A Life Course Perspective on the Social Determinants of Multiracial American Health

Abstract

Few studies provide data on the health of self-identified multiracial (two or more races) Americans. Subsequently, we know little about this population and existing health disparities. Three areas relevant to multiracial health include health status, health care service utilization, and health related to racial stability over the life course. Although some investigations report the health service use of children and adolescents, almost no studies report the health service use of multiracial young adults. Most studies on multiracial groups are cross-sectional and thus focus on a single time point, so it is difficult to establish how health indicators change for multiracial groups over time. This dissertation employs epidemiological methods to investigate the health of self-identified multiracial young adults in a series of three papers. There are three guiding questions in this dissertation. First, "Do multiracial adults have better or worse self-rated health than monoracial groups?" Second, "Do multiracial young adults use health care services at the same rate as monoracial groups?" Third, "How is consistency in racial categories over time related to self-rated health for multiracial young adults in the United States?" I used data from the National Longitudinal Study of Adolescent Health (N = 20,774) in-home sample taken during the period 1994-2008 to examine factors related to multiracial health as individuals enter different phases of life. Using multivariate logistic regression I tested a series of hypotheses for three distinct research questions. In the first paper, I found that there are differences in self-rated health for some multiracial groups. In the second paper, I found that there are differences in the rates of health care service utilization when comparing specific multiracial groups to the monoracial majority. In the third paper, I found that there are differences in report of self-rated health when comparing monoracial adults with multiracial adults who switch racial categories over time. These findings contribute to the wider understanding of health disparities for vulnerable populations and assist in identifying salient mechanisms of health disparities over the life course. These results also demonstrate the importance of critically examining changes in racial categories as related to health status over time.