Enclave Status Research Articles

Abstract IA039: Individual, cultural, and area-based factors associated with survivorship care among Asian American childhood cancer survivors

Abstract With treatment advances for childhood cancer, over 80% of patients achieve long-term survival. However, cancer treatments often lead to serious issues, including chronic health problems and early mortality. As a result, life-long cancer-focused long-term follow-up care (LTFU) is essential for childhood cancer survivors (CCS) to screen for, prevent, and treat late effects. Among Asian Americans, who represent the fastest growing ethnic group and the largest group of new immigrants in the United States, rates of LTFU and factors influencing cancer-focused care among CCS are unknown. To address this research gap, we are currently recruiting a population-based cohort of roughly 330 young adult Asian American CCS and their parents in Los Angeles and Orange Counties, California, to examine individual, cultural, and area-level factors (e.g., impacts of residence in an ethnically concentrated neighborhood or “ethnic enclave”) related to survivorship care utilization. Our preliminary data from the Project Forward cohort, a cancer registry–derived, population-based study of risk and protective factors of cancer-related follow-up care among young adult CCS Indicated lower rates of LTFU among Asian American (versus other racial and ethnic groups) and was lowest for non-US-born Asian American CCS (45.8% compared to 62% non-Latino white). To better understand the potential role of neighborhood level enclave in LTFU, we examined all cancer cases of Asian race/ethnicity ages 18-39, living in Los Angeles or Orange County, California, diagnosed while under age 21 in the years 1991-2018 (N=743). Focusing on the most common subgroups (Chinese, Korean, Vietnamese, and Filipino), we were able to identify distinct clusters of residential enclave neighborhoods for each subgroup. We then linked cases via their census tract of residence to American Community Survey data to examine factors associated with LTFU among CCS. For all Asian subgroups, the proportion of non-US born individuals was higher inside the enclave than outside, as was the proportion of individuals reporting they speak English “less than very well.” In addition, the direction of the differences varied in potential LTFU-related factors by enclave status and Asian subgroup: for example, Koreans residing inside a Korean enclave were more likely to have access to a vehicle while Filipinos living inside Filipino enclaves were more likely to not have vehicle access (in both cases, versus those residing outside enclaves). Thus, factors related to enclave residence may have unique positive and negative associations with LTFU. Overall, understanding the dynamics of individual, cultural, and enclave-related factors will help identify methods to increase culturally congruent outreach and intervention strategies to promote LTFU for Asian American CCS. Citation Format: Kimberly A. Miller. Individual, cultural, and area-based factors associated with survivorship care among Asian American childhood cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA039.

Asian American/Pacific Islander and Hispanic Ethnic Enclaves, Neighborhood Socioeconomic Status, and Hepatocellular Carcinoma Incidence in California: An Update.

Using more recent cancer registry data, we analyzed disparities in hepatocellular carcinoma (HCC) incidence by ethnic enclave and neighborhood socioeconomic status (nSES) among Asian American/Pacific Islander (AAPI) and Hispanic populations in California. Primary, invasive HCC cases were identified from the California Cancer Registry during 1988-1992, 1998-2002, and 2008-2012. Age-adjusted incidence rates (per 100,000 population), incidence rate ratios, and corresponding 95% confidence intervals were calculated for AAPI or Hispanic enclave, nSES, and the joint effects of ethnic enclave and nSES by time period (and the combination of the three periods), sex, and race/ethnicity. In the combined time period, HCC risk increased 25% for highest versus lowest quintile of AAPI enclave among AAPI males. HCC risk increased 22% and 56% for lowest versus highest quintile of nSES among AAPI females and males, respectively. In joint analysis, AAPI males living in low nSES areas irrespective of enclave status were at 17% to 43% increased HCC risk compared with AAPI males living in areas of nonenclave/high nSES. HCC risk increased by 22% for Hispanic females living in areas of low nSES irrespective of enclave status and by 19% for Hispanic males living in areas of nonenclave/low nSES compared with their counterparts living in areas of nonenclave/high nSES. We found significant variation in HCC incidence by ethnic enclave and nSES among AAPI and Hispanic populations in California by sex and time period. Future studies should explore how specific attributes of enclaves and nSES impact HCC risk for AAPI and Hispanic populations.

