This study examines neighborhood influences on alcohol, cigarette and marijuana use among a predominantly Latino middle school sample. Drawing on theories of immigrant adaptation and segmented assimilation, we test whether neighborhood immigrant, ethnic, and socioeconomic composition, violent crime, residential instability, and family structure have differential effects on substance use among youth from different ethnic and acculturation backgrounds. Data are drawn from self-reports from 3,721 7th grade students attending 35 Phoenix, Arizona middle schools. Analysis was restricted to the two largest ethnic groups, Latino students of Mexican heritage and non-Hispanic Whites. After adjusting for individual-level characteristics and school- level random effects, only one neighborhood effect was found for the sample overall, an undesirable impact of neighborhood residential instability on recent cigarette use. Sub-group analyses by individual ethnicity and acculturation showed more patterned neighborhood effects. Living in neighborhoods with high proportions of recent immigrants was protective against alcohol, cigarette, and marijuana use for Latino students at different acculturation levels, while living in predominantly Mexican heritage neighborhoods (mostly non-immigrants) was a risk factor for alcohol and marijuana use for less acculturated Latinos. There were scattered effects of neighborhood poverty and crime, which predicted more cigarette and alcohol use, respectively, but only among more acculturated Latinos. Inconsistent effects confined to bilingual and more acculturated Latinos were found for the neighborhood's proportion of single mother families and its residential instability. No neighborhood effects emerged for non-Hispanic White students. Results suggested that disadvantaged neighborhoods increase substance use among some ethnic minority youth, but immigrant enclaves appear to provide countervailing protections.
neighborhood effects; substance use; adolescents; Mexican Americans; acculturation
Research on the “Immigrant,” or “Latino health paradox” has demonstrated that Latinos exhibit better health than U.S.-born whites, for multiple health outcomes, despite adjusting for socioeconomic status. However, little empirical research has focused on women and even less has focused on how the neighborhood residential environment is associated with these health differences, particularly in the area of diet.
We analyzed baseline data from 641 low-income women, nested within 184 census tracts, enrolled in a nutrition intervention trial for postpartum women. Individual-level variables, including race/ethnicity, nativity and duration of time in the United States, language acculturation, emotional and instrumental support, and socioeconomic position, were merged with tract-level variables from U.S. Census data (2000) based on residential address. We assessed daily fruit and vegetable servings through a semi-quantitative food frequency questionnaire. Using MLWin 2.0 software, we employed a 2-level linear regression model to ascertain associations of neighborhood immigrant, racial, and socioeconomic composition with individual diet, adjusting for individual-level socio-demographic characteristics.
In our fully adjusted model, we observed a statistically significant increase of 1/3 of fruit and vegetable daily servings for each 10 percentage point increase in the tract foreign born population. Each 10 percentage point increase in the tract Black population was associated with a significant 1/5 serving decrease in individual daily fruit and vegetable intake.
Among this population of U.S. and foreign-born women, neighborhood composition was associated with individual diet, above and beyond individual level characteristics, illuminating neighborhood context, immigrant health and diet.
We expand the search for modifiable features of neighborhood environments that alter obesity risk in two ways. First, we examine residents’ access to neighborhood retail food options in combination with neighborhood features that facilitate physical activity. Second, we evaluate neighborhood features for both low income and non-low income neighborhoods (bottom quartile of median neighborhood income vs. the top three quartiles).
Our analyses use data from the Utah Population Database merged with U.S. Census data and Dun & Bradstreet business data for Salt Lake County, Utah. Linear regressions for BMI and logistic regressions for the likelihood of being obese are estimated using various measures of the individual’s neighborhood food options and walkability features.
As expected, walkability indicators of older neighborhoods and neighborhoods where a higher fraction of the population walks to work is related to a lower BMI/obesity risk, although the strength of the effects varies by neighborhood income. Surprisingly, the walkability indicator of neighborhoods with higher intersection density was linked to higher BMI/obesity risk. The expected inverse relationship between the walkability indicator of population density and BMI/obesity risk is found only in low income neighborhoods.
We find a strong association between neighborhood retail food options and BMI/obesity risk with the magnitude of the effects again varying by neighborhood income. For individuals living in non-low income neighborhoods, having one or more convenience stores, full-service restaurants, or fast food restaurants is associated with reduced BMI/obesity risk, compared to having no neighborhood food outlets. The presence of at least one healthy grocery option in low income neighborhoods is also associated with a reduction in BMI/obesity risk relative to no food outlets. Finally, multiple food options within a neighborhood reduce BMI/obesity risk, relative to no food options, for individuals living in either low-income or non-low neighborhoods.
