions adjusting for age, sex, current SES, and current depressive symptoms indicated that SES and psychosocial risk in family environments during childhood interact to inform sleep quality, actigraphy derived wake after sleep onset (WASO), actigraphy derived Sleep Efficiency (SE) and ABP. Conclusions: Psychosocial risk in the childhood family environment may offset previously documented relationships between childhood SES and health-relevant outcomes in college students.

Objectives: To investigate whether childhood adversity exacerbates the relationship between sleep restriction and inflammation., Methods: Participants (N = 46) were randomly assigned to an experimental sleep restriction group (n = 25) or a night of typical sleep (n = 21). Participants provided a dried blood spot sample the morning before and after the experimental night., Results: A significant interaction emerged between childhood adversity and group assignment on C-reactive protein (CRP) after the experimental night (Beta = -0.02, SE = 0.01, P = .03, 95% CI: -0.05, -0.002). Sleep restriction resulted in an increase in CRP at high levels of childhood adversity (+1 SD; Effect = -0.57, SE = 0.15, P< .001; 95% CI: -0.87, -0.26) but not low levels of childhood adversity (Effect = -0.08, SE = 0.10, P = .40; 95% CI: -0.29, 0.12)., Conclusion: Childhood adversity may amplify the effect of sleep loss on markers of inflammation., (Copyright © 2022 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Childhood adversity is linked to adverse health in adulthood. One posited mechanistic pathway is through physiological responses to acute stress. Childhood adversity has been previously related to both exaggerated and blunted physiological responses to acute stress, however, less is known about the psychological mechanisms which may contribute to patterns of physiological reactivity linked to childhood adversity., Objective: In the current work, we investigated the role of challenge and threat stress appraisals in explaining relationships between childhood adversity and cortisol reactivity in response to an acute stressor., Methods: Undergraduate students ( n = 81; 61% female) completed an online survey that included general demographic information and the Risky Families Questionnaire 24 h before a scheduled lab visit. In the lab, a research assistant collected a baseline salivary cortisol sample. Following the baseline period, participants were read instructions for the Trier Social Stress Test (TSST), a validated psychological lab stressor. Next, they completed a challenge vs. threat task appraisal questionnaire and completed the speech and math portion of the TSST. Twenty minutes following the start of the TSST, a second salivary sample was collected to measure changes in salivary cortisol following the TSST., Results: Linear regression analyses adjusted for age, sex, childhood socioeconomic status (SES), and baseline cortisol levels, showed childhood adversity associated with changes in cortisol levels [ B = -0.29 t (73) = -2.35, p = 0.02, R 2=0.07 ]. Linear regression analyses controlling for age, sex, and childhood SES showed childhood adversity associated with both challenge [ B = -0.52 t (74) = -5.04, p < 0.001, R 2=0.24 ] and threat [ B = 0.55 t (74) = 5.40, p < 0.001, R 2=0.27 ] appraisals. Significant indirect effects of childhood trauma on cortisol reactivity were observed through challenge appraisals [ B = -0.01 (95% confidence interval = -0.02, -0.003)], and threat appraisals [ B = -0.01 (95% confidence interval = -0.01, -0.003)]., Conclusion: Childhood adversity may contribute to blunted cortisol reactivity, a pattern of response which is linked to obesity, addiction, and other behavior-related diseases. Our findings suggest that this relationship is in part a product of stress appraisals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Counts, Ginty, Larsen, Kampf and John-Henderson.)

American Indians are at increased risk for cardiovascular disease in adulthood, and levels of physical activity and body mass index associate with cardiovascular disease risk. Recent research indicates that one's mindset may play a role in determining health behaviors and outcomes. In a sample of 105 American Indian college students, greater growth health mindset associated with lower body mass index. Bootstrapping analyses revealed a significant indirect effect of health mindset on body mass index through levels of physical activity. These findings suggest that interventions aiming to promote growth health mindsets may be successful in reducing risk for cardiovascular disease in American Indian college students.

Background: Childhood abuse increases risk for high levels of distress in response to future stressors. Interpersonal social support is protective for health, particularly during stress, and may be particularly beneficial for individuals who experienced childhood abuse., Objective: Investigate whether childhood abuse predicts levels of posttraumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic, and test whether the perceived availability of social companionship preceding the pandemic moderates this relationship., Methods: During Phase 1, adults ( N = 120; Age M [SD] = 19.4 [0.94]) completed a retrospective measure of childhood adversity along with a measure of perceived availability of opportunities for social engagement immediately preceding the pandemic. Two weeks after the COVID-19 pandemic declaration, participants completed the Impact of Event Scale-Revised (IES-R) with respect to the pandemic. Hierarchical linear regression analyses examined the interaction between childhood abuse and the perceived availability of social companionship preceding the pandemic as a predictor of PTSD symptoms., Results: Adjusting for covariates, the interaction between childhood abuse and perceived availability of others to engage with before the onset of the pandemic was a significant predictor of IES-hyperarousal (β = -0.19, t = -2.06, p = 0.04, Δ R 2 = 0.032, CI: [-0.31 to -0.01])., Conclusion: Levels of perceived opportunities for social companionship before the pandemic associates with levels of hyperarousal related to the pandemic, particularly for individuals who experienced high levels of childhood abuse. More research is needed to understand how to mitigate the higher levels of distress related to the pandemic for these individuals in order to reduce risk for future psychiatric disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 John-Henderson, Counts and Ginty.)

