Impact of Adverse Childhood Experiences on Maternal Health and Birth Weight in Appalachia PDF
Preview Impact of Adverse Childhood Experiences on Maternal Health and Birth Weight in Appalachia
Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 Impact of Adverse Childhood Experiences on Maternal Health and Birth Weight in Appalachia Kristen Baker Dickerson Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theEpidemiology Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Kristen Baker Dickerson has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Allison Litton, Committee Chairperson, Public Health Faculty Dr. Amany Refaat, Committee Member, Public Health Faculty Dr. Ernest Ekong, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract Impact of Adverse Childhood Experiences on Maternal Health and Birth Weight in Appalachia by Kristen Baker Dickerson MPH, A.T. Stills University, 2007 BS, Ohio University, 2002 AD, Ohio University, 2012 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2017 Abstract Adverse birth outcomes and adverse childhood experiences (ACE) are concerns in the United States, with potential to impact health indices now and in the future. The purpose of this study was to quantitatively examine the association between maternal exposure to ACE, low birth weight, and county of residence in the Appalachian population using the Life Course Approach as the theoretical framework. A cross-sectional study design and clustering strategy was used to randomly select potential respondents from a data set that was provided by Ohio Department of Health. Self-administered questionnaires were sent to potential respondents to collect information about ACE in the maternal population of Appalachia, Ohio with an overall response rate of 29.5% and 212 total participants. A chi-square analysis was completed and no significant association was found between county of residence and risk of low birth weight. However, statistically significant associations were found between the different types of ACE exposure and low birth weight delivery as well as Appalachian county of residence and exposure to ACE. As the sample of low birth weight deliveries was small, it is recommended that the relationship between ACE exposure and low birth weight be further studied to develop more purposeful health interventions to improve maternal health in Appalachia, Ohio specifically, as well as other rural communities. Reducing rates of adverse birth outcomes and chronic disease burden in Appalachia have potential to reduce health disparities between urban and Appalachian communities, allowing for positive social change for many socioeconomically disadvantaged communities and improving population health. Impact of Adverse Childhood Experiences on Maternal Health and Birth Weight in Appalachia by Kristen Baker Dickerson MPH, A.T. Stills University, 2007 BS, Ohio University, 2002 AD, Ohio University, 2012 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University November 2017 Dedication This work is to the millions of women that have been impacted by adverse birth outcomes, and my children Ethan and Elizabeth, for whom I strive to be the best I can be every day. May you learn from me half as much as I have learned from you. Acknowledgments I would like to thank my husband Adam for supporting all my endeavors wholeheartedly, my children for cheering me on and making life brighter, and my family (John, Alice, Jessica, Jeanann, and Charlie) for all the love, support, and sacrifice they have given me over the years. I wouldn’t be where I am today without you. I would also like to thank all the faculty that have assisted me this far with my work, especially Dr. Litton, who has motivated, supported, and pushed me to become successful. Thank you. Table of Contents List of Tables ..................................................................................................................... vi List of Figures .................................................................................................................. viii Chapter 1: Background ........................................................................................................1 Introduction ....................................................................................................................1 Background of Problem .................................................................................................2 Problem Statement .......................................................................................................10 Purpose of Study ..........................................................................................................12 Research Questions and Hypotheses ...........................................................................13 Theoretical Framework ................................................................................................14 Nature of Study ............................................................................................................15 Study Design ..........................................................................................................16 Variables ................................................................................................................16 Methodology ..........................................................................................................19 Definitions....................................................................................................................21 Scope and Delimitations ..............................................................................................25 Scope….. ................................................................................................................25 Delimitations ..........................................................................................................27 Limitations ...................................................................................................................28 Study Design ..........................................................................................................28 Construct Validity ..................................................................................................29 Population ..............................................................................................................30 i Significance..................................................................................................................31 Summary ......................................................................................................................32 Chapter 2: Literature Review .............................................................................................34 Introduction ..................................................................................................................34 Problem Statement .................................................................................................34 Purpose of Study ....................................................................................................35 Literature Search Strategy............................................................................................36 Theoretical Foundation ................................................................................................37 Literature Review.........................................................................................................39 Birth Outcomes ......................................................................................................39 Disparity in Birth Outcomes ..................................................................................41 Maternal Health .....................................................................................................45 Life Course.............................................................................................................64 Summary and Conclusions ..........................................................................................66 Limitations of Current Research ..................................................................................66 Implications..................................................................................................................68 Chapter 3: Research Method ..............................................................................................72 Introduction ..................................................................................................................72 Purpose of Study ....................................................................................................73 Research Design and Rationale ...................................................................................74 Variables ................................................................................................................74 Research Design.....................................................................................................75 ii Methodology ................................................................................................................80 Population ..............................................................................................................80 Sampling ................................................................................................................81 Recruitment, Participation, and Data Collection .........................................................88 Recruitment and participation ................................................................................88 Data Collection ......................................................................................................90 Instrumentation ............................................................................................................91 Data Analysis Plan .................................................................................................93 Operationalization ..................................................................................................97 Threats to Validity .......................................................................................................98 External ..................................................................................................................98 Internal ...................................................................................................................99 Construct ................................................................................................................99 Empirical ..............................................................................................................100 Ethical Procedures .....................................................................................................101 Agreements and Permissions ...............................................................................101 Treatment of Participants .....................................................................................101 Confidentiality .....................................................................................................103 Summary ....................................................................................................................104 Chapter 4: Results ............................................................................................................105 Introduction ................................................................................................................105 Research Questions and Hypotheses ...................................................................105 iii
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