IMMIGRANT NEIGHBORHOOD CONCENTRATION, ACCULTURATION AND OBESITY AMONG YOUNG ADULTS HIROMI ISHIZAWA The George Washington University ANTWAN JONES The George Washington University Researchers repeatedly find that immigrants are healthier than their native-born counterparts. Among immigrant children, however, findings are mixed. Moreover, the effect of neighborhood context on obesity has not been fully examined. Using the National Longitudinal Study of Adult Health, this study investigates the linkages between acculturation, neighborhood characteristics, and obesity among young adults, including the potential for residing in an immigrant neighborhood, to mediate the adverse effects of low neighborhood socioeconomic conditions on obesity. Consistent with the unhealthy assimilation model, an immigrant health advantage is found for first generation Asians. Conversely, a greater likelihood of being obese is found for second and third and higher generation Hispanics relative to third and higher generation Whites. Further, a high concentration of immigrants and linguistically isolated households appear to work as a buffer against health risks that relate to obesity, particularly in poor neighborhoods. ABSTRACT: Although showing signs of leveling, the obesity rate continues to be high in the United States (Levi et al., 2013). Approximately 17% of children aged 2–19 and 35% of individuals aged above 20 are obese (Fryar, Carroll, & Ogden, 2012; National Center for Health Statistics, 2013). More importantly, the racial and ethnic disparities in obesity persist. In particular, Hispanics have higher obesity rates compared to non-Hispanic Whites among children as well as adults (Fryar et al., 2012; Ogden, Carroll, Kit, & Flegal, 2013). Such disparities are significant because racial and ethnic minority populations are increasing at a faster rate than non-Hispanic Whites, which is partly attributable to the increase in the number of children of immigrants (Humes, Jones, & Ramirez, 2011). Immigration from Latin America and Asia increased after the passage of the Immigration and Nationality Act of 1965, and a sizable proportion of the children of post-1965 immigrants are in their transition to young adulthood. Given that children of immigrants represent a large proportion of U.S. population growth, their health in early adulthood (and as they age) will have a significant impact on the nation as a whole. Research examining racial and ethnic health disparities consistently finds that immigrants enjoy better health outcomes than their native-born counterparts across numerous indicators (Cunningham, Ruben, & Narayan, 2008). Much of the earlier work on immigrant health argues that ethnic health disparities are primarily due to differences in diet and food preparation, exercise habits, and other behaviors that are risk factors associated with morbidity and mortality (Markides & Coreil, 1986). Although immigrants may enjoy better health than native-born populations, this advantage declines Direct correspondence to: Hiromi Ishizawa, Department of Sociology, The George Washington University, 409 Phillips Hall, 801 22nd Street NW, Washington, DC 20052. E-mail: [email protected]. JOURNAL OF URBAN AFFAIRS, Volume 00, Number 0, pages 1–14. C 2015 Urban Affairs Association Copyright All rights of reproduction in any form reserved. ISSN: 0735-2166. DOI: 10.1111/juaf.12208 2 I JOURNAL OF URBAN AFFAIRS I Vol. 00/No. 0/2015 as the length of residence in the United States increases (Cho, Frisbie, Hummer, & Rogers, 2004; Frisbie, Cho, & Hummer, 2001). As an explanation for this relationship, some researchers argue that unhealthy acculturation, or the adoption of unhealthy behaviors that are pervasive in mainstream U.S. society, is a contributing factor that reverses the immigrant health advantage (Abra´ıdo-Lanza, Chao, & Fl´orez, 2005). Together, the research suggests that health norms and behaviors in both immigrants’ countries of origin and in the United States shape the health and well-being of immigrants. However, researchers have not fully explored one of the components that is central to the unhealthy acculturation argument: the neighborhood context. As Fitzpatrick and LaGory (2003, p. 36) argue, “health is a product not only of how we live, but also of where we live.” Following this argument, neighborhoods and places of residence should be viewed as “risk spaces” and “resource spaces.” Any hazards and risks that impact health are unevenly distributed across places. For instance, health risks related to location include building deterioration, which is predominantly concentrated in socioeconomically disadvantaged areas. Further, race/ethnic minorities are more likely to reside in low-quality neighborhoods than Whites (Osypuk, Galea, McArdle, & Acevedo-Garcia, 2009). On the other hand, neighborhood resources such as neighborhood-based supportive social networks and accessible health care facilities and services protect residents from local hazards and risks impacting their health. The advantages and disadvantages of neighborhoods also have a time dimension. Although change occurs, neighborhoods are somewhat resilient to change (Sharkey, 2013). Because of the stability that exists in neighborhoods, there may be enduring consequences to long-term exposure to local hazards and risks, particularly in locations with high concentrations of poverty (Sampson, 