USA; obesity; body mass index (BMI); neighborhood walkability; food environment; retail food outlets
We examine whether individual and neighborhood socioeconomic context contributes to black/white disparities in mortality among USA older adults. Using national longitudinal data from the Americans' Changing Lives study, along with census tract information for each respondent, we conduct multilevel survival analyses. Results show that black older adults are disadvantaged in mortality in younger old age, but older black adults have lower mortality risk than whites after about age 80. Both individual SES and neighborhood socioeconomic disadvantage contribute to the mortality risk of older adults but do not completely explain race differences in mortality. The racial mortality crossover persists even after controlling for multilevel SES, suggesting that black older adults experience selective survival at very old ages. Addressing the individual and neighborhood socioeconomic disadvantage of blacks is necessary to reduce mortality disparities that culminate in older adulthood.
We draw upon social disorganization theory to examine the effects of community characteristics on the distribution of offsite alcohol outlets in San Diego County, California. Of particular interest is whether alcohol availability varies according to neighborhood racial/ethnic composition once measures of social disorganization (socioeconomic disadvantage, residential instability, and racial/ethnic heterogeneity) are controlled. Using data from the 1990 Census and 1993 alcohol license reports, we estimate a series of negative binomial regression models with corrections for spatial autocorrelation. The results show that percent Asian is associated with lower offsite alcohol outlet density. Once socioeconomic disadvantage is controlled, percent Latino is related to lower alcohol availability. Although similar suppressor patterns are observed, percent Black is generally unrelated to outlet density. Consistent with social disorganization theory, socioeconomic disadvantage and residential instability predict increased alcohol availability. Neighborhood racial/ethnic composition is either unrelated or inversely related to outlet density once social disorganization and other neighborhood characteristics are taken into account.
Alcohol outlets; alcohol availability; race and ethnicity; social disorganization theory; neighborhoods
Understanding the factors that drive individuals' residential preferences is a critical issue in the study of racial segregation. An important debate within this field is whether individuals – especially whites – prefer to live in predominantly white neighborhoods because they wish to avoid the social problems that may be more likely to occur in predominantly black neighborhoods (i.e., the racial proxy hypothesis) or because of racial factors that go beyond these social class-related characteristics. Through a multilevel analysis of data from the 2004–2005 Chicago Area Study and several administrative sources, we assess the extent to which the racial proxy hypothesis describes neighborhood satisfaction among whites, African Americans, and Latinos living across a broad range of neighborhood contexts. The racial proxy perspective applies weakly to whites' satisfaction: whites report less satisfaction in neighborhoods with more minority residents, and only some of their dissatisfaction can be attributed to local social characteristics. The racial proxy hypothesis applies more strongly to blacks' and Latinos' satisfaction. In some cases, especially for Latinos, higher levels of satisfaction in integrated neighborhoods can largely be attributed to the fact that these places have better socioeconomic conditions and fewer social problems than predominantly minority communities. At the same time, effects of racial/ethnic composition persist in unique and somewhat divergent ways for blacks and Latinos, supporting the assertion that racial composition matters, above and beyond its relation to social class. Taken together, these findings suggest that individuals balance both socioeconomic and race-related concerns in their residential preferences.
Guided by social disorganization theory, this article examines the influence of neighborhood characteristics on intragroup and intergroup robbery, net of spatial proximity in a predominantly native-born Latino/Mexican-origin city—San Antonio, Texas. From census tract and official police robbery data, the findings indicate that intragroup robbery is more common than intergroup robbery. Multivariate results show that variation in black intra-group robbery lies primarily in highly disadvantaged neighborhoods; whereas variation in Latino intergroup robbery is found in neighborhoods with more disadvantage, racial/ethnic heterogeneity, recent immigrants, and blacks. Residential instability persistently influences all robbery types. Disaggregating robberies by race and ethnicity reveals the importance of examining Latinos as offenders and victims. The case of San Antonio serves as a harbinger of conditions that may exist in the growing number of majority-Latino cities—and suggests the need to investigate crime experiences that move beyond studying racial dichotomies of violence.
