All ETDs from UAB

Advisory Committee Chair

Elizabeth Baker

Advisory Committee Members

Verna Keith

Irena Stepanikova

Sylvie Mrug

Gregory Pavela

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

A growing body of studies highlights that many adult diseases and health disparities in late-life are rooted in childhood adversities. However, there is little research that examines how social stratification processes structure the inequality in early-life stress exposure, and the effects of stress exposure on health outcomes may vary based on the intersections of social stratification categories. Drawing on an integrated framework of the life course stress process and intersectionality theory, this study examines the patterns in childhood adverse experiences (ACEs) by race/ethnicity and gender and how race/ethnicity, gender, and adult socioeconomic status (SES) combine to modify the effects of ACEs on chronic health conditions. This study uses data from four rounds of the Behavioral Risk Factor and Surveillance System (2009-2012). The primary predictor variable is a count measure of ACEs. The outcome of interest is a count variable of ever-diagnosed six chronic health conditions. The analysis includes multivariable Poisson regression models predicting the number of chronic health conditions as a function of ACEs. The analytic sample consists of 103,364 non-institutionalized adults. Findings indicate that racial-ethnic minority groups and women report higher rates of ACEs compared to non-Hispanic whites and men, respectively. There is a robust association between ACEs and chronic health conditions even after controlling for a broad range of factors. The measures of health behaviors and mental distress mediate the association between ACEs and chronic health conditions. The multiplicative models indicate that the effects of ACEs on chronic health conditions are complexly conditioned by the intersections of gender, race/ethnicity, and adult SES. The impact of ACEs is stronger for women. The SES indicators differentially moderated the effects of ACEs on chronic conditions across racial-ethnic groups. Compared to NH-whites, income did not protect the harms of ACEs on health for Asians and American Indians. While being employed was consistently protective against the effects of ACEs on chronic health conditions for non-Hispanic blacks and multi-racial groups, education did not offer the same protective effect on health among Asians and American Indians. Findings have implications for the effective prevention of public health problems through intervention efforts in early-life.

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