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Influence of Individual-Level Neighborhood Factors on Health Promoting and Risk Behaviors in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Authors

Asmi Panigrahi,1,2 Erik Rodriquez,1 Jennifer Bayly,1,3 Eliseo Peréz-Stable1, 1Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD , 2Rutgers New Jersey Medical School, Newark NJ , 3Rutgers Robert Wood Johnson Medical School, New Brunswick NJ

Introduction

There is a consistent body of evidence which indicates that neighborhood context influences a range of health behaviors and outcomes, yet there remains a dearth of research investigating the impact of neighborhood environment on immigrant health, particularly among Hispanic/Latino populations of diverse national backgrounds. Given that Hispanics/Latinos constitute nearly half of the US immigrant population and almost one-fifth of the US population at large, there is a crucial need to understand how neighborhood environment influences Hispanic/Latino health, especially as social position and ethnicity are often tightly linked to people's place of residence. To address this research gap, relationships between individual-level neighborhood factors and health promoting and risk behaviors were evaluated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study.

Methods

Participants included 5313 foreign-born and US-born men and women, 18-74 years old, recruited from San Diego, Chicago, Miami, and New York City, and from Mexican, Puerto Rican, Cuban, Central American, Dominican and South American background. All participants underwent a baseline clinical exam and sociocultural survey including measures of neighborhood social cohesion and neighborhood problems. Health behaviors evaluated included physical activity; colorectal, prostate, breast, and cervical cancer screening; current smoking; excessive or binge drinking; uncontrolled hypertension; and obesity.

Results

Participants had a mean age of 42.5 years (SD 0.38), 54.8% were women, and 72.8% were foreign born. Over half (55.4%) of foreign-born participants did not have health insurance, compared to only 27.8% of US-born participants. Mean perceived neighborhood problems were greater in US-born vs foreign-born participants [Mean (SE)=12.9 (0.16) vs 11.6 (0.14), p <0.001]. However there was no significant difference between mean perceived neighborhood social cohesion in US-born vs foreign-born participants (15.8 vs 15.8). Health protective behaviors were consistently less prevalent among foreign-born vs US-born participants including physical activity (62.2% vs 67.6%), colon cancer screening (50.5% vs 71.5%) pap smear (72.4% vs 80.8%), mammogram (74.4% vs 84.4%), and prostate cancer screening (51.9% vs 63.3%). At the same time, health risk behaviors including smoking (31.4% vs 15.8%), obesity (49.9% vs 36.5%), uncontrolled hypertension (60.3% vs 71.2%), and poor diet (16.8% vs 36.6%) were also consistently less prevalent among foreign-born vs US-born participants. Foreign-born participants with higher perceived neighborhood problems were less likely to meet physical activity recommendations [OR (95% CI)=0.74 (0.58, 0.95) p<0.05]. Foreign-born participants with less perceived neighborhood social cohesion were less likely to be adherent to pap smear guidelines [OR (95% CI) = 0.48 (0.23, 0.98) p<0.05].

Conclusion

These results suggest that neighborhood factors may uniquely contribute to health behaviors of Hispanic/Latino immigrants versus US-born Hispanics/Latinos, and that neighborhood environment is important for health systems and providers to consider in prevention and treatment strategies that influence Hispanic/Latino health. This research was supported by the NIH Intramural Research Program.

References

1. Abraído-Lanza AF, Echeverría SE, Flórez KR. Latino Immigrants, Acculturation, and Health: Promising New Directions in Research. Annual Review of Public Health 2016 37:1, 219-236
2. Castaneda H, Holmes SM, Madrigal DS, Young MED, Beyeler N, Quesada J. Immigration as a Social Determinant of Health. Annual Review of Public Health 2015;36:375-392.
3. Roux AVD, Mair C. Neighborhoods and health. Annals of the New York Academy of Sciences. 2010;1186(1):125-145.
https://www.migrationpolicy.org/article/frequently-requested-statistics-immigrants-and-immigration-united-states#Demographic Frequently Requested Statistics on Immigrants and Immigration in the United States
4. Zong J, Batalova J, and Hallock J. (Washington, DC: Migration Policy Institute, 2018),

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