Heterogeneity of Hepatitis B Infection Among Pregnant Asian American and Pacific Islander Women.

INTRODUCTION: Perinatal transmission of hepatitis B virus among Asian Americans and Pacific Islanders is a key driver of racial health disparities in liver cancer and mortality in the U.S. This study documents the prevalence of hepatitis B virus infection among pregnant women across racial/ethnic groups and among Asian Americans and Pacific Islanders to assess the need for intervention, and then identifies the individual correlates of hepatitis B virus infection among Asian American and Pacific Islander pregnant women. METHODS: Using the 2014-2015U.S. birth rate population data, this study estimates a series of logistic regression models to examine the associations between individual-level correlates and hepatitis B virus infection among Asian American and Pacific Islanders pregnant women. Data were analyzed in July 2017. RESULTS: Among Asian American and Pacific Islander pregnant women, Chinese American mothers are ten times more likely to experience hepatitis B virus infection than are Asian Indian and Japanese American mothers. Foreign-born mothers are significantly more likely to experience hepatitis B virus infection during pregnancy than those of their U.S.-born counterparts. Maternal SES characteristics are important correlates of hepatitis B virus infection among pregnant women. CONCLUSIONS: Studies must disaggregate the pan-ethnic Asian American and Pacific Islander category to examine the health and health disparities of Asian Americans and Pacific Islanders. Given the heterogeneity of hepatitis B virus infection prevalence among Asian American and Pacific Islander pregnant women, the effectiveness of prevention and intervention programs depends on careful consideration of ethnicity in conjunction with group-specific factors.

Parenting Strain among Mexican-origin Mothers: Differences by Parental Legal Status and Neighborhood.

Despite increasing recognition of the critical importance of legal status for understanding the well-being of immigrants and their families, there has been scant research on this topic due to data limitations. Using Wave 1 of the Los Angles Family and Neighborhood Survey (2000-2002) and the 2000 decennial census, we investigate how parenting strain among Mexican-origin mothers varies by legal status and neighborhood context. We find significant differences in parenting strain by nativity and legal status, with undocumented mothers reporting the lowest level. Results from multilevel models with cross-level interactions reveal that the influence of neighborhood immigrant concentration differs by legal status. Percent foreign born in the neighborhood is associated with reduced parenting strain for documented Mexican-origin mothers while it is associated with heightened parenting strain for undocumented Mexican-origin mothers. Findings provide empirical support for the need to recognize legal status distinctions in studies of the well-being of immigrants and their families.

The Black-White Disparity in Sexually Transmitted Diseases During Pregnancy: How Do Racial Segregation and Income Inequality Matter?

BACKGROUND: We investigate the roles of residential racial segregation and income inequality for the black-white disparity in acquiring sexually transmitted diseases (STD) during pregnancy in a multilevel framework. METHODS: The analytic sample consisted of non-Hispanic white (n = 79,271) and non-Hispanic black (n = 17,669) mothers from 2012 population birth data from Pennsylvania. We used the 2009 to 2013 American Community Survey for neighborhood characteristics of mothers; we used multilevel models. RESULTS: First, neighborhood-level factors are important for understanding this disparity because racial segregation and income inequality are significantly associated with acquiring STD during pregnancy, regardless of race. Second, racial segregation moderates the relationships between race/ethnicity and the acquisition of STD during pregnancy. White mothers are more vulnerable to neighborhood segregation than black mothers, and black mothers are less likely to acquire STD during pregnancy than white mothers if they reside with co-ethnics. Third, mothers residing in the most socioeconomically disadvantaged neighborhoods-as indicated by both absolute and relative measures of income inequality-have the highest odds of acquiring STD during pregnancy, regardless of race. CONCLUSIONS: Neighborhood-level segregation and income inequality are important for understanding the acquisition of STDs during pregnancy. Our findings have important implications for future research and for place-specific prevention and intervention to reduce the racial disparity in STD during pregnancy.

Experiencing discrimination in Los Angeles: Latinos at the intersection of legal status and socioeconomic status.

Despite its recent slowdown, immigration from Latin America continues to be a controversial issue. Some scholars argue that the social climate is increasingly inhospitable to Latinos, potentially fueling discriminatory attitudes and behaviors. However, little research has examined Latinos' experiences with discrimination, especially variation by nativity and legal status. We address this issue with research on perceived discrimination among Mexican and Central American residents of Los Angeles County, a major destination for Latin American immigrants. Using data from the Los Angeles Family and Neighborhood Survey and the American Community Survey, the analyses consider immigrants' legal status, intersectionality, and competing perspectives on assimilation. The results show that undocumented immigrants do not report especially high levels of discrimination. Instead, young U.S.-born Latinos are the most likely to report mistreatment in interpersonal and institutional domains. Neighborhood ethnoracial and income diversity also have implications for perceived exposure to different types of discrimination.

