Neighborhood composition and incidence of cancer among Hispanics in the United States

Neighborhood ethnic density and preterm birth across seven ethnic groups in New York City

Residential segregation limits non-white ethnic groups' access to white neighborhood resources, but may also reduce their exposure to discrimination and facilitate social support. We computed adjusted preterm birth risk differences (RDs) for seven ethnic groups comparing >25% to ≤ 25% ethnic density neighborhoods using 1995-2003 New York City birth records and a spatial ethnic density measure. RDs ranged from -15.0 per 1000 (95% CI: -18.5, -11.4) for whites to 6.4 per 1000 (95% CI: 2.8, 9.9) for blacks, with Hispanic and Asian estimates falling in between but tending to be protective. Results suggest that ethnic density is uniquely harmful for non-Hispanic blacks.

Ethnic density and preterm birth in African-, Caribbean-, and US-born non-Hispanic black populations in New York City

Segregation studies suggest that the health of blacks in the United States is poorer in majority-black compared with mixed-race neighborhoods. However, segregation studies have not examined black immigrants, who may benefit from social support and country-of-origin foods in black immigrant areas. The authors used 1995-2003 New York City birth records and a spatial measure of ethnic density to conduct a cross-sectional investigation of the risks of preterm birth for African-, Caribbean-, and US-born non-Hispanic black women associated with neighborhood-level African-, Caribbean-, and US-born non-Hispanic black density, respectively. Preterm birth risk differences were computed from logistic model coefficients, comparing neighborhoods in the 90th percentile of ethnic density with those in the 10th percentile. African black preterm birth risks increased with African density, especially in more deprived neighborhoods, where the risk difference was 6.1 per 1,000 (95% confidence interval: 1.9, 10.2). There was little evidence of an ethnic density effect among non-Hispanic black Caribbeans. Among US-born non-Hispanic blacks, an increase in preterm birth risk associated with US-born black density was observed in more deprived neighborhoods only (risk difference = 12.5, 95% confidence interval: 6.6, 18.4). Ethnic density seems to be more strongly associated with preterm birth for US-born non-Hispanic blacks than for non-Hispanic black immigrants.

Breast cancer incidence patterns among California Hispanic women: differences by nativity and residence in an enclave

BACKGROUND

Breast cancer incidence is higher in U.S.-born Hispanic women than foreign-born Hispanics, but no studies have examined how these rates have changed over time. To better inform cancer control efforts, we examined incidence trends by nativity and incidence patterns by neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants).

METHODS

Information about all Hispanic women diagnosed with invasive breast cancer between 1988 and 2004 was obtained from the California Cancer Registry. Nativity was imputed from Social Security number for the 27% of cases with missing birthplace information. Neighborhood variables were developed from Census data.

RESULTS

From 1988 to 2004, incidence rates for U.S.-born Hispanics were parallel but lower than those of non-Hispanic whites, showing an annual 6% decline from 2002 to 2004. Foreign-born Hispanics had an annual 4% increase in incidence rates from 1995 to 1998 and a 1.4% decline thereafter. Rates were 38% higher for U.S.- than foreign-born Hispanics, with elevations more pronounced for localized than regional/distant disease, and for women>50 years of age. Residence in higher SES and lower Hispanic enclave neighborhoods were independently associated with higher incidence, with Hispanic enclave having a stronger association than SES.

CONCLUSIONS

Compared with foreign-born, U.S.-born Hispanic women in California had higher prevalence of breast cancer risk factors, suggesting that incidence patterns largely reflect these differences in risk factors.

IMPACT

Further research is needed to separate the effects of individual- and neighborhood-level factors that affect incidence in this large and growing population.

Impact of neighborhood racial composition and metropolitan residential segregation on disparities in breast cancer stage at diagnosis and survival between black and white women in California

We examined the impact of metropolitan racial residential segregation on stage at diagnosis and all-cause and breast cancer-specific survival between and within black and white women diagnosed with breast cancer in California between 1996 and 2004. We merged data from the California Cancer Registry with Census indices of five dimensions of racial residential segregation, quantifying segregation among Blacks relative to Whites; block group ("neighborhood") measures of the percentage of Blacks and a composite measure of socioeconomic status. We also examined simultaneous segregation on at least two measures ("hypersegregation"). Using logistic regression we examined effects of these measures on stage at diagnosis and Cox proportional hazards regression for survival. For all-cause and breast-cancer specific mortality, living in neighborhoods with more Blacks was associated with lower mortality among black women, but higher mortality among Whites. However, neighborhood racial composition and metropolitan segregation did not explain differences in stage or survival between Black and White women. Future research should identify mechanisms by which these measures impact breast cancer diagnosis and outcomes among Black women.

