Prior studies have demonstrated an association between retrospective reports of experiencing trauma in childhood and the current incidence of type 2 diabetes in adulthood. Much less is known about this association among low-income minority patients in primary care settings. We replicated the adverse childhood experiences (ACEs) Centers for disease control and prevention (CDC) study with a low-income minority sample of primary care patients (N = 801) at a community-based healthcare center. We conducted a cross-sectional retrospective quantitative survey study to examine the association between participants’ reports of past childhood trauma and their current health care outcomes. Data were analyzed using binary logistic regression to evaluate the hypothesis that low income minority patients who reported more childhood trauma (abuse, neglect, household dysfunction, cumulative adverse childhood experiences [ACEs]) would more likely be diagnosed with type 2 diabetes. Results suggest that the number of ACEs in our sample were considerably higher than the original CDC ACEs study, as almost 50 % of patients surveyed at our clinic reported 4 or more ACEs, confirming that trauma is central in our urban primary care setting. The results of the cumulative ACEs score was in the expected direction and was significant, suggesting that participants who cumulatively reported experiencing more childhood trauma were more likely to be diagnosed with type 2 diabetes in adulthood. These findings have implications for family therapists, primary care providers, researchers, and policy makers to develop more collaborative approaches to primary care that better target the negative sequelae of ACEs.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Aaron, D. J., & Hughes, T. L. (2007). Association of childhood sexual abuse with obesity in a community sample of lesbians. Obesity, 15(4), 1023–1028. doi:10.1038/oby.2007.634.
Alim, T. N., Feder, A., Graves, R. E., Wang, Y., Weaver, J., Westphal, M., et al. (2008). Trauma, resilience, and recovery in a high-risk African-American population. The American Journal of Psychiatry, 165(12), 1566–1575.
Alvarez, J., Pavao, J., Baumrind, N., & Kimerling, R. (2007). The relationship between child abuse and adult obesity among California women. American Journal of Preventive Medicine, 33(1), 28–33. doi:10.1016/j.amepre.2007.02.036.
Anda, R. F., & Felitti, V. J. (2003). Origins and essence of the study. ACE reporter, 1(1):1–2. Retrieved from http://acestudy.org/yahoo_site_admin/assets/docs/ARV1N1.127150541.pdf.
Bays, H. E., Chapman, R. H., & Grandy, S. (2007). The relationship of body mass index to diabetes mellitus, hypertension and dyslipidaemia: Comparison of data from two national surveys. International Journal of Clinical Practice, 61(5), 737–747. doi:10.1111/j.1742-1241.2007.01336.x.
Bentley, T., & Widom, C. S. (2009). A 30-year follow-up of the effects of child abuse and neglect on obesity in adulthood. Obesity, 17(10), 1900–1905. doi:10.1038/oby.2009.160.
Bischoff, R. J., Springer, P. R., Felix, D. S., & Hollist, C. S. (2011). Finding the heart of medical family therapy: A content analysis of medical family therapy casebook articles. Families, Systems and Health, 29(3), 184. doi:10.1037/a0024637.
Bonomi, A. E., Cannon, E. A., Anderson, M. L., Rivara, F. P., & Thompson, R. S. (2008). Association between self-reported health and physical and/or sexual abuse experienced before age 18. Child Abuse and Neglect, 32(7), 693–701. doi:10.1016/j.chiabu.2007.10.004.
Braveman, P., & Barclay, C. (2009). Health disparities beginning in childhood: A life-course perspective. Pediatrics, 124(Suppl 3(5)), S163. doi:10.1542/peds.2009-1100D.
Brondolo, E., Gallo, L. C., & Myers, H. F. (2009). Race, racism and health: Disparities, mechanisms, and interventions. Journal of Behavioral Medicine, 32(1), 1–8. doi:10.1007/s10865-008-9190-3.
Campbell, T. L. (2003). The effectiveness of family interventions for physical disorders. Journal of Marital and Family Therapy, 29(2), 263–281. doi:10.1111/j.1752-0606.2003.tb01204.x.
Cannon, E. A., Bonomi, A. E., Anderson, M. L., Rivara, F. P., & Thompson, R. S. (2010). Adult health and relationship outcomes among women with abuse experiences during childhood. Violence and Victims, 25(3), 291–305. doi:10.1891/0886-6708.25.3.291.
