Residential segregation and mental health among Latinos in a nationally representative survey

Residential segregation and Black-White differences in physical and mental health: Evidence of a health paradox?

Ample research finds that residential segregation is detrimental to Black Americans' physical health and exacerbates Black-White physical health disparities. However, less is known about how residential segregation may influence Black Americans' mental health and Black-White differences in mental health. Drawing on U.S. census data and a state representative study of Indiana residents (N = 2,685), I examine associations between residential segregation and multiple dimensions of physical and mental health. Consistent with past research, I find that residential segregation has an adverse association with physical health among Black respondents. In contrast, I find residential segregation to have a salubrious association with Black respondents' mental health, producing a Black mental health advantage at higher levels of segregation. I conclude by discussing the implications of these findings for research on residential segregation and health and the Black-White mental health paradox.

Empirical evidence supporting the inclusion of multi-axes segregation in assessing US county health

To facilitate community action toward health equity, the County Health Rankings & Roadmaps program (CHR&R) assigns health rankings to US counties. The CHR&R conceptual model considers White-Black and White-non-White dissimilarity values to represent residential segregation as part of the family and social support subcomponent. As the US is greying and becoming more multi-racial-ethnic, the two-group White-centered segregation measures are inadequate to capture segregation among population subgroups in the US. Thus, we evaluate the relevancy of segregation measures that consider multiple racial, ethnic, and age groups in assessing US county health. Besides using the two-group dissimilarity index to measure White-centered racial segregation as conceptualized by CHR&R, the study also uses the multi-group generalized dissimilarity index to measure racial-ethnic-age segregation by counties, employing both aspatial and spatial versions of these measures. These indices are computed for counties using the 2015-2019 American Community Survey data at the census tract level. Descriptive statistics and regressions controlling for sociodemographic factors and healthcare access are used to assess the contributions of individual segregation measures to mortality (life expectancy, years of potential life lost and premature mortality) and morbidity (frequent mental distress, frequent physical distress, and low birth weight) indicators representing county health. Overall, correlations between these indicators and most segregation measures are significant but weak. Regression results show that many segregation measures are not significantly related to mortality indicators, but most are significantly associated with morbidity indicators, with the magnitudes of these associations higher for the multi-group racial-ethnic-age segregation index and its spatial version. Results provide evidence that racial-ethnic-age segregation is associated with county-level morbidity and that spatial measures capturing segregation of multiple population axes should be considered for ranking county health.

Identifying the Social Determinants of Treated Hypertension in New and Established Latino Destination States

Little is known about the influence of social and environmental contexts on Latino hypertension-related disparities. This study examined the influence of social determinants of cardiovascular health on medically treated hypertension, contrasting established vs. new Latino destination states. Logistic regression models were fitted to analyze 2017 Behavioral Risk Factors Surveillance Survey data from 8,999 Latinos. Overall, 70.4% indicated having treated hypertension. History of diabetes (OR = 2.60) and access to healthcare (OR = 2.38) were associated with treated hypertension, regardless of destination state. In established destinations, Latinos who graduated high school (OR = 1.19) or attended college (OR = 1.32) had higher odds of treated hypertension; whereas those who completed college were less likely to have treated hypertension (OR = 0.80). In contrast, in both new and non-destination states, the odds of treated hypertension were consistently lower across levels of educational attainment. Results highlight the need for cardiovascular-risk reduction interventions to incorporate the social and environmental context in the development process.

Inequitable Housing Practices and Youth Internalizing Symptoms: Mediation Via Perceptions of Neighborhood Cohesion