social disorganization; intragroup/intergroup; robbery; Latino/Hispanic/Mexican-origin
A growing body of literature has documented a link between neighborhood context and health outcomes. However, little is known about the relationship between neighborhood context and body mass index (BMI) or whether the association between neighborhood context and BMI differs by ethnicity. This paper investigates several neighborhood characteristics as potential explanatory factors for the variation of BMI across the United States; further, this paper explores to what extent segregation and the concentration of disadvantage across neighborhoods help explain ethnic disparities in BMI. Using data geo-coded at the census tract-level and linked with individual-level data from the Third National Health and Examination Survey in the United States (U.S.), we find significant variation in BMI across U.S. neighborhoods. In addition, neighborhood characteristics have a significant association with body mass and partially explain ethnic disparities in BMI, net of individual-level adjustments. These data also reveal evidence that ethnic enclaves are not in fact advantageous for the body mass index of Hispanics—a relationship counter to what has been documented for other health outcomes.
BMI; Weight; Obesity; NHANES; USA; Neighbourhood effects; Spatial analysis; Ethnicity; Social class
We construct a dynamic racial residential history typology and examine its association with self-rated health and mortality among black and white adults. Data are from a national survey of U.S. adults, combined with census tract data from 1970–1990. Results show that racial disparities in health and mortality are explained by both neighborhood contextual and individual socioeconomic factors. Results suggest that living in an established black neighborhood or in an established interracial neighborhood may actually be protective of health, once neighborhood poverty is controlled. Examining the dynamic nature of neighborhoods contributes to an understanding of health disparities.
National data do not account for race differences in health risks resulting from racial segregation or the correlation between race and socioeconomic status. Therefore, these data may inaccurately attribute differences in obesity to race rather than differing social context. The goal of this study was to investigate whether race disparities in obesity among women persist in a community of black people and white people living in the same social context with similar income.
Race disparities in obesity were examined among black women and white women living in the same social context with similar income, using the data from the Exploring Health Disparities in Integrated Communities-SWB (EHDIC-SWB) study, and these estimates were compared to national data (National Health Interview Survey) to determine if race disparities in obesity were attenuated among women in EHDIC-SWB. Obesity was based on participants’ self-reported height and weight. Logistic regression was used to examine the association between race and obesity.
In the national sample, black women exhibited greater odds of being obese (OR 1.99, 95% CI 1.71 to 2.32) than white women after controlling for covariates. In the EHDIC-SWB sample, black women had similar odds of being obese (OR 1.25, 95% CI 0.90 to 1.75) as compared to white women, after adjusting for covariates.
There are no race disparities in obesity among poor, urban women sharing the same social context. Developing policies that focus on modifying social aspects of the environment may reduce disparities in obesity among low-income women living in urban communities.
Epidemiologic studies of obesity have not examined the prevalence and relationship of mental-health conditions with obesity for diverse ethnic and racial populations in the United States.
(1) To assess whether obesity was associated with diverse psychiatric diagnoses across a representative sample of non-Latino whites, Latinos, Asians, African-Americans, and Afro-Caribbeans; and (2) to test whether physical health status, smoking, sociodemographic characteristics, and psychiatric comorbidities mediate any of the observed associations.
Our analyses used pooled data from the NIMH Collaborative Psychiatric Epidemiology Surveys (CPES). Analyses tested the association between obesity and psychiatric disorders in a diverse sample of Americans (N=13,837), while adjusting for factors such as other disorders, age, gender, socioeconomic status, smoking and physical health status (as measured by chronic conditions and WHO-DAS scores) in different models.
The relationship between obesity and last-year psychiatric disorders varied by ethnicity/race. The likelihood of having mood or anxiety disorder was positively associated with obesity for certain racial/ethnic groups, but was moderated by differences in physical health status. Substance-use disorders were associated with decreased odds for obesity in African-Americans.
The role of physical health status (as measured by chronic conditions and WHO-DAS scores) dramatically changes the pattern of associations between obesity and psychiatric disorders, suggesting the important role it plays in explaining differential patterns of association across racial and ethnic groups.
obesity; depression; anxiety; ethnic/racial minority groups
Research suggests that, among Latinos, there are health benefits associated with living in a neighborhood populated with coethnics. While social networks and social cohesion are the proposed explanation for the salubrious effect and are assumed to be characteristics of Latino immigrant enclaves, evidence for this is limited. We used multilevel regression to test the relative contribution of individual race/ethnicity and neighborhood concentration of Mexican Americans as predictors of social networks and social cohesion. After accounting for personal characteristics, we found a negative association between neighborhood concentration of Mexican Americans and social cohesion. Among Latinos, living in a neighborhood with increased coethnics was associated with increased social ties. Compared to non-Latino whites, Mexican Americans reported more social ties but lower social cohesion. Contrary to the assumption that Mexican immigrant enclaves beget social cohesion, we did not find this to be true in Chicago neighborhoods.