Neighborhoods and chronic disease onset in later life

OBJECTIVES

To strengthen existing evidence on the role of neighborhoods in chronic disease onset in later life, we investigated associations between multiple neighborhood features and 2-year onset of 6 common conditions using a national sample of older adults.

METHODS

Neighborhood features for adults aged 55 years or older in the 2002 Health and Retirement Study were measured by use of previously validated scales reflecting the built, social, and economic environment. Two-level random-intercept logistic models predicting the onset of heart problems, hypertension, stroke, diabetes, cancer, and arthritis by 2004 were estimated.

RESULTS

In adjusted models, living in more economically disadvantaged areas predicted the onset of heart problems for women (odds ratio [OR] = 1.20; P < .05). Living in more highly segregated, higher-crime areas was associated with greater chances of developing cancer for men (OR = 1.31; P < .05) and women (OR = 1.25; P < .05).

CONCLUSIONS

The neighborhood economic environment is associated with heart disease onset for women, and neighborhood-level social stressors are associated with cancer onset for men and women. The social and biological mechanisms that underlie these associations require further investigation.

Adverse housing and neighborhood conditions and inflammatory markers among middle-aged African Americans

Adverse housing and neighborhood conditions are independently associated with an increased risk of various diseases and conditions. One possible explanation relates to systemic inflammation, which is associated with these adverse health outcomes. The authors investigated the association between housing and neighborhood conditions with inflammatory markers using data about 352 persons aged 49-65 years from the African American Health study. Participants were identified by a multistage random selection process in 2000 to 2001(response rate, 76%). Blood was analyzed for soluble cytokine receptors (interleukin-6, tumor necrosis factor alpha), C-reactive protein, and adiponectin. Neighborhood and housing characteristics consisted of five observed block face conditions (external appearance of the block on which the subject lived), four perceived neighborhood conditions, four observed housing conditions (home assessment by the interviewers rating the interior and exterior of the subject's building), and census-tract level poverty rate from the 2000 census. Differences in some inflammatory markers were found by age, gender, chronic conditions, and body mass index (all Bonferroni-adjusted p < 0.0034). There was no association between any of the housing/neighborhood conditions and the pro-inflammatory markers and potential associations between some housing/neighborhood conditions and adiponectin (p < 0.05, Bonferroni-adjusted p > 0.0034). Inflammation does not appear to be a mediator of the association between poor housing/neighborhood conditions and adverse health outcomes in middle-aged African Americans.

Neighbourhood ethnic composition and diet among Mexican-Americans

OBJECTIVES

We explore the association between a neighbourhood's ethnic composition and the foods and nutrients consumed by Mexican-Americans.

DESIGN

Cross-sectional survey of a large national sample, from the Third National Health and Nutrition Examination Survey (1988-94), was linked to the 1990 Census. The outcomes were food frequencies and serum levels of micronutrients. The variable of interest was percentage of Mexican-Americans at the census tract level.

SETTING

United States.

SUBJECTS

A total of 5306 Mexican-American men and women aged 17-90 years.

RESULTS

Increased percentage of Mexican-Americans at the census tract level was associated with less consumption of fruits, carrots, spinach/greens and broccoli and with lower serum levels of Se, lycopene, alpha-carotene, vitamin C and folate. By contrast, increased percentage of Mexican-Americans at the census tract level was associated with more consumption of corn, tomatoes, hot red chilli peppers and legumes such as beans, lentils or chickpeas.

CONCLUSIONS

An increased percentage of Mexican-Americans at the census tract level was associated with less consumption of selective foods (e.g. some fruits, broccoli) and low levels of serum Se or vitamin C, but it was associated with more consumption of other foods (e.g. legumes, tomatoes, corn products) that may have positive effects on health in this population.

The influence of acculturation and breast cancer-specific distress on perceived barriers to genetic testing for breast cancer among women of African descent

OBJECTIVE

Rising health disparities are increasingly evident in relation to use of genetic services (including genetic counseling and testing) for breast cancer risk, with women of African descent less likely to use genetic services compared with Whites. Meanwhile, little is known regarding potential within-group acculturation and psychological differences underlying perceived barriers to genetic testing among women of African descent.

