文章基本信息

标题：The Latino Paradox in Neighborhood Context: The Case of Asthma and Other Respiratory Conditions
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作者：Kathleen A. Cagney ; Christopher R. Browning ; Danielle M. Wallace 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：5
页码：919-925
DOI：10.2105/AJPH.2005.071472
语种：English
出版社：American Public Health Association
摘要：Objectives. Evidence indicates that foreign-born Latinos have a health advantage compared with US-born persons of the same socioeconomic status. An explanation for this paradox has remained elusive. We examined the extent to which this paradox exists for the prevalence of asthma and other respiratory conditions. We then explored the role of neighborhood social context in understanding any observed advantage. We invoked theories of social organization, collective efficacy, and the urban ethnic enclave. Methods. We combined data from the Project on Human Development in Chicago Neighborhoods Community Survey with 2 other data sources and used hierarchical generalized linear modeling techniques. Results. We found a distinctly graded effect for asthma and other breathing problems among foreign-born Latinos, depending on community composition. Foreign-born Latinos embedded in a neighborhood that had a high percentage of foreign-born residents experienced a significantly lower prevalence of asthma and other breathing problems; those in communities that had a low percentage of foreign-born residents had the highest prevalence overall (even when compared with African Americans). Conclusions. Foreign-born Latinos have a respiratory health advantage only in enclave-like settings. Contexts such as these may provide the cohesiveness critical for effective prevention. Racial and ethnic disparities in health status continue to cause concern prompting numerous efforts in clinical practice and policy to enhance access to care, increase adherence to treatment regimes, and improve health habits. One anomaly in the disparities literature is the oft-documented “Latino Paradox.” Also described as the Hispanic or Epidemiological Paradox, these terms refer to the relatively good health and longer life span of foreign-born Latinos when expectations (in most analyses, primarily based on their socioeconomic status) suggest far greater morbidity and mortality than observed. The paradox has been documented for several health outcomes, including all-cause mortality, infant mortality, and functional status. 1 ^– 3 Recent work indicates that the mortality paradox may be the result of return migration effects, at least for those of Mexican origin. 4 Evidence related to morbidity, however, continues to indicate a health advantage for foreign-born Latinos when compared with their US-born counterparts. 5 In addition to migration and associated data artifact explanations, social and cultural capital (i.e., community-level social cohesiveness, norms, and practices) have been hypothesized as mechanisms responsible for the relatively beneficial health trajectories of Latino immigrants. 4 ^, 6 High levels of social capital may affect the community’s potential to encourage positive health habits or sanction negative ones. This hypothesized health behavior pathway, however, does not address larger forces that operate at the neighborhood level. Neighborhood-level influences, such as the availability of social support or the accessibility and quality of public parks, may have independent effects on health. Moreover, community characteristics may condition any Latino advantage; that is, foreign-born Latinos may benefit from being embedded in immigrant-dominated and potentially more supportive contexts. 7 By contrast, foreign-born Latinos living in communities without a strong immigrant presence may be at a disadvantage. Knowledge of the comparative morbidity experience of US-born and foreign-born Latinos is limited, 7 as is understanding of the role of community context in shaping their health. Asthma, in particular, remains relatively understudied in the Latino population. 8 ^– 12 The prevalence of asthma appears to vary across small areas and to be affected by neighborhood characteristics 13 ; attention to social context is important to understanding the prevalence of asthma in population subgroups. 14 The urban ethnic enclave provides a rich example of the form of community social context where networks are dense and the transmission of health-enhancing information is likely great. We examine the extent to which the Latino Paradox exists for asthma and other respiratory conditions. We then extend previous research by moving beyond individual-level predictors to examine the social context in which these conditions take root. We employed theories of social organization, collective efficacy, 15 ^, 16 immigrant adaptation, and the urban ethnic enclave 17 ^– 19 to understand how neighborhood social context contributes to asthma and other respiratory conditions, by Latino foreign-born status. Social organization and collective efficacy theories enabled us to draw out components of community life that could be important both to the prevalence of respiratory conditions and to the social organizational features of the ethnic enclave. Structural features of the neighborhood (e.g., residential stability, ethnic heterogeneity, and economic status) set the stage for neighborhood social processes to emerge. These social processes—collective efficacy and social network interaction and social exchange—may have independent effects on health. 20 Collective efficacy captures the level of trust and attachment in the neighborhood that can be drawn on for mutually beneficial action (i.e., the ability of the community to come together for the common good). For example, neighbors may take responsibility for maintaining safe streets and parks; residents are then drawn outdoors where they get exercise and fresh air. Neighbors do so because “it’s what we do in our community,” rather than because it directly benefits someone they know. Social interaction and social exchange, by contrast, capture the breadth of potentially health-protective social support within a community, and these measures speak to direct social interaction. For example, sharing health information or driving a neighbor to the doctor are the types of instrumental activities that result from dense network connections. Our aim in applying these theoretical frameworks was to introduce a conceptualization of the enclave experience that is congruent with previous work but adds an emphasis on neighborhood-level social processes. The interdependence of individual and community characteristics may largely explain the Latino paradox: the relative health advantage of foreign-born Latinos may be contingent on features of their residential context.