Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Major/Program

Public Health

First Advisor's Name

Elena Bastida

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Zoran Bursac

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Mariana Sanchez

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Edgar Vieira

Fourth Advisor's Committee Title

Committee member

Keywords

Aging, Mexican Americans, Mortality, Diabetes, Early Life Experiences

Date of Defense

3-18-2021

Abstract

Despite Mexican Americans experiencing many chronic illnesses, e.g., diabetes and obesity, they exhibit higher life expectancy than other population groups in the United States. This is known as the Hispanic Paradox. This dissertation aimed to further contribute to the literature on the “paradox” by investigating the association between psychosocial factors rarely investigated in this population, such as social support, self- rated health, and stressful life events, with incident diabetes and all-cause mortality.

Data for this dissertation are from the Border Epidemiological Study of Aging, known as BESA, a population based longitudinal study consisting of four waves conducted in South Texas from 1994 to 2006/07. Additional 12 years of mortality data were requested from the National Death Index (NDI-CDC) database resulting in a total of 24 years of survival follow-up (1995-2019). The initial probability sample yielded 1089 Mexican American participants, 45 years or older. When weighed the sample was statistically representative of 300,000 border residents.

Findings indicate that low social support, loss of a father between 5 – 30 years old, and loss of a child at any time are independent risk factors for developing type 2 diabetes. Additionally, findings from the Cox Hazard Model indicate that losing a father between the ages of 5 – 17 increased the mortality risk decades later after adjusting for demographics, education, self-rated heath, and physical health. The median survival age for those losing a father between the ages of 5 – 17 years was 83 years old compared to 86 for those who did not experience this loss. Moreover, a better self-rating of health in late midlife increased over all life expectancy, even after adjusting for demographics, education, physical and mental health at the time of first health assessment.

It is suggested that results presented in this dissertation have the potential to advance gerontological policy by providing insights on older adults at risk for diabetes and lower survival through the assessment of psychosocial stress. Policy enhancing social support interventions at the population level are recommended cost-effective strategies for promoting health. Finally, research investigating efficacy of culturally tailored interventions aimed to support social environments is recommended.

Identifier

FIDC009572

Available for download on Thursday, April 20, 2023

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