At some point in their lives, an estimated 2.6% of adult Americans have a drug disorder [
Children of addicted parents have twice the risk of premature death in comparison to their peers who do not have addicted parents [
Parental addictions often result in or exacerbate other adverse childhood experiences such as parental divorce [
A pattern of unhealthy adult behaviors is often found among individuals with a history of parental addictions. In order to deal with negative experiences, adult children of addicts may develop risky health behaviors as a coping mechanism. These behaviors may in turn lead to a person being at an increased risk for chronic diseases [
Dysfunctional home environments, which include exposure to parental addictions, have been correlated with childhood physical inactivity [
A negative correlation exists between parental addictions in childhood and later educational attainment [
A history of parental addictions is often associated with anxiety and stress disorders in childhood [
Consistent findings indicate that higher rates of arthritic conditions are associated with older age [
Based on a large, regionally representative Canadian sample, this study investigated the relationship between self-reports of childhood exposures to parental alcohol or drug addictions and self-reports of health professionals’ diagnosis of arthritis. In order to study this relationship, adjustments were made for age, gender, and race, in addition to the following four types of risk factors: (1) adult socioeconomic status; (2) adult health behaviors; (3) other adverse childhood experiences; and (4) mood and anxiety disorders.
Statistics Canada’s 2005 Canadian Community Health Survey (CCHS 3.1) was a nationally representative, multistage stratified survey of health status, health care usage, and determinants of health [
Logistic regression analyses were conducted to investigate the association between parental addictions and arthritis. The initial analysis and each subsequent analysis included parental addictions, race, gender, and age. The second analysis examined adult socioeconomic status including level of educational achievement and household income. The third analysis examined health risk behaviors in adulthood including smoking, alcohol consumption, activity level, and obesity. The fourth model included other adverse childhood experiences including parental divorce/separation, childhood abuse, and parental unemployment/childhood poverty. The fifth analysis focused on adult mental health including mood and anxiety disorders. The final model controlled for all of the aforementioned factors. The purpose of the analysis was to examine the impact that controlling for additional risk factors would have on the association between parental addictions and arthritis.
In the logistic regression analyses, the sample size varied from
The survey asked respondents to report on their experiences while living at home in their childhood and teenage years. Exposure to parental addictions was determined through a positive response to the following question: “did either of your parents drink or use drugs so often that it caused problems for the family?”
Respondents were asked to report on their experiences with chronic illnesses that were “long-term conditions that have lasted or are expected to last six months or more” and that “had been diagnosed by a health professional.” Individuals were then asked if they had “Arthritis or rheumatism, excluding fibromyalgia?”
Demographic characteristics that were included in the analyses were age (18–39, then by decade until 79, then 80 and older) and self-reported race (visible minority and white).
Using the same preamble as the parental addictions questions described above, other adverse childhood experiences were determined based on responses to questions regarding parental unemployment (“Did your father or mother not have a job for a long time when they wanted to be working?”) childhood physical abuse (“Were you ever physically abused by someone close to you?”), and parental divorce (“Did your parents get a divorce?”).
Adult health behaviors included in the analysis comprised smoking status, body mass index (BMI), activity level, and level of alcohol consumption. Self-reported smoking status was categorized as either current or former smokers compared to never smokers. Body Mass Index was based on self-reported data on weight and height, which was then placed into four categories: obese (
Adult socioeconomic status included level of education (less than high school, high school graduation, and postsecondary graduation) and household income (<$15,000, $15,000–$29,999, $30,000–$49,999, $50,000 or more, missing).
Respondents were asked if they had the following “long-term conditions that have lasted or are expected to last six months or more and that had been diagnosed by a health professional”: “do you have a mood disorder such as depression, bipolar disorder, mania, or dysthymia?” Anxiety disorders were assessed using the question “Do you have an anxiety disorder such as a phobia, obsessive compulsive disorder, or a panic disorder?”
It should be noted that it is impossible to determine with this dataset the timing of the onset of the adult health behaviors and mental health problems. They may have begun before or after the onset of arthritis.
One in five respondents in the regional representative sample used for this study, reported they had been diagnosed by a health professional with arthritis (20.4%; 95% CI = 18.9%–21.9%). The prevalence of self-reported experiences of parental addictions was found to be 14.5% (95% CI = 13.1%–15.9%). Sample characteristics are presented in Table
Description of those with arthritis and those without arthritis*.
