Date of Conferral

2022

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Vasileios Margaritis

Abstract

Diabetes is a prevalent and costly chronic condition that can lead to other comorbid conditions such as heart disease. Disease management is essential but can be stressful and complicated, especially for individuals who have developed maladaptive behaviors in response to exposure to adverse childhood events (ACEs), which are chronic stressors that impact physiological and psychological development. There is limited research on the potential relationship between childhood adversity and engagement in protective health behaviors among U.S. populations with diabetes or diabetes with comorbid heart disease. The ACEs pyramid was the theoretical framework of this quantitative cross-sectional study concerning morbidity and early mortality. The aim of the study was to investigate the association between the existence of any type of ACEs and the level of engagement in tertiary protective health behaviors when controlling for age, race, and sex. Secondary data from the ACEs module of the Centers for Disease Control and Prevention’s 2019 Behavioral Risk Factor Surveillance System survey were analyzed. Logistic regression results indicated a significant relationship between age and protective health behaviors when assessing for counts of ACEs and types of ACEs among those with diabetes (OR = .977, 95% CI [.966, .988]; OR = .957, 95% CI [.935, .980]). In addition, men were less likely to exhibit high engagement in tertiary protective health behaviors (OR = .696, 95% CI [.576, .821]). The positive social change implications of this study include informing the development of public health interventions to promote disease and health self-management among individuals with diabetes or diabetes with comorbid heart disease.

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