Neighbourhoods and homicide mortality: an analysis of race/ethnic differences.

OBJECTIVE: To examine whether measures of neighbourhood economic deprivation, social disorganisation, and acculturation explain homicide mortality differentials between Mexican Americans, non-Hispanic black Americans, and non-Hispanic white Americans, net of individual factors. DESIGN: Prospective study, National Health Interview Survey (1986-1994) linked to subsequent mortality in the National Death Index (1986-1997). SETTING: United States of America. PARTICIPANTS: A nationally representative sample of non-institutionalised Mexican Americans, non-Hispanic black Americans, and non-Hispanic white Americans, aged 18-50 at the point of interview. ANALYSIS: Cox proportional hazard models estimate the risk of death associated with various neighbourhood and individual factors. MAIN RESULTS: Both individual and neighbourhood risk factors partially account for race/ethnic disparities in homicide. Homicide mortality risks are between 20% and 50% higher for residents of areas that have economic inequality of 0.50 or greater based on the coefficient of variation, or where 4% or more of the residents are Mexican American, 10% or more of the residents are non-Hispanic black, or 20% or more of the households are headed by single parents (p< or = 0.05). But residents of areas where 10% or more of their neighbours are foreign born have 35% lower mortality risks than people living in areas with fewer foreign born people (p< or =0.05). These differences persist even after controlling for individual level risk factors. CONCLUSIONS: The findings support economic deprivation, social disorganisation, and acculturation theories, and suggest that both neighbourhood and individual risk factors affect race/ethnic differences in homicide mortality. Public health policies must focus on both individual and neighbourhood factors to reduce homicide risks in vulnerable populations.

Prenatal care utilization among non-Hispanic Whites, African Americans, and Mexican Americans.

OBJECTIVES: The general objective of this study is to explain differentials in prenatal care (PNC) utilization in a nationally representative sample of non-Hispanic White (Anglo), African American, and Mexican American women. METHOD: The analysis is based on the National Maternal and Infant Health Survey. Multivariate, multinomial logistic regression models were employed to adjust for demographic, socioeconomic, medical risk, and program participation factors, as well as for perceived barriers. Both race/ethnic-specific models and models with race/ethnicity as a covariate were estimated. RESULTS: Inadequate PNC use was much less common among Anglos (10.4%) as compared to African Americans and Mexican Americans (22.1% and 25.0%, respectively). In fully adjusted models, the odds ratio (OR) of African Americans receiving inadequate PNC was 1.46, while the risk for Mexican Americans was greater (OR = 1.93). Perception of obstacles to PNC access doubled the odds of receiving inadequate care, but this psychosocial variable had little impact on race/ethnic differentials. Race/ethnic-specific models uncovered potentially important racial/ethnic variations associated with perception of barriers, marital status, and program participation. CONCLUSIONS: Although the same risk factors sometimes have different effects across race/ethnic groups, and while certain findings indicate a beneficial impact of health outreach efforts and program participation, our findings support the conclusion that PNC utilization continues to be stratified along race/ethnic lines.

Acculturation and breast-feeding intention and practice in Hispanic women on the US-Mexico border.

OBJECTIVES: To explore the extent to which acculturation indicators predict both breast-feeding history and intentions among Mexican-American mothers having their first births, and among those having subsequent births. DESIGN: Cross-sectional survey in a hospital post-partum unit. METHODS: 3,036 Hispanic women were interviewed post-partum in their hospital room. A survey was administered in English or Spanish, and included questions about prenatal care, diet, work exposures, contraceptive use, and breast-feeding history and intentions. For the purposes of this study, acculturation was measured using a series of indicators including language spoken at home, language ability, country of birth, and country in which last schooling was received. RESULTS: Previous breast-feeding was significantly associated with educational attainment, speaking both English and Spanish at home, having had prenatal care during the previous pregnancy, and with both country variables (country of birth and country where finished school). Women with less education, women who were single, and women who did not receive any prenatal care were less likely to intend to breast-feed than were women with a college education, women with a partner, and women who received any prenatal care. Women born in Mexico (for multiparous women), or having finished school in Mexico (for primiparous women), were more likely to intend to breast-feed. CONCLUSIONS: Acculturation is associated with breast-feeding history and intention to breast-feed. Acculturation is a complex construct and traditional measures of acculturation based on language preference may not be as useful on the US-Mexico border. It is recommended that further study be conducted to determine what factors prevent women from breast-feeding, even though they intend to do so, especially in multi-cultural communities like those around the US-Mexico border.

