All ETDs from UAB

Advisory Committee Chair

Elizabeth H Baker

Advisory Committee Members

Olivio J Clay

Robin G Lanzi

Irena Stepanikova

Joseph D Wolfe

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Background: Unmet need (UN) can be characterized as a person not getting care even when they think they need it. Younger populations are understudied for UN, even though UN can emerge as early as adolescence. The aim of this dissertation is to use the national Longitudinal Study of Adolescent to Adult Health (Add Health) to examine whether adolescent socioeconomic status (SES) or health factors better predict UN over time, and how UN differs by race/ethnicity. Life course perspective, cumulative advantage and disadvantage hypothesis, and fundamental cause theory inform my hypotheses. Primary hypotheses: 1) The likelihood of UN will increase over time as adolescents transition into adulthood; 2) Racial/ethnic minorities will be more likely than whites to have UN throughout the transition from adolescence to young adulthood, net of controls; 3) Higher adult SES will be associated with lower odds of UN in adulthood, net of controls; 4) The likelihood of poorer SRH will increase over time as adolescents transition into adulthood. Results: In longitudinal analysis (N=27,981 person period observations) I found that blacks and Native Americans have higher log odds of UN than whites after controlling for adolescent SES, adult transitions, and health measures. I also found that adolescent SES suppresses the beneficial relationship for excellent SRH for blacks compared to whites. In cross-sectional analysis (N=5,895 respondents) I found that those with the highest SES are most protected from UN, and that adolescent SES has some influence on adult SES attainment. Timing of life events such as college attendance at traditional age (18-21) is the only education group with lower odds of UN (OR=0.715, p<0.01). Discussion: Those with the most advantaged SES accumulate more benefits protecting respondents from UN and poorer SRH compared to those with lower SES, supporting cumulative advantage. Despite blacks having better health measures than whites, they are at greater risk of UN, supporting the weathering hypothesis and fundamental cause of health disparity. Timing of events in the life course also matters for log odds of experiencing UN.

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