Early-Life War Exposure and Chronic Pain in Vietnam: Rui (Zoe) Huang on Life-Course Pathways
Author(s): Scott Douglas Jacobsen
Publication (Outlet/Website): The Good Men Project
Publication Date (yyyy/mm/dd): 2026/03/21
Rui (Zoe) Huang is a PhD candidate in the University at Buffalo (UB) Department of Sociology and Criminology. Drawing on the life course and socio-ecological perspectives, her research seeks to understand how social inequalities shape health and population’s well-being, with a particular focus on chronic pain. Her recent Journal of Health and Social Behavior paper uses the 2018 Vietnam Health and Aging Study to examine how early-life war exposure shapes later-life chronic pain and to identify the key underlying mechanisms.
Scott Douglas Jacobsen interviews Rui (Zoe) Huang, a UB sociology and criminology PhD candidate studying how inequality and war shape chronic pain across the life course. Using the 2018 Vietnam Health and Aging Study, Huang shows early-life war exposure predicts later-life pain through neurodevelopmental stress, physical health burden, psychological distress, and PTSD. She operationalizes wartime violence and “malevolent living conditions” with exposure scales, finding distress and PTSD explain much of the living-conditions effect. Social engagement may signal resilience but does not erase harm. Huang urges postwar policies: trauma care, cohort-specific education support, healthier coping, and pain management for aging populations.
Scott Douglas Jacobsen: What made you focus on chronic pain, rather than PTSD alone?
Rui (Zoe) Huang: I focused on chronic pain because pain is a major public health issue in its own right. It’s a leading cause of disability worldwide and carries exceptionally large personal and societal costs. Yet it has been relatively overlooked in life-course research on the long-run health consequences of war. At the same time, war does not only produce observable physical and psychological injuries (e.g., PTSD and distress), it can also shape later-life health through less visible downstream adversities, such as constrained socioeconomic opportunities and unhealthy coping, that accumulate over the life course and are tightly linked to chronic pain risk. As a “sensitive barometer of population health”, pain helps capture these long-lasting, multi-pathway impacts of war. Finally, because PTSD and pain are often comorbid, centering pain allows us to build on the PTSD literature and better understand how trauma is embodied over time.
Jacobsen: How did you operationalize wartime violence? ?
Huang: We operationalized wartime violence as a 4-item exposure scale capturing whether respondents had ever (yes/no) been exposed to: (1) dead or seriously injured American soldiers, (2) dead or seriously injured Vietnamese soldiers, (3) dead or seriously injured civilians, and/or (4) being wounded in the warzone. We then summed these dichotomous items (range 0–4) and categorized the total into low (0), medium (1-2) and high (3-4) exposure to allow for potential non-linear effects.
Jacobsen: Following from the previous question, what about malevolent wartime living conditions?
Huang: We operationalized malevolent wartime living conditions as a five-item exposure scale capturing whether respondents had ever (yes/no) experienced: (1) displacement due to evacuations or bombings, (2) sleep difficulties due to noise/inhospitable environments, (3) illness/weakness due a shortage of clean water, (4) illness/weakness due a shortage of food, and (5) fear of being injured or killed. We summed these binary items (range 0–5) and categorized the total into low (0), medium (1–2), and high (3–5) exposures.
Jacobsen: Your results suggest childhood exposure is potent. Are neurodevelopmental stress effects, disrupted schooling, or later coping behaviors, more plausible?
Huang: Our evidence most strongly supports neurodevelopmental and physiological stress pathways that later manifest as mental and physical health burden. Building on the life course perspective, we argue that prolonged childhood stress and material deprivation can shape lifelong physiological reactivity and development, and our mediation results indicate that early-life war exposures influence later-life pain primarily through poorer physical and mental health, particularly psychological distress.
Disrupted schooling is also a credible pathway, and we do observe lower educational attainment among those with greater war exposures. however, in our study, education explains relatively little of the war–pain association (though it may matter more for other health outcomes). Coping behaviors appear more mixed: wartime violence is associated with higher smoking, whereas malevolent wartime living conditions are associated with a lower likelihood of heavy drinking. Overall, behavioral pathways contribute little to the war–pain relationship in our analyses, but future work should examine a broader range of coping behaviors and life-course processes in greater detail.
Jacobsen: You highlight psychological distress and PTSD as major pathways. How much of the association is explained by them?
Huang: In our study, psychological distress and PTSD account for a large share of the war-pain association, particularly for exposures to malevolent living conditions. Overall, distress explains 46.67% and PTSD explains 18.94% of the association between malevolent living conditions and pain (about 65.6% combined), while for wartime violence, distress and PTSD explained 13.97% and 12.69% of war-pain association, respectively (around 26.7% combined).
Jacobsen: Resilience factors come from social engagement. How does this work?
Huang: In our study, we found that greater exposure to wartime violence is associated with greater social engagement in later life. This is consistent with the idea that shared traumatic experiences may foster bonding and community building, which may in turn encourage people to participate in social activities. Previous studies have also documented similar dynamics. For example, Sagi-Schwarts et al. (2013) found that Holocaust survivors reported greater social support after war, and they also lived longer and more satisfied lives, compared to their peers who did not experience Holocaust. Although our mediation results suggest that this “resilience” signal is not large enough to offset the overall negative impact of war exposure on chronic pain, it points to an important avenue for future research, especially to examine whether social engagement may bring long-term benefits for other outcomes such as mental health, functioning, or longevity.
Jacobsen: What are the biggest limitations of using retrospective reports of war exposure?
Huang: Recall bias is an important concern. In particular, because chronic pain is associated with cognitive impairment, respondents with severe pain may not accurately recall their wartime experience, which could result in an underestimation of war impacts. In addition, people who are currently affected by distress and PTSD may remember or reinterpret their past experience differently, potentially introducing differential reporting that could bias our estimates.
Jacobsen: Which post-war interventions are realistic for governments?
Huang: The central policy implication is that postwar recovery efforts should recognize psychological trauma as a long-term population health concern. Psychological distress and PTSD are elevated for children, adolescents, and young adults exposed to war, and account for a substantial proportion of the increased pain prevalence among people with war exposure. Programs that are culturally appropriate and effective at reducing distress or PTSD could meaningfully reduce chronic pain and related disability in later life.
Recovery efforts may also need to be tailored to specific age cohort. For those who were of primary or secondary school age during the war, strengthening educational access and quality during and after the conflict may help prevent later adverse socioeconomic trajectories. For those who were young children during the war, interventions that promote healthy coping may be especially beneficial, given that children are more likely to adopt unhealthy behavioral responses to war such as tobacco use.
Finally, the strikingly high overall prevalence of pain among older Vietnamese suggests an urgent need for pain prevention and management in Vietnam and in other conflict-affected countries with similar histories of mass mobilization.
Jacobsen: Thank you very much for the opportunity and your time, Rui.
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