Centers for Disease Control and Prevention. (2010). Adverse childhood experiences (ACE) study: Questionnaires. Retrieved Aug 20, 2012, from http://www.cdc.gov/ace/questionnaires.htm.
Centers for Disease Control and Prevention. (2011). National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States. Retrieved from http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.
Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82(2), 217–225. doi:10.1016/j.jad.2003.12.013.
Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse and Neglect, 34(6), 454–464. doi:10.1016/j.chiabu.2009.09.020.
Chaufan, C., Davis, M., & Constantino, S. (2011). The twin epidemics of poverty and diabetes: Understanding diabetes disparities in a low-income Latino and immigrant neighborhood. Journal of Community Health, 36(6), 1032–1043. doi:10.1007/s10900-011-9406-2.
Clabby, J., & Howarth, D. (2007). Managing CHF and depression in an elderly patient: Being open to collaborative care. Families, Systems, and Health, 25(4), 457–464. doi:10.1037/1091-7518.104.22.1687.
Crane, D. R., & Christenson, J. D. (2008). The medical offset effect: Patterns in outpatient services reduction for high utilizers of health care. Contemporary Family Therapy, 30(2), 127–138. doi:10.1007/s10591-008-9058-2.
Dinca-Panaitescu, M., Dinca-Panaitescu, S., Bryant, T., Daiski, I., Pilkington, B., & Raphael, D. (2011). Diabetes prevalence and income: Results of the Canadian community health survey. Health Policy, 99(2), 116–123. doi:10.1016/j.healthpol.2010.07.018.
Drury, S. S., Scheeringa, M. S., Schmidt, K. E., & Nelson, C. A. (2010). From biology to behavior to the law: Policy implications of the neurobiology of early adverse experiences. Whittier Journal of Child and Family Advocacy, 10, 25.
Dube, S., Fairweather, D., Pearson, W., Felitti, V., Anda, R., & Croft, J. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71(2), 243–250. doi:10.1097/PSY.0b013e3181907888.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129–136. doi:10.1037/h0089260.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245–258. doi:10.1016/S0749-3797(98)00017-8.
Ford, E. S., Anda, R. F., Edwards, V. J., Perry, G. S., Zhao, G., Li, C., et al. (2011). Adverse childhood experiences and smoking status in five states. Preventive Medicine, 53(3), 188–193. doi:10.1016/j.ypmed.2011.06.015.
Friestad, C., Ase-Bente, R. & Kjelsberg, E. (2012). Adverse childhood experiences among women prisoners: Relationships to suicide attempts and drug abuse. International Journal of Social Psychiatry. Advance online publication. doi:10.1177/0020764012461235.
Gerrity, P. (2010). And to think that it happened on 11th street: A nursing approach to community-based holistic care and health care reform. Alternative Therapies in Health and Medicine, 16(5):62–67. Retrieved from: http://www.library.drexel.edu/cgi-bin/r.cgi?url=http://search.proquest.com/docview/755053961?accountid=10559.
Goodwin, R. D., & Stein, M. B. (2004). Association between childhood trauma and physical disorders among adults in the United States. Psychological Medicine, 34(3), 509–520. doi:10.1017/S003329170300134X.
Goodwin, R. D., & Weisberg, S. P. (2002). Childhood abuse and diabetes in the community. Diabetes Care, 25(4), 801–802. doi:10.2337/diacare.25.4.801.
Greenfield, E. A., Lee, C., Friedman, E. L., & Springer, K. W. (2011). Childhood abuse as a risk factor for sleep problems in adulthood: Evidence from a U.S. national study. Annals of Behavioral Medicine, 42(2), 245–256. doi:10.1007/s12160-011-9285-x.
Grella, C. E., Stein, J. A., & Greenwell, L. (2005). Associations among childhood trauma, adolescent problem behaviors, and adverse adult outcomes in substance-abusing women offenders. Psychology of Addictive Behaviors, 19(1), 43–53. doi:10.1037/0893-164X.19.1.43.