2012). Indeed, the neighborhood has long been understood as an important aspect of immigrant adaptation to U.S. society. According to spatial assimilation theory (Massey, 1985), residential location is a direct reflection of the level of acculturation and socioeconomic mobility that immigrants experience. Newly arrived immigrants who are unfamiliar with the environment first settle in a central city containing a high concentration of people from the same country of origin, where there is limited exposure to the host society’s culture and norms. Spatial dispersion then occurs as immigrants acculturate and achieve socioeconomic mobility. While the presence of immigrant residential concentration among contemporary immigrants and their descendants has been found not only in inner cities but also in suburbs (Logan, Zhang, & Alba, 2002), the predominant pattern of immigrant neighborhoods exhibiting low socioeconomic status (SES) suggests that residents may have a heightened exposure to poor health risks. On the other hand, neighborhood-based social networks may serve as protective factors (Ellen, Mijanovich, & Dillman, 2001). For instance, social networks within immigrant neighborhoods may be able to shape norms about accepted health-related behaviors, such as low levels of high-fat food consumption (Osypuk et al., 2009). Further, residing in immigrant neighborhoods means that residents may have more opportunity to share information about doctors and health care services with neighbors who speak the same non-English language (Deri, 2005). In recognizing the role that context of reception plays in the immigrant integration process, segmented assimilation theory posits that children are integrated into various segments of a society, and this process is determined in part by the type of neighborhood in which these children reside (Portes & Zhou, 1993). Past studies have examined the effects of neighborhood context on various integration outcomes and have found support for segmented assimilation theory (Finch, Lim, Perez, & Do, 2007; Tong, 2010; cf. Xie & Greenman, 2011). For instance, Zhou and Bankston (1994) found that immigrant neighborhoods benefit socioeconomically disadvantaged children by buffering them from at-risk behaviors prevalent among native-born underclass youth. In immigrant neighborhoods, children of immigrants have access to ethnic culture and resources that limit incorporation into poor neighborhoods. In other words, immigrant neighborhoods may serve as a buffer that slows down acculturation with respect to specific health norms and behaviors of the host society. In order to examine each of these possibilities, this study uses the National Longitudinal Study of Adult Health (Add Health) to examine the linkages between acculturation, neighborhood characteristics, and obesity among young adults. I Immigrant Neighborhood and Obesity I 3 ACCULTURATION AND OBESITY Child obesity prevalence in the United States has increased since the 1980s and has occurred in all age and race/ethnic groups (Cossrow & Falkner, 2004). Marked increases in obesity have been seen among non-Hispanic Blacks and Mexican Americans (Hedley et al., 2004). On the other hand, a lower or equivalent level of obesity is generally found among Asian children (Anderson & Whitaker, 2009) as well as Asian adults (Hao & Kim, 2009) compared to their White counterparts. More specific to immigrant populations, the health literature often relies on the unhealthy assimilation model to understand immigrant health. This theory explains the worsening of health outcomes across immigrant generations in terms of acculturation that leads to unhealthy behaviors. Consistent with this theory, past studies found that the likelihood of being overweight is higher for native-born than for foreign-born children (Gordon-Larsen, Harris, Ward, & Popkin, 2003; Popkin & Udry, 1998). More specifically, first-generation Asians and Hispanics were less likely to be obese than their secondand third-generation counterparts (Popkin & Udry, 1998). Differences in diet (Singh & Siahpush, 2002), physical activity (Singh, Stella, Siahpush, & Kogan, 2008), and parenting (Arredondo et al., 2006; Elder et al., 2010) are mechanisms that researchers have found to help explain this generational difference in obesity among immigrant populations. On the other hand, many findings are inconsistent with the unhealthy assimilation model. Hispanic children of immigrants have been found to be more likely to be overweight than Hispanic children of native-born parents (Balistreri & Van Hook, 2009; Van Hook & Baker, 2010; Van Hook, Baker, Altman, & Frisco, 2012). An explanation for this finding is the immigrant vulnerability hypothesis, which argues that children of immigrants have greater vulnerability to obesity upon arrival in the United States because their parents spend much time and resources transitioning to a new environment (Van Hook et al., 2012). Conversely, Hamilton, Cardoso, Hummer, and Padilla (2011) found no consistent immigrant generational pattern for overweight status by examining several race/ethnic groups, including Asians and Hispanics. The study observed a lower prevalence of overweight status among second generation Hispanics, compared to both the first and third generations. On the other hand, a higher prevalence of being overweight was found for second generation Asians compared to their