Immigration and the health of Asian and Pacific Islander adults in the United States.

The authors used the 1992-1995 National Health Interview Survey to examine the effect of immigrant status (both nativity and duration of residence in the United States) on the health of Asian and Pacific Islander adults by constructing models in which national origin was also specified. In logistic regression models adjusted for age, marital status, living arrangement, family size, and several socioeconomic indicators, immigrants were found to be in better health than their US-born counterparts, but their health advantages consistently decreased with duration of residence. For example, for Asian and Pacific Islander immigrants whose duration of residence was less than 5 years, 5-9 years, and 10 years or more, the odds ratios for activity limitations were 0.45 (95% confidence interval (CI): 0.33, 0.62), 0.65 (95% CI: 0.46, 0.93), and 0.73 (95% CI: 0.60, 0.90), respectively. Similar findings emerged for respondent-reported health and bed days due to illness. These results support the validity and complementarity of the migration selectivity and acculturation hypotheses. However, the picture was not uniformly positive. The health of certain Asian and Pacific Islander groups, notably Pacific Islanders and Vietnamese, was found to be less favorable than average. Finally, after adjustment for health status, immigrants seemed to have less adequate access to formal medical care.

Disability status differentials across fifteen Asian and Pacific Islander groups and the effect of nativity and duration of residence in the U.S.

This study examines disparities in disability status across 15 Asian and Pacific Islander American (API) subpopulations and how nativity and duration in the U.S. influence these differences. Employing three disability questions (work limitations, mobility limitations, and self-care limitations) from the 1990 PUMS, the authors find substantial heterogeneity in disability status across API subgroups: while Japanese American adults have the most favorable outcomes, Other Southeast Asian adults (Laotians, Hmong, and Cambodians), followed by Vietnamese and Pacific Islander adults, suffer from a high risk of disabilities. Many of the disparities in disability status across API subpopulation adults are attributable to differentials in demographic characteristics and SES. The inclusion of an interaction term of age and nativity/duration of residence in the U.S. in multivariate regression analyses demonstrates that the effect of nativity/duration plays a different role across age, net of demographic, and SES risk factors. The overall findings are also consistent with previous studies on the relationship between immigrant health and nativity/duration. That is, immigrants with short duration in the U.S. have superior health status, measured by risk of disability, than longer-term immigrants and their U.S.-born counterparts.

Racial/ethnic disparities in infant mortality: the role of behavioral factors.

Using the National Maternal and Infant Health Survey 1988 (NMIHS), a nationally representative sample of mothers, we investigate the role of behavioral factors in explaining racial/ethnic disparities in infant mortality. In particular, we focus on the following variables: weight gain during pregnancy, prenatal care utilization, exercise, vitamin use, and substance use during pregnancy. These analyses are conducted by modeling both time of death (neonatal vs. postneonatal) and cause of death (infections, perinatal complications, delivery complications, congenital malformations, SIDS, other causes) outcomes. Our results suggest that behavioral factors are partially responsible for observed race/ethnic differentials in infant mortality, but are not as important as sociostructural determinants such as SES.

Religious involvement and U.S. adult mortality.

We use recently released, nationally representative data from the National Health Interview Survey-Multiple Cause of Death linked file to model the association of religious attendance and sociodemographic, health, and behavioral correlates with overall and cause-specific mortality. Religious attendance is associated with U.S. adult mortality in a graded fashion: People who never attend exhibit 1.87 times the risk of death in the follow-up period compared with people who attend more than once a week. This translates into a seven-year difference in life expectancy at age 20 between those who never attend and those who attend more than once a week. Health selectivity is responsible for a portion of the religious attendance effect: People who do not attend church or religious services are also more likely to be unhealthy and, consequently, to die. However, religious attendance also works through increased social ties and behavioral factors to decrease the risks of death. And although the magnitude of the association between religious attendance and mortality varies by cause of death, the direction of the association is consistent across causes.

