Impact of Adverse Childhood Experiences on Maternal Health and Birth Weight in Appalachia

198 Pages·2017·2.48 MB·English

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
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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