first and third and higher generation counterparts. Still, other studies have found a curvilinear relationship between generational status and obesity. Specifically, obesity and overweight prevalence are highest among first and third and higher generation Asians and lowest among second generation Asians, a result mainly attributable to physical inactivity in the first and third generations (Singh, Kogan, & Stella, 2009). Further, research has found that acculturation does not necessarily lead to unhealthy behaviors (Creighton, Goldman, Pebley, & Chung, 2012). A recent study indicates that the association between acculturation and health varies by socioeconomic characteristics of immigrants (Ra, Cho, & Hummer, 2013). For example, among Korean immigrants, a longer duration of residence in the United States is related to better health and positive health behaviors among the highly educated. While findings on the association between acculturation and obesity are mixed, the effect of neighborhood context on obesity has not been fully examined among immigrant populations (Finch et al., 2007; Osypuk, Diez-Roux et al., 2009). NEIGHBORHOOD, UNEVEN DEVELOPMENT, AND OBESITY While much research has focused on the effects of individual characteristics on various health outcomes, broader contextual circumstances have also been found to influence these outcomes (Diez-Roux, 2007; Jones, 2013). Obesity is not an exception. Socioeconomic characteristics of neighborhoods are associated with obesity prevalence (McLaren, 2007; Parks, Housemann, & Brownson, 2003). Residents in socioeconomically disadvantaged neighborhoods are more likely to be obese compared to residents of more affluent neighborhoods (Law, Power, Graham, & Merrick, 2007). It is likely that these socioeconomically disadvantaged neighborhoods also have a lower quality built environment, leading to poor health behavior outcomes (Lovasi, Neckerman, Quinn, Weiss, & Rundle, 4 I JOURNAL OF URBAN AFFAIRS I Vol. 00/No. 0/2015 2009; Taylor et al., 2007). For instance, the lack of physical resources such as parks, playgrounds, and supermarkets are associated with sedentary behavior, poor diet, negative neighborhood perceptions, and low levels of utilization of and knowledge about the neighborhood (Gordon-Larsen, Nelson, Page, & Popkin, 2006). The quantity and quality of health-related physical structures is a function of the socioeconomic status of a neighborhood. In general, city amenities such as proximity to medical facilities or farmer’s markets are strategically placed in neighborhoods that are socioeconomically stable or on the verge of turning into areas of high socioeconomic status, while socioeconomically disadvantaged areas do not have access to these amenities. Developers, in turn, feel that profit margins are low in disadvantaged neighborhoods, which guides their decision not to place amenities in those areas that need it the most (Harvey, 1989; Smith, 2008). In addition, the policy decisions within cities, such as exclusionary zoning and suburban subsidization, contribute to uneven development (Squires & Kubrin, 2005). In fact, consistent with spatial assimilation theory, neighborhoods with high immigrant concentrations are characterized by poor quality with respect to walkability, safety, and availability of recreational exercise resources (Osypuk, Diez-Roux et al., 2009). Therefore, the effect of residing in immigrant neighborhoods on health is of particular theoretical and practical interest because it is usually the first point of reception for immigrant families and thus shapes the kind of experience they have in the United States. HYPOTHESES The following hypotheses are derived from the two major theoretical arguments that link immigration to health: 1. Unhealthy assimilation model: The lower likelihood of obesity among Asian and Hispanic young adults decreases across immigrant generational status. 2. Segmented assimilation theory: Higher immigrant and linguistically isolated household concentrations of the neighborhood in which young adults reside during adolescence correlate with a lower likelihood of obesity. 3. Segmented assimilation theory: The negative effect of residing in socioeconomically disadvantaged neighborhoods on the likelihood of obesity is lessened in neighborhoods with higher immigrant concentrations. DATA AND METHODS The current research relies on the National Longitudinal Study of Adult Health (Add Health), which is a nationally representative sample of adolescents in Grades 7–12 who were followed from 1994 to 2009. The data are ideal to test the segmented assimilation theory and unhealthy assimilation model because of the large sample size, the inclusion of neighborhood-level characteristics, and the collection of major health behavior indicators. At the first wave of data collected in 1994–1995, there were 20,745 adolescents in the core sample, with an oversampling of various Asian and Hispanic groups, such as Chinese, Cuban, and Puerto Rican (UNC Carolina Population Center, 2013). By the third wave (2001–2002), 15,197 respondents had been retained. To ensure adequate sample size, the analyses are restricted to Hispanics and Asians of all generational statuses with third and higher generation White young adults as the comparison group. The final analytic sample contains 10,063 young adults. Immigrant generational status is categorized as follows: first generation is assigned to those who were born abroad and have at least one foreign-born parent; second generation are those born in the United States with at least one foreignborn parent; and third and higher generation are those born in the United States with native-born parents. The data are not disaggregated further by subgroup because, with the exception of Mexican and Mexican Americans, none of the subgroups have a large enough sample size for further analysis. I Immigrant Neighborhood and Obesity I 5 Dependent Variable Body mass index (BMI) is assessed at Wave III when the majority of respondents are in their late teens to 20s. Respondents were asked to report their weight and height. Because the respondents were over 18 at survey date, an unstandardized BMI is calculated using the conventional BMI equation (Centers for Disease Control and Prevention, 2011). As the dependent measure, a dichotomous variable is employed, with a BMI of at least 30 indicating obesity. Independent Variables Acculturation Much debate exists in the literature regarding the measurement of acculturation as unidimensional or multidimensional (Chun, 2003), but two measures have been used in much research to approximate a potential change in cultural patterns consistent with the host society (Sam & Berry, 2006). As defined above, immigrant status is partitioned out as first generation, second generation, and third and higher generation. In addition, household language is often used as a dimension of acculturation. If a young adult grew up in a household where a non-English language is used, it is coded as one and used as the reference category. Family Characteristics Following the work of Bearman and Moody (2004), a composite measure for family socioeconomic status uses parent education and occupational status as of Wave I, which ranges from one (low family SES) to 10 (high family SES). The two household structure variables are: (1) whether a young adult lived in a two-parent household, a single-parent household, or other household structure (e.g., extended family members present in a household) and (2) the number of siblings in a household. To account for any genetic linkage between parents and offspring, a variable for a family history of obesity measures whether the respondent’s biological mother or father was obese. Young Adult Characteristics The sedentary behavior scale sums the number of hours per week the respondent watches TV, watches videos, and plays computer games. Thus, higher scores on this scale correspond to higher levels of sedentary behavior. The scale is standardized around a mean of zero such that positive values correspond to sedentary behavior and negative values indicate more of an active lifestyle. The Cronbach’s α for this measure is .6, which is considered an acceptable result for internal consistency of the items in the scale (Kline, 2000). Because breastfeeding is negatively associated with obesity (Armstrong & Reilly, 2002), a measure is included for whether or not the respondent was breastfed. Age in months and gender are also included as controls in the analyses. Neighborhood Characteristics To help test the segmented assimilation thesis, three variables on the characteristics of neighborhoods where the respondent resided during adolescence (Wave I) are used. These two variables are taken from 1990 U.S. Census, which was attached to Add Health data. The geographic unit is the census tract. The first two variables are (1) the logged median household income within the respondent’s neighborhood, and (2) the immigrant neighborhood scale. The immigrant neighborhood scale is constructed from two variables: the proportion of foreign-born residents and the proportion of persons aged 5 years and older who live in linguistically isolated households. These two measures yield a Cronbach’s α of .9, indicating strong internal consistency between the items. Again, the scale is standardized around a mean of zero such that positive values correspond to higher immigrant and linguistically isolated households. 6 I JOURNAL OF URBAN AFFAIRS I Vol. 00/No. 0/2015 A dichotomous measure is used to indicate whether a respondent lived in a socioeconomically advantaged or disadvantaged area. Different methods are available to categorize socioeconomic status of the neighborhood. Tong (2010) used median household income: disadvantaged neighborhoods are those with median household incomes lower than overall median household income across all neighborhoods included in the data, and advantaged neighborhoods are those with median household incomes higher than overall median household income. A second threshold relies on the poverty rate. Kneebone, Nadeau, and Berube (2011) describe neighborhoods with a poverty rate between 20% and 40% as high poverty neighborhoods and with a poverty rate higher than 40% as extreme poverty neighborhoods. This approach suggests categorizing neighborhoods as advantaged (poverty rate lower than 20%) and disadvantaged (poverty rate higher than 20%). The two approaches yield similar results, and results using the poverty rate are presented below (results using median household income are available upon request). Methods Logistic regression is used to model whether or not a young adult is obese at the third wave of data collection. The first model predicts the likelihood of being obese by including measures of