Immigrant Enclaves and Inadequate Prenatal Care among Mexican-origin Mothers.

OBJECTIVES: This study is an investigation of the relationships between residing in different types of ethnic enclave neighborhoods and inadequate use of prenatal care among Mexican-origin mothers. METHODS: A unique dataset was created using National Center for Health Statistics 2008 restricted-use detailed natality files, the 2005-2009 American Community Survey, and the Department of Health and Human Services Area Resource file. Hierarchical modeling was used. RESULTS: Mexican-origin mothers' residential contexts are associated with the inadequacy of their prenatal care utilization beyond their individual characteristics. Specifically, residing in Mexican immigrant enclaves is associated with increased odds of having inadequate use of prenatal care. In contrast, residing in other types of ethnic enclaves (Mexican/Hispanic ethnic enclaves) and non-Hispanic white neighborhoods is associated with decreased odds of having inadequate utilization of prenatal care even after the inclusion of contextual-level controls for individual characteristics, neighborhood socioeconomic status, and the availability of healthcare infrastructure resources. CONCLUSIONS: Residing in immigrant enclaves is important for understanding the inadequacy of prenatal care utilization for Mexican-origin mothers. These findings have policy implications for designing place-based programs to target certain residential contexts where women are at greater risk of having inadequate use of prenatal care.

Early cognitive skills of Mexican-origin children: The roles of parental nativity and legal status.

Although one-third of children of immigrants have undocumented parents, little is known about their early development. Using data from the Los Angeles Family and Neighborhood Survey and decennial census, we assessed how children's cognitive skills at ages 3 to 5 vary by ethnicity, maternal nativity, and maternal legal status. Specifically, Mexican children of undocumented mothers were contrasted with Mexican children of documented mothers and Mexican, white, and black children with U.S.-born mothers. Mexican children of undocumented mothers had lower emergent reading skills than all other groups and lower emergent mathematics skills than all groups with U.S.-born mothers. Multilevel regression models showed that differences in reading skills are explained by aspects of the home environment, but the neighborhood context also matters. Cross-level interactions suggest that immigrant concentration boosts emergent reading and mathematics skills for children with undocumented parents, but does not similarly benefit children whose parents are native born.

Putting Families Into Place: Using Neighborhood-Effects Research and Activity Spaces to Understand Families.

Neighborhood is an important context in which individuals and families are embedded. Yet family studies researchers have been relatively slow to incorporate spatial approaches into family science. Although limited theoretical and methodological attention has been devoted to families in neighborhood-effects research, family scholars can contribute greatly to theories about neighborhood effects, and neighborhood-effects research can help move the field of family studies forward. This article reviews the theories, applications, and limitations of research on neighborhood effects and discusses how family studies can benefit from incorporating a spatial perspective from neighborhood-effects research. I then present an innovative methodology-referred to as activity spaces-emerging in neighborhood-effects research, and I discuss how this approach can be used to better understand the complexity and heterogeneity of families. Last, I highlight ways to incorporate space into family studies by "putting families into place."

Examining the complexity and variation of health care system distrust across neighborhoods: Implications for preventive health care.

PURPOSE: Recently, the institutional performance model has been used to explain the increased distrust of health care system by arguing that distrust is a function of individuals' perceptions on the quality of life in neighborhood and social institutions. We examined (1) whether individuals assess two dimensions of distrust consistently, (2) if the multilevel institutional performance model explains the variation of distrust, and (3) how distrust patterns affect preventive health care behaviors. METHODOLOGY: Using data from 9,497 respondents in 914 census tracts (neighborhoods) in Philadelphia, we examined the patterns of how individuals evaluate the competence and values distrust using the Multilevel Latent Class Analysis (MLCA), and then investigated how neighborhood environment factors are associated with distrust patterns. Finally, we used regression to examine the relationships between distrust patterns and preventive health care. FINDINGS: The MLCA identified four distrust patterns: Believers, Doubters, Competence Skeptics, and Values Skeptics. We found that 55 % of the individuals evaluated competence and values distrust coherently, with Believers reporting low levels and Doubters having high levels of distrust. Competence and Values Skeptics assessed distrust inconsistently. Believers were the least likely to reside in socioeconomically disadvantaged and racially segregated neighborhoods than other patterns. In contrast to Doubters, Believers were more likely to use preventive health care, even after controlling for other socioeconomic factors including insurance coverage. PRACTICAL IMPLICATIONS: Our findings suggest that distrust patterns are function of neighborhood conditions and distrust patterns are associated with preventive health care. This study provides important policy implications for health care and future interventions.