Abstract C053: Testicular cancer in Hispanics: Incidence of subtypes over time according to neighborhood sociodemographic factors in California

Abstract Background: Hispanic men in the U.S. experience the second-highest incidence rate of testicular cancer, behind non-Hispanic (NH) White men. Incidence of testicular cancer is increasing in the U.S., despite reports of a plateau during the 1990’s, and increases are especially steep in the Hispanic population. To date, the literature does not address whether the incidence of testicular cancer or the observed increases in incidence differ according to neighborhood factors. Purpose: We examined incidence rates and changes in incidence over time for testicular cancer histologic subtypes (i.e., seminoma and nonseminoma) according to neighborhood socioeconomic status (nSES) among Hispanic and, for comparison, NH White men, and according to neighborhood ethnic enclave among Hispanic men, using California Cancer Registry Data. Methods: We conducted a population-based study of 12,228 Hispanic and NH White men diagnosed with testicular cancer in California during three pericensal periods 1988-1992, 1998-2002, and 2008-2012. We calculated incidence rates according to nSES and, among Hispanics, according to ethnic enclave. Incidence rate ratios were calculated to compare incidence rates across nSES and ethnic enclave and to examine changes in incidence rates over time. Results: Hispanic men residing in high SES neighborhoods, compared to low SES neighborhoods, had greater incidence of both seminoma and nonseminoma testicular cancer across pericensal periods (2008-2012, high to low nSES, seminoma IRR, 1.67; 95% CI, 1.38-2.02 and nonseminoma IRR, 1.22; 95% CI, 1.00-1.48). Hispanic men residing in low ethnic enclave neighborhoods also had higher incidence of both seminoma and nonseminoma across pericensal periods. Between the periods 1998-2002 and 2008-2012, Hispanic men residing in low SES neighborhoods experienced increased incidence of seminoma (IRR, 2008-2012 compared to 1998-2002, 1.39; 95% CI, 1.17-1.65) while those residing in both low and middle SES neighborhood experienced increased incidence of nonseminoma (IRR, 2008-2012 compared to 1998-2002 for low nSES, 1.87; 95% CI, 1.57-2.20 and for middle nSES, 1.48; 95% CI, 1.21-1.79). Conclusions: While Hispanic men residing in neighborhoods with higher SES and lower enclave status have greater incidence of both seminoma and nonseminoma testicular cancer, recent increases in incidence are driven by Hispanic men residing in lower SES neighborhoods, particularly for the nonseminoma histologic subtype. Citation Format: Mindy C DeRouen, Meg McKinley, Sumit A Shah, Hala T Borno, Rhonda Aoki, Daphne Y Lichtensztajn, John T Leppert, James D Brooks, Benjamin Chung, Scarlett L Gomez, Iona Cheng. Testicular cancer in Hispanics: Incidence of subtypes over time according to neighborhood sociodemographic factors in California [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C053.

Nativity, ethnic enclave residence, and breast cancer survival among Latinas: Variations between California and Texas.

Among Latinas with breast cancer, residence in an ethnic enclave may be associated with survival. However, findings from prior studies are inconsistent. The authors conducted parallel analyses of California and Texas cancer registry data for adult (aged ≥18years) Latinas who were diagnosed with invasive breast cancer from 1996 to 2005, with follow-up through 2014. Existing indices applied to tract-level 2000 US Census data were used to measure Latinx enclaves and neighborhood socioeconomic status (nSES). Multivariable Cox proportional hazard models were fit for all-cause and breast cancer-specific survival adjusted for year of diagnosis, patient age, nativity (with multiple imputation), tumor stage, histology, grade, size, and clustering by census tract. Among 38,858 Latinas, the majority (61.3% in California and 70.5% in Texas) lived in enclaves. In fully adjusted models for both states, foreign-born women were found to be more likely to die of breast cancer and all causes when compared with US-born women. Living in enclaves and in neighborhoods with higher SES were found to be independently associated with improved survival from both causes. When combined into a 4-level variable, those in low nSES nonenclaves had worse survival for both causes compared with those living in low nSES enclaves and, in the all-cause but not breast cancer-specific models, those in high nSES neighborhoods, regardless of enclave status, had improved survival from all causes. Applying the same methods across 2 states eliminated previously published inconsistent associations between enclave residence and breast cancer survival. Future studies should identify specific protective effects of enclave residence to inform interventions.

Disparities in hepatocellular carcinoma incidence by race/ethnicity and geographic area in California: Implications for prevention.

