Dissertations, Theses, and Capstone Projects

Date of Degree

6-2016

Document Type

Dissertation

Degree Name

D.P.H.

Program

Public Health

Advisor

Mary Clare Lennon

Committee Members

Juan Battle

Holly Reed

Joseph Ravenell

Subject Categories

Cardiovascular Diseases | Community Health and Preventive Medicine | Inequality and Stratification | Medicine and Health | Public Health | Public Health Education and Promotion | Race and Ethnicity

Keywords

Race, Ethnicity, Nativity, men, chronic disease, health disparities

Abstract

Compared to non-Hispanic whites, non-Hispanic blacks have higher rates of mortality from heart disease, cancer, cardiovascular disease, and HIV/AIDS. Black men have a life expectancy approximately 4.7 years than the life expectancy of non-Hispanic white men, due in part to higher prevalence of chronic disease among black men. Many factors are hypothesized to contribute to disparities in health between races, including differences in socioeconomic status; culturally-linked behaviors such as diet, substance use, and physical activity; access to quality healthcare and other resources; and experiences of racism, both institutional and interpersonal. However, in public health research, race is usually treated as a static categorization of people into homogenous groups. Yet, among an increasingly diverse black community, particularly in urban areas such as New York City, these determinants also vary by ethnicity ad nativity within the black race, thus decreasing the validity of between-race comparisons. Ethnicity or other potentially meaningful subdivisions within races is rarely measured and within-race heterogeneity is rarely acknowledged by public health researchers. This study examines the extent to which the heterogeneity of blacks by ethnicity and nativity affects the results of race-based health disparities research and determines whether examining determinants of health will illuminate variation in the impact of specified risk factors for poor health by ethnicity or nativity. I used hierarchical regression analyses of two existing cross-sectional datasets (the NYU School of Medicine Men’s Health Initiative baseline data and the NYC Department of Health and Mental Hygiene Community Health Survey for 2009-2012). Results indicate that socioeconomic status, rather than behavior or access to care, was the largest contributor to differences in health outcomes by race. Meanwhile, results varied by dataset for analyses by nativity and ethnicity. Few differences in outcomes between subgroups were seen for the Community Health Survey. However, among participants in the Men’s Health Initiative, foreign-born participants compared to US-born participants, and Caribbeans compared African Americans, had significantly better self-rated health and less burden of comorbidity. However, these same groups were less likely to be aware of having hypertension, indicating potentially greater burden of diagnosed chronic disease among these two sub-groups. Having a personal doctor was significantly related to greater awareness of hypertension. Additional results are included and implications and recommendations based on the findings are presented in the study conclusion.

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