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|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.