Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
12-2026
Committee Chair or Co-Chairs
Megan Quinn
Committee Members
David Shoham, Bethesda O'Connell
Abstract
Background: Systemic lupus erythematosus (SLE) disproportionately affects African American women and contributes to racial health disparities in the United States. Although genetic susceptibility influences disease risk, growing evidence suggests that social determinants of health (SDOH), including neighborhood conditions, structural racism, and socioeconomic disadvantage, contribute to disease development and progression. Epigenetic mechanisms may provide a biological pathway linking adverse social conditions to chronic disease disparities. This dissertation examined the influence of SDOH on SLE disparities through evidence synthesis and empirical investigation to inform public health practice and policy.
Methods: This integrated learning experience consisted of three complementary manuscripts. Aim 1 was a PRISMA-ScR scoping review examining associations among SDOH, epigenetic mechanisms, and chronic disease outcomes. Aim 2 was a secondary cross-sectional analysis of baseline data from a case-control study the Social Factors, Epigenomics, and Lupus in African American Women (SELA) Study examining neighborhood racial composition and SLE disease activity using generalized estimating equations (GEE). Aim 3 was a secondary case-control analysis of SELA data examining neighborhood racial composition and confirmed SLE diagnosis using GEE.
Results: Aim 1: Twenty-two studies demonstrated associations between adverse SDOH, epigenetic alterations, and chronic disease outcomes. Neighborhood disadvantage, economic instability, food insecurity, adverse childhood experiences, and discrimination were associated with accelerated biological aging and poorer health outcomes, whereas educational attainment, social capital, supportive relationships, and neighborhood resources were protective. Aim 2: Neighborhood racial composition was not associated with SLE disease activity after adjustment for age and educational attainment; however, lower educational attainment was associated with greater disease activity. Aim 3: Neighborhood racial composition was associated with confirmed SLE diagnosis after adjustment for age, educational attainment, and Sea Islander status. Each one-percentage-point increase in neighborhood African American composition was associated with approximately 2.3% higher odds of SLE diagnosis.
Conclusions: Adverse SDOH contribute to chronic disease disparities through individual- and neighborhood-level pathways. Neighborhood racial composition was associated with SLE diagnosis but not disease activity, suggesting neighborhood context may influence disease occurrence more than disease severity. These findings support public health policies and community interventions that address structural inequities and neighborhood disadvantage to reduce SLE disparities among African American women.
Document Type
Dissertation - unrestricted
Recommended Citation
Morman, Vanessa CL, "Weathering the Divide: Social Determinants, Neighborhood Context, and Systemic Lupus Erythematosus Among African American Women" (2026). Electronic Theses and Dissertations. Paper 4769. https://dc.etsu.edu/etd/4769
Copyright
Copyright by the authors.
