Bridges to Wellness: Protective Adults During Childhood Mitigate the Toll of Childhood Abuse Among Indigenous Adults

Abstract

Childhood physical and sexual abuse are associated with negative mental and physical health outcomes in adulthood. There may also exist protective factors which attenuate the relationship between childhood abuse and poor health outcomes. Focusing specifically on American Indian and Alaskan Native (AI/AN) adults, a diverse population which has been marginalized and understudied, this study aims to investigate whether the presence of a protective adult in the household may attenuate the association between childhood abuse and poor health outcomes in adulthood. Secondary analyses were conducted on data from the 2021, 2022, and 2023 Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. An analytic sample of 2,140 adults who self-identified as AI/AN were analyzed using binary logistic regression. The outcomes of interest were key physical and mental health outcomes such as heart disease, stroke, major depressive disorder, and cognitive deficit, among others. The key exposure of interest was childhood abuse (physical abuse alone, sexual abuse with or without co-occurring physical abuse, versus neither form of abuse). Childhood physical and/or sexual abuse was associated with higher odds of negative physical and mental health outcomes. Adjusting for demographic factors and socioeconomic factors partially attenuated this relationship. Adjusting for the presence of a protective adult also attenuated the relationship between abuse and several of the outcomes studied, particularly for respondents who had a protective adult present all of the time. These findings have implications for public health initiatives aimed at strengthening support for AI/AN children and adolescents.