Ethnic enclaves; Social ties; Social cohesion; Latino immigrants; Neighborhoods
Longitudinal data from the Panel Study of Income Dynamics are used to examine patterns and determinants of migration into neighborhoods of varying racial and ethnic composition. Consistent with spatial assimilation theory, higher income and education facilitate moving into neighborhoods containing proportionally more non-Hispanic whites and, among Latinos, the native-born move to “more Anglo” neighborhoods than immigrants. Consistent with place stratification theory, blacks move to neighborhoods with significantly fewer Anglos than do comparable Latinos, and the effect of income on migration into more Anglo neighborhoods is stronger for most minority groups than for Anglos. Latinos differ only slightly from Anglos in their migration into neighborhoods with large black populations, and blacks do not differ from Anglos in the migration into neighborhoods with large Latino populations.
Few studies have examined geographic variation in hypertension disparities, but studies of other health outcomes indicate that racial residential segregation may help to explain these variations. The authors used data from 8,071 black and white participants in the National Health and Nutrition Examination Survey (1999–2006) who were aged 25 years or older to investigate whether black-white hypertension disparities varied by level of metropolitan-level racial residential segregation and whether this was explained by race differences in neighborhood poverty. Racial segregation was measured by using the black isolation index. After adjustment for demographics and individual-level socioeconomic position, blacks had 2.74 times higher odds of hypertension than whites (95% confidence interval (CI): 2.32, 3.25). However, race differences were significantly smaller in low- than in high-segregation areas (Pinteraction = 0.006). Race differences in neighborhood poverty did not explain this heterogeneity, but poverty further modified race disparities: Race differences were largest in segregated, low-poverty areas (odds ratio = 4.14, 95% CI: 3.18, 5.38) and smallest in nonsegregated, high-poverty areas (odds ratio = 1.24, 95% CI: 0.77, 2.01). These findings suggest that racial disparities in hypertension are not invariant and are modified by contextual levels of racial segregation and neighborhood poverty, highlighting the role of environmental factors in the genesis of disparities.
health status disparities; hypertension; prejudice; social environment
Studies that examine the relationship between neighborhood characteristics and weight are limited because residents are not randomly distributed into neighborhoods. If associations are found between neighborhood characteristics and weight in observational studies, one cannot confidently draw conclusions about causality. We use data from the Utah Population Database (UPDB) that contain body mass index (BMI) information from all drivers holding a Utah driver license to undertake a cross-sectional analysis that compares the neighborhood determinants of BMI for youth and young adults. This analysis assumes that youth have little choice in their residential location while young adults have more choice. Our analysis makes use of data on 53,476 males and 47,069 females living in Salt Lake County in 2000. We find evidence of residential selection among both males and females when BMI is the outcome. The evidence is weaker when the outcomes are overweight or obesity. We conclude that studies that ignore the role of residential selection may be overstating the causal influence of neighborhood features in altering residents’ BMI.
Although widely reported among Latinos, contradictory evidence exists regarding the generalizability of the immigrant paradox; that foreign nativity is protective against psychiatric disorders. We examine whether this paradox applies to all Latino groups by contrasting estimates of lifetime psychiatric disorders among Latino immigrants, Latino U.S-born, and non-Latino whites.
Data from the National Latino and Asian American Study and the National Comorbidity Survey Replication represent some of the largest nationally-representative samples with psychiatric information.
In aggregate, Latinos are at lower risk of most psychiatric disorders compared to non-Latinos whites and, consistent with the immigrant paradox, U.S.-born Latinos report higher rates for most psychiatric disorders than Latino immigrants. However, rates vary when data are stratified by nativity and disorder and adjusted by demographic and socioeconomic differences across groups. Among Mexicans, the immigrant paradox consistently holds across mood, anxiety and substance disorders while it is only evident among Cubans and Other Latinos for substance disorders. No differences were found in lifetime prevalence rates between migrant and U.S.-born Puerto Ricans.
Caution should be exercised in generalizing the immigrant paradox to all Latinos and for all psychiatric disorders. Aggregating Latinos into a single group masks great variability in lifetime risk for psychiatric disorders, with some subgroups, like Puerto Ricans, suffering from psychiatric disorders at rates comparable to non-Latino whites. Our findings thus suggest that the protective context in which immigrants lived in their country of origin possibly inoculated them against risk for substance disorders, particularly if they immigrated as adults.