Pinpointing the sources of the Asian mortality advantage in the USA.

BACKGROUND: Asian-Americans outlive whites by an average of nearly 8 years. By determining the sources of the Asian mortality advantage, we can pinpoint where there is the greatest potential for raising the life expectancy of whites and other groups in the USA. METHODS: Our analyses include all Asian and white deaths in the USA between 2006 and 2010, from the Center for Disease Control. Using the International Classification of Diseases (V.10), we code causes of deaths into 19 categories, based on the most common causes as well as causes particularly relevant to racial differences. We then create life tables and apply a newly-developed demographic method to determine whether Asians have longer life expectancy because they are less likely than whites to die of causes of death that strike at younger ages, or because they tend to outlive whites regardless of cause of death. RESULTS: Nearly 90% of the Asian-white life expectancy gap is attributable to the fact that Asians tend to outlive whites regardless of the cause of death. The causes that contribute the most to the gap are heart disease (24%) and cancers (18%). Men contribute somewhat more to the gap than women do (55% vs 45%), primarily because Asian-white differences in mortality are greater among men than among women with respect to suicide, traffic accidents and accidental poisoning. CONCLUSIONS: For almost all causes of death, Asian victims tend to be older than white victims. The greatest potential for raising the life expectancy of whites to that of Asians, then, resides in efforts that effectively increase whites' average age at death for the most common causes of death.

How Does the Context of Reception Matter? The Role of Residential Enclaves in Maternal Smoking During Pregnancy Among Mexican-Origin Mothers.

This study investigated whether and how different patterns of group exposure within residential contexts (i.e., living in a Mexican immigrant enclave, a Mexican ethnic enclave, a pan-Hispanic enclave, or a non-Hispanic white neighborhood) are associated with smoking during pregnancy among Mexican-origin mothers. Using a hierarchical linear modeling approach, we found that Mexican-origin mothers' residential contexts are important for understanding their smoking during pregnancy. Residence in an ethnic enclave is associated with decreased odds of smoking during pregnancy, while residence in a non-Hispanic white neighborhood is associated with increased odds of smoking during pregnancy, above and beyond the mothers' individual characteristics. The magnitude of the associations between residence in an ethnic enclave and smoking during pregnancy is similar across the different types of ethnic enclaves examined. The important roles of inter- and intra-group exposures suggests that in order to help Mexican-origin women, policy makers should more carefully design place-based programs and interventions that target geographic areas and the specific types of residential contexts in which women are at greater risk.

Exploring geographic variation in US mortality rates using a spatial Durbin approach.

Previous studies focused on identifying the determinants of mortality in US counties have examined the relationships between mortality and explanatory covariates within a county only, and have ignored the well-documented spatial dependence of mortality. We challenge earlier literature by arguing that the mortality rate of a certain county may also be associated with the features of its neighboring counties beyond its own features. Drawing from both the spillover (i.e., same direction effect) and social relativity (i.e., opposite direction effect) perspectives, our spatial Durbin modeling results indicate that both theoretical perspectives provide valuable frameworks to guide the modeling of mortality variation in US counties. Our empirical findings support that mortality rate of a certain county is associated with the features of its neighbors beyond its own features. Specifically, we found support for the spillover perspective in which the percentage of the Hispanic population, concentrated disadvantage, and the social capital of a specific county are negatively associated with the mortality rate in the specific county and also in neighboring counties. On the other hand, the following covariates fit the social relativity process: health insurance coverage, percentage of non-Hispanic other races, and income inequality. Their direction of the associations with mortality in the specific county is opposite to that of the relationships with mortality in neighboring counties. Methodologically, spatial Durbin modeling addresses the shortcomings of traditional analytic approaches used in ecological mortality research such as ordinary least squares, spatial error, and spatial lag regression. Our results produce new insights drawn from unbiased estimates.

Why lifespans are more variable among blacks than among whites in the United States.

Lifespans are both shorter and more variable for blacks than for whites in the United States. Because their lifespans are more variable, there is greater inequality in length of life-and thus greater uncertainty about the future-among blacks. This study is the first to decompose the black-white difference in lifespan variability in America. Are lifespans more variable for blacks because they are more likely to die of causes that disproportionately strike the young and middle-aged, or because age at death varies more for blacks than for whites among those who succumb to the same cause? We find that it is primarily the latter. For almost all causes of death, age at death is more variable for blacks than it is for whites, especially among women. Although some youthful causes of death, such as homicide and HIV/AIDS, contribute to the black-white disparity in variance, those contributions are largely offset by the higher rates of suicide and drug poisoning deaths for whites. As a result, differences in the causes of death for blacks and whites account, on net, for only about one-eighth of the difference in lifespan variance.

