Leveraging Differences between Caribbean Blacks and African-Americans to Test the Weathering Hypothesis

Racial inequalities in health are well documented in the literature, specifically with respect to Blacks and Whites in the United States (U.S.) These stark racial differences in health may be explained by the weathering hypothesis, whereby Blacks experience earlier deterioration of health resulting from cumulative stress from living in a race-conscious society. Despite the abundance of research on the weathering hypothesis to account for racial disparities, few research studies have attempted to empirically test this theory as it relates to cardio-metabolic disease disparities. Using nationally representative data from the National Survey of American Life (NSAL) and the National Comorbidity Survey Replication (NCS-R), the weathering hypothesis was examined in the context of cardio-metabolic disease disparities among a U.S. sample of Whites, African-Americans and Caribbean Blacks. This dissertation was organized into three main papers: The first paper (“Application of the Weathering Hypothesis: A Systematic Review of the Research”) is a systematic review of the existing literature that empirically tests the weathering hypothesis, which informed the methods in papers 2 and 3 of this dissertation. The second paper (“Cardio-Metabolic Disease Disparities: Comparisons between Caribbean Blacks, African-Americans and Whites to Test the Weathering Hypothesis”) tests the weathering hypothesis as an explanation for health disparities compared with other potential explanations (e.g. minority stress, socioeconomic status, health behaviors and genetics). The third paper (“Racial and Ethnic Disparities in Cardio-metabolic Disease: The Role of Racial Group Identification and Discrimination-Specific Coping”) assesses whether and to what extent racial socialization factors (racial identity and coping strategies) affect racial disparities in cardio-metabolic disease, as well as influence the effect of racial discrimination on cardio-metabolic disease. The systematic review informs future studies of the weathering hypothesis as a comprehensive framework for understanding racial disparities in health outcomes, but highlights the need for additional studies examining the impact of weathering on health outcomes other than birth outcomes. In paper 2, the results showed some support for the weathering hypothesis, but the patterns were not fully consistent with the predictions of this hypothesis. The results in paper 3 revealed racial differences in racial socialization factors (racial identity and coping strategies), but these factors did not explain racial/ethnic disparities in cardio-metabolic disease. Future studies should examine the effect of structural racism on racial disparities in cardio-metabolic disease as another test of the weathering hypothesis.