Disordered urban environments negatively impact mental health symptoms and disorders. While many aspects of the built environment have been studied, one influence may come from inequitable, discriminatory housing practices such as redlining, blockbusting, and gentrification. The patterns of disinvestment and reinvestment that follow may be an underlying mechanism predicting poor mental health. In this study, we examine pathways between such practices and internalizing symptoms (i.e., anxiety and depression) among a sample of African American youth in Baltimore, Maryland, considering moderation and mediation pathways including neighborhood social cohesion and sex. In our direct models, the inequitable housing practices were not significant predictors of social cohesion. In our sex moderation model, however, we find negative influences on social cohesion: for girls from gentrification, and for boys from blockbusting. Our moderated mediation model shows that girls in gentrifying neighborhoods who experience lower social cohesion have higher levels of internalizing symptoms. Likewise for boys, living in a formerly blockbusted neighborhood generates poorer social cohesion, which in turn drives higher rates of internalizing symptoms. A key implication of this work is that, in addition to standard measures of the contemporary built environment, considering other invisible patterns related to discriminatory and inequitable housing practices is important in understanding the types of neighborhoods where anxiety and depression are more prevalent. And while some recent work has discussed the importance of considering phenomena like redlining in considering long-term trajectories of neighborhoods, other patterns such as blockbusting and gentrification may be equally important.

Ethnic enclaves, social capital, and psychological well-being of immigrants: the case of Chinese older immigrants in Chicago

Objectives: Using a large sample of Chinese older immigrants in Chicago, this study asked two questions: (1) Is living in Chinatown associated with better psychological well-being? (2) What is the role of social capital in such an association?Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (N = 3,105). Depression and quality of life (QoL) were compared between those who lived in Chinatown and those who didn't. Negative binomial regressions (for depression) and logistic regressions (for QoL) were performed to examine the associations between Chinatown residence, social capital, and the two outcomes.Results: Net of social capital and the control variables, living in Chinatown was marginally associated with fewer depressive symptoms (β= -.137, p = .057), but a significantly lower likelihood of reporting good QoL (OR = .797, CI: .661-.962). Although various forms of social capital were projective of positive psychological well-being, given the overall low social capital of the Chinatown residents, they heightened the mental health risks of this population.Conclusion: The neighborhood context may function to reproduce social disadvantage among aging immigrant populations. The findings point to the importance of intervention at the mezzo level to improve the psychological wellbeing of this population.

Spatially varying racial inequities in cardiovascular health and the contribution of individual- and neighborhood-level characteristics across the United States: The REasons for geographic and racial differences in stroke (REGARDS) study

Black-White inequities in cardiovascular health (CVH) pose a significant public health challenge, with these disparities also varying geographically across the US. There remains limited evidence of the impact of social determinants of health on these inequities. Using a national population-based cohort from the REasons for Geographic and Racial Differences in Stroke study, we assessed the spatial heterogeneity in Black-White differences in CVH and determined the extent to which individual- and neighborhood-level characteristics explain these inequities. We utilized a Bayesian hierarchical statistical framework to fit spatially varying coefficient models. Results showed overall and spatially varying inequities, where Black participants had significantly poorer CVH. The maps of the state level random effects also highlighted how inequities vary. The evidence produced in this study further highlights the importance of multilevel approaches - at the individual- and neighborhood-levels - that need to be in place to address these geographic and racial differences in CVH.

Community ethnic density, ethnic segregation, and ethnic minorities' common mental disorders in the UK

Studies in the UK demonstrate evidence that ethnic minorities living in communities with a higher proportion of co-ethnics report better mental health: co-ethnic density effects. This paper aims to address three gaps in this literature. Firstly, most UK research has focused on acute mental disorders (e.g., psychosis), with little work examining co-ethnic density effects for more common mental disorders. Secondly, there is a paucity of research exploring the role that residential segregation may play alongside co-ethnic density in minority mental health. Thirdly, little systematic testing has examined at what geographic-scale co-ethnic density effects are most salient for minority-group mental health. To address these potential gaps, we apply multi-level linear regression modelling to a large-scale, nationally-representative UK panel dataset, containing an ethnic minority booster-sample, to study the community-level drivers of mental health-related quality-of-life (SF-12 Mental Component Summary Score). The results demonstrate mixed support for the protective-effects of co-ethnic density on mental well-being. However, they demonstrate broadly consistent support for the impact of residential segregation on mental well-being. In particular, that segregation exerts a non-linear effect: mental well-being is at its most positive at medium-levels of segregation, somewhat more negative at low-levels of segregation, and much more negative at higher-levels of segregation. These patterns are present for the 'all ethnic minority' sample, and stronger for Black sub-groups compared to Asian sub-groups. These relationships appear most consistent at meso-local geographic scales (Middle Super Output Areas). These findings have important implications for theorising our understanding of the nexus between the community and mental health among minority-groups.