METHODS

Hypothesized contributions of acculturation factors and breast cancer-specific distress to perceived barriers to genetic testing were examined with a statistical analysis of baseline data from 146 women of African descent (56% US born and 44% foreign born) meeting genetic breast cancer risk criteria and participating in a larger longitudinal study that included the opportunity for free genetic counseling and testing. Perceived barriers assessed included: (1) anticipation of negative emotional reactions, (2) stigma, (3) confidentiality concerns, (4) family-related worry, and (5) family-related guilt associated with genetic testing.

RESULTS

In multivariate analyses, being foreign born was a significant predictor of anticipated negative emotional reactions about genetic testing (beta=0.26; SE=0.11; p=0.01). Breast cancer-specific distress scores (avoidance symptoms) were positively related to anticipated negative emotional reactions (beta=0.02; SE=0.005; p=<0.0001), confidentiality concerns (beta=0.02; SE=0.01; p=0.02), and family-related guilt (beta=0.02; SE=0.01; p=0.0009) associated with genetic testing.

CONCLUSIONS

Results suggest an influence of acculturation and breast cancer-specific distress on perceived barriers to genetic testing among women of African descent. The potential utility of culturally tailored genetic counseling services taking into account such influences and addressing emotional and psychological concerns of women considering genetic testing for breast cancer should be investigated.

Another Mexican birthweight paradox? The role of residential enclaves and neighborhood poverty in the birthweight of Mexican-origin infants

Examining whether contextual factors influence the birth outcomes of Mexican-origin infants in the US may contribute to assessing rival explanations for the so-called Mexican health paradox. We examined whether birthweight among infants born to Mexican-origin women in the US was associated with Mexican residential enclaves and exposure to neighborhood poverty, and whether these associations were modified by nativity (i.e. mother's place of birth). We calculated metropolitan indices of neighborhood exposure to Mexican-origin population and poverty for the Mexican-origin population, and merged with individual-level, year 2000 natality data (n=490,332). We distinguished between neighborhood exposure to US-born Mexican-origin population (i.e. ethnic enclaves) and neighborhood exposure to foreign-born (i.e. Mexico-born) Mexican-origin population (i.e. immigrant enclaves). We used 2-level hierarchical linear regression models adjusting for individual, metropolitan, and regional covariates and stratified by nativity. We found that living in metropolitan areas with high residential segregation of US-born Mexican-origin residents (i.e. high prevalence of ethnic enclaves) was associated with lower birthweight for infants of US-born Mexican-origin mothers before and after covariate adjustment. When simultaneously adjusting for exposure to ethnic and immigrant enclaves, the latter became positively associated with birthweight and the negative effect of the former increased, among US-born mothers. We found no contextual birthweight associations for mothers born in Mexico in adjusted models. Our findings highlight a differential effect of context by nativity, and the potential health effects of ethnic enclaves, which are possibly a marker of downward assimilation, among US-born Mexican-origin women.

Neighborhood composition and cancer among Hispanics: tumor stage and size at time of diagnosis

BACKGROUND

We have previously reported that cancer incidence for lung, female breast, and colon and rectum for Hispanics decreases with increasing percentage of Hispanics at the census tract. In contrast, cervical cancer incidence increases with increasing percentage of Hispanics at the census tract.

METHODS

In this study, we investigate the hypothesis that Hispanics living in census tracts with high percentages of Hispanics are diagnosed with more advanced cancer, with respect to tumor size and stage of diagnosis. Data from the Surveillance, Epidemiology, and End Results registry and the U.S. Census Bureau were used to estimate the odds of diagnosis at a "late" stage (II, III, IV) versus "early" stage (I) and breast cancer tumor size among Hispanics as a function of census tract percent Hispanic. Hispanic ethnicity in the Surveillance, Epidemiology, and End Results registry was identified by medical record review and Hispanic surname lists. The study also used income of Hispanics living in the census tract and controlled for age at diagnosis and gender.

RESULTS

We found that Hispanics living in neighborhoods with higher density of Hispanic populations were more likely to be diagnosed with late-stage breast, cervical, or colorectal cancer, and to have a larger tumor size of breast cancer.

