Abstract Body (Do not enter title and authors here): Background: Cardiovascular health (CVH) in childhood is a predictor of long-term health outcomes. Positive Childhood Experiences (PCEs) are recognized for their potential protective role in health, especially in otherwise difficult environments. The Healthy Outcomes from Positive Experiences (HOPE) framework offers a structured, strengths-based approach to conceptualize and measure PCEs; however, it has seen limited use in CVH research.
Objective: To examine the underlying structure of PCEs and identify associations between PCEs and CVH indicators in U.S. children ages 6-17 years.
Methods: Using data from the 2021-2022 National Survey of Children’s Health (NSCH), we conducted Principal Component Analysis (PCA) to explore the underlying structure of 15 PCEs and their alignment with the HOPE framework. We then examined associations between PCEs and a subset of CVH indicators. The CVH indicators included: physical activity (PA) (meets guidelines, insufficient PA, no PA), sleep (meets age-appropriate guidelines, suboptimal, very suboptimal), and body mass index (BMI) (obese, overweight, normal/underweight) using logistic and multinomial regressions. Models were adjusted for child’s sex, age, race/ethnicity, poverty level, caregiver’s education level, family structure, and insurance status.
Results: Analysis of data revealed five principal components (PC): (PC1) positive social and emotional engagement, (PC2) neighborhood characteristics, (PC3) caregiver health and family resilience, (PC4) community involvement and extracurricular participation, and (PC5) access to community and healthcare. Each count increase in PC1-5 was associated with decrease in the relative risk (RR) of no PA, with the largest effect observed for PC4 (RR=0.44, 95% CI [0.39,0.49]). PC1-3, and PC5 were inversely associated with very suboptimal sleep; each count increase in PC1 was assoicated with decreased likelihood of very suboptimal sleep (RR=0.69, [0.64,0.75]), with similar findings for PC2-3 and PC5. PC1, PC3, and PC5 were also inversely associated with BMI, where each count increase was associated with a 10.1%, 10.5%, and 7.4% decrease in RR of obesity, respectively.
Conclusion: PCEs identified by the HOPE framework demonstrate a significant association with a subset of CVH indicators. More research is warranted to uncover the mechanistic nature of these relationships and inform the development of tailored interventions to promote PCEs for improved CVH in children.