Racial/ethnic segregation and health disparities: Future directions and opportunities

Health researchers have investigated the association between racial segregation and racial health disparities with multilevel approaches. This study systematically reviews these multilevel studies and identifies broad trends and potential directions for future research on racial segregation and health disparities in the US. After searching databases including CINAHL and MEDLINE, we identified and systematically reviewed 66 articles published between 2003 and 2019 and found four major gaps in racial/ethnic segregation and health disparities: (a) the concept of segregation was rarely operationalized at the neighborhood level, (b) except for the evenness and exposure dimension, other dimensions of segregation are overlooked, (c) little attention was paid to the segregation between whites and non-black minorities, particularly Hispanics and Asians, and (d) mental health outcomes were largely absent. Future directions and opportunities include: First, other segregation dimensions should be explored. Second, the spatial scales for segregation measures should be clarified. Third, the theoretical frameworks for black and non-black minorities should be tested. Fourth, mental health, substance use, and the use of mental health care should be examined. Fifth, the long-term health effect of segregation has to be investigated, and finally, other competing explanations for why segregation matters at the neighborhood level should be answered.

SALaMA study protocol: a mixed methods study to explore mental health and psychosocial support for conflict-affected youth in Detroit, Michigan

BACKGROUND

Families resettling to the U.S. from conflict-affected countries in the Middle East and North Africa (MENA) face countless challenges. These families must cope with experiences of armed conflict and forced migration while also assimilating to a new society. According to the 'immigrant paradox,' time spent in a new country can compound the effects of migration and assimilation challenges and lead to deteriorated mental health. This study aims to assess the psychosocial wellbeing of MENA-born or first-generation adolescents attending school in the Detroit metropolitan area (DMA) to understand how schools, families, and communities play a role in supporting these adolescents' wellbeing.

METHODS

The quantitative component of this mixed methods study will involve a self-administered survey with a sample of students whose responses will be linked to academic records and behavioral assessments. The survey will utilize validated instruments to measure depressive and anxiety symptoms (Hopkins Symptom Checklist-37A), hope (Children's Hope Scale), resilience (Child and Youth Resilience Measure-12), externalizing and prosocial behavior (Hopkins Symptom Checklist-37A, Strengths and Difficulties Questionnaire), school belonging (Psychological Sense of School Membership), and peer relationships (Multidimensional Scale of Perceived Social Support). Differences in outcomes will be analyzed across two strata: students born in the MENA region and first-generation students whose parents immigrated to the US from the MENA region. The qualitative component will involve semi-structured key informant interviews with parents, school administrators, educators, and mental health providers, and focus group discussions (FGDs) with a purposive sample of adolescents born - or whose parents were born - in the MENA region. The FGDs will include a participatory ranking activity where participants will be asked to free-list and rank ideas about how schools can better support students like them. Thematic content analysis will be conducted to identify common themes.

DISCUSSION

This study will contribute evidence about the wellbeing of adolescents who come from - or whose parents come from - conflict-affected countries currently living in the U.S. Findings can be used to inform program and policy development to enable schools and their community partners to serve this population more effectively.

Ethnic density, immigrant enclaves, and Latino health risks: A propensity score matching approach

Whether minority concentration in a neighborhood exposes residents to, or protects them from, health risks has generated burgeoning scholarly interests; yet endogeneity as a result of neighborhood selection largely remains unclear in the literature. This study addresses such endogeneity and simultaneously investigates the roles of co-ethnic density and immigrant enclaves in influencing high blood pressure and high cholesterol level among Latinos, the largest minority group in the United States. Pooled cross-sectional data that included both native and foreign-born Latinos of Puerto Rican, Mexican, and other origins (N = 1563) from the 2006 and 2008 Southeastern Pennsylvania Household Health Survey were linked to census-tract profiles from the 2005-2009 American Community Survey. Results from both multilevel regression and propensity score matching analysis confirmed the deleterious effect of residential co-ethnic density on Latino adults' health risks over and above individual risk factors. We also found selection bias associated with the observed protective effect of immigrant concentration, which is likely a result of residential preference.