Gustafson, T. B., & Sarwer, D. B. (2004). Childhood sexual abuse and obesity. Obesity Research, 5, 129–135. doi:10.1111/j.1467-789X.2004.00145.x.
IBM Corp. (2010). IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.
Irving, S. M., & Ferraro, K. F. (2006). Reports of abusive experiences during childhood and adult health ratings: Personal control as a pathway? Journal of Aging and Health, 18(3), 458–485. doi:10.1177/0898264305280994.
Kendall-Tackett, K. A., & Marshall, R. (1999). Victimization and diabetes: An exploratory study. Child Abuse and Neglect, 23(6), 593–596. doi:10.1016/S0145-2134(99)00033-2.
Kessler, R. C., Plotnick, R., Hwang, I., Sampson, N. A., Pecora, P. J., & Williams, J. (2008). Effects of enhanced foster care on the long-term physical and mental health of foster care alumni. Archives of General Psychiatry, 65(6), 625–633. doi:10.1001/archpsyc.65.6.625.
Kumanyika, S. K., Lancaster, K. J., Samuel-Hodge, C. D., Whitt-Glover, M. C., Gary, T. L., Prewitt, T. E., Samuel-Hodge, C. et al (2007). Expanding the obesity research paradigm to reach African American communities. Preventing Chronic Disease, 4(4):A112. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099277/pdf/PCD44A112.pdf?tool=pmcentrez.
Lutenbacher, M., Cohen, A., & Conner, N. M. (2004). Breaking the cycle of family violence: Understanding the perceptions of battered women. Journal of Pediatric Health Care, 18(5), 236–243. doi:10.1016/j.pedhc.2004.04.002s.
McCubbin, H. I., & Patterson, J. M. (1983a). Family stress and adaption to crisis: A double ABCX Model of family behavior. In D. H. Miller & B. Miller (Eds.), Family studies review yearbook. Beverly Hills, CA: Sage.
McCubbin, H. I., & Patterson, J. M. (1983b). The family stress process: The double ABCX model of adjustment and adaptation. In H. I. McCubbin, M. B. Sussman, & J. M. Patterson (Eds.), Social stress and the family: Advances and developments in family stress theory and research (pp. 7–37). New York NY: Haworth Press.
McDaniel, S. H., & LeRoux, P. (2007). An overview of primary care family psychology. Journal of Clinical Psychology in Medical Settings, 14(1), 23–32. doi:10.1007/s10880-006-9050-7.
Messina, N., Grella, C., Burdon, W., & Prendergast, M. (2007). Childhood adverse events and current traumatic distress. Criminal Justice and Behavior, 34(11), 1385–1401. doi:10.1177/0093854807305150.
Moeller, T. P., Bachmann, G. A., & Moeller, J. R. (1993). The combined effects of physical, sexual, and emotional abuse during childhood: Long-term health consequences for women. Child Abuse and Neglect, 17(5), 623–640. doi:10.1016/0145-2134(93)90084-I.
Noll, J. G., Zeller, M. H., Trickett, P. K., & Putnam, F. W. (2007). Obesity risk for female victims of childhood sexual abuse: A prospective study. Pediatrics, 120(1), e61–e67. doi:10.1542/peds.2006-3058.
Panzer, P. G., & Bloom, S. L. (2003). Introduction to on sanctuary principles and practice in clinical settings (special section). Psychiatric Quarterly, 74(2), 115–117.
Parrish, M., Miller, L., & Peltekof, B. (2011). Addressing depression and accumulated trauma in urban primary care: Challenges and opportunities. Journal of Health Care for the Poor and Underserved, 22(4), 1292–1301. doi:10.1353/hpu.2011.0139.
Phelps, K. W., Howell, C. D., Hill, S. G., Seemann, T. S., Lamson, A. L., Hodgson, J. L., et al. (2009). A collaborative care model for patients with type-2 diabetes. Families, Systems and Health, 27(2), 131–140. doi:10.1037/a0015027.
Rich-Edwards, J. W., Spiegelman, D., Lividoti Hibert, E. N., Jun, H., Todd, T. J., Kawachi, I., et al. (2010). Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. American Journal of Preventive Medicine, 39(6), 529–536. doi:10.1016/j.amepre.2010.09.007.