CONCLUSIONS

Our findings suggest that the benefits of lower cancer incidence in high tract percent Hispanics are partially offset by poorer access and reduced use of screening in conjunction with lower income, poorer health insurance coverage, and language barriers typical of these communities.

Ethnic/racial homogeneity and sexually transmitted disease: a study of 77 Chicago community areas

BACKGROUND

Sexually transmitted diseases (STDs) remain an intractable public health problem in the United States. Wide ethnic and racial disparities persist in the rates of reported STDs. Blacks and Hispanics have higher rates of chlamydia and gonorrhea than European Americans.

METHODS

With data collected in 2002 from 77 well defined communities in Chicago, we examined the association of ethnic/racial homogeneity of the communities and incidence of chlamydia and gonorrhea. The multivariate regression models controlled for other sociodemographic variables.

RESULTS

Communities where at least 60% of the residents were black had significantly higher incidence rates of these 2 STDs compared with communities where at least 60% of the residents were Hispanic. Independent of ethnic/racial homogeneity of the community, the incidence of these STDs was higher in communities that had a larger percentage of persons living in poverty, a larger percentage unemployed, fewer high school graduates, and more residents between the ages of 15 and 44.

CONCLUSION

The challenge for public health authorities is to consider policy options that respond not only to sexual risk behaviors, but also to the contextual attitudes, cultural traditions, and norms, and social circumstances in ethnically homogeneous communities that may affect the spread of STDs in disadvantaged urban populations.

Factors influencing physician referrals of patients to clinical trials

PURPOSE

Initial trials in the NIH Parkinson's disease (PD) network (NET-PD) included 91% Caucasian non-Latino patients, although PD is thought to be as common among African Americans and Latinos. Our purpose was to assess physicians' attitudes and beliefs about patient recruitment, particularly minorities, into clinical trials.

METHODS

We surveyed 200 physicians from areas near the NET-PD clinics with > or =40% African Americans or Latinos. Physicians were asked about attitudes toward research, likelihood of referring patients to PD trials and past research participation, and administered the Trust in Medical Researchers Scale (TIMRS). Using logistic regressions, we identified physician characteristics associated with patient referral to clinical trials.

RESULTS

The TIMRS was lower among African-American physicians and physicians with high proportions of minority patients. Likelihood of trial referral was associated with previous referral to trials (OR=4.24, 95% CI: 2.09-8.62) and higher TIMRS (OR=1.06, 95% CI: 1.001-1.12). TIMRS results were similar among physicians not previously referring to trials.

CONCLUSIONS

Study results emphasize the importance of developing a trusting relationship with local physicians if investigators expect these physicians to refer their patients to clinical trials. The trust-related barriers for minority-serving physicians, regardless of their own race/ethnicity, seem to mirror the trust-related issues for their minority patients.

Acculturation and familiarity with, attitudes towards and beliefs about genetic testing for cancer risk within Latinas in East Harlem, New York City

Recent research underscores the need for increasing use of genetic testing for cancer risk in Latinos. This study examined the influence of acculturation on attitudes, beliefs about and familiarity with genetic testing for cancer risk in a community-based sample of Latinas in East Harlem, New York City (N = 103). Multivariate linear regression models analyzed the relationship of acculturation to: (1) familiarity (2) perceived benefits (3) perceived barriers and (4) concerns about abuses of genetic testing for cancer risk. Controlling for sociodemographic factors, results revealed that with increasing acculturation Latinas were more familiar with genetic testing (beta = 1.62, SE = 0.72, p = 0.03), more likely to cite perceived benefits (beta = 1.67, SE = 0.79, p = 0.04), and less likely to report perceived barriers related to genetic testing (beta = -2.76, SE = 1.64, p = 0.10). Study results may help inform the development of culturally-appropriate health education outreach materials and programs targeted to increase awareness, knowledge and understanding about genetic testing for cancer risk within Latinas.

Oral squamous cell carcinoma incidence by subsite among diverse racial and ethnic populations in California

OBJECTIVE

The aim of this report was to examine the oral cancer incidence by sex, race/ethnicity, and anatomical subsite.

STUDY DESIGN

Data from the California Cancer Registry (CCR) were used to calculate the age-adjusted incidence rates of invasive oral squamous cell carcinoma (OSCC) by sex, race/ethnicity, and anatomical subsite among residents in California during 1988 to 2001.