To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non-Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables.
We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I.
The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non-Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking.
Social status differences between Latinos and non-Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.
Latinos; Hispanics; Limitations; Work disability; Housework disability
As the body of evidence linking disparities in the health of urban residents to disparate social, economic and environmental contexts grows, efforts to delineate the pathways through which broader social and economic inequalities influence health have burgeoned. One hypothesized pathway connects economic and racial and ethnic inequalities to differentials in stress associated with social and physical environments, with subsequent implications for health. Drawing on data from Detroit, Michigan, we examined contributions of neighborhood-level characteristics (e.g., poverty rate, racial and ethnic composition, residential stability) and individual-level characteristics (e.g., age, gender) to perceived social and physical environmental stress. We found that neighborhood percent African American was positively associated with perceptions of both social and physical environmental stress; neighborhood percent poverty and percent Latino were positively associated with perceived physical environmental stress; and neighborhood residential stability was negatively associated with perceived social environmental stress. At the individual level, whites perceived higher levels of both social and physical environmental stress compared to African American residents of the same block groups, after accounting for other variables included in the models. Our findings suggest the importance of understanding and addressing contributions of neighborhood structural characteristics to perceptions of neighborhood stress. The consistency of the finding that neighborhood racial composition and individual-level race influence perceptions of both social and physical environments suggests the continuing importance of understanding the role played by structural conditions and by personal and collective histories that vary systematically by race and ethnicity within the United States.
Perceived social environmental stress; Perceived physical environmental stress; Residential stability; Urban health
The race and ethnicity of neighbours are thought to be critical in shaping household mobility underlying residential segregation. However, studies on this topic have used data at the census-tract level of analysis rather than at the proximate-neighbour level. Using a non-publicly available version of the neighbour-cluster sample within the American Housing Survey, this study incorporates data on the race, ethnicity and socioeconomic characteristics of the proximate neighbours of White, Black and Latino households and examines their impact on household residential satisfaction, out- and in-mobility. Results indicate that proximate-neighbour race and ethnicity matter in influencing endpoints of the mobility process and do not necessarily parallel those at the census-tract level. Implications of these findings are discussed as they relate to the study of residential segregation.
This study investigated the association between San Francisco neighborhoods’ racial/ethnic residential composition and the rate of mental-health-related 911 calls.
Calls to the San Francisco 911 system from January 2001 through June 2003 (n=1,341,608) were divided into mental-health-related and other calls. Police sector data in the call records were overlaid onto U.S. Census tracts to estimate sector demographic and socioeconomic characteristics. Negative binomial regression was used to estimate the association between black, Asian, Latino and white resident percentage and rates of mental-health-related calls.
Percent of black residents was associated with a lower rate of mental-health-related calls (IRR=.99, 95% CI .98–1.00). Percent of Asian and Latino residents had no significant effect.
The observed relationship between black residents and mental-health-related calls is not consistent with known emergency mental health service utilization patterns. The paradox between underutilization of the 911 system and overutilization of psychiatric emergency services deserves further investigation.
Research on neighborhoods and health has been growing. However, studies have not investigated the association of specific neighborhood measures, including socioeconomic and built environments, with cancer incidence or outcomes. We developed the California Neighborhoods Data System (CNDS), an integrated system of small area-level measures of socioeconomic and built environments for California, which can be readily linked to individual-level geocoded records. The CNDS includes measures such as socioeconomic status, population density, racial residential segregation, ethnic enclaves, distance to hospitals, walkable destinations, and street connectivity. Linking the CNDS to geocoded cancer patient information from the California Cancer Registry, we demonstrate the variability of CNDS measures by neighborhood socioeconomic status and predominant race/ethnicity for the 7,049 California census tracts, as well as by patient race/ethnicity. The CNDS represents an efficient and cost-effective resource for cancer epidemiology and control. It expands our ability to understand the role of neighborhoods with regard to cancer incidence and outcomes. Used in conjunction with cancer registry data, these additional contextual measures enable the type of transdisciplinary, “cells-to-society” research that is now being recognized as necessary for addressing population disparities in cancer incidence and outcomes.
Neighborhood; Socioeconomic environment; Built environment; Immigration; Contextual factors; GIS
We examined the impact of metropolitan racial residential segregation on stage at diagnosis and all-cause and breast cancer-specific survival between and within black and white women diagnosed with breast cancer in California between 1996 and 2004.