Contextual and developmental predictors of sexual initiation timing among Mexican-origin girls.

Using data from a longitudinal study of Mexican-origin girls (ages 11-17 at Time 1), we examined sociocultural (i.e., family structure, nativity, and acculturation), interpersonal (i.e., supportive parenting and conflict), and developmental (i.e., menarche timing and autonomy expectations) predictors of sexual initiation. Using Cox proportional hazards models, we explored whether Time 1 variables predicted the occurrence and timing of first sexual intercourse reported 2.5 and 3.5 years later. Results indicated that the likelihood of early sexual intercourse was higher among first-generation than second-generation immigrants. In addition, living with a stepparent (compared with two biological parents) was associated with a higher likelihood of early intercourse. Furthermore, early autonomy expectations emerged as a salient predictor of intercourse, such that girls with earlier autonomy expectations were more likely to have earlier intercourse than girls with later autonomy expectations. Taken together, results highlight the importance of considering developmental and contextual factors when studying Mexican-origin girls' sexual initiation.

Immigration and the Family Circumstances of Mexican-Origin Children: A Binational Longitudinal Analysis.

Using data from the birth cohort of the Early Childhood Longitudinal Study (n = 1,200) and the Mexican Family Life Survey (n = 1,013), this study investigated the living arrangements of Mexican-origin preschool children. The analysis examined children's family circumstances in both sending and receiving countries, used longitudinal data to capture family transitions, and considered the intersection between nuclear and extended family structures. Between ages 0-1 and 4-5, Mexican children of immigrants experienced significantly more family instability than children in Mexico. They were more likely to transition from 2-parent to single-parent families and from extended family households to simple households. There were fewer differences between U.S. children with immigrant versus native parents, but the higher level of single parenthood among children of natives at ages 0-1 and the greater share making transitions from a 2-parent to a single-parent family suggest ongoing erosion of children's family support across generations in the United States.

Racial segregation and maternal smoking during pregnancy: a multilevel analysis using the racial segregation interaction index.

Drawing from both the place stratification and ethnic enclave perspectives, we use multilevel modeling to investigate the relationships between women's race/ethnicity (i.e., non-Hispanic white, non-Hispanic black, Asian, and Hispanic) and maternal smoking during pregnancy, and examine if these relationships are moderated by racial segregation in the continental United States. The results show that increased interaction with whites is associated with increased probability of maternal smoking during pregnancy, and racial segregation moderates the relationships between race/ethnicity and maternal smoking. Specifically, living in a less racially segregated area is related to a lower probability of smoking during pregnancy for black women, but it could double and almost triple the probability of smoking for Asian women and Hispanic women, respectively. Our findings provide empirical evidence for both the place stratification and ethnic enclave perspectives.

Why the racial gap in life expectancy is declining in the United States.

BACKGROUND: Blacks have lower life expectancy than whites in the United States. That disparity could be due to racial differences in the causes of death, with blacks being more likely to die of causes that affect the young, or it could be due to differences in the average ages of blacks and whites who die of the same cause. Prior studies fail to distinguish these two possibilities. OBJECTIVE: In this study we determine how much of the 2000-10 reduction in the racial gap in life expectancy resulted from narrowing differences in the cause-specific mean age at death for blacks and whites, as opposed to changing cause-specific probabilities for blacks and whites. METHOD: We introduce a method for separating the difference-in-probabilities and difference-inage components of group disparities in life expectancy. RESULTS: Based on the new method, we find that 60% of the decline in the racial gap in life expectancy from 2000 to 2010 was attributable to reduction in the age component, largely because of declining differences in the age at which blacks and whites die of chronic diseases. CONCLUSION: Our findings shed light on the sources of the declining racial gap in life expectancy in the United States, and help to identify where advances need to be made to achieve the goal of eliminating racial disparities in life expectancy.

Spatializing health research: what we know and where we are heading.

Beyond individual-level factors, researchers have adopted a spatial perspective to explore potentially modifiable environmental determinants of health. A spatial perspective can be integrated into health research by incorporating spatial data into studies or analysing georeferenced data. Given the rapid changes in data collection methods and the complex dynamics between individuals and environment, we argue that geographical information system (GIS) functions have shortcomings with respect to analytical capability and are limited when it comes to visualizing the temporal component in spatio-temporal data. In addition, we maintain that relatively little effort has been made to handle spatial heterogeneity. To that end, health researchers should be persuaded to better justify the theoretical meaning underlying the spatial matrix in analysis, while spatial data collectors, GIS specialists, spatial analysis methodologists and the different breeds of users should be encouraged to work together making health research move forward through addressing these issues.