Sachs-Ericsson, N., Blazer, D., Plant, E. A., & Arnow, B. (2005). Childhood sexual and physical abuse and the 1-year prevalence of medical problems in the national comorbidity survey. Health Psychology, 24(1), 32–40. doi:10.1037/0278-622.214.171.124.
Shavers, V. L., & Shavers, B. S. (2006). Racism and health inequity among Americans. Journal of the National Medical Association, 98(3), 386–396.
Shaw, B., & Krause, N. (2002). Exposure to physical violence during childhood, aging, and health. Journal of Aging and Health, 14(4), 467–494. doi:10.1177/089826402237179.
Skogrand, L., Singh, A., Allgood, S., DeFrain, J., DeFrain, N., & Jones, J. E. (2007). The process of transcending a traumatic childhood. Contemporary Family Therapy, 29, 253–270. doi:10.1007/s10591-007-9049-8.
Taloyan, M., Wajngot, A., Johansson, S., Tovi, J., & Sundquist, J. (2010). Poor self-rated health in adult patients with type diabetes in the town of Södertälje: A cross-sectional study. Scandinavian Journal of Primary Health Care, 28(4), 216–220. doi:10.3109/00016349.2010.501223.
Tell, S. J., Pavkov, T., Hecker, L., & Fontaine, K. L. (2006). Adult survivors of child abuse: An application of John Gottman’s sound marital house theory. Contemporary Family Therapy, 28, 225–238. doi:10.1007/s10591-006-9004-0.
Tuchman, A. M. (2011). Diabetes and race: A historical perspective. American Journal of Public Health, 101(1), 24–33. doi:10.2105/AJPH.2010.202564.
U.S. Department of Health and Human Services. (2012). Diabetes and African Americans. Retrieved from http://minorityhealth.hhs.gov/templates/content.aspx?lvl=2&lvlID=51&ID=3017.
Walker, E. A., Gelfand, A., Katon, W. J., Koss, M. P., Von Korff, M., Bernstein, D., et al. (1999). Adult health status of women with histories of childhood abuse and neglect. The American Journal of Medicine, 107(4), 332–339. doi:10.1016/S0002-9343(99)00235-1.
Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47. doi:10.1007/s10865-008-9185-0.
Williams, D. R., & Sternthal, M. (2010). Understanding racial-ethnic disparities in health: Sociological contributions. Journal of Health and Social Behavior, 51(Suppl(1)), S15–S27. doi:10.1177/0022146510383838.
Williamson, D. F., Thompson, T. J., Anda, R. F., Dietz, W. H., & Felitti, V. (2002). Body weight and obesity in adults and self-reported abuse in childhood. International Journal of Obesity and Related Metabolic Disorders, 26(8), 1075–1082. doi:10.1038/sj.ijo.0802038.
Wrenn, G. L., Wingo, A. P., Moore, R., Pelletier, T., Gutman, A. R., Bradley, B., et al. (2011). The effect of resilience on posttraumatic stress disorder in trauma-exposed inner-city primary care patients. Journal of the National Medical Association, 103(7), 560–566.
Wyatt, G. E. (1985). The sexual abuse of Afro-American and White-American women in childhood. Child Abuse and Neglect, 9(4), 507–519. doi:10.1016/0145-2134(85)90060-2.
Yaturu, S. (2011). Obesity and type 2 diabetes. Journal of Diabetes Mellitus, 1(4), 79–95. doi:10.4236/jdm.2011.14012.
Zielinski, D. S. (2009). Child maltreatment and adult socioeconomic well-being. Child Abuse and Neglect, 33(10), 666–678. doi:10.1016/j.chiabu.2009.09.001.
We thank all study participants for sharing their personal life histories. Supported by the BARRA Inc., Foundation, Philadelphia, Pennsylvania.
About this article
Cite this article
Lynch, L., Waite, R. & Davey, M.P. Adverse Childhood Experiences and Diabetes in Adulthood: Support for a Collaborative Approach to Primary Care. Contemp Fam Ther 35, 639–655 (2013). https://doi.org/10.1007/s10591-013-9262-6
- Childhood trauma
- Ethnic minority
- Collaborative care