Objective: To investigate associations between risk in family environments and health-relevant outcomes in college and the role of loneliness. Participants: College students at a state university ( N  = 360). Methods: We utilized linear regression to examine relationships between risk in family environments and loneliness, perceived stress, affect, and self-rated health. We tested for indirect effects of risk in family environments on outcomes through loneliness Results: Analyses showed that risk in family environments associated with loneliness ( β  = 0.12 t [358] = 2.22, p = .03, R 2 change = .02), perceived social stress ( β  = 0.20, t [357] = 3.88, p  < 0.001, R 2 change = .04), negative and positive affect ( β  = 2.44, t [357] = 3.95, p < .001, R 2 change = .04), and ( β = -0.18 t [357]= -3.44, p = .001, R 2 change = .03 respectively), and self-rated health ( β  = 0.19, t [359] = 4.57, p < .001, R 2 change = .10). Significant indirect effects were observed for risk in early family on all outcomes through loneliness. Conclusion: These findings provide initial evidence that risk in childhood family environments may negatively affect health by increasing loneliness in college students.

American Indian adults are at an increased risk for cardiovascular disease compared with non-Hispanic white adults. Scant research exists examining the underlying physiological and psychological mechanisms associated with these risks. This study aimed to examine possible psychological and physiological stress-related mechanisms related to cardiovascular disease risk in healthy American Indian and non-Hispanic white adults. Forty American Indian (60% female, Mean age = 19.93, SD = 2.08 years) and 45 non-Hispanic white (70% female, Mean age = 20.18, SD = 2.22 years) participants attended an in-person laboratory session. Salivary cortisol and cardiovascular activity were measured before (baseline), during, and after exposure to a 10-minute mental arithmetic task. Compared to non-Hispanic white participants, American Indian had diminished salivary cortisol (p < .001), blood pressure (p's < .001), and heart rate (p = .041) responses to acute psychological stress. These effects could not be accounted for by differences in task performance or self-reported engagement. Previous research has shown that exaggerated responses to stress are associated with increased risk of cardiovascular disease. However, diminished responses to stress are associated with early childhood stress and future adverse behaviors (e.g., addiction, obesity). Diminished reactivity may influence behaviors that can impact future development of cardiovascular disease in American Indian populations., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Diminished cardiac reactions to acute psychological stress are associated with adverse behavioral and health-relevant outcomes. It has been proposed that diminished cardiac reactivity may be a marker for deficits in motivational functioning both at the biological and behavioral levels. Social participation reflects the frequency with which individuals participate in social events and has motivational components. As such, it is a distinct construct from other constructs such as social integration, which measures the number of social roles an individual has. Additionally, lower levels of social participation and diminished reactivity have been associated with similar adverse health outcomes. Therefore, it is possible that diminished cardiac reactivity is associated with lower levels of social participation. We aimed to examine whether diminished cardiovascular reactivity in response to an acute lab stressor was associated with reported social participation. The analyses were conducted using publicly available data from the Pittsburgh Cold Study 3 (PCS3). The PCS3 was a prospective viral-challenge study, which included participants completing an in-lab social evaluative stressor (N = 202, Age = M = 29.71, SD = 10.66) and measuring cardiovascular responses at baseline and in response to the stressor. Separate regression analyses for each cardiovascular variable (SBP, DBP, MAP, and HR) demonstrated that lower cardiovascular reactivity was associated with less social participation. These associations were still evident following adjustment for respective baseline cardiovascular levels, age, sex, race, depressive symptomology, body mass index, socioeconomic status, smoking status, and levels of social integration (R 2 changes: ≥ 0.017; ps ≤ 0.02) The findings provide initial evidence that blunted cardiac reactivity may be a precursor to low levels of social participation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: Low socioeconomic status (SES) in childhood associates with poor sleep quality in adulthood. Separately, childhood family environments shape health into adulthood. Here, we investigated whether these early life factors independently or interactively inform global sleep quality in college students., Design: Cross-sectional., Participants: College students at a state university (N = 391)., Measurements: As a measure of childhood SES, we asked participants to consider their families' socioeconomic standing relative to the rest of the society during their childhood. We used the Risky Family questionnaire to measure adversity and the presence of warmth and affection in the family environment during childhood, and the Pittsburgh Sleep Quality Index as a measure of current global sleep quality. We used linear regressions adjusting for age and sex to examine relationships between childhood SES, risk in childhood family environments, and global sleep quality., Results: Lower childhood SES and greater risk in childhood family environments independently predicted poor sleep quality. Importantly, in low-risk family environments, there was no significant difference in sleep quality as a function of childhood SES. However, students who were from low childhood SES backgrounds who also reported high levels of risk in their early family environments had the worst sleep quality., Conclusions: Findings highlight the importance of considering socioeconomic and family environments in childhood as informants of sleep quality across the lifespan. Compromised sleep quality in college students could affect academic performance and health over time., (Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background:  Despite the growing chronic disease burden in low- and middle-income countries, there are significant gaps in our understanding of the financial impact of these illnesses on households. As countries make progress towards universal health coverage, specific information is needed about how chronic disease care drives health expenditure over time, and how this spending differs from spending on acute disease care., Methods:  A 19-year panel dataset was constructed using data from the Kagera Health and Development Surveys. Health expenditure was modelled using multilevel regression for three different sub-populations of households: (1) all households that spent on healthcare, (2) households affected by chronic disease and (3) households affected by acute disease. Explanatory variables were identified from a review of the health expenditure literature, and all variables were analysed descriptively., Findings:  Households affected by chronic disease spent 22% more on healthcare than unaffected households. Catastrophic expenditure and zero expenditure are both common in chronic disease-affected households. Expenditure predictors were different between households affected by chronic disease and those unaffected. Expenditure over time is highly heterogeneous and household-dependent., Conclusions:  The financial burden of healthcare is greater for households affected by chronic disease than those unaffected. Households appear unable to sustain high levels of expenditure over time, likely resulting in both irregular chronic disease treatment and impoverishment. The Tanzanian government's current efforts to develop a National Health Financing Strategy present an important opportunity to prioritize policies that promote the long-term financial protection of households by preventing the catastrophic consequences of chronic disease care payments., (© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The "Unfinished Agenda" of infectious diseases is of great importance to policymakers and research funding agencies that require ongoing research evidence on their effective management. Journal publications help effectively share and disseminate research results to inform policy and practice. We assess research investments to United Kingdom institutions in HIV, tuberculosis and malaria, and analyse these by numbers of publications and citations and by disease and type of science., Methods: Information on infection-related research investments awarded to United Kingdom institutions across 1997-2010 were sourced from funding agencies and individually categorised by disease and type of science. Publications were sourced from the Scopus database via keyword searches and filtered to include only publications relating to human disease and containing a United Kingdom-based first and/or last author. Data were matched by disease and type of science categories. Investment (United Kingdom pounds) and publications were compared to generate an 'investment per publication' metric; similarly, an 'investment per citation' metric was also developed as a measure of the usefulness of research., Results: Total research investment for all three diseases was £1.4 billion, and was greatest for HIV (£651.4 million), followed by malaria (£518.7 million) and tuberculosis (£239.1 million). There were 17,271 included publications, with 9,322 for HIV, 4,451 for malaria, and 3,498 for tuberculosis. HIV publications received the most citations (254,949), followed by malaria (148,559) and tuberculosis (100,244). According to UK pound per publication, tuberculosis (£50,691) appeared the most productive for investment, compared to HIV (£61,971) and malaria (£94,483). By type of science, public health research was most productive for HIV (£27,296) and tuberculosis (£22,273), while phase I-III trials were most productive for malaria (£60,491). According to UK pound per citation, tuberculosis (£1,797) was the most productive area for investment, compared to HIV (£2,265) and malaria (£2,834). Public health research was the most productive type of science for HIV (£2,265) and tuberculosis (£1,797), whereas phase I-III trials were most productive for malaria (£1,713)., Conclusions: When comparing total publications and citations with research investment to United Kingdom institutions, tuberculosis research appears to perform best in terms of efficiency. There were more public health-related publications and citations for HIV and tuberculosis than other types of science. These findings demonstrate the diversity of research funding and outputs, and provide new evidence to inform research investment strategies for policymakers, funders, academic institutions, and healthcare organizations.

