Adolescent Loneliness and Health in Early Adulthood

The health consequence of loneliness in the early life course is an understudied topic in the sociological literature. Using data from Waves 1–3 of the National Longitudinal Study of Adolescent Health, we examine pre-disease pathways in the relationship between adolescent loneliness and early adult health. Our results indicate that loneliness during adolescence is associated with diagnosed depression, poorer adult self-rated health, and metabolic risk factors related to cardiovascular disease. High depressive symptoms and parent support are important pathways through which the health consequences of loneliness are exacerbated or offset. There is also evidence that lonely youth remain at higher risk for experiencing adult depression and poor self-rated health even in the presence of equivalent levels of parental support relative to non-lonely adolescents. Furthermore, lonely adolescent females are more vulnerable to reporting poor adult self-rated health and being overweight or obese in adulthood. In sum, our study demonstrates the importance of adolescent loneliness for elevating the risk of poor health outcomes in adulthood

Adolescent Loneliness and Health in Early Adulthood

The health consequence of loneliness in the early life course is an understudied topic in the sociological literature. Using data from Waves 1–3 of the National Longitudinal Study of Adolescent Health, we examine pre-disease pathways in the relationship between adolescent loneliness and early adult health. Our results indicate that loneliness during adolescence is associated with diagnosed depression, poorer adult self-rated health, and metabolic risk factors related to cardiovascular disease. High depressive symptoms and parent support are important pathways through which the health consequences of loneliness are exacerbated or offset. There is also evidence that lonely youth remain at higher risk for experiencing adult depression and poor self-rated health even in the presence of equivalent levels of parental support relative to non-lonely adolescents. Furthermore, lonely adolescent females are more vulnerable to reporting poor adult self-rated health and being overweight or obese in adulthood. In sum, our study demonstrates the importance of adolescent loneliness for elevating the risk of poor health outcomes in adulthood

Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood

The burden and determinants of complications and comorbidities in contemporary youth-onset diabetes are unknown

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

What you don\u27t 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\u27s Behavioral Model of Health Services Use (1995) is used to model diabetes diagnostic disparities among young adults with diabetes. Tests of Andersen\u27s 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

Development of the diabetes typology model for discerning Type 2 diabetes mellitus with national survey data.

OBJECTIVE:To classify individuals with diabetes mellitus (DM) into DM subtypes using population-based studies. DESIGN:Population-based survey. SETTING:Individuals participated in 2003-2004, 2005-2006, or 2009-2010 the National Health and Nutrition Examination Survey (NHANES), and 2010 Coronary Artery Risk Development in Young Adults (CARDIA) survey (research materials obtained from the National Heart, Lung, and Blood Institute Biologic Specimen and Data Repository Information Coordinating Center). PARTICIPANTS:3084, 3040 and 3318 US adults from the 2003-2004, 2005-2006 and 2009-2010 NHANES samples respectively, and 5,115 US adults in the CARDIA cohort. PRIMARY OUTCOME MEASURES:We proposed the Diabetes Typology Model (DTM) through the use of six composite measures based on the Homeostatic Model Assessment (HOMA-IR, HOMA-%β, high HOMA-%S), insulin and glucose levels, and body mass index and conducted latent class analyses to empirically classify individuals into different classes. RESULTS:Three empirical latent classes consistently emerged across studies (entropy = 0.81-0.998). These three classes were likely Type 1 DM, likely Type 2 DM, and atypical DM. The classification has high sensitivity (75.5%), specificity (83.3%), and positive predictive value (97.4%) when validated against C-peptide level. Correlates of Type 2 DM were significantly associated with model-identified Type 2 DM. Compared to regression analysis on known correlates of Type 2 DM using all diabetes cases as outcomes, using DTM to remove likely Type 1 DM and atypical DM cases results in a 2.5-5.3% r-square improvement in the regression analysis, as well as model fits as indicated by significant improvement in -2 log likelihood (p<0.01). Lastly, model-defined likely Type 2 DM was significantly associated with known correlates of Type 2 DM (e.g., age, waist circumference), which provide additional validation of the DTM-defined classes. CONCLUSIONS:Our Diabetes Typology Model reflects a promising first step toward discerning likely DM types from population-based data. This novel tool will improve how large population-based studies can be used to examine behavioral and environmental factors associated with different types of DM

Ethnic Differences in Family Stress Processes Among African- Americans and Black Caribbeans

Several theories of stress exposure, including the stress process and the family stress model for economically disadvantaged families, suggest that family processes work similarly across race/ ethnic groups. Much of this research, however, treats African-Americans as a monolithic group and ignores potential differences in family stress processes within race that may emerge across ethnic groups. This study examines whether family stress processes differ intraracially in African- American and Black Caribbean families. Using data from the National Survey of American Life, a national representative data set of African-American and Black Caribbean families, we assess the extent to which parents’ stress appraisals and psychological adjustment are related to their adolescent children’s stress appraisals, psychological adjustment, and depressive symptoms. Our study illustrates that stress processes differ by ethnicity and operate through varying pathways in African-American and Black Caribbean families. The implications of intraracial variations in stress processes are discussed

Sensitivity analyses using C-peptide matching and increased variance explained.

<p>Sensitivity analyses using C-peptide matching and increased variance explained.</p

Latent class analysis of all diabetic respondents in the study samples indicated, by the diabetes correlates on the X-axis: National Health and Nutrition Examination Survey (NHANES) and the Coronary Artery Risk Development in Young Adults survey (CARDIA).

<p>Latent class analysis of all diabetic respondents in the study samples indicated, by the diabetes correlates on the X-axis: National Health and Nutrition Examination Survey (NHANES) and the Coronary Artery Risk Development in Young Adults survey (CARDIA).</p