Composition and Accumulation of Childhood Stressors and Associations with Health Outcomes Among American Indian Adults with Type-Two Diabetes

Introduction: Extensive research has demonstrated the relationship between ACEs and myriad health conditions, yet few studies examine the composition and differential accumulation of ACES using latent class analysis methods, nor approach the work from a lens of equity. Despite disproportionate ACEs exposures and extreme health disparities among American Indians (AIs), little research has examined the relationship between ACEs and health outcomes among AIs. This study examined the role of ACEs accumulation and composition on health outcomes for AI adults diagnosed with type two diabetes. Principles of equity and community-based participatory research were applied to an analysis of the links between ACEs and health disparities in five tribal communities in the Midwest. Innovation of this work includes the potential for direct, community-informed application of findings to systems level interventions in tribal communities and tribal federal policy implications.

Methods: Latent class analysis was used to determine the number and the composition of distinct participant profiles based on fourteen childhood adversity exposures among Midwest American Indian adults with type-two diabetes (N=190). Latent class groups were then used in multinomial logistic regression models to assess the association between class membership and five emotional and behavioral health distal outcome variables (depressive symptoms, generalized anxiety disorder symptoms, diabetes related distress, current binge drinking, and lifetime alcohol use disorder).

Results: A three class model with ten indicator variables fit the data best. Indicator variables included Sexual, Emotional, and Physical abuse, Household violence, Neglect, Household mental illness, Household incarceration, Parenthood, Bullied, and Community violence. One subgroup class (Extreme) was characterized by very high likelihood of maltreatment exposure and high to moderate likelihood of experiencing other adversities. Another subgroup (HVI) had high likelihood of experiencing household violence and incarceration. A low adversity group (Low) was very low on all but one indicator. Preliminary results indicated that compared to the low group, the HVI group had about 4 times the odds of experiencing high depressive symptoms, while the extreme group had over 15 times the odds. Regarding generalized anxiety disorder, the HVI group had over four times the odds of high symptomology and the extreme group had almost eight times the odds. Individuals from all subgroups had approximately the same odds of becoming a smoker.

Conclusions: Among other implications, findings suggest that these tribes consider implementing a non-traditional tobacco use prevention population strategy and screening primary care patients for ACEs.