No arthritis |
Arthritis |
Total | |
---|---|---|---|
|
|||
Parental addiction | |||
No | 8,245 (85.9%) | 2,937 (83.9%) | 11,182 (85.5%) |
Yes | 1,386 (14.1%) | 468 (16.1%) | 1,854 (14.5%) |
|
|||
Sex | |||
Male | 4,540 (50.6%) | 1,203 (40.1%) | 5,743 (48.4%) |
Female | 5,116 (49.4%) | 2,215 (59.9%) | 7,331 (51.6%) |
Age, years | |||
12–39 | 4,069 (46.9%) | 227 (8.7%) | 4,296 (39.1%) |
40–49 | 1,725 (22.0%) | 326 (15.2%) | 2,051 (20.6%) |
50–59 | 1,525 (15.6%) | 709 (24.1%) | 2,234 (17.3%) |
60–69 | 1,054 (7.9%) | 764 (20.5%) | 1,818 (10.4%) |
70–79 | 777 (5.1%) | 819 (19.3%) | 1,596 (8.0%) |
≥80 | 506 (2.5%) | 574 (12.2%) | 1,079 (4.5%) |
Race | |||
White | 8,340 (85.1%) | 3,119 (91.3%) | 11,459 (86.4%) |
Visible minority | 1,210 (14.9%) | 260 (8.7%) | 1,470 (13.6%) |
|
|||
Education | |||
Less than high school | 2,074 (16.1%) | 1,362 (32.8%) | 3,436 (19.5%) |
High school graduate | 2,750 (31.1%) | 688 (24.0%) | 3,438 (29.7%) |
Postsecondary graduate | 4,729 (52.8%) | 1,324 (43.2%) | 6,053 (50.8%) |
Household income | |||
Missing data | 1,328 (13.5%) | 547 (15.4%) | 1,875 (13.9%) |
<$15,000 | 804 (4.7%) | 527 (10.8%) | 1,331 (6.0%) |
$15,000–$29,999 | 1,434 (10.2%) | 822 (18.8%) | 2,256 (12.0%) |
$30,000–$49,999 | 1,929 (18.5%) | 684 (20.9%) | 2,613 (19.0%) |
≥$50,000 | 4,161 (53.1%) | 838 (34.1%) | 4,999 (49.3%) |
|
|||
Body Mass Index category, | |||
Underweight or normal | 4,135 (45.3%) | 1,093 (32.5%) | 5,228 (42.7%) |
Overweight | 3,323 (34.6%) | 1,242 (37.4%) | 4,565 (35.2%) |
Obese | 1,809 (16.8%) | 972 (27.5%) | 2,781 (19.0%) |
Missing data | 389 (3.3%) | 111 (2.5%)E | 500 (3.2%) |
Smoking status | |||
Current or former | 6,532 (65.3%) | 2,381 (72.5%) | 8,913 (66.7%) |
Never | 3,114 (34.7%) | 1,034 (27.5%) | 4,148 (33.3%) |
Alcohol use | |||
Abstainer/very light drinker | 6,874 (69.8%) | 2,789 (79.8%) | 9,663 (71.8%) |
Lower consumption | 2,099 (24.8%) | 472 (17.9%) | 2,571 (23.4%) |
Higher consumption | 508 (5.4%) | 92 (2.4%)E | 600 (4.8%) |
Physical activity level | |||
Active | 2,317 (24.1%) | 573 (16.6%) | 2,890 (22.5%) |
Moderate | 2,380 (25.2%) | 737 (22.2%) | 3,117 (24.6%) |
Inactive | 4,949 (50.8%) | 2,100 (61.3%) | 7,049 (52.9%) |
|
|||
Physically abused as a child | |||
No | 8,951 (93.5%) | 3,100 (89.3%) | 12,051 (92.6%) |
Yes | 705 (6.5%) | 318 (10.7%) | 1,023 (7.3%) |
Parents unemployed for a long time | |||
No | 8,743 (90.9%) | 3,068 (90.6%) | 11,829 (90.8%) |
Yes | 816 (9.1%) | 280 (9.4%) | 1,096 (9.2%) |
Parents divorced | |||
No | 8,524 (86.9%) | 3,133 (91.2%) | 11,695 (87.8%) |
Yes | 1,121 (13.1%) | 239 (8.8%) | 1,360 (12.2%) |
|
|||
Has mood disorder | |||
No | 9,158 (95.0%) | 2,434 (91.5%) | 12,291 (94.3%) |
Yes | 493 (5.0%) | 283 (8.5%) | 776 (5.7%) |
Has anxiety disorder | |||
No | 9,283 (96.2%) | 3,208 (92.9%) | 12,491 (95.6%) |
Yes | 367 (3.6%) | 206 (7.1%) | 573 (4.4%) |
EIndicates that estimate is associated with a moderately high sampling variability and therefore should be interpreted with caution.
After controlling for age, gender, and race, individuals with a history of parental addictions had a significantly higher odds of self-reporting arthritis, as compared to their peers who did not report a history of parental addictions (
Logistic regression models of factors associated with arthritis.