We merged data from the California Cancer Registry with Census indices of five dimensions of racial residential segregation, quantifying segregation among Blacks relative to Whites; block group (“neighborhood”) measures of the percentage of Blacks and a composite measure of socioeconomic status. We also examined simultaneous segregation on at least two measures (“hypersegregation”). Using logistic regression we examined effects of these measures on stage at diagnosis and Cox proportional hazards regression for survival.
For all-cause and breast-cancer specific mortality, living in neighborhoods with more Blacks was associated with lower mortality among black women, but higher mortality among Whites. However, neighborhood racial composition and metropolitan segregation did not explain differences in stage or survival between Black and White women.
Future research should identify mechanisms by which these measures impact breast cancer diagnosis and outcomes among Black women.
Breast cancer; Survival; Stage at diagnosis; Residential segregation; Race
In 1 previous study, it was shown that neighborhood socioeconomic disadvantage is associated with cognitive decline among Latinos. No studies have explored whether and to what extent individual-level socioeconomic factors account for the relation between neighborhood disadvantage and cognitive decline. The purpose of the present study was to assess the influence of neighborhood socioeconomic position (SEP) on cognitive decline and examine how individual-level SEP factors (educational level, annual income, and occupation) influenced neighborhood associations over the course of 10 years. Participants (n = 1,789) were community-dwelling older Mexican Americans from the Sacramento Area Latino Study on Aging. Neighborhood SEP was derived by linking the participant's individual data to the 2000 decennial census. The authors assessed cognitive function with the Modified Mini-Mental State Examination. Analyses used 3-level hierarchical linear mixed models of time within individuals within neighborhoods. After adjustment for individual-level sociodemographic characteristics, higher neighborhood SEP was significantly associated with cognitive function (β = −0.033; P < 0.05) and rates of decline (β = −0.0009; P < 0.10). After adjustment for individual educational level, neighborhood SEP remained associated with baseline cognition but not with rates of decline. Differences in individual educational levels explained most of the intra- and interneighborhood variance. These results suggest that the effect of neighborhood SEP on cognitive decline among Latinos is primarily accounted for by education.
aging; cognition; education; Mexican Americans; residence characteristics
African American and Latino teenagers and communities are frequently assumed to have weaker norms against teenage pregnancy than whites. Despite their importance, adolescents’ norms about teenage pregnancy have not been measured or their correlates and consequences documented. This study examines individual-level and contextual variation in adolescents’ embarrassment at the prospect of a teenage pregnancy and its relationship with subsequent teenage pregnancy. Descriptive analyses find that norms vary by gender and individual- and neighborhood-level race, ethnicity, and socioeconomic status (SES). In multivariate analyses, neighborhood-level racial/ethnic associations with embarrassment are explained by neighborhood-level SES. Embarrassment is associated with a lower likelihood of subsequent teenage pregnancy but does not mediate racial, ethnic, or socioeconomic influences, underscoring the importance of both norms and structural factors for understanding teenage fertility.
The spatial segregation of the U.S. population by socioeconomic position and especially race-ethnicity suggests that the social contexts or “neighborhoods” in which people live may substantially contribute to social disparities in hypertension. The Chicago Community Adult Health Study did face-to-face interviews, including direct measurement of blood pressure, with a representative probability sample of adults in Chicago. These data were used to estimate socioeconomic and racial-ethnic disparities in the prevalence, awareness, treatment, and control of hypertension, and to analyze how these disparities are related to the areas in which people live. Hypertension was significantly negatively associated with neighborhood affluence/gentrification, and adjustments for context eliminated the highly significant disparity between blacks/African-Americans and whites, and reduced the significant educational disparity by 10–15% to borderline statistical significance. Awareness of hypertension was significantly higher in more disadvantaged neighborhoods and in places with higher concentrations of blacks (and lower concentrations of Hispanics and immigrants). Adjustment for context completely eliminated blacks’ greater awareness, but slightly accentuated the lesser awareness of Hispanics and the greater levels of awareness among the less educated. There was no consistent evidence of either social disparities in or contextual associations with treatment of hypertension, given awareness. Among those on medication, blacks were only 40–50% as likely as whites to have their hypertension controlled, but context played little or no role in either the level of or disparities in control of hypertension. In sum, residential contexts potentially play a large role in accounting for racial-ethnic, and to a lesser degree, socioeconomic disparities in hypertension prevalence and, in a different way, awareness, but not in treatment or control of diagnosed hypertension.
Neighborhoods; social disparities; multi-level modeling; health inequalities; hypertension; blood pressure