CHILDHOOD STRESSORS AND BEHAVIORAL HEALTH AMONG AMERICAN INDIANS WITH TYPE 2 DIABETES: AN EXPANDED ASSESSMENT OF ADVERSE CHILDHOOD EXPERIENCES USING LATENT CLASS ANALYSIS

Abstract

American Indians experience morbidity and premature mortality at disproportionate and increasing rates compared to other Americans. Type 2 diabetes and behavioral health challenges are major contributors to American Indian morbidity and mortality. Moreover, research demonstrates that social stressors, including childhood adversities, impact health and wellness across diverse populations. Yet, little is known about the prevalence of childhood adversities for American Indians with type two diabetes, nor which childhood events and situations generally impact the health of Natives, nor if there are particular combinations of childhood stressors that have differential impacts on Native health. This dissertation situates empirical analyses within an overall health inequities agenda, considers prior research on childhood adversities and health, and recognizes historically unjust traumas and contemporary American Indian-specific social stressors as having continued health effects. Given the rationale and framework described above, childhood stressors are analyzed for a sample of American Indian adults with type 2 diabetes from the Great Lakes region (N= 190). Childhood adversities for this sample are analyzed in three distinct ways. First, I estimate the prevalence of seven conventional childhood adversities and “ACEs scores” and compare these to other study estimates. Findings indicate high exposure rates for singular types of childhood adversities and disproportionate ACEs scores among this sample. Second, I use latent class analysis to explore patterns of co-occurring childhood stressors. Ten types of childhood stressors meaningfully contribute to identification of three distinct profiles of childhood stressors: Class 1: Low Adversity Class; Class 2: Household Violence and Incarceration Class; and Class 3: High Adversity Class. In a final analysis, I examine the association between childhood stressor profiles and depressive symptoms, alcohol misuse, and commercial tobacco use. This analysis shows that depressive symptoms are differentially associated across latent classes. Alcohol misuse and commercial tobacco use are not differentially associated across the latent subgroups. This dissertation expands knowledge about the childhood stressors experienced among American Indians with type 2 diabetes. It suggests that more research is needed to understand the health consequences that may result from childhood adversities for American Indians, particularly those with type 2 diabetes. Multiple practice and policy implications are discussed.