To date there have been a limited number of studies on racial/ethnic residential segregation and health, and most prior work has focused on black-white segregation and mortality. Using a large-scale population sample in Utah, this study is among the first to examine and document how Latino-white spatial segregation is associated with the risk of obesity for Latinos and whites, whether neighborhood socioeconomic resources, the built environment, and subcultural orientation serve as the underlying mechanisms, and whether neighborhood context helps explain obesity disparities across ethnic and immigrant groups.
Consistent with a handful of studies that have investigated the link between black segregation and obesity [8
], this study found Latino residential isolation was linked to increased risks of obesity for residents of Latino-concentrated neighborhoods. Previous work has rarely considered immigrant concentration when examining the segregation and health link. Since we are interested in Latino-white segregation we need to consider how the theoretically conflicting forces of residential segregation by ethnicity and immigrant enclave would bear out empirically. In this study, the theoretical prior
that immigrant-concentrated neighborhoods can offer benefits despite the structural deprivation they often face received consistent empirical support. Net of individual and neighborhood variables, immigrant concentration was negatively correlated with the risk of obesity. However, the net detrimental effect of segregation suggests that the injurious deprivation forces are stronger than the protective cultural forces in isolated Latino neighborhoods. We also found that foreign-born Latinos have significantly healthier BMI levels and lower risks of obesity whereas US-born Latinos are the most disadvantaged in terms of the risk of obesity compared to whites and foreign-born Latinos. These findings echo another national study documenting that once immigration’s impact is teased out, the net level of Latino-white disparities greatly increases, suggesting the American obesity epidemic would be much more severe without the mass immigration that began in 1965 [28
]. Clearly, immigration must be taken into account when addressing obesity disparities and more work needs to be done to investigate how to check the erosion of immigrants’ initial body composition advantage.
Another interesting finding of this study is that neighborhood effects are generally stronger for women than for men. This is consistent with previous findings that women’s health-related outcomes are more responsive to neighborhood context [10
]. We also found gender differences in terms of the relationship between residential isolation, neighborhood features, and obesity. Socioeconomic and physical features helped explain about 10% of the isolation effect for men and about 20% for women. For men, the isolation effect was not attributable to higher prevalence of obesity in more isolated neighborhoods at all; however, for women, neighborhood prevalence played a notable role (13%). A similar pattern of the mediating role of obesity prevalence in the segregation-obesity link was reported in a national sample focusing on black-white residential segregation [8
], but that study did not conduct a gender-stratified analysis. Sources of the observed gender differences in neighborhood effects are evasive. It can be speculated though that women are more affected by the neighborhood environment because they tend to spend more time at home as well as in local neighborhoods considering their lower levels of labor market participation and their typically heavier duties of child care compared to men. Moreover, as previously argued [10
], the status of being obese may be becoming normative in segregated ethnic enclaves, and women, being more sensitive to weight-related norms given that they are more likely than men to compare themselves to others with respect to appearance, would be more affected by a neighborhood weight-related subculture that is more tolerant and less stigmatizing than the mainstream culture. These speculations cannot be directly tested in this study and warrant further investigation.
Despite the observed gender differences, one emerging pattern from this study is that place matters for individual risk of obesity for both men and women. This is in line with a small but rapidly growing literature [22
]. Higher neighborhood SES exhibited significant association with lower risks of obesity. Net of the SES and segregation effect, several aspects of the built environment simultaneously featured strong influences. In addition, obesity prevalence exerted additional impact on the risk of obesity. These associations showed up independently of one another, suggesting multifarious pathways linking residence to obesity. Among the demographic, socioeconomic, physical, and cultural aspects of neighborhood context examined in this study, perhaps the most modifiable environment features that could prevent weight gain and its associated problems would be the built environmental factors such as greenness, park access, and mixed land use.
That said, we also found neighborhood context did not help explain why Latino natives are disadvantaged whereas Latino immigrants are advantaged compared to US-born whites in terms of the risk of obesity. Previous research has found neighborhood context was an important mediator underlying health disparities between blacks and whites [19
]. Whether place explains Latino-white disparities in obesity has not been well examined and is worth exploring further.
Several limitations of this study are noteworthy. First, this study relied on self-reported height and weight which can incur response bias. Second, few individual control variables are available in our data; therefore, some of the observed neighborhood effects may be overestimated. Third, the cross-sectional nature of this study disallows any causal inference on the association between neighborhood context and the risk of obesity. Selection bias cannot be ruled out from the analyses. Fourth, the sample is based on one state, Utah, which is characterized by an especially healthy population (perhaps due to health practices of Mormons) [30
]. We must therefore be cautious in generalizing from these results to patterns in other places. Nevertheless, it can be argued that there is a need to understand how obesity and other health issues manifest themselves in particular communities, even if those communities have some unusual characteristics.
Future work equipped with richer individual and neighborhood variables should continue to inquire into how residential segregation is linked to weight status, and more attention should be paid to minorities such as Latinos and Asians that are traditionally under-researched in the health-segregation literature. Immigration should be routinely considered when addressing public health concerns with respect to these groups. Moreover, health disparities across Latino and Asian subgroups should be detailed; these nuanced analyses are rarely available. Most importantly, longitudinal studies are urgently needed to sort out the causation versus selection effect in the observed associations between neighborhood context and weight status.