acculturation (immigrant generational status and non-English language use) and race /ethnicity. The second model predicts obesity by interacting race/ethnicity and immigrant generational status. The third model introduces the individual-level and neighborhood-level variables to investigate any changes in the association between race/ethnic immigration generational status and obesity. A final model assesses the effect of interacting the immigrant neighborhood scale and the socioeconomically disadvantaged neighborhoods dichotomous measure to examine whether the effect of residing in immigrant neighborhoods on obesity varies by neighborhood type. Because the data were collected using a clustered, stratified sampling design, the svy command in Stata 13.1 is used to account for design effects. Prior research using these data suggests that the design effects and the hierarchical nature of the data (with individual and census tract level measures) can be appropriately controlled for with the svy command (Grilli & Pratesi, 2004; Rabe-Hesketh & Skrondal, 2006). RESULTS Figure 1 presents obesity prevalence among young adults by race/ethnicity and immigrant generational status. As expected, overall obesity is more prevalent among Hispanics (21%) and least among Asians (11%) compared to third and higher generation Whites (17%). Consistent with the unhealthy assimilation model, the percentage of obesity increases across immigrant generations among Asian as well as Hispanic young adults, albeit the difference is starker among Asians. The characteristics of young adults by race/ethnicity are shown in Table 1. Surprisingly, the percent of family history of obesity is the highest among third and higher generation Whites (22%), followed by Hispanics (16%) and Asians (8%). Several characteristics of Hispanics suggest the higher prevalence of obesity relative to Asians: they are more likely to have lower levels of family socioeconomic status and reside in socioeconomically disadvantaged neighborhoods. By contrast, Asian young adults have similar levels of family socioeconomic status as third and higher generation Whites. Further, they are more likely to reside in two-parent households, be breastfed, and reside in higher socioeconomic status neighborhoods. According to past work, these characteristics make Asian young adults less likely to be obese. It is important to point out, however, that Hispanic young adults are more likely to have grown up in immigrant neighborhoods, as the mean immigrant neighborhood scale takes a value of .85 for the group. Table 2 shows the results of the logistic regression analysis predicting obesity. The results are presented as odds ratios such that values above unity denote positive effects and those below unity negative effects. The results from Model 1 show that the likelihood of being obese varies by immigrant generation. First generation young adults are less likely to be obese compared to the third and higher I Immigrant Neighborhood and Obesity I 7 25% 22.2% 20% PERCENT OBESE 17.4% 21.7% 20.9% 20.5% 17.7% 15% 11.2% 11.1% 1st 2nd 3rd+ Generaon Generaon Generaon All 10% 7.7% 5% 0% 3rd+ 1st 2nd 3rd+ Generaon Generaon Generaon Generaon White All Hispanic Asian FIGURE 1 Distribution of Obesity at Wave III by Race/Ethnicity and Immigrant Generational Status (N = 10063) Source: National Longitudinal Study of Adult Health. TABLE 1 Weighted Descriptive Statistics by Race/Ethnicity Total Sample Mean or % SE Immigrant generational status First Generation 9.17% Second Generation 12.99% Third+ Generation 77.84% Acculturation Non-English language 8.59% spoken at home Family characteristics Socioeconomic Index 5.63 Number of siblings 1.36 Household Structure Two Parent 77.87% One Parent 18.20% Other 3.93% Family history of obesity 20.85% Young adult’s characteristics Sedentary behavior −0.06 scale Breastfed 43.62% Age (in years) 22.29 Female 48.93% Neighborhood characteristics Median household $31184.84 income Immigrant neighborhood −0.16 scale Disadvantaged 19.88% neighborhood Unweighted N % White Sample Mean or % SE Hispanic Sample Mean or % SE Asian Sample Mean or % SE — — — 0.00% 0.00% 100.00% — — — 23.72% 41.86% 34.42% — — — 42.42% 40.72% 16.86% — — — — 0.05% — 44.33% — 42.84% — (0.12) (0.03) 5.89 1.26 (0.12) (0.03) 4.17 1.78 (0.14) (0.07) 5.88 1.62 (0.25) (0.14) — — — — 78.58% 17.81% 3.61% 22.50% — — — — 72.73% 21.65% 5.62% 15.97% — — — — 82.27% 13.84% 3.90% 7.59% — — — — (0.02) −0.06 (0.02) −0.04 (0.02) −0.06 (0.03) — (0.12) — 43.04% 22.26 49.42% — (0.13) — 44.26% 22.44 47.44% — (0.23) — 51.78% 22.41 45.28% — (0.26) — (948.85) $31446.93 (1047.92) $28241.51 (1474.61) $36771.56 (1738.84) (0.07) −0.38 (0.01) 0.85 (0.31) 0.40 (0.11) — 16.35% — 40.12% — 15.88% — 10,063 100.00% 6,915 68.72% Source: National Longitudinal Study of Adult Health, Waves I and III. 2,205 21.91% 943 9.37% 8 I JOURNAL OF URBAN AFFAIRS I Vol. 00/No. 0/2015 TABLE 2 Logistic Regression Results Predicting Obesity: Odds Ratios Model 1 Model 2 Immigrant generation status (Third+ generation) First generation .65∗ Second generation .92∗ Race/Ethnicity (White) Asian .72 Hispanic 1.39∗ Race/ethnic immigrant generational status (White, third+ generation) Asian, first generation .39∗∗ Asian, second generation .59 Asian, third+ generation 1.22 Hispanic, first generation .99 Hispanic, second generation 1.33∗ Hispanic, third generation 1.32∗ Acculturation Non-English