The incidence of hepatocellular carcinoma (HCC) has been rising rapidly in the United States. California is an ethnically diverse state with the largest number of incident HCC cases in the country. Characterizing HCC disparities in California may inform priorities for HCC prevention. By using data from the Surveillance, Epidemiology, and End Results 18-Registry Database and the California Cancer Registry, age-adjusted HCC incidence in California from 2009 through 2013 was calculated by race/ethnicity and neighborhood ethnic enclave status. A geographic analysis was conducted using Medical Service Study Areas (MSSAs) as the geographic unit, and race/ethnicity-specific standardized incidence ratios (SIRs) were calculated to identify MSSAs with higher-than-expected HCC incidence compared with the statewide average. During 2009 through 2013, the age-adjusted incidence of HCC in California was the highest in Asians/Pacific Islanders (APIs) and Hispanics (>100% higher than whites), especially those living in more ethnic neighborhoods (20%-30% higher than less ethnic neighborhoods). Of the 542 MSSAs statewide, 42 had elevated HCC incidence (SIR ≥ 1.5; lower bound of 95% confidence interval > 1) for whites, 14 for blacks, 24 for APIs, and 36 for Hispanics. These MSSAs have 24% to 52% higher proportions of individuals below the 100% federal poverty line than other MSSAs. APIs and Hispanics residing in more ethnic neighborhoods and individuals residing in lower income neighborhoods require more extensive preventive efforts tailored toward their unique risk factor profiles. The current race/ethnicity-specific geographic analysis can be extended to other states to inform priorities for HCC targeted prevention at the subcounty level, eventually reducing HCC burden in the country.

Incidence of lung cancer histologic cell-types according to neighborhood factors: A population based study in California.

BackgroundThe relationships between neighborhood factors (i.e., neighborhood socioeconomic status (nSES) and ethnic enclave) and histologic subtypes of lung cancer for racial/ethnic groups, particularly Hispanics and Asian American/Pacific Islanders (AAPIs), are poorly understood.MethodsWe conducted a population-based study of 75,631 Californians diagnosed with lung cancer from 2008 through2012. We report incidence rate ratios (IRRs) for lung cancer histologic cell-types by nSES among racial/ethnic groups (non-Hispanic (NH) Whites, NH Blacks, Hispanics and AAPIs) and according to Hispanic or Asian neighborhood ethnic enclave status among Hispanics and AAPIs, respectively. In addition, we examined incidence jointly by nSES and ethnic enclave.ResultsPatterns of lung cancer incidence by nSES and ethnic enclave differed across race/ethnicity, sex, and histologic cell-type. For adenocarcinoma, Hispanic males and females, residing in both low nSES and high nSES neighborhoods that were low enclave, had higher incidence rates compared to those residing in low nSES, high enclave neighborhoods; males (IRR, 1.17 [95% CI, 1.04–1.32] and IRR, 1.15 [95% CI, 1.02–1.29], respectively) and females (IRR, 1.29 [95% CI, 1.15–1.44] and IRR, 1.51 [95% CI, 1.36–1.67], respectively). However, AAPI males residing in both low and high SES neighborhoods that were also low enclave had lower adenocarcinoma incidence.ConclusionsNeighborhood factors differentially influence the incidence of lung cancer histologic cell-types with heterogeneity in these associations by race/ethnicity and sex. For Hispanic males and females and AAPI males, neighborhood ethnic enclave status is strongly associated with lung adenocarcinoma incidence.

The formation and remarkable persistence of the Oecusse-Ambeno enclave, Timor

The Oecusse-Ambeno enclave of Timor has persisted as a geographically distinct zone under Portuguese governance for over three centuries, enduring repeated efforts to undo its enclave status. This article analyses the confluence of economic, religious, and political elements that brought and kept Oecusse within Portuguese rule on Timor. Strong local authorities controlled trade linkages, maintained political and military ties with colonial rule, and wove Catholicism into existing customary practices and hierarchies, forging a strong regional identity that fostered sustained alliance with the Portuguese. Finally, the article discusses the impacts of Oecusse's enclave status over the past century.

