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

Abstract

ObjectivesThe 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.DesignSurvey data for this observational study were collected using computer-assisted survey interviewing techniques between 2013 and 2015.SettingParticipants were randomly selected from AI tribal clinic facilities on five reservations in the upper Midwestern USA.ParticipantsInclusion 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 measuresWe 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.ResultsAn 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.ConclusionsThis 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.

Understanding measures of racial discrimination and microaggressions among American Indian and Alaska Native college students in the Southwest United States

“…Because attitude and policy shifts may occur at a slow pace, we touch upon ways to support marginalized and oppressed communities in managing racial discrimination. Practitioners can encourage victims of race-based trauma to seek social support [ 3 ] and encourage allies to speak up when they witness discrimination and microaggressions. This can reduce the burden of effort on BIPOC and has the potential to buffer consequences of experiencing racial discrimination.…”

Sources of Stress Among Midwest American Indian Adults with Type 2 Diabetes

“…Research on interpersonal and other traumas among AIs, help explain disproportionate rates of post-traumatic stress disorder (Beals et al, 2013), cardiovascular disease, chronic pain, depressive symptoms (Tehee et al, 2017), as well as differences in blood glucose levels (Goins, Noonan, Gonzales, Winchester, & Bradley, 2017) and treatment modality among AIs with T2D (Jacob et al, 2013). Studies also conclude that stressor exposures during childhood and adolescence increase risk for T2D (Jiang et al, 2008), problematic substance use (Boyd-Ball, Dishion, Myers, & Light, 2011; Brockie et al, 2015; Koss et al, 2003; Whitesell et al, 2009), and impact additional aspects of AI health (Baldwin, Brown, Wayment, Nez, & Brelsford, 2011; Brockie, Elm, & Walls, 2018; Kenney & Singh, 2016; Warne et al, 2017). This important body of work sheds light on historical, discriminatory, traumatic, and early life stressors as determinants of poor health and health care access.…”

Cultural Sources of Strength and Resilience: A Case Study of Holistic Wellness Boxes for COVID-19 Response in Indigenous Communities

“…Similarly, fostering “natural recovery mechanisms” is recommended in early mental health interventions following disaster events ( National Institute of Mental Health, 2002 ; Everly et al, 2008 , p. 409). Cultural connection and practices have been shown to be protective for physical and psychosocial health in Indigenous communities ( Brockie et al, 2018 ). Indigenous peoples believe wholeheartedly and unquestionably in the healing power of culture ( Hartmann and Gone, 2012 ; Gone, 2013 ; Moghaddam et al, 2015 ).…”

“…Supplementary Table 1 includes a full list of holistic box contents. Traditional cultural and spiritual practices have been shown to be protective for mental and physical health among Indigenous populations ( Brockie et al, 2018 ). Thus, strengthening cultural connection during the time of COVID-19 is one approach to building mental and emotional resilience.…”