language spoken 1.07 1.04 Family characteristics Socioeconomic Index Number of siblings in household Household Structure (Two parent) One parent Other Familial history of obesity Young adult’s characteristics Breastfed Sedentary behavior scale Age Female Neighborhood characteristics Median household income Immigrant neighborhood scale Disadvantaged neighborhood Immigrant neighborhood scale × Disadvantaged neighborhood Constant .21∗∗∗ .21∗∗∗ F statistics 4.85∗∗∗ 3.85∗∗∗ Note: Reference categories are in parentheses. Model 3 Model 4 .56 .90 1.69 1.29 1.49∗ 1.35∗ .51 .83 1.29 1.24 1.43∗ 1.32∗ .97 .99 .94∗∗∗ .96 .94∗∗∗ .96 .96 .84 2.68∗∗∗ .96 .84 2.69∗∗∗ .74∗∗∗ 1.23∗∗∗ 1.01∗∗∗ .74∗∗∗ 1.22∗∗∗ 1.01∗∗∗ 1.07 1.07 .82 .87∗ 1.32∗ .80 .99 1.27 .84∗ .24 13.51∗∗∗ .31 12.62∗∗∗ ∗ p < 0.05; ∗∗ p < 0.01; ∗∗∗ p < 0.001. generations, which is consistent with the unhealthy assimilation model. In addition, in accord with past findings, Hispanic young adults had a higher likelihood of being obese compared to third and higher generation Whites. Model 2 provides further clarification by showing that the association between immigrant generational status and obesity varies by race/ethnicity. Second and third and higher generation Hispanics are more likely to be obese compared to third and higher generation Whites. On the other hand, first-generation Asians are less likely to be obese compared to third and higher generation Whites. When individual-level (characteristics of family and young adult) and neighborhood-level variables are added in Model 3, the higher likelihood of being obese remains for second and third and higher generation Hispanics, while the coefficients for first generation Asians become nonsignificant. Further, the odds ratio for second generation Hispanics (1.49) is slightly higher than for third and higher generation Hispanics (1.35), suggesting a curvilinear association between immigrant generational status and obesity among Hispanics. Two neighborhood-level variables are significant. The results show that higher scores on the immigrant concentration scale (percentages of I Immigrant Neighborhood and Obesity I 9 immigrant population and linguistically isolated households) are associated with a lower likelihood of being obese. Further, residing in socioeconomically disadvantaged neighborhoods is associated with a higher likelihood of being obese. The odds ratios for all other statistically significant independent variables are of the expected size. Sedentary behavior and family history of obesity are positively associated with the odds of being obese, and family socioeconomic status is negatively associated with obesity risk. The final model in Table 2 shows the odds ratios predicting obesity with an interaction between the immigrant neighborhood scale and the socioeconomic disadvantage neighborhood measure. While the main effects are no longer significant, the interaction itself is. The coefficient suggests that the likelihood of being obese is lower as the immigrant neighborhood scale increases with that effect being highest for adolescents living in socioeconomically disadvantaged neighborhoods. As expected, this result is consistent with the immigrant neighborhood effect being stronger in poor neighborhoods. DISCUSSION AND CONCLUSIONS The primary objectives of this study were to investigate the association between acculturation, neighborhood characteristics, and obesity among young adults, and to examine the potential for residing in an immigrant neighborhood to mediate the adverse effects of low neighborhood socioeconomic conditions on obesity. While past research has mainly examined the effects of individual or family characteristics on obesity among children of immigrants, little is known about the role of neighborhood characteristics in understanding obesity across immigrant generations. To our knowledge, no previous study examines how neighborhood characteristics during adolescence influence the likelihood of obesity as youth make their transition to adulthood. Therefore, this study informs the literature on immigrant health by examining neighborhood characteristics during adolescence as indicators of cumulative risks and resources. First, the study investigated the association between immigrant generational status and obesity for two race/ethnic groups, Hispanics and Asians. The findings are generally consistent with the unhealthy assimilation model (Gordon-Larsen et al., 2003; Popkin & Udry, 1998). The results show that first-generation Asians are less likely to be obese compared to third and higher generation Whites, but no difference is found for higher immigrant generational status Asians. For Hispanics, while the likelihood of being obese is higher for the second and third and higher generation compared to third and higher generation Whites, first-generation Hispanic young adults are not significantly different from third and higher generation Whites. These patterns are consistent with recent research (Creighton et al., 2012) and may support the protective culture hypothesis which emphasizes the link between group-specific immigrant behavioral norms and immigrant health (Scribner, 1996). However, Hamilton et al. (2011, p. 809) argue that “the protective role of co-ethnic communities is not necessarily culturally-specific but may be specific to the first generation.” Indeed, net of individualand neighborhood-level