Future Directions in Residential Segregation and Health Research: A Multilevel Approach

Acevedo‐García, Dolores; Lochner, Kimberly A.; Osypuk, Theresa L.; Subramanian, S. V.

doi:10.2105/ajph.93.2.215

Cited by 428 publications

(352 citation statements)

References 59 publications

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“…Dissimilarity (i.e., the unevenness of the minority group distribution over the MSA) was excluded because researchers have argued persuasively that this dimension does not have clear conceptual foundations for associations with health. 27,31 Centralization (i.e., the extent to which minority group members reside in the Central Business District) was excluded because recent work has shown that the central city-suburb distinction has become less relevant to racial/ethnic residential patterns. 46 Finally, concentration (i.e., the amount of physical space occupied by minority group members) was excluded because this segregation measure appears to be more relevant to understanding the spread of infectious disease 47,48 than the diffusion of health behaviors such as smoking.…”

Section: Independent Variablesmentioning

confidence: 99%

“…Segregation-defined as the spatial separation of one group from another on the basis of race/ethnicity 26,27 -is considered a fundamental cause of the concentrated poverty and health inequalities experienced by African Americans in the US. [28][29][30] While segregation has declined over the last few decades, African Americans remain the most segregated racial/ ethnic minority in the US, and most live in urban areas with high segregation.…”

Section: Introductionmentioning

confidence: 99%

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Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

et al. 2007

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Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born AfricanAmerican women (n=403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important sociodemographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

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Section: Independent Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

et al. 2007

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“…[13][14][15][16] These dimensions of the social environment have well-established relationships to a range of health outcomes, [17][18][19] including cancer-related outcomes. 20 Recent evidence suggests that segregation and local racial composition may also affect disparities in breast cancer outcomes.…”

Section: Introductionmentioning

confidence: 99%

Residential Racial Composition, Spatial Access to Care, and Breast Cancer Mortality among Women in Georgia

et al. 2011

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We explored the association between neighborhood residential racial composition and breast cancer mortality among Black and White breast cancer patients in Georgia and whether spatial access to cancer care mediates this association. Participants included 15,256 women living in 15 metropolitan statistical areas in Georgia who were diagnosed with breast cancer between 1999 and 2003. Residential racial composition was operationalized as the percent of Black residents in the census tract. We used gravity-based modeling methods to ascertain spatial access to oncology care. Multilevel Cox proportional hazards models and mediation analyses were used to test associations. Black women were 1.5 times more likely to die from breast cancer than White women. Residential racial composition had a small but significant association with breast cancer mortality (hazard ratios [HRs]=1.04-1.08 per 10% increase in the percent of Black tract residents). Individual race did not moderate this relationship, and spatial access to care did not mediate it. Residential racial composition may be part of the socioenvironmental milieu that produces increased breast cancer mortality among Black women. However, there is a lack of evidence that spatial access to oncology care mediates these processes.

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“…Few studies have tested these pathways to see whether monitoring the quality of a neighborhood can explain the effects of segregation or not. 8 Further studies on the effect of segregation with controlling the concentration of the addressed contextual factors are recommended to test whether segregation of a contextual factor acts through the concentration of that factor or other contextual factors at a provincial level.…”

Section: Resultsmentioning

confidence: 99%

“…It also affects intergroup connections in society. 4 Many papers have explored the effects of living in more segregated communities on health disparities and the links between residential segregation and health outcomes, including the relation between racial residential segregation and overall death, 5,6 tuberculosis, 7 cardiovascular diseases, 8 high body mass index, 9 pre-term birth in black populations, 10 and also social outcomes such as early adolescent sexual activity, 11,12 black homicide rates, 13,14 poor self-rated health, 9,15 access to employment, educational inequalities, crime, and other aspects of social and economical well-being. 16 So far, our literature review has shown that the relation between segregation and disability has not yet been investigated.…”

Section: Introductionmentioning

confidence: 99%

Association of Residential Segregation and Disability: A Multilevel Study Using Iranian Census Data

et al. 2012

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The association of racial segregation and health outcomes has been reviewed recently in the literature, but the health effect of other contexts of segregation with respect to residential environment has not as yet been fully reviewed. Besides, most of the literature on segregation has been performed in Western countries. Here, we undertake a multilevel analysis of residential segregation of socioeconomic and demographic factors and disability rate in an Eastern developing country in order to elucidate the effects of this aspect of segregation on disability rate. The latest Iranian national census in 2006 was used to measure segregation indices and perform the analysis. Information theory index and its ordinal form were applied to measure evenness dimension of segregation of categorical and ordinal variables, respectively. Segregation of contextual and structural characteristics of residential environment, which are important determinants of socioeconomic status in Iran, had different relations with disability rate. Provinces which were segregated by type of occupation of residents, sex, and ownership of a motorcycle had a lower individual disability rate, while age segregation and house ownership had a positive effect on the rate of individual disability in the province. The findings also showed that almost all the aforementioned segregation indices had the same effect on the rate of family disability. The unique contribution of this study is that it considers how segregation with respect to aspects of social characteristics other than race affects health outcomes. Further studies in this regard may reveal new insights into health outcome inequalities.

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Future Directions in Residential Segregation and Health Research: A Multilevel Approach

Cited by 428 publications

References 59 publications

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Residential Racial Composition, Spatial Access to Care, and Breast Cancer Mortality among Women in Georgia

Association of Residential Segregation and Disability: A Multilevel Study Using Iranian Census Data

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