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, 8 (9), e022265

Examining Protective and Buffering Associations Between Sociocultural Factors and Adverse Childhood Experiences Among American Indian Adults With Type 2 Diabetes: A Quantitative, Community-Based Participatory Research Approach

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Examining Protective and Buffering Associations Between Sociocultural Factors and Adverse Childhood Experiences Among American Indian Adults With Type 2 Diabetes: A Quantitative, Community-Based Participatory Research Approach

Teresa N Brockie et al. BMJ Open.

Abstract

Objectives: The purpose of this study was to determine the frequency of select adverse childhood experiences (ACEs) among a sample of American Indian (AI) adults living with type 2 diabetes (T2D) and the associations between ACEs and self-rated physical and mental health. We also examined associations between sociocultural factors and health, including possible buffering processes.

Design: Survey data for this observational study were collected using computer-assisted survey interviewing techniques between 2013 and 2015.

Setting: Participants were randomly selected from AI tribal clinic facilities on five reservations in the upper Midwestern USA.

Participants: Inclusion criteria were a diagnosis of T2D, age 18 years or older and self-identified as AI. The sample includes n=192 adults (55.7% female; mean age=46.3 years).

Primary measures: We assessed nine ACEs related to household dysfunction and child maltreatment. Independent variables included social support, diabetes support and two cultural factors: spiritual activities and connectedness. Primary outcomes were self-rated physical and mental health.

Results: An average of 3.05 ACEs were reported by participants and 81.9% (n=149) said they had experienced at least one ACE. Controlling for gender, age and income, ACEs were negatively associated with self-rated physical and mental health (p<0.05). Connectedness and social support were positively and significantly associated with physical and mental health. Involvement in spiritual activities was positively associated with mental health and diabetes-specific support was positively associated with physical health. Social support and diabetes-specific social support moderated associations between ACEs and physical health.

Conclusions: This research demonstrates inverse associations between ACEs and well-being of adult AI patients with diabetes. The findings further demonstrate the promise of social and cultural integration as a critical component of wellness, a point of relevance for all cultures. Health professionals can use findings from this study to augment their assessment of patients and guide them to health-promoting social support services and resources for cultural involvement.

Keywords: ACEs; American Indians; adverse childhood experiences; culture; type 2 diabetes.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Self-rated physical health by ACE exposure and social support. ACE, adverse childhood experience.
Figure 2
Figure 2
Self-rated physical health by ACE exposure and diabetes-specific support. ACE, adverse childhood experience.

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References

    1. Anda RF, Whitfield CL, Felitti VJ, et al. Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatr Serv 2002;53:1001–9. 10.1176/appi.ps.53.8.1001 - DOI - PubMed
    1. Dube SR, Anda RF, Felitti VJ, et al. Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. JAMA 2001;286:3089–96. - PubMed
    1. Dube SR, Anda RF, Felitti VJ, et al. Adverse childhood experiences and personal alcohol abuse as an adult. Addict Behav 2002;27:713–25. 10.1016/S0306-4603(01)00204-0 - DOI - PubMed
    1. Dube SR, Anda RF, Felitti VJ, et al. Exposure to abuse, neglect, and household dysfunction among adults who witnessed intimate partner violence as children: implications for health and social services. Violence Vict 2002;17:3–17. 10.1891/vivi.17.1.3.33635 - DOI - PubMed
    1. Dube SR, Felitti VJ, Dong M, et al. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 2003;111:564–72. 10.1542/peds.111.3.564 - DOI - PubMed

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