characteristics, the first-generation health advantage among Asians become statistically nonsignificant. Second, this study identified some effects of neighborhood context on obesity. In support of segmented assimilation theory, higher values on the immigrant neighborhood scale are associated with lower levels of obesity. This finding suggests that a high concentration of immigrants serves as a buffer against the risk of obesity, which is consistent with the second hypothesis. This relationship between immigrant concentration and obesity is particularly strong in socioeconomically disadvantaged neighborhoods, thus supporting the third hypothesis. This finding speaks to past work that found immigrant neighborhoods are more likely to have better access to healthy foods despite having low-quality neighborhood amenities including fewer physical activity resources and worse walkability (Osypuk, Diez-Roux et al., 2009). This finding underscores the importance of the neighborhood context. Overall, the findings of this study not only show the important role of neighborhoods where young adults grow up, but also contribute to the literature by showing that residing in an immigrant neighborhood mediates the adverse effects of low neighborhood socioeconomic conditions on obesity. 10 I JOURNAL OF URBAN AFFAIRS I Vol. 00/No. 0/2015 The findings of this study contribute to the broader body of literature that argues that maintaining ethnic culture can actually facilitate upward assimilation (Feliciano, 2001; Portes & Rumbaut, 2001). Although this study did not find a positive effect of non-English language on obesity, growing up in immigrant neighborhoods, indicating the maintenance of ties to an ethnic community, appears to have such a positive effect. The results from this research have direct health policy and urban policy implications. There has been an increased call for policy to combat the rising rates of obesity in communities of color, particularly in neighborhoods with large Latino populations (Ramirez, Chalela, Gallion, Green, & Ottoson, 2011). Local community engagement has been shown to be a powerful force in changing neighborhoods into healthy places (Brisson & Usher, 2007). For instance, the Communities for a Better Environment (CBE) organization has operated in the context of southeast Los Angeles, and they are known to be influential in dissemination of information that benefits the community. For instance, CBE created a knowledge map that assesses the direct risks and threats to health in that community (Gonz´alez et al., 2007). These kind of tools can help provide communities with health impact assessments, which contain information from both the built and social environment that could influence urban health (Corburn, 2007). In other place-based research on obesogenic environments, community development seems to be the mechanism that changes environments into health-promoting places (Sadler, Gilliland, & Arku, 2012). Our findings suggest that these communities are not inherently health-poor places. Rather, local entities can be great advocates for placing health-promoting amenities in distressed urban areas, and they can help develop tools to help residents find health-promoting amenities and avoid health risks, which is particularly helpful for those who have recently migrated to the area. This research also informs urban policy. Some U.S. urban planning efforts have evolved to producing and reproducing places that are consistent with New Urbanist development, which strives to provide areas with well-designed, mixed-income, mixed-use, and eco-friendly places (Talen, 2013). However, New Urbanist development has the potential to erase some of the culture and social cohesion of an already existing community within the revitalized urban enclave. In a case study of Santa Ana, California, Gonz´alez and Lejano (2009) suggest that the barrios, which are place-based expressions of Latino culture and heritage, were going through this New Urbanist rejuvenation. However, in the process, the Renaissance Specific Plan for redeveloping Santa Ana devotes two of 150 pages on each barrio, and references the primary residential group (Latino, Hispanic or immigrant) only one time. As previously discussed, immigrant communities are entrenched in the American landscape and should not be deconstructed and destroyed, because they offer many benefits to the residents of those places. This research also suggests that health outcomes are not necessarily enhanced for Hispanics who live in immigrant deconcentrated neighborhoods. Immigrant neighborhoods are not problematic for health outcomes merely because of the ethnic composition of the neighborhood (Do & Finch, 2008). Urban policy should take a more meso-level approach to suggest ways where the social and built environment could be enhanced to promote better health outcomes without destroying the cultural, historical, and social fabric that is interwoven in these communities. Several limitations to this research are worth noting. First, obesity among subgroups of Asians and Hispanics was not analyzed due to small sample sizes. However, such subgroup analyses may be fruitful since a recent work indicates that South Asian children have higher levels of obesity and overweight compared to their White counterparts (Balakrishnan, Webster, & Sinclair, 2008). Second, because Add Health data are a