Using path analysis to examine the relationship between sexual abuse in childhood and diabetes in adulthood in a sample of US adults

To understand mechanisms underlying the relationship between adverse childhood experiences (ACE) and diabetes the study evaluated mediators of the relationship between childhood sexual abuse and diabetes in adulthood. This study used cross-sectional data from the 2011 Behavioral Risk Factor Surveillance Survey (BRFSS). Participants totaled 48, 526 who completed the ACE module. Based on theoretical relationships, path analysis was used to investigate depression and obesity as pathways between childhood sexual abuse, and diabetes in adulthood. Among adults with diabetes, 11.6% experienced sexual abuse. In the unadjusted model without mediation, sexual abuse was significantly associated with depression (OR=4.48, CI 4.18-4.81), obesity (OR=1.28, CI 1.19-1.38), and diabetes (OR=1.39, CI 1.25-1.53). In the unadjusted model with mediation, depression and obesity were significantly associated with diabetes (OR=1.59, CI 1.48-1.72, and OR=3.77, CI 3.45-4.11, respectively), and sexual abuse and diabetes was no longer significant (OR=1.10, CI 0.98-1.23), suggesting full mediation. After adjusting for covariates in the mediation model, significance remained between sexual abuse and depression (OR=3.04, CI 2.80-3.29); sexual abuse and obesity (OR=1.41, CI 1.29-1.53), depression and diabetes (OR=1.35, CI 1.23-1.47); and obesity and diabetes (OR=3.53, CI 3.20-3.90). The relationship between sexual abuse and diabetes remained insignificant (OR=1.09, CI 0.96-1.24). This study demonstrates that depression and obesity are significant pathways through which childhood sexual abuse may be linked to diabetes in adulthood. These results can guide intervention development, including multifaceted approaches to treat depression and increase physical activity in patients with a history of sexual abuse to prevent diabetes.

Relationship between individual categories of adverse childhood experience and diabetes in adulthood in a sample of US adults: Does it differ by gender?

AIMS

ACEs are known to increase risk for diabetes in adulthood. However, little is known about the differential impact of individual ACE categories on diabetes risk, and whether this relationship is gender specific.

METHODS

Data from the 2011 BRFSS was used in this study. Participants included 48,526 adults who completed the ACE module across 5 states. Using logistic regression, we examined the odds of diabetes in adulthood related to eight individual categories of ACEs: sexual abuse, physical abuse, verbal abuse, mental illness, substance abuse, incarceration, separation/divorce, and violence. A gender interaction term was included to test if this relationship varied between men and women.

RESULTS

In adjusted analyses, sexual abuse (OR 1.57, CI 1.240; 1.995) had the strongest positive association followed by verbal (OR 1.29, CI 1.117; 1.484) and physical abuse (OR 1.26, CI 1.040; 1.516). Having a parent with mental illness was also significantly associated with increased odds of diabetes (OR 1.19, CI 0.996; 1.416). No interaction between ACEs and diabetes status by gender in any of the eight categories was found.

CONCLUSIONS

Overall, this study found that four ACE categories were significantly associated with increased odds of diabetes in adulthood with sexual abuse being the strongest predictor.

Does primary language influence the receipt of influenza and pneumococcal immunizations among community-dwelling older adults?

OBJECTIVES

To examine (a) the influence of primary language on the receipt of influenza and pneumococcal immunizations and (b) the feasibility of being immunized in a nontraditional setting.

METHOD

The population was multiethnic, linguistically diverse, community-dwelling, low income, older adults in California. Face-to-face interviews were conducted with 164 participants (response rate 82%). Questions from BRFSS and CHIS were used.The questionnaire was implemented in six languages.

RESULTS

Influenza vaccination within the past 12 months was reported by 75.3%, but only 50.6% reported ever receiving the pneumococcal vaccine. Immunization predictors: Influenza-insurance through MediMedi, rating one's health as excellent/good, living with another person, and English as a primary language; pneumococcal-insurance through MediMedi and English as a primary language. Majority were willing to be immunized in nontraditional setting, especially those with limited English proficiency.

DISCUSSION

Need exists for cultural and linguistically appropriate immunization outreach methods for older adults and practitioners.

Disability and preventive cancer screening: results from the 2001 California Health Interview Survey

OBJECTIVE

We sought to evaluate preventive cancer screening compliance among adults with disability in California.

METHODS

We used data from the 2001 California Health Interview Survey to compare disabled and nondisabled adults for differences in preventive cancer screening behaviors. Compliance rates for cancer screening tests (mammography, Papanicolaou test, prostate-specific antigen, sigmoidoscopy/colonoscopy, and fecal occult blood test) between the 2 subpopulations were evaluated.

RESULTS

Women with disabilities were 17% (Papanicolaou tests) and 13% (mammograms) more likely than women without disabilities to report noncompliance with cancer screening guidelines. Interactions between disability and reports of a doctor recommendation on cervical cancer screening were significant; women with disabilities had a lower likelihood of receiving a recommendation. Men with disabilities were 19% less likely than men without disabilities to report a prostate-specific antigen test within the last 3 years.

CONCLUSIONS

secondary to structural and/or clinical factors underpinning the differences found.

The epidemiology of alcohol abuse among employed men and women

This chapter examines the relationships between the workplace and the use and abuse of alcohol and discusses some methodological problems in studies that assess these relationships. In an analysis of data from a representative sample of employed men and women in metropolitan Detroit, we find that pressures of the job (job competition and time pressures) are related to the use of alcohol and that job pressures, less complex work with data, people, and things, and feelings of job stress are related to the abuse of alcohol. As we interpret the findings, alcohol is consumed as a means of coping with a stressful work environment whether that consumption is for tension reduction or for self-stimulation. Several alternative interpretations of the findings are addressed with other data from the Detroit study, and we suggest directions for further research on the working and drinking experiences of employed men and women.

Alcohol use and depression symptoms among employed men and women

A representative sample of 1,367 employed men and women in Detroit responded to questions about drinking practices and symptoms of depression. After controlling for age, education, family income, marital status, medication use, fathers' drinking, and other variables, increased quantity of alcohol consumed per drinking occasion was associated with increased depression symptoms in the sober state among men and women. Depression symptoms may be one of a group of not fully identified drug after-effect disorders involving psychological functioning.