2025 Theses Doctoral

Understanding Intergenerational Health Communication in Minority Households: Advocating Children as Health Educators

Lee, Yejin

This dissertation addresses the persistent challenge of health disparities within racial and ethnic minority families, focusing on the critical, yet underexplored, role of children as agents of intergenerational health communication. Situated within the context of multigenerational households, which are prevalent in these underserved communities, this study investigates the complex factors that influence the effectiveness of child-mediated health education for a condition as significant and culturally embedded as Alzheimer's disease and related dementias (ADRD).

The primary purpose of this study was to identify the specific caregiver demographic characteristics and family system dynamics that facilitate or impede the process of child-led health information transfer and to understand its subsequent impact on caregiver health information receptivity (dementia knowledge) and perceptions of child comfort. This research was guided by a dual theoretical framework, integrating the Health Belief Model (Rosenstock, 1974) and Family Systems Theory (Bowen, 1978). This study employed a secondary data analysis of quantitative survey data from parent caregivers (baseline N=394) participating in the Old SCHOOL Hip Hop (OSHH) clinical trial, a culturally tailored, school-based dementia education program in New York City. Key measures included caregiver demographics, family dynamics, dementia knowledge (Assess Symptoms and Knowledge of Alzheimer's Disease [ASK-AD] scale), and perceived child comfort (Dementia Attitudes Scale [DAS]). Data were analyzed using descriptive statistics, Chi-square tests, and various logistic regression models.

Key findings provide compelling evidence that children can serve as effective health educators. The strongest predictors of caregiver knowledge gain were child-initiated communication behaviors, including the consistent sharing of program materials and subsequent parent-child conversations. However, the effectiveness of this process was significantly moderated by contextual factors. Prior family exposure to ADRD predicted both baseline discussions and consistent child sharing. Higher caregiver education and neighborhood socioeconomic status predicted higher baseline knowledge. Critically, persistent racial disparities were observed across multiple outcomes.

This dissertation concludes that while child-mediated health communication is a powerful and viable strategy for improving health literacy in underserved families, its success and equity are contingent upon a deep understanding of the cultural contexts and systemic barriers that shape family life. The findings present an urgent call to action for the development of more deeply culturally tailored, family-centered health education programs. Such programs must ethically empower children as supportive health partners, provide accessible and sustained support for caregivers from diverse educational and socioeconomic backgrounds, and actively work to mitigate systemic inequities. By doing so, this innovative, intergenerational approach can be leveraged to its full potential to foster family health preparedness, enhance health literacy, and advance health equity in the communities that need it most.