school-based survey, Oropesa and Landale (2009) caution researchers regarding the inherent exclusion of migrant youth who are never enrolled in school. Their research found that a relatively significant portion of young immigrants from Mexico had never enrolled for school in the United States and thus were more likely to migrate to work. This undercount of Mexican-born youth in our study may result in a biased estimate of obesity prevalence among this group, and the direction and size of this bias is unknown. Third, measures of parent health behaviors were not included in the study, and these would have been useful for understanding the intergenerational transmission of culture. Because obesity among young adults is also a function of the household context, the analyses would have been richer if relevant measures were available. I Immigrant Neighborhood and Obesity I 11 Finally, given that this study suggests neighborhood context is important for understanding obesity among immigrant and nonimmigrant young adults, future research should further examine the role of neighborhoods by including measures of the built environment that are relevant to understanding obesity. Place-based features such as supermarket density or availability, neighborhood walkability, proximity to primary care physicians or clinics, and parks or physical activity resources all are related to health generally and specifically in the case of obesity. These high-quality neighborhood amenities may be absent in low-income areas while immigrant neighborhoods may have amenities to counterbalance some of the disadvantages. By carefully measuring and incorporating the built environment, future research can expand upon this current endeavor. In sum, this study suggests some potential health benefits for young adults from residing in immigrant neighborhoods during adolescence. While those benefits are less likely to come from the adoption of health norms and behaviors that are prevalent in the United States (i.e., acculturation), it may be that the immigrant neighborhood is counterbalancing the negative impact that residing in poor neighborhoods often has on this population. While past urban studies have found that immigrant concentration adversely influences the socioeconomic adjustment of immigrants (Chiswick & Miller, 2005), the study here suggests that this spatial concentration may be more protective against obesity than living in nonimmigrant neighborhoods for some immigrant groups. Thus, the discussion of place in the sociology of health (Entwisle, 2007; Fitzpatrick & LaGory, 2003) needs to be expanded, and should include how uneven development in place and the community and demographic dynamics within neighborhoods are both unique structural risk factors that disadvantage or advantage residents in urban areas. ACKNOWLEDGEMENTS: A previous version of this article was presented at the 2014 Population Association of America meeting in Boston, MA. This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due to Ronald R. 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Big boys and little girls: Gender, acculturation, and weight among young children of immigrants. Journal of Health and Social Behavior, 51(2), 117–144. VanHook, J., Baker, E. H., Altman, C. E., & Frisco, M. L. (2012). Canaries in a coalmine: Immigration and overweight among Mexican-origin children in the US and Mexico. Social Science and Medicine, 74, 125–134. Xie, Y., & Greenman, E. (2011). The social context of assimilation: Testing implications of segmented assimilation theory. Social Science Research, 40, 965–984. Zhou, M., & Bankston, C L., III. (1994). Social capital and the adaptation of the second generation: The case of Vietnamese youth in New Orleans. International Migration Review, 28, 821–845. ABOUT THE AUTHORS Hiromi Ishizawa is Assistant Professor of Sociology at The George Washington University. Her main areas of research include social and family demography, immigration, sociology of language, and urban sociology. Her primary research goal is to understand diversity in immigrants’ pathways of incorporation into a host society. In particular, she focuses on the residential and familial contexts in which immigrants and their children reside, and how these contexts affect how they are integrated into American society. Beyond the United States, she conducts research on another immigrant destination country, New Zealand. Her recent publications specifically focus on residential segregation and patterns of ethnic neighborhoods among recent immigrant groups and the indigenous Maori population. Antwan Jones is Assistant Professor of Sociology at The George Washington University. He has published research on various health outcomes. However, he focuses his research on the residential and neighborhood context in which individuals live as a way to understand health disparities among marginalized populations. Engaged in national and international research, he has located himself in the field of urban sociology by elucidating how residential processes and neighborhood contexts are essential to the study of adult cardiovascular disease, child obesity and disability among the elderly. Currently, he serves on the board of directors for the Society for the Study of Social Problems as well as the Capital City Area Health Education Center.
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