Demographics |
Demographics and SES |
Demographics and health behaviours |
Demographics and childhood stressors |
Demographics and mental health |
Fully Adjusted Model | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | ||||||
|
|||||||||||||||||
Parental addiction | |||||||||||||||||
No | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | |||||
Yes |
|
1.38–1.80 |
|
1.37–1.79 |
|
1.35–1.76 |
|
1.15–1.53 |
|
1.30–1.70 |
|
1.12–1.51 | |||||
|
|||||||||||||||||
Sex | |||||||||||||||||
Male | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | |||||
Female |
|
1.32–1.60 |
|
1.27–1.55 |
|
1.42–1.75 |
|
1.28–1.56 |
|
1.26–1.53 |
|
1.28–1.59 | |||||
Age, years | |||||||||||||||||
12–39 | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | |||||
40–49 |
|
3.12–4.39 |
|
3.34–4.72 |
|
2.82–3.99 |
|
3.19–4.51 |
|
3.16–4.45 |
|
3.12–4.45 | |||||
50–59 |
|
7.19–9.94 |
|
7.53–10.47 |
|
6.13–8.54 |
|
7.26–10.12 |
|
7.25–10.06 |
|
6.55–9.24 | |||||
60–69 |
|
12.16–17.23 |
|
10.86–15.50 |
|
10.26–14.67 |
|
12.74–18.18 |
|
12.82–18.22 |
|
10.41–15.16 | |||||
70–79 |
|
17.35–25.05 |
|
13.93–20.43 |
|
15.74–22.94 |
|
17.99–26.16 |
|
18.48–26.77 |
|
14.55–21.75 | |||||
≥80 |
|
20.67–31.80 |
|
15.49–24.35 |
|
20.11–31.38 |
|
21.87–33.93 |
|
22.11–34.13 |
|
17.90–28.84 | |||||
Race | |||||||||||||||||
White | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | 1.00 | Referent | |||||
Visible minority | 0.91 | 0.78–1.07 | 0.85 | 0.72–1.00 | 0.92 | 0.78–1.09 | 0.87 | 0.74–1.03 | 0.93 | 0.79–1.09 | 0.86 | 0.73–1.02 | |||||
|
|||||||||||||||||
Education | |||||||||||||||||
Less than high school | — | — | — |
|
1.08 |
— | — | — | — | — | — | — | — | — |
|
1.02–1.32 | |
High school graduate | — | — | — | 1.07 | 0.95 |
— | — | — | — | — | — | — | — | — | 1.06 | 0.94–1.19 | |
Postsecondary graduate | — | — | — | 1.00 | Referent | — | — | — | — | — | — | — | — | — | 1.00 | Referent | |
Household income | |||||||||||||||||
Missing data | — | — | — |
|
1.04–1.42 | — | — | — | — | — | — | — | — | — |
|
1.03–1.43 | |
<$15,000 | — | — | — |
|
1.68–2.49 | — | — | — | — | — | — | — | — | — |
|
1.40–2.11 | |
$15,000–$29,999 | — | — | — |
|
1.39–1.90 | — | — | — | — | — | — | — | — | — |
|
1.27–1.75 | |
$30,000–$49,999 | — | — | — |
|
1.26–1.64 | — | — | — | — | — | — | — | — | — |
|
1.18–1.55 | |
≥$50,000 | — | — | — | 1.00 | Referent | — | — | — | — | — | — | — | — | — | 1.00 | Referent | |
|
|||||||||||||||||
BMI category | |||||||||||||||||
Underweight or normal | — | — | — | — | — | — | 1.00 | Referent | — | — | — | — | — | — | 1.00 | Referent | |
Overweight | — | — | — | — | — | — |
|
1.25–1.57 | — | — | — | — | — | — |
|
1.24–1.57 | |
Obese | — | — | — | — | — | — |
|
1.87–2.43 | — | — | — | — | — | — |
|
1.80–2.34 | |
Missing data | — | — | — | — | — | — | 1.12 | 0.82–1.53 | — | — | — | — | — | — | 1.15 | 0.83–1.58 | |
Smoking status | |||||||||||||||||
Current or former | — | — | — | — | — | — |
|
1.27–1.59 | — | — | — | — | — | — |
|
1.21–1.52 | |
Never | — | — | — | — | — | — | 1.00 | Referent | — | — | — | — | — | — | 1.00 | Referent | |
Alcohol use | |||||||||||||||||
Abstainer/very light drinker | — | — | — | — | — | — |
|
1.11–2.00 | — | — | — | — | — | — |
|
1.11–2.02 | |
Lower consumption | — | — | — | — | — | — | 1.23 | 0.91–1.68 | — | — | — | — | — | — | 1.33 | 0.97–1.82 | |
Higher consumption | — | — | — | — | — | — | 1.00 | Referent | — | — | — | — | — | — | 1.00 | Referent | |
Physical activity level | |||||||||||||||||
Active | — | — | — | — | — | — | 1.00 | Referent | — | — | — | — | — | — | 1.00 | Referent | |
Moderate | — | — | — | — | — | — | 1.02 | 0.88–1.19 | — | — | — | — | — | — | 1.01 | 0.87–1.18 | |
Inactive | — | — | — | — | — | — |
|
1.03–1.35 | — | — | — | — | — | — | 1.14 | 1.00–1.31 | |
|
|||||||||||||||||
Physically abused as a child | |||||||||||||||||
No | — | — | — | — | — | — | — | — | — | 1.00 | Referent | — | — | — | 1.00 | Referent | |
Yes | — | — | — | — | — | — | — | — | — |
|
1.90–2.70 | — | — | — |
|
1.60–2.30 | |
Parents unemployed for a long time | |||||||||||||||||
No | — | — | — | — | — | — | — | — | — | 1.00 | Referent | — | — | — | 1.00 | Referent | |
Yes | — | — | — | — | — | — | — | — | — | 1.16 | 0.97–1.38 | — | — | — | 1.14 | 0.95–1.36 | |
Parents divorced | |||||||||||||||||
