Title: Acculturation in Context
Description: Background: Compared to non-Latino whites, Latinos in the United States carry a disproportionate burden in mortality due to diabetes, chronic liver disease, and cirrhosis, and there is evidence that immigrants’ health behaviors and outcomes worsen as they become more acculturated. Additionally, the neighborhoods where Latinos live influence their health behaviors and outcomes through availability of retailers and products (such as fast food restaurants, liquor stores), density of advertising and advertisement language, and whether the neighborhood is an ethnic enclave. In this work, I examine the effects of acculturation and these built environment factors on diet, BMI, and alcohol use in Dominican Latinas, with a focus on the potential interaction between individual- and neighborhood-level variables. Methods: Dominican Latinas over 40 were recruited from target neighborhoods in northern Manhattan and western Bronx as part of a larger study, and invited to complete a survey (N=420). I used mapping software (ArcGIS) to merge this survey data with intensive street audit data collected near participants’ residences (N=229 street sides).

I supplemented the neighborhood audit with data from a reliable business database (ReferenceUSA). The analytical approach differed based on the structure of each hypothesized model. For moderated mediation models, I used a percentile bootstrap to obtain model estimates and confidence intervals at different percentiles of the moderator. For models without moderated mediation, I used OLS regression, logistic regression, or Poisson GLM, depending on the distribution of the outcome. Results: When analyzing diet and BMI outcomes, I found that negative influences in the built environment (such as fast food retailer density and processed food advertising in English and Spanish) were associated with higher BMI, but only in the least acculturated participants in the sample. There were no significant effects of positive influences in the built environment (such as fresh food retailers and fresh food advertisements) at any level of acculturation. For alcohol outcomes, less acculturated participants were less likely to report drinking, and this effect was strongest among those with greater alcohol retailer density near their residences.

Number of Latino owned businesses (a measure of whether an area is an ethnic enclave) was sometimes protective and other times detrimental, depending on participant acculturation and the specific outcome measured. Conclusions: There is evidence that less acculturated Latinas are more susceptible to negative influences of the built environment than their more acculturated counterparts, and have higher BMIs due to these contextual factors. However, lower acculturation may be protective for alcohol outcomes. The effects of ethnic enclave neighborhoods on health are complex and dependent on both individual-level acculturation and the specific outcome investigated. The findings in this work highlight the importance of considering individual and contextual factors concurrently when modeling health behaviors and outcomes in Latinos.