Degree Name

PhD (Doctor of Philosophy)



Date of Award


Committee Chair or Co-Chairs

Jill Stinson

Committee Members

Andi Clements, Stacey Williams, Julia Dodd


The empirical investigation of adverse childhood events (ACEs) and their relationship with health and well-being outcomes in later life is increasing. Less is known about factors that may promote resilience for those who have survived such challenges, such as how resilience may be facilitated for those with ACEs residing in a marginalized region such as South Central Appalachia. Multidimensional spirituality, social support, stigma related to ACEs, and Appalachian acculturation may serve as both valid cultural factors and potential indicators of resilience. Cross-sectional, simultaneous multiple regression analysis was performed on data collected from 272 adult patients of a South Central Appalachian based medically assisted treatment (MAT) program utilizing PROCESS macro (Hayes, 2018). Participants were 53.8% male, 94.4% Caucasian, 44.9% aged 35-50 years old, and 63.6% employed. Endorsement of increased spirituality was helpful for those in MAT in South Central Appalachia who self-reported ACEs. However, as one endorsed an increasing number of ACEs, spirituality was no longer salient but instead was associated with worsened health outcomes and lessened hope. The three dimensions of spirituality (Ritualistic, Theistic, and Existential) moderated these relationships in similar but nuanced ways. Social support, on the other hand, improved mental health regardless of ACE score. Stigma and Appalachian acculturation were only related to other variables at the bivariate level but not within the hypothesized moderation model. Our study offers preliminary insight into culturally relevant resilience within South Central Appalachia, however additional investigation is needed to better understand the complex facets of health and well-being outcomes in this marginalized region.

Document Type

Dissertation - unrestricted


Copyright by the authors.