Article Text
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.
- adverse childhood experiences
- ACEs
- American Indians
- type 2 diabetes
- culture
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Footnotes
Contributors TNB was responsible for drafting the literature review, discussion and conclusions sections. JHLE edited and added substantive content to the manuscript. MLW performed data analyses and drafted methods and results sections and oversaw data collection. All authors reviewed the final version of the manuscript.
Funding This study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number DK091250 (M L Walls, PI).
Disclaimer The contents of this manuscript are attributable to the authors and do not necessarily represent the viewpoints of the NIH.
Competing interests None declared.
Patient consent Not required.
Ethics approval Project methodology and human subjects approval was granted by the University of Minnesota (IRB) and National Indian Health Service IRBs.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data sharing available.