Efforts to explain the excess burden of hypertension among blacks emphasizes genetics, health behaviors (i.e. diet, smoking, physical inactivity), access to care, and socioeconomic position (SEP). Although these factors may contribute to one's risk of hypertension, they do not fully account for the elevated risk observed among blacks. Increasingly, studies have demonstrated that modifiable risk factors and SEP may be patterned by features of the neighborhood environment such as neighborhood poverty. Few studies investigating neighborhood context have related these characteristics to broader social processes and spatial inequalities such as racial and ethnic residential segregation that may influence hypertension among blacks. Further, studies exploring the relationship between residential segregation and hypertension outcomes have been sparse. Thus, this dissertation examines the relationship between residential segregation and self-reported hypertension among blacks in New York City. To accomplish this goal, the dissertation: (1) reviews the existing empirical research investigating residential segregation and its contribution to health and provides a methodological assessment of the research; (2) assesses the magnitude of the association between residential segregation and self-reported hypertension among blacks; and (3) investigates the mediating pathways between residential segregation and self-reported hypertension. Individual-level data obtained from the New York City Community Health Survey and data about perceptions of the neighborhood environment obtained from the New York City Social Indicator Survey were linked to 2000 US Census data. The Census data was used to define two constructs of racial and ethnic residential segregation a formal (Wong's local index) and a proxy measure (racial composition). Prevalence odds ratios were estimated using a multilevel logistic model for both constructs of residential segregation, controlling for individual-level confounders, area-level poverty, and hypothesized mediators.
The empirical research examining the association between residential segregation and health risk and disparities was reviewed. A comprehensive search of several databases yielded 39 articles. In general, most studies found an association between residential segregation and poor health; however, there was some evidence to support a protective association between segregation and health. Additionally, a methodological assessment of the literature addressed issues related to the variation in the conceptualization and operationalization of residential segregation.
The second paper examined the relationship between residential segregation and self-reported hypertension. It was hypothesized that high levels of residential segregation would be independently and positively associated with self-reported hypertension before and after adjusting for individual-level characteristics and area-level poverty. In the fully adjusted model, there was no evidence in support of an association between self-reported hypertension and either measure of residential segregation. However, a statistical interaction was observed between residential segregation and nativity status (p=0.0431). Foreign-born blacks residing in highly segregated neighborhoods had a lower odds of reporting hypertension (aOR: 0.86; 95% Cl: 0.75, 0.99) compared to their counterparts residing in less segregated areas.
The third paper investigated mediating pathways between residential segregation and self-reported hypertension. It was hypothesized that smoking and weight status would partially mediate the association between residential segregation and self-reported hypertension after accounting for individual-level factors and area-level poverty. Neighborhood social environment factors (i.e. perception of neighborhood quality, safety, violence, trust, and local municipal services), were also hypothesized to mediate the relationship between residential segregation and self-reported hypertension. Evidence for mediation was only observed among foreign-born blacks. Specifically, perceptions of neighborhood quality and neighborhood safety explained the relationship between residential segregation and self-reported hypertension.
The overall findings from the dissertation suggests: (1) there are several methodological and analytic issues that should be considered when examining residential segregation and health outcomes; (2) the differential effect of residential segregation by nativity status should be further explored; (3) intermediary pathways between residential segregation and health outcomes at the individual- and neighborhood-level should be examined further; and (4) the contribution of social support and supportive networks in compensating for neighborhood material disadvantage in segregated areas merits closer attention.
|Advisor:||Borrell, Luisa N.|
|School Location:||United States -- New York|
|Source:||DAI-B 69/10, Dissertation Abstracts International|
|Subjects:||Black studies, Public health, Epidemiology|
|Keywords:||Hypertension, Neighborhood effects, Residential segregation|
Copyright in each Dissertation and Thesis is retained by the author. All Rights Reserved
The supplemental file or files you are about to download were provided to ProQuest by the author as part of a
dissertation or thesis. The supplemental files are provided "AS IS" without warranty. ProQuest is not responsible for the
content, format or impact on the supplemental file(s) on our system. in some cases, the file type may be unknown or
may be a .exe file. We recommend caution as you open such files.
Copyright of the original materials contained in the supplemental file is retained by the author and your access to the
supplemental files is subject to the ProQuest Terms and Conditions of use.
Depending on the size of the file(s) you are downloading, the system may take some time to download them. Please be