University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Background: Racial residential segregation (RRS) is a fundamental cause of racial disparities in cardiovascular disease (CVD) risk and prevalence. While the effects of RRS on Black-White disparities in CVD have been well documented, knowledge about the effect of RRS on CVD disparities among men is limited. Cardiovascular health (CVH) is inversely associated with CVD risk and may prevent CVD disparities in later adult years if better understood. Thus, the goal of this dissertation is to examine whether RRS influences the emergence of race differences in CVH among young Black and White men in the US. Methods: Data for aims 1 and 2 were drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health). In aim 1, we used logistic regression to examine whether RRS influenced the association between race and CVH among young men (ages 24-32; N=5,080). In aim 2, we used mixed effects latent growth modeling to examine whether RRS during adolescence contributed to alternative body mass index (BMI), sleep, and cigarette use male trajectories by race from adolescence to young adulthood (ages 13-31; (N=8,612). Lastly, aim 3 used concept mapping data collected from a community sample of 30 young Black men residing in two southern Black communities to understand their conceptualizations of how CVH is linked to residential context. Results: In aim 1,we observed race disparities in ideal CVH when young Black and White men reside in neighborhoods comprised of 55% or more White residents. In aim 2, BMI, sleep, and cigarette use trajectories differed by neighborhood RRS during adolescence for White males. However, adolescent RRS caused different trajectories only for BMI among Black males. In aim 3, the final concept map depicted eight conceptual domains classified into two overarching domains of neighborhood features that were either protective or harmful to Black men’s CVH. Conclusion: Overall, study findings advance knowledge of the extent that RRS influences Black-White differences in CVH among young men. Taken together, findings from this dissertation have the potential to inform research, healthcare delivery, and policy solutions to better serve young men within their residential contexts and attenuate racial disparities in CVD.Doctor of Philosoph
