Browsing by Subject "Health and well-being"

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    Adverse Childhood Experiences and Adult Well-Being: Impacts by Type, Timing, and Early Childhood Intervention
    (2018-06) Giovanelli, Alison
    Despite an extensive literature describing the detrimental effects of Conventional Adverse Childhood Experiences (ACEs-C) (e.g., abuse, neglect, and household dysfunction) on physical and mental health, large-scale studies have not assessed links to broader measures of well-being. Furthermore, the observed dose-response relationships in physical and mental health outcomes have been found for predominately middle-class Caucasian samples in relatively high-resource environments. The original ACE survey also neglected to assess experiences more common in high-risk contexts (“Expanded” ACEs; e.g., witnessing or victimization in a violent crime, family financial problems). Importantly, although effective preventive interventions like high-quality early education can reduce rates of child abuse and neglect, little is known about how participation affects the incidence and consequences of ACEs. Given the ACE literature’s clear policy and practice implications, these gaps warrant investigation.In light of these gaps, this study longitudinally evaluates 1) associations between ACEs and educational attainment, income, crime, depressive symptoms, smoking, and self-rated health in a primarily African-American sample 2) differential effects of timing and type of ACE, 3) the potential compensatory effects of early childhood intervention on ACEs, and 4) moderation of intervention effects on adult outcomes by sex and demographic risk. Follow-up data were analyzed for 88% of the original 1539 participants in the ChicagoLongitudinal Study (N = 1352), a prospective large-scale investigation of the impact of an early childhood intervention program and early experiences on life-course well-being. Born between 1979 and 1980 in high-poverty neighborhoods, retrospective report and administrative records were used to assess ACEs from birth to 18 and outcomes at age 37. Over two-thirds of the study sample experienced ≥1 Conventional or Expanded ACE (ACEs-CE), and over half experienced ≥1 Conventional ACE (ACEs-C). After controlling for demographic risk and intervention status, participants reporting ACEs were more likely to have poor outcomes than those without ACEs, and for several domains of adult well-being, the relations between ACEs and outcomes increased in a graded fashion. Participants with ≥4 ACEs-C from birth to 18 had a significantly increased likelihood of incarceration (OR = 3.71; p <.06), lifetime smoking history (OR = 3.40; p <.001) and current depressive symptoms (OR = 3.10; p <.05). High ACEs-C experienced only in the early childhood period (≥2 prior to age 5) were also associated with increased likelihood of lifetime incarceration (OR = 2.23; p <.05), smoking (OR = 3.46; p <.001), and current depressive symptoms (OR = 2.56; p <.05). It should be noted that, while Expanded ACEs may be an important and informative type of adversity, they did not substantially increase predictive power over ACEs-C for most outcomes. Child abuse and neglect from birth to 18 related to crime, education and income, whereas household dysfunction was associated with smoking and depression. Participants with any CAN completed, on average, .5 fewer grades than those without CAN (β = -.57; p < .01), and were about half as likely to obtain a BA or AA degree (OR = 0.51; p < .01). They were also about half as likely to make an income above the average entry wage (OR = 0.51; p < 01), and twice as likely to have been incarcerated or arrested for a felony (OR = 2.16; p <.01 and OR = 2.13; p <.001, respectively). Participants in the HD group had nearly twofold increased odds of smoking (OR = 1.79; p <.01) and were over twice as likely to report significant depressive symptoms (OR = 2.19; p <.05) compared to the group without HD. Furthermore, early intervention significantly moderated the association between ACEs-CE and highest grade completed (β = 0.59; p <.05) and attainment of a Bachelor’s or Associate’s Degree (OR = 2.17; p <.05). Overall, these findings suggest that ACEs exert detrimental effects on adult well-being in low-SES children above and beyond the effects of demographic risk and poverty, and speak to the need to continue to support underserved communities in active ways. Although ameliorating poverty and its negative impacts continues to be high priority, greater investments in interventions aimed at reducing the incidence and counteracting the effects of ACEs are also imperative.
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    Well-Being, Community Development, and Andean Worldview: An Analysis of Meanings and Changes in Pedro Moncayo, Ecuador using Photovoice
    (2019-04) Fricas, Jennifer
    The goals of the research presented in this dissertation were to understand and analyze how communities in Andean Ecuador think about, initiate, and engage with their own community development. The study focused on health-related community development and its findings contribute to broader debates about what constitutes development and about how community members act as agents of their own development. The findings also resist the traditional discourse and practices of international development and complicate the ways in which U.S. university faculty educate students about global (health) development. The study was framed by decolonial theoretical approaches and the notion of cosmovisión Andina – an epistemology of the south – which I bring into conversation with the capability approach. Data collection was informed by ethnography, community-based participatory research, and the visual arts. The data collection method was photovoice, a form of participatory photography which enables co-researchers to build capacity in basic photography, after which they engage with the themes under investigation by capturing photos of parts of their daily lives and belief systems, which they then choose to bring forward for further explanation, discussion, and debate. I spent a total of four and a half months in Cantón Pedro Moncayo and during this time I also employed the ethnographic research methods of participant observation, interviewing, and document review. The study findings are presented here in two separate results chapters, the first of which deals with the characteristics of sumak kawsay/buen vivir, the way they appear in and condition everyday life, and the ways in which they have changed in the last two decades. These findings are analyzed in terms of embodiment, which can be thought of as a way of looking at the interaction between human bodies and their environments by regarding the body not just as an object, but an existential ground for culture. Embodiment presupposes certain ideas that also align with principles of Cosmo vision Andina, such that the human being is social and intersubjective, living in a community and an environment simultaneously, as well as within an evolving historical context. Particularities of embodiment appeared repeatedly in the co-researchers’ explanations of what it means to actively enact a good life and how these meanings are under tension, changing, and continually negotiated with a context of various internal and external development-related pressures. The second results chapter pertains to modes of participation and area programs and services which either operate to help co-researchers live in alignment with sumak kawsay/buen vivir or need improvement in order to do so. These study findings point to the ways in which co-researchers and their communities simultaneously work to produce and survive community development. What emerged was an interesting tension between the scale of services (both among governmental levels and within areas of parishes), citizen involvement in services, and their perceptions of the utility of their involvement. Issues of scale and friction help to problematize the effectiveness of sumak kawsay/buen vivir at a national versus a hyper-local scale and shed light on the sources of and possible solutions to frustrated development aspirations and cross-level community development collaboration. This study produced a number of implications for the fields of international development, global health, and U.S. higher education teaching and research in these disciplines. First, the study reinforces the need for a discourse and practice of development which centers hyper-local development, which is better aligned with the epistemologies and praxis of indigenous knowledges and represents a refusal of being coopted into discourses of sustainable or participatory development. Second, those working in health and development nonetheless need to expand their notions of what constitutes well-being. An enlargement of notions of well-being which is more aligned with the embodied characteristics of sumak kawsay counters the narrowmindedness of traditional economically-based notions of development. Third, and based on the previous two points, I argue that we must actively resist the single narrative of development and the single narrative of well-being in U.S. higher education institutions. Finally, I outline the ways in which visual research methods hold unique possibilities for advancing active participation and additional understanding of indigenous knowledges of well-being and practices of hyper-local development. I also outline the challenges which stem from an international, participatory, visual arts, and cross-language research study and how I dealt with these. What all of the study implications share is a decolonial focus on the absolute necessity of coupling concepts and praxis in resistance to the status quo, whether that be in development practice, health practice, teaching practice, or research.