OP16 Impact of poverty and family adversity on adolescent health. A multi-trajectory analysis using the UK Millennium cohort study

Background Both poverty and family adversities including domestic violence, parental mental illness and parental drug and alcohol use are associated with poor outcomes across the life course. However, the complex relationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on child health outcomes in adolescence. Methods We used longitudinal data from the nationally representative UK Millennium Cohort study on 11564 children born between 2000 and 2002, followed through six survey waves. Family adversities were defined here as parent reported domestic violence and abuse, parental alcohol use and parental mental illness. We used a group-based multi-trajectory cluster model to define trajectories of poverty and family adversity for children aged 9 months to 14 years. We assessed associations of these trajectories and child outcomes at age 14 years (child socioemotional behavioural problems, cognitive disability, obesity, alcohol and drug use) using multivariable logistic regression adjusting for confounders. Results Six trajectories were identified: persistent alcohol misuse (7.7%), low poverty and family adversity (43.2%), persistent domestic violence and abuse (3.4%), persistent parental mental illness (11.9%), persistent poverty (22.6%) and poverty and parental mental illness (11.1%). Compared to the low poverty and family adversity trajectory, children in the other trajectory groups experienced worse outcomes, particularly for combined exposure to poverty and parental mental illness. Compared with children with low adversity, those in the parental mental illness and poverty group were particularly at increased risk of socioemotional behavioural problems (adjusted OR 6.4, 95% CI 5.0 - 8.3), cognitive disability (aOR 3.1, CI 2.4 - 4.2), drug use (aOR 1.7, CI 1.4 - 2.0) and obesity (aOR 1.8, CI 1.3 - 2.5). Conclusion Over half of children in the UK grow up experiencing poverty and adversities associated with poor health in adolescence. Persistent poverty and/or persistent parental mental illness affect over four in ten UK children. The combination of both affects one in ten and is very strongly associated with adverse child outcomes, particularly poor child mental health.