WHAT YOU DON’T KNOW CAN HURT YOU: EARLY LIFE COURSE RACIAL HEALTH DISPARITIES IN UNDIAGNOSED DIABETES

This dissertation addresses several issues related to racial health disparities in undiagnosed diabetes in American young adults in a three-article format. The first chapter examines rates of diabetes severity across age-matched samples of young adults from two large nationally representative studies. Although the purpose of this study was to explore the impact of nonresponse on prevalence estimates, I find that the prevalence discrepancies have less to do with which respondents are missing blood samples and more to do with the samples coming from initial samples that are not equivalent. The second chapter uses an adaptation of the Stress Process Model to identify the effects of racial minority status, perceived discrimination, mastery, and risky coping strategies on diabetes severity in a race-stratified young adult sample. Data from the National Longitudinal Study of Adolescent Health were used to analyze diabetes risk severity using multinomial logistic regression analysis. Large disparities in diabetes risk severity were found by race, particularly for undiagnosed diabetes. Multivariate results show complex relationships between experiencing discrimination and diabetes risk severity by race, which suggest that discrimination effects diabetes risk severity differently for blacks and whites. The final study examines the impact of help seeking and diagnosis allocation with diabetes diagnosis disparities. Andersen’s Behavioral Model of Health Services Use (1995) is used to model diabetes diagnostic disparities among young adults with diabetes. Tests of Andersen’s model using data from the National Longitudinal Study of Adolescent Health reveal no difference in help seeking across race/ethnic groups. Although all race/ethnic groups were equally likely to seek care, large diagnostic disparities persist for blacks. As a result, young adult black diabetics are significantly less likely to receive a diagnosis for diabetes even when they sought care in the previous three months. Taken together, this dissertation reveals that racial health disparities in diabetes diagnoses are complex. Estimates of the prevalence, predictors, and pathways to diagnosis differ by race in meaningful and previously unexplored ways. This research serves to document this problem, provide foundational evidence of meaningful relationships, and shed light on the possible public health and policy implications associated with these disparities. Adviser: Bridget J. Goosb