Social and early life adversity and chronic health conditions among Tunisian adults

Sana El Mhamdi, Andrine Lemieux, Manel Ben Fredj, Ines Bouanene, Arwa Ben Salah, Hela Abroug, Kamel Ben Salem, Mustafa Al'Absi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Early life adversities (ELAs) are shown as significant risk factors for chronic health conditions (CHCs). ELAs include multiple types of abuse such as the social abuse (peer, community, and collective violence). The purpose is to describe the relationship between childhood social abuse and chronic conditions in adulthood among a sample of adults in Tunisia and to investigate the role of obesity and tobacco use as mediators of this association. A cross-sectional study was conducted in Tunisia, from January to June 2016 using the Arabic Adverse Childhood Experiences International Questionnaire (ACE-IQ). Items of social abuse (peer violence, witnessing community violence, and exposure to collective violence) were analyzed. A total of 2,120 adults were enrolled. After adjustment for age, gender, and intrafamilial ELA, social adversities were associated significantly with the selected CHC. Experiencing more than two social ELA increase the risk of occurrence of hypertension and coronary diseases. After accounting for the indirect effect of body mass index, statistically significant partial mediation effects were observed for the cumulative number of social ELA as the exposure variable and chronic diseases as the outcome variable (p ≤. 001; % mediated = 44.5%). These findings support an association between many chronic health disorders and childhood social abuse, independently of intrafamilial ACEs.

Original languageEnglish (US)
Pages (from-to)949-958
Number of pages10
JournalTranslational behavioral medicine
Issue number4
StatePublished - Oct 8 2020

Bibliographical note

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  • Adult survivors of child adverse events
  • Child abuse
  • Chronic disease
  • Tunisia

PubMed: MeSH publication types

  • Journal Article


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