Determining Diabetes: The Role of Educational Attainment and Race/Ethnicity in the Link between Health Behaviors and Diabetes

Abstract

Drawing on a theoretical framework that integrates the social determinants of health perspective with health lifestyles theory (Cockerham 2005) and social psychological theories of person control (Mirowsky and Ross 2003), this dissertation examines the degree to which the relationship between health behaviors, such as physical activity and diet, and diabetes status is dependent on educational attainment and race/ethnicity. Educational attainment and race/ethnicity are powerful social factors that are associated with the prevalence of diabetes as well as the behaviors such as diet and physical activity that are known to cause many cases of diabetes. Current health policies seek to reduce or eliminate social disparities in diabetes by encouraging disadvantaged groups to increase their physical activity, eat healthier diets, and lose weight. However, some literature suggests that social factors, particularly education and race/ethnicity, may not only structure available resources and behaviors, but may influence individual’s ability to benefit from healthy behaviors. Using data from National Health and Nutrition Examination Survey (NHANES), a series of multinomial logistic regression models were estimated to determine how association between health behaviors and diabetes varied by education and race/ethnicity. The difference in the probability of having diabetes for those who were active compared to inactive was higher among those with a high school or college education and lowest for those with less than high school and some college. Only for those with a college education did being active result in a lower likelihood of having prediabetes. Similarly, it was only for non-Hispanic whites that the risk of prediabetes was lower for those who were active compared to those who inactive. The findings related to diet indicate that the likelihood of having diabetes was actually higher at better scores for those with less than a college education and non-Hispanic blacks. Overall, these findings suggest that it should not be assumed that the relationship between health behaviors and diabetes status is consistent across social groups. Current efforts to foster health equity may be undermined by social stressors, as a result of social inequality, that negate the benefit of otherwise healthy behaviors.