Preterm birth risk in New York City’s ethnic and immigrant enclaves Public Deposited

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  • March 22, 2019
Creator
  • Mason, Susan Marshall
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Residential segregation of ethnic groups in the United States (US) results in ethnic enclaves that isolate non-white ethnic groups from resources available to whites. But enclaves may also reduce exposure to discrimination, provide a context for political organizing and, among immigrants, slow adoption of detrimental American health behaviors. The net influence of segregation on health may be ethnic- or immigrant-group specific, but most studies of ethnic density in the US have focused on the black population alone. Using geocoded New York City birth records for 1995-2003 and a spatial measure of ethnic density computed from 2000 US Census data, this dissertation investigated 1) the risk of preterm birth among seven ethnic groups associated with residence in an ethnic enclave, 2) the risk of non-Hispanic black preterm birth associated with Hispanic, Asian, non-Hispanic white, and non-Hispanic black ethnic density, and 3) the risk of preterm birth among African-, Caribbean-, and US-born non-Hispanic black women associated with residence in African, Caribbean, and US-born neighborhoods. Adjusted risk differences comparing ethnic enclaves (>25% ethnic density) to lower-density neighborhoods ranged from -13.6 per 1,000 (-16.6, -9.5) among whites to 5.6 per 1,000 (95% CI: 0.7, 10.5) among blacks. Hispanic and Asian responses to ethnic density were smaller, but tended to be protective, especially in poorer neighborhoods. Among non-Hispanic blacks, preterm birth risk was reduced in Hispanic neighborhoods relative to white ones (RD=-9.6 per 1,000 births; 95% CI: -16.6, -2.5). Increasing black African and Caribbean immigrant density was associated with increased risks of preterm birth among African- and Caribbean-born non-Hispanic black women, especially in poorer neighborhoods, but this effect was small compared to the substantial detrimental effect of US-born black density on US-born black preterm birth risk (RD=12.5 per 1,000; 95% CI: 6.6, 18.4). The results suggest that US-born blacks are uniquely harmed by segregation into enclaves, particularly if their neighborhoods are poor. The protective effect of enclaves on other ethnic groups, and, for black women, of residence in Hispanic neighborhoods, points to the potential for psychosocial factors to counteract material deprivation.
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  • In Copyright
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  • "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Public Health (Epidemiology)."
Advisor
  • Kaufman, Jay S.
Degree granting institution
  • University of North Carolina at Chapel Hill
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  • Chapel Hill, NC
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  • Open access
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