Birth outcome, not pregnancy process: reply to van der Veen.

In a recent article (Frisbie, Forbes, and Pullum 1996) we documented racial/ethnic differences in birth outcomes according to a more fine-grained classification than has typically been employed in the demographic literature. In his commentary, van der Veen focuses on the measurement of one of the dimensions of that classification, maturity of the infant, as proxied by the fetal growth ratio. The crux of the critique is easily seen in van der Veen's statement that "all of my disagreements with Frisbie et al.'s method arise from their particular use of a postnatal standard for the assessment of intrauterine growth." Our critic misunderstands our objective: He fails to realize our interest in birth outcome, not pregnancy process, and does not perceive that our intent was to extend the research extant in both the demographic and public-health literatures in which patently postnatal (i.e., ex utero) measures are taken as outcomes interesting in their own right and/or as risk factors for infant mortality and infant and childhood morbidity. Specifically, he does recognize that we purposefully expanded our focus to include moderately compromised births to determine if they were at higher risk than the normal births with whom they are conventionally categorized. Our discussion draws on research cited in the original article, on studies cited by our critic, and on a few more recent investigations. Although we have never argued that ours is the only, or even the best approach in all cases, we try to clarify the rationale for, and adduce additional empirical evidence of, the utility of the method we used.

Impact of future cigarette smoking scenarios on mortality of the adult population in the United States, 2000-2050.

The prevalence of cigarette smoking in the United States has declined over the past few decades. However, some leveling-off in prevalence rates has been observed in recent years, and the rate for teenagers and young adults has even turned upward. This paper considers four alternative scenarios of future cigarette smoking patterns in the United States for the population 25 and over and measures the impact these different scenarios would have on excess mortality due to smoking and on the sex and age distributions of deaths. Scenarios reflecting higher levels of smoking prevalence produce considerably more deaths than scenarios tied to lower levels. As many as two and one-half million excess deaths would take place in the decade of the 2020's if a high prevalence, rather than low prevalence, assumption proves correct. Even when a constant prevalence, assumption proves correct. Even when a constant prevalence assumption is compared with a moderately-declining prevalence assumption, as many as one million excess deaths would be generated during that decade alone. Lowering smoking prevalence rates would also change the population sex ratio by reducing deaths for males more than deaths for females, and by contributing to the aging of the population. The results are interpreted in terms of the overall impact of smoking on mortality and with regard to public and private policy decisions related to cigarette smoking.

Demographic and socioeconomic links to cigarette smoking.

This paper illuminates the demographic and socioeconomic factors associated with smoking statuses. It employs the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement and logistic regression to examine the covariates of smoking status among the U.S. adult population. Polychotomous logistic regression, which provides an alternate way to examine smoking practices, simultaneously considers multiple variables and their interactions, controls for other important covariates, produces predicted values and patterns, and allows multiple comparisons. By examining interactions, we have found that age displays distinct, often curvilinear, patterns with smoking; that compared to females, males have higher rates of cigarette consumption except at the youngest ages; that Anglos, especially Anglo males, exhibit high probabilities of cigarette consumption but also high probabilities of being former smokers; that Black males exhibit high probabilities of light smoking, but only at the older ages, and that they also exhibit high probabilities of being former light smokers; and that Mexican-American females are the least likely to currently smoke or to have ever smoked. By clearly elucidating the demographic and socioeconomic variations in smoking, arguably the most salient marker of health behavior, we can better target programs and policies geared toward the reduction of smoking-related diseases and deaths.

Infant mortality by cause of death: main and interaction effects.

We examine infant mortality among the 1980-1982 live birth cohorts in the state of Florida, specific to five categories of underlying cause of death: infections, perinatal conditions, delivery complications, congenital malformations, and sudden infant death syndrome. The gross and net effects of eight categorical and continuous independent variables, along with 11 first-order interactions, are examined with microlevel data through the use of multinomial logit regression. Findings suggest the complexity of variable effects by cause of death and indicate the simultaneous importance of biological and social factors. It is important that the pattern of interactions suggests an overall dependence of infant life chances on social circumstances. It also suggests that these effects are attenuated for some variables and causes of death at lower birth weights, probably due to advances in health care organization, access, and technology.