HIV-1 protease (PR) is a viral enzyme vital to the production of infectious virions. It is initially synthesized as part of the Gag-Pol polyprotein precursor in the infected cell. The free mature PR is liberated as a result of precursor autoprocessing upon virion release. We previously described a model system to examine autoprocessing in transfected mammalian cells. Here, we report that a covariance analysis of miniprecursor (p6*-PR) sequences derived from drug naïve patients identified a series of amino acid pairs that vary together across independent viral isolates. These covariance pairs were used to build the first topology map of the miniprecursor that suggests high levels of interaction between the p6* peptide and the mature PR. Additionally, several PR-PR covariance pairs are located far from each other (>12 Å Cα to Cα) relative to their positions in the mature PR structure. Biochemical characterization of one such covariance pair (77-93) revealed that each residue shows distinct preference for one of three alkyl amino acids (V, I, and L) and that a polar or charged amino acid at either of these two positions abolishes precursor autoprocessing. The most commonly observed 77V is preferred by the most commonly observed 93I, but the 77I variant is preferred by other 93 variances (L, V, or M) in supporting precursor autoprocessing. Furthermore, the 77I93V covariant enhanced precursor autoprocessing and Gag polyprotein processing but decreased the mature PR activity. Therefore, both covariance and biochemical analyses support a functional association between residues 77 and 93, which are spatially distant from each other in the mature PR structure. Our data also suggests that these covariance pairs differentially regulate precursor autoprocessing and the mature protease activity.