Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health

Williams, David R.; Collins, Chiquita

doi:10.1093/phr/116.5.404

Cited by 1,336 publications

(1,071 citation statements)

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“…26 A few health studies, however, have paid attention to the influence of this pervasive form of social stratification. 29,31 We found no studies that examined the influence of segregation on smoking in any population.…”

Section: Introductionmentioning

confidence: 98%

“…Segregation-defined as the spatial separation of one group from another on the basis of race/ethnicity 26,27 -is considered a fundamental cause of the concentrated poverty and health inequalities experienced by African Americans in the US. [28][29][30] While segregation has declined over the last few decades, African Americans remain the most segregated racial/ ethnic minority in the US, and most live in urban areas with high segregation. 26 A few health studies, however, have paid attention to the influence of this pervasive form of social stratification.…”

Section: Introductionmentioning

confidence: 99%

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Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

et al. 2007

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Approximately 10% of African-American women smoke during pregnancy compared to 16% of White women. While relatively low, the prevalence of smoking during pregnancy among African-American women exceeds the Healthy People 2010 goal of 1%. In the current study, we address gaps in extant research by focusing on associations between racial/ethnic residential segregation and smoking during pregnancy among urban African-American women. We linked measures of segregation to birth certificates and data from the 2000 census in a sample of US-born AfricanAmerican women (n=403,842) living in 216 large US Metropolitan Statistical Areas (MSAs). Logistic regression models with standard errors adjusted for multiple individual observations within MSAs were used to examine associations between segregation and smoking during pregnancy and to control for important sociodemographic confounders. In all models, a u-shaped relationship was observed. Both low segregation and high segregation were associated with higher odds of smoking during pregnancy when compared to moderate segregation. We speculate that low segregation reflects a contagion process, whereby salutary minority group norms are weakened by exposure to the more harmful behavioral norms of the majority population. High segregation may reflect structural attributes associated with smoking such as less stringent tobacco control policies, exposure to urban stressors, targeted marketing of tobacco products, or limited access to treatment for tobacco dependence. A better understanding of both deleterious and protective contextual influences on smoking during pregnancy could help to inform interventions designed to meet Healthy People 2010 target goals.

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

et al. 2007

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“…Further, because non-white and non-native populations tend to be more economically disadvantaged, the growing heterogeneity among Black Americans may introduce additional dimensions of stratification within this group (Hernandez, 2004). Although Caribbean immigrants may have an initial health advantage as new arrivals, with longer residency they are exposed to discrimination and other stressful life events that erode their physical and mental health (Feagin & McKinney, 2003;Kreiger, 2000;Williams, 2001). …”

Section: Introductionmentioning

confidence: 99%

Profiles of depressive symptoms among African Americans and Caribbean Blacks

Lincoln

Chatters

Taylor

et al. 2007

Social Science & Medicine

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Latent profile analysis was used to summarize profiles of depressive symptoms among a nationally representative sample of U.S.-born and Caribbean-born Blacks. Analyses are based on the responses of 4,915 African Americans and Caribbean Blacks from the National Survey of American Life. A high symptoms and a low symptoms class were identified. Age, gender, negative social interaction within the individual's social network (e.g., conflict demands, criticism) and racial discrimination were associated with depressive symptoms in the low symptoms class, whereas socioeconomic status, gender, emotional support and negative interaction were associated with depressive symptoms in the high symptoms class. The findings demonstrate the heterogeneity within the Black population in the USA and the distinct sociodemographic, family network and stress correlates of depressive symptoms for each latent class.

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“…1,2 As health care systems are asked to address the social and environmental factors influencing their patients, a better understanding of the relationship between different social determinants of health and outcomes is necessary. In this issue of JGIM, Nelson et al examine the association between neighborhood socioeconomic status (NSES) and all-cause mortality in a national sample of veterans.…”

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confidence: 99%

Advancing the Understanding of Social Determinants of Health Through Geospatial Analysis

2016

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S ocial determinants of health, such as neighborhood characteristics and residential segregation, are increasingly recognized as factors significantly influencing health outcomes and contributing to inequities in health. 1,2 As health care systems are asked to address the social and environmental factors influencing their patients, a better understanding of the relationship between different social determinants of health and outcomes is necessary. In this issue of JGIM, Nelson et al. examine the association between neighborhood socioeconomic status (NSES) and all-cause mortality in a national sample of veterans. 3 Using Veteran Health Administration (VHA) data on individual veteran characteristics and US Census Bureau data on census tract characterized NSES, Nelson et al. found those in the lowest (poorest) decile were 10% more likely to die than those living in the highest (wealthiest) decile, after adjustment for socio-demographics, individual income, and comorbidities. 3 The authors should be commended for their analysis incorporating available spatial information and a national sample of veterans, addressing limitations of prior studies by using a population with racial/ethnic and income diversity and simultaneously adjusting for individual comorbidities and socioeconomic factors. 3 Results from Nelson et al.'s study provide further evidence for inclusion of social determinants of health in decisions influencing provision of high-quality health care, such as risk adjustment and resource allocation. Additionally, it serves as an example of the increasing role spatial data analysis is playing in health services research and in understanding the role of social determinants. A wide variety of spatial analysis models and analytic frameworks are available to provide information about community needs and barriers to care and to provide guidance to policy makers as they consider how to allocate resources in the most cost-effective manner. 4 Although Nelson et al. obtain global estimates of the association between NSES and mortality while accounting for within-county correlation, the spatial random effect is used chiefly as a mechanism to account for this association. A natural extension of this work, expanding further into the field of spatial analysis, would be to examine spatial patterns in mortality across the study region after establishing a global effect of NSES. In fact, it might be of particular interest to explore whether the effect of NSES on mortality itself varies across space, through the inclusion of spatially varying regression coefficients for NSES, allowing investigators to identify areas where NSES has the most profound impact on mortality. 5 We anticipate that spatial statistical methods will play an increasingly important role in the design and implementation of community-based efforts to improve access to care while reducing health costs. As seen in the paper by Nelson et al., the VA is well suited to conduct work using spatial analysis. As the largest managed care provider in the US, the VA has...

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Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health

Cited by 1,336 publications

References 64 publications

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Associations Between Residential Segregation and Smoking During Pregnancy Among Urban African-American Women

Profiles of depressive symptoms among African Americans and Caribbean Blacks

Advancing the Understanding of Social Determinants of Health Through Geospatial Analysis

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