Are immigrant enclaves healthy places to live? The Multi-ethnic Study of Atherosclerosis

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Abstract

The growing size and changing composition of the foreign-born population in the USA highlights the importance of examining the health consequences of living in neighborhoods with higher proportions of immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in four US cities, we examined whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) among Hispanic and Chinese Americans (n = 1902). Secondarily we tested whether neighborhoods with high proportions of immigrants exhibited better or worse neighborhood quality, and whether these dimensions of neighborhood quality were associated with healthy behaviors. Neighborhood immigrant composition was defined based on the Census 2000 tract percent of foreign-born from Latin-America, and separately, percent foreign-born from China. After adjustment for age, gender, income, education, neighborhood poverty, and acculturation, living in a tract with a higher proportion of immigrants was associated with lower consumption of high-fat foods among Hispanics and Chinese, but with being less physically active among Hispanics. Residents in neighborhoods with higher proportions of immigrants reported better healthy food availability, but also worse walkability, fewer recreational exercise resources, worse safety, lower social cohesion, and lower neighborhood-based civic engagement. Associations of neighborhood immigrant composition with diet persisted after adjustment for reported neighborhood characteristics, and associations with physical activity were attenuated. Respondent-reported neighborhood healthy food availability, walkability, availability of exercise facilities and civic participation remained associated with behaviors after adjusting for immigrant composition and other covariates. Results show that living in an immigrant enclave is not monolithically beneficial and may have different associations with different health behaviors.

Introduction

Immigrants are a large and increasingly important segment of the US population, and today's immigrants are more ethnically diverse than ever (Grieco, 2003, Zhou, 2001). Immigrants and ethnic minorities are highly likely to live in neighborhoods with high proportions of other immigrants and/or with other residents from the same ethnic group (Logan et al., 2002, Suro and Tafoya, 2004). Immigrant enclaves (neighborhoods with high proportions of immigrants) are one feature of the American receiving context that may facilitate successful immigrant adaptation (Logan and Lewis Mumford Center, 2003, Portes and Stepick, 1993, Wilson and Portes, 1980), by offering cultural goods, social networks, and lower communication costs for non-English language speakers (Fernandez Kelly & Schauffler, 1996). Through these pathways and others, immigrant enclaves may affect health.

Neighborhoods with high proportions of immigrants may be associated with health behaviors simply due to the individual-level characteristics of residents. For example, immigrants in immigrant enclaves may be less acculturated than those in neighborhoods with fewer immigrants, and acculturation has been linked to health behaviors (Abraido-Lanza et al., 2005, Gordon, 1964, Kandula et al., 2004, Lara et al., 2005, Salant and Lauderdale, 2003, Singh and Siahpush, 2002). However, there are a number of mechanisms through which neighborhood immigrant composition may affect health independently of individual-level characteristics such as level of acculturation or socioeconomic position.

A variety of health-relevant social features of neighborhoods may be associated with neighborhood immigrant composition. For example, neighborhood-linked social networks and social control may reinforce norms regarding healthy behaviors or sanction unhealthy ones (Zhou & Bankston, 1996). The resources flowing through social capital and social networks (Fernandez Kelly and Schauffler, 1996, Portes, 1998, Portes and Rumbaut, 2006, Zhou and Bankston, 1996) may support healthy behavior. In addition, immigrant enclaves may insulate individuals from potentially stressful discriminatory exposures (Fernandez Kelly and Schauffler, 1996, Portes and Rumbaut, 2006), which may result in the adoption of unhealthy behaviors as coping mechanisms.

Neighborhood structural context may also play a role. Certain migrant-related resources such as the presence of ethnic food stores relevant for diet, or services like gyms accessible in other languages (Portes et al., 1992, Zhou and Bankston, 1996) may be more common in immigrant enclave neighborhoods. Other structural features such as high poverty or lack of safe walking environments, or advertising of harmful products like tobacco may also be associated with neighborhood immigrant composition (Hackbarth et al., 1995, Pucci et al., 1998). Immigrants, including immigrants from racial minority groups, are likely to live in very poor neighborhoods (Logan et al., 2002, Logan and Lewis Mumford Center, 2003, Menjivar, 2000, Osypuk et al., in press), and neighborhood poverty may have detrimental effects on health behaviors. On the other hand, neighborhoods characterized by high immigrant concentration may buffer co-ethnic immigrants from the deleterious effects of poverty (Patel et al., 2003, Zhou and Bankston, 1996).

Using data from a large, multi-ethnic population-based study, we investigated whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) after adjustment for individual-level characteristics (including individual-level measures of acculturation) in a multi-ethnic study of middle-aged and older adults, in four major US cities. We also investigated the specific social and structural features of neighborhoods that may explain the links between immigrant enclaves and health. We exploit data that are rich in measures of health behaviors and of multiple dimensions of neighborhood context, to investigate whether immigrant neighborhoods may matter for diet and physical activity, and if so, why, and whether the associations are the same across different ethnic groups and different health behaviors. Lastly, we test whether certain neighborhood quality factors, articulated in our theoretical framework, may mediate enclave–health behavior associations including: individual-level SES, neighborhood poverty, neighborhood-based physical resources (availability of healthy foods, presence of physical activity facilities, walking environment), or neighborhood social context (social cohesion, civic participation, safety).

Section snippets

Methods

We used individual-level data from the Multi-ethnic Study of Atherosclerosis (MESA), a 10-year longitudinal study of risk factors for atherosclerosis (Bild et al., 2002). The MESA cohort includes 6814 men and women aged 45–84 years and free of clinical cardiovascular disease at baseline, recruited from six field centers: Baltimore, MD; Chicago, IL; Forsyth County, NC; Los Angeles, CA; New York, NY; and St Paul, MN. At each site, a probability sample of more than 1000 participants was selected

Results

Selected characteristics of the sample are shown in Table 2. The mean age was 61.7 years and 51% of the sample was female. The Hispanic sample was heterogeneous by country of birth: 33% were born in the US, 24% in Mexico, 24% in Central America or the Caribbean (primarily Dominican Republic and Cuba), 10% in Puerto Rico, and 8% in South America. The majority of the Chinese sample was born in Mainland China (61%), 18% was born in Taiwan, 5% in Hong Kong, and 4% in the US. Hispanics were of lower

Discussion

This study has four principal findings. First, Chinese and Hispanic adults living in neighborhoods with higher immigrant composition tended to have diets lower in fat or processed foods than their counterparts who lived in neighborhoods with lower proportions of immigrants. Second, among Hispanic individuals, living in a neighborhood with higher proportions of Latin-American immigrants was associated with lower levels of physical activity. Third, consistent with our results for diet and

Acknowledgements

The Multi-ethnic Study of Atherosclerosis (MESA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with MESA investigators. MESA is supported by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute. This work was supported in part by R01 HL071759 and P60 MD002249 (Dr Diez Roux). Funding for this analysis for Drs. Osypuk and Hadley was provided by the Robert Wood Johnson Foundation

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