Racialized Realignment of Time and its Effects on Health Inequities: An Investigation of Time-Use as a Proxy for Differential Lived Experiences at the Intersection of Race and Gender.

Abstract

Research on social-structural determinants of health has greatly increased understanding of institutional policies and practices undergirding well-documented racial/ethnic disparities. Yet, this research has typically focused on one social identity (race), one institutional policy or practice, one place-based setting, and/or one temporal stage at a time. As such, the field has made huge strides in drawing attention to underlying sources of racial disparities, however, may be losing insight into the ways in which these macro-level influences are experienced day-to-day. Drawing on Geronimus’ weathering hypothesis, this dissertation explores daily time-use profiles as a novel investigative approach that may more holistically capture the interactive and cumulative effects of different structural-level forms of discrimination on the daily lives of marginalized groups. Using hypertension, one of the most persistent racial health inequities in the U.S. as an example, I explore how time-use profiles may relate to stress processes and the disparate differences we see in prevalence and timing of onset between non-Hispanic White and Black males and females. While hypertension prevalence is highest in middle through old age, increasingly evidence suggests race and gender differentials are evident by young adulthood, suggesting precursors may be present in youth. Black women, in particular, experience the steepest age-gradient increase in hypertension as they age from adolescence through middle-age. Study 1 explores time-use variations among Black and White males and females in the American Time Use Survey, answering the question, “Are Black and White Americans spending time differently with age from adolescence into young adulthood?” Study 2 is a qualitative investigation highlighting time-use profiles of Black adolescent girls in metro Detroit, MI with the aim of increasing understanding on daily time demands and stressors that may explain the steeper age-gradient for Black females across adolescence and young adulthood. Lastly, study 3 employs the National Longitudinal Study of Adolescent Health (Add Health) to investigate whether time-use differences affect the probability of early onset hypertension across race/gender groups.