Date of Award

1-1-2023

Language

English

Document Type

Master's Thesis

Degree Name

Master of Science (MS)

College/School/Department

Department of Epidemiology and Biostatistics

Content Description

1 online resource (iii, 42 pages)

Dissertation/Thesis Chair

Allison AA Appleton

Committee Members

Allison AA Appleto, Elizabeth EV Vasquez

Keywords

ACEs, Intersectionality, Obesity

Subject Categories

Public Health

Abstract

AbstractObesity is a chronic disease that plagues about 34% of the world population and rising (CDC,2023). Obesity develops over time due to lifestyle factors, biological factors, and the environment. Life course epidemiology approaches understanding the etiology of obesity by pinpointing how particular events in a lifetime can facilitate later life obesity. One emerging important early life factor that may influence adult obesity risk is adverse childhood experiences (ACEs). Rates of ACEs are higher in sexual minorities, women, and nonwhite individuals (Hughes et al., 2022). Furthermore, the rate of obesity is higher in women and nonwhite communities (CDC,2023). Knowing this information, this study inquires how the intersectionality between sexual orientation, race, and gender affects the association between ACEs and obesity. This study aims to investigate the association between ACEs and adulthood obesity while looking at the differences between the obesity and ACE association according to race/ethnicity, sex, and sexual orientation. This was done using a cross-sectional wave of data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) with a study population of 24,632 participants. We use logistic regression to understand (1) the association between ACEs and obesity, and (2) whether that association was modified by race/ethnicity, gender, sexual orientation, and intersectionality via stratified models. It was hypothesized that those who are nonwhite, female, and a sexual minority will have a higher rate of ACEs leading to an increased risk of obesity. Consistent with previous literature we found a significant dose-response association between adverse childhood experiences and adulthood obesity when adjusted for covariates. In the final model adjusted for covariates, the odds of obesity were 1.419 (95%CI1.313, 1.533) times higher in respondents who had 4 or more ACEs compared to those who had no ACEs; the odds of obesity were 1.161 (95% CI 1.094, 1.232) for those who had 1-3 ACEs compared to those who had no ACEs. While considering the unique view of intersectionality, we found that the odds of obesity of those who were not in any of the marginalized groups with 4 or more ACEs was 1.283 (95% CI 1.116, 1.475) times higher compared to participants with no ACEs, and the odds of obesity of those who are in one or more of the marginalized groups with 4 or more ACEs is 1.517 (95% CI 1.382, 1.665) times higher compared to participants with no ACEs. This pattern of results was similar when considering the parts of the intersectionality index (sex, race/ethnicity, sexual orientation). This study helps to expand public health knowledge on how childhood adversity can lead to obesity later in life, and how that association is experienced by different social minorities.

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