RESULTS

Although non-Hispanic (NH) black men have the highest overall incidence rate for OSCC, NH whites and NH blacks have similar incidence patterns by subsite, but the male-to-female (M:F) rate ratio is higher among NH blacks. The OSCC incidence rates for Hispanics are much lower than those for NH whites and NH blacks and similar to those of Asians. The Asian ethnic groups display dramatic variations in terms of the subsite-specific incidence rates and M:F rate ratios.

CONCLUSION

The findings illustrate the heterogeneity and complexity of oral cancer by anatomical location and the importance of cultural habits and behavioral factors in the development of oral cancer.

Understanding and representing 'place' in health research: a relational approach

Epidemiology, sociology, and geography have been successful in re-establishing interest in the role of place in shaping health and health inequalities. However, some of the relevant empirical research has relied on rather conventional conceptions of space and place and focused on isolating the "independent" contribution of place-level and individual-level factors. This approach may have resulted in an underestimate of the contribution of 'place' to disease risk. In this paper we argue the case for extensive (quantitative) as well as intensive (qualitative) empirical, as well as theoretical, research on health variation that incorporates 'relational', views of space and place. Specifically, we argue that research in place and health should avoid the false dualism of context and composition by recognising that there is a mutually reinforcing and reciprocal relationship between people and place. We explore in the discussion how these theoretical perspectives are beginning to influence empirical research. We argue that these approaches to understanding how place relates to health are important in order to deliver effective, 'contextually sensitive' policy interventions.

Determinants of prostate cancer stage in northern New England: USA Franco-American contextual effects

Despite screening for prostate cancer, mortality in the United States remains substantial. In northern New England, we know little about either determinants of stage at diagnosis--an important predictor of survival--or health outcomes for Franco-Americans, the region's largest ethnic minority. The objective of this investigation was to identify predictors of late prostate cancer stage in a rural, predominantly white state with a large Franco-American population. The Maine Cancer Registry provided incident cases from 1995 to 1998. We modeled individual-level variables (age, sex, race, French ethnicity by surname, and payer) and contextual/town-level variables (socioeconomic measures, population density, Franco ancestry proportion, distance to health care, and weather severity) with multiple logistic regression for late stage. We found that age categories 50-64, 65-74, and 75-84 years--but not 40-49 years--(versus 85+) were protective for late stage, as was residence in higher snowfall areas. Diagnosis in the earlier years of the study, particularly for French-surnamed men, and residence in a high-Franco area conferred greater risk for late disease. However, in a two-way interaction, residence in towns with high Franco ancestry proportion protected French-surnamed men (OR=0.09, type 3 p<0.0593). Using an established framework for social network theory we explore the potential reasons for this interaction, including: high social cohesion, a wide range of strong ties of long duration, and frequent contact, which might have facilitated access to resources as well as social support and normative influences toward health care seeking. The absence of an association of cancer stage with socioeconomic variables may stem from the mixed sociodemographic profiles in rural and urban regions of Maine. We feel that further research should therefore refine these and other contextual measures to elucidate effects on preventable morbidity and mortality; expand our knowledge of Franco-American health outcomes and social networks; and evaluate the utility of assigning French ethnicity by surname.

Oral and pharyngeal cancer incidence and mortality among Hispanics, 1996-2002: the need for ethnoregional studies in cancer research

OBJECTIVES

We investigated whether oral cavity and pharyngeal cancer (OPC) incidence and mortality statistics among Hispanics in New York State differed from those among Hispanics in the United States as a whole.

METHODS

OPC incidence and mortality statistics for 1996-2002 were obtained from the New York State Cancer Registry and compared with national statistics released by the Surveillance, Epidemiology, and End Results (SEER) program for the same period.

RESULTS

Among Hispanic men, OPC incidence rates were approximately 75% and 89% higher in New York State and New York City, respectively, than national rates reported by the SEER program. No notable differences were identified among Hispanic women. Incidence rates among New York State Hispanic men were 16% higher than those of their non-Hispanic White counterparts. The difference was twice as high (32%) among Hispanic men in New York City. Mortality rates among both men and women exhibited patterns similar to the incidence patterns.

CONCLUSIONS

Ethnoregional differences exist in the incidence and mortality rates of OPC in the United States. New York State Hispanic men exhibit much higher incidence and mortality rates than US Hispanics as reported by the SEER program.

Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations

BACKGROUND

The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos.

METHODS

Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated.

RESULTS

The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages.

CONCLUSIONS

The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.