Violence exposure across the life-course and allostatic load: Applying the structural life course modeling approach to examine violence temporal patterns and the promotive and protective role of adolescent social connectedness.

Exposure to violence is a major public health concern whose physiological consequences accumulate across the life-course in ways that are not yet fully understood. Although violence exposure has been linked to elevated allostatic load markers (AL), no study has directly compared whether developmental timing, cumulative burden or recency of exposure most strongly drives this relationship, nor whether adolescent social connectedness operates through promotive effects, protective effects, or both to mitigate these physiological consequences. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), and the Structured Life Course Modeling Approach (SLCMA), this study addressed both gaps by simultaneously testing three competing temporal hypotheses and examining whether peer, school, and parent connectedness during adolescence operated through promotive or protective pathways. Results revealed that cumulative violence exposure across development showed the strongest association with adult AL, outperforming both developmental timing-specific and recency-based hypotheses. Of the three social connectedness domains examined, only peer connectedness demonstrated significant promotive effects on reducing AL, while no domain buffered the relationship between cumulative violence exposure and adult AL. These findings suggest that the cumulative burden of violence across development, not when it occurs, drives physiological dysregulation, and that peer relationships during adolescence may represent a unique and lasting pathway to promote physiological health. Given that elevated AL is a strong risk factor for chronic disease and premature mortality, sustained efforts to reduce violence exposure across the life course and strengthen adolescent peer relationships are warranted as complementary public health priorities.