Deprivation and the Hispanic health paradox: Neighborhood effects on children's wheezing outcomes in El Paso, Texas
This study examines the impact of hypothetical health determinants—including objective and relative economic deprivation, as well as foreign-born composition—at the neighborhood-level on respiratory wheezing among Hispanic children in El Paso, Texas while accounting for individual-level covariates based on hierarchical logistic modeling (HLM). Due to El Paso's majority Latino/a population, focus is placed on the so-called "Hispanic health paradox" through analysis of the impact of neighborhood foreign-born composition on Hispanic children's wheezing. Neighborhood-level variables at the census tract-level are derived from US Census data. ^ The percent of families in poverty and the GINI coefficient for income (income inequality) are used to measure objective and relative economic deprivation, respectively. The percent of foreign-born individuals in census tracts is used to operationalize neighborhood foreign-born composition. Individual-level data come from a survey (N=1904) of parents/guardians of fourth and fifth graders in all 58 elementary schools in the El Paso Independent School District. Child's sex, socioeconomic status, indoor/housing exposures, health behaviors, body mass index, residential duration in El Paso and primary caretaker's nativity are utilized at the individual-level, since they are well-established determinants of respiratory health outcomes. Due to the focus on neighborhood contextual effects, only Hispanic children living in the same home or within 1 km of that home for past year are included in the analysis (N=1322 children within 63 census tracts). ^ In addition, this study applies multiple imputation to the individual-level dataset (N=10 datasets) to address missing values and analyzes the multiply imputed data in the HLM statistical software package. Results reveal that the percent of families in poverty at the neighborhood-level consistently predicts less children's wheezing, while income inequality (GINI) has no effect on wheezing. Percent foreign-born also has a significant neighborhood effect associated with reduced wheezing. In terms of cross-level interactions, children in poverty (as opposed to not in poverty), with better health status (as opposed to worse) and with foreign-born (as opposed to US-born) primary caretakers enjoy respiratory health benefits from living in neighborhoods with a higher proportion of the population being foreign-born. In conclusion, this study provides evidence of neighborhood effects on children's wheezing in El Paso, Texas; some of those contextual effects conform to the extant literature and others do not.^
Health Sciences, General|Sociology, Environmental Justice
Kim, Young-An, "Deprivation and the Hispanic health paradox: Neighborhood effects on children's wheezing outcomes in El Paso, Texas" (2013). ETD Collection for University of Texas, El Paso. AAI1545174.