Background: Research on the "immigrant" or "Latino health paradox" has demonstrated that Latinos exhibit better health than U.S.-born whites, for multiple health outcomes, despite adjusting for socioeconomic status. However, little empirical research has focused on women and even less has focused on how the neighborhood residential environment is associated with these health differences, particularly in the area of diet. Methods: We analyzed baseline data from 641 low-income women, nested within 184 census tracts, enrolled in a nutrition intervention trial for postpartum women. Individual-level variables, including race/ethnicity, nativity, duration of time in the United States, language acculturation, emotional and instrumental support, and socioeconomic position, were merged with tract-level variables from U.S. Census data (2000) based on residential address. We assessed daily fruit and vegetable servings through a semiquantitative food frequency questionnaire. Using MLWin 2.0 software, we employed a 2-level linear regression model to ascertain associations of neighborhood immigrant, racial, and socioeconomic composition with individual diet, adjusting for individual-level sociodemographic characteristics. Results: In our fully adjusted model, we observed a statistically significant increase of 1/3 of fruit and vegetable daily servings for each 10-percentage point increase in the tract foreign-born population. Each 10-percentage point increase in the tract Black population was associated with a significant 1/5 serving decrease in individual daily fruit and vegetable intake. Conclusions: Among this population of U.S. and foreign-born women, neighborhood composition was associated with individual diet, above and beyond individual-level characteristics, illuminating neighborhood context, immigrant health, and diet.
Bibliographical noteFunding Information:
We acknowledge and thank Pamela Waterman, Amy Sapp, and Sidney Atwood for their help and expertise with ArcView GIS, census data, and data organization and merging. The authors acknowledge the following funding sources, which made this research possible: Ruth L. Kirschstein National Research Service Award (NRSA) F31- NS046161-02 Pre-doctoral Fellowship (T.D.); Vitamin Settlement Grant, State of Massachusetts (Peterson, PI); Reducing Disease Risk in Low-income, Postpartum Women 1 R01 HD37368-01 (NICHD) (Peterson, PI) (K.P.); Center for Minority Health, University of Pittsburgh Graduate School of Public Health and Project Export, 5P60 MD-000-207-04 (NCMHD) (T.D.). S. V. Subramanian is supported by the National Institutes of Health Career Development Award (National Institute Heart Lung and Blood Institute, 1 K25 HL081275).