No | — | — | — | — | — | — | — | — | — | 1.00 | Referent | — | — | — | 1.00 | Referent | |
Yes | — | — | — | — | — | — | — | — | — | 0.98 | 0.83–1.17 | — | — | — | 0.96 | 0.80–1.15 | |
|
|||||||||||||||||
Has mood disorder | |||||||||||||||||
No | — | — | — | — | — | — | — | — | — | — | — | — | 1.00 | Referent | 1.00 | Referent | |
Yes | — | — | — | — | — | — | — | — | — | — | — | — |
|
1.61–2.41 |
|
1.35–2.05 | |
Has anxiety disorder | |||||||||||||||||
No | — | — | — | — | — | — | — | — | — | — | — | — | 1.00 | Referent | 1.00 | Referent | |
Yes | — | — | — | — | — | — | — | — | — | — | — | — |
|
1.39–2.17 |
|
1.36–2.16 |
OR indicates odds ratio; CI: confidence interval; BMI: body mass index; SES: socioeconomic status.
Odds ratios statistically significant at the
Source: subsample of Canadian provinces of Manitoba and Saskatchewan in the 2005 Canadian Community Health Survey.
Further adjustment of three categories of potential risk factors failed to make significant impact on the strength of the relationship between history of parental addictions and arthritis: adult socioeconomic status (
This study indicated that the prevalence in Manitoba and Saskatchewan of arthritis is 20.4%. This is a little higher than estimates of the national prevalence rate of 15.3% [
In this study, respondents who reported a history of parental addictions had significantly higher odds of arthritis. The association between parental substance abuse and arthritis remained significant even after controlling for demographic characteristics and four additional groups of factors that are strongly associated with parental addictions, namely, other adverse childhood experiences, adult health behaviors, adulthood socioeconomic position, and mental health issues (i.e., mood disorders and anxiety disorders).
These findings support previous research demonstrating an increased risk of arthritis in adults who were raised by parents with substance abuse problems [
Kopec and Sayre’s Canadian cohort study [
The seminal researchers in the field have suggested that adult health behaviors largely account for the relationship between exposure to parental addictions and adult health conditions (i.e., [
Adjusting for other adverse childhood experiences reduced the magnitude of the association between exposure to parental substance abuse and arthritis (
An important avenue for future research is the “biological embedding” of adverse childhood experiences [
There are several limitations to this study. We had to rely on self-report of a health professional’s diagnosis of arthritis and self-report of parental addictions. Although reasonable concordance (87% [
Furthermore, the CCHS did not ask questions on several important factors including gender of the parent with an addiction and the severity and form of addiction (drug, alcohol, etc.). The gender of the addicted parent mediates the experience of adult related health outcomes [
The strengths of this study include the use of a large, regionally representative sample to examine the relationship between of parental addictions and arthritis. With a response rate of 84%, the quality of the data used in this study was high. Finally, the dataset provided responses to a broad range of questions allowing us to control for more factors than most previous research studies.
Future research would benefit from a focus on factors associated with resilience. Reich et al. [
To conclude, despite controlling for a broad range of potentially mediating risk factors, the relationship between experiencing a history of parental addictions and the cumulative lifetime incidence of arthritis in adulthood was strong. Future research would benefit from a prospective research design, which would assist investigators to identify the potential pathways that mediate the relationship between parental addictions and a diagnosis of arthritis in adulthood. Future studies should examine psychophysiological factors, such as HPA axis dysfunction, that may provide useful insights.
The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors would like to thank Araf Khaled, Yi Xin Rachel Zhou and Marla Battiston for assistance with preparation of the tables. The first author (Esme Fuller-Thomson) would like to gratefully acknowledge support received from the Sandra Rotman Endowed Chair in Social Work.