Abstract B26: Individual- and neighborhood-level immigration factors and breast cancer risk among Latinas in the San Francisco Bay Area: The Neighborhoods and Breast Cancer (NABC) Study

Abstract Among U.S. Latinas, breast cancer risk is lower among foreign-born than U.S.-born women; however, after adjustment for known risk factors, the association remained in post-menopausal women only. To evaluate the extent to which breast cancer risk among Latinas may be affected by neighborhood characteristics, we examined the independent and joint associations of individual-level (nativity, language use, generational status, percent of life in U.S.) and neighborhood-level (residence in ethnic enclave) immigration factors with breast cancer risk in 1401 Latina cases and 1074 Latina controls pooled from two population-based San Francisco Bay Area studies. Ethnic enclaves refer to areas that maintain more Latino cultural mores and are ethnically distinct from the surrounding area. Block group-level measures of socioeconomic status (SES) and ethnic enclave are based on indices comprising multiple Census 2000 measures, and developed via principal components analyses. Unconditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI), with adjustment for relevant confounders and block group clustering. Among pre-menopausal women, we identified a synergistic effect between individual- and neighborhood-level immigration factors. Compared to U.S.-born Latinas living in low ethnic enclaves (i.e., less ethnic), foreign-born Latinas in high enclaves (i.e., more ethnic) had a lower risk of breast cancer, which was attributable primarily to differences in reproductive risk factors (age at menarche, parity, breastfeeding, age at first birth), education, and neighborhood SES. There was also a synergistic effect between neighborhood SES and ethnic enclave, with the reduction in breast cancer risk greatest among women in high SES and high enclave neighborhoods [OR (95% CI) = 0.30 (0.15-0.60)] compared to women living in high SES and low enclave neighborhoods. Risk reductions were more moderate among those in low SES neighborhoods and similar across ethnic enclave status [low SES/high enclave OR = 0.64 (0.41-1.01); low SES/low enclave OR = 0.60 (0.41-0.86), compared to high SES/low enclave]. Similar patterns of synergistic effects were found among post-menopausal women. Compared to U.S.-born Latinas living in low enclaves, foreign-born Latinas in high enclaves had a considerably lower risk of breast cancer [OR (95% CI) = 0.41 (0.28-0.61)], while the moderate risk reductions among U.S.-born Latinas living in high enclaves and foreign-born in low enclaves were no longer statistically significant after adjusting for behavioral and reproductive risk factors. Neighborhood SES had a stronger effect on breast cancer risk than ethnic enclave. Compared to those living in high SES and low enclave neighborhoods, ORs were similar for low SES/low enclave [OR=0.65 (0.45-0.93)] and low SES/high enclave [OR=0.53 (0.39-0.71)]. Our results suggest that, even after accounting for individual-level factors, the SES and ethnic/acculturation level of neighborhoods play an important role in influencing breast cancer risk among Latinas. Risk among Latinas is lower in more ethnic and lower SES neighborhoods, although among pre-menopausal women, the ethnic enclave effect appears to be explained by reproductive factors. Identifying the specific aspects of these neighborhoods (e.g., more built environment, social support /networks, ethnic foods) that Latina women reside in may provide insights into breast cancer risk factors, and strategies for risk reduction. Citation Format: Scarlett Lin Gomez, Salma Shariff-Marco, Juan Yang, Meera Sangaramoorthy, Theresa H.M. Keegan, Jocelyn Koo, Clayton Schupp, Andrew Hertz, David O. Nelson, Esther M. John. Individual- and neighborhood-level immigration factors and breast cancer risk among Latinas in the San Francisco Bay Area: The Neighborhoods and Breast Cancer (NABC) Study. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B26. doi:10.1158/1538-7755.DISP13-B26

A multilevel analysis of gender, Latino immigrant enclaves, and tobacco use behavior.

Research suggests that immigrant enclaves positively influence health behaviors such as tobacco use through supportive social networks and informal social control mechanisms that promote healthy behavioral norms. Yet, the influence of social cohesion and control on tobacco use may depend on smoking-related norms, which can vary by gender. This study examines the influence of neighborhood Latino immigrant enclave status on smoking and cessation among Hispanic men and women. Data from the Los Angeles Family and Neighborhood Survey was combined with census data to assess the relationship between immigrant enclaves, gender, and smoking using multilevel regression. The effect of the Hispanic enclave environment on smoking differed by gender. Living in an enclave had a harmful effect on tobacco use among Hispanic men, marginally increasing the likelihood of smoking and significantly reducing cessation. This effect was independent of neighborhood socioeconomic status, nativity, and other individual demographics. Neighborhood immigrant concentration was not associated with smoking or cessation for Hispanic women. Research, interventions, and policies aimed at reducing smoking among Hispanics may need to be gender responsive to ensure effectiveness as well as health and gender equity.

Havens of risks or resources? A study of two Latino neighborhoods in New York City.

Research has been mixed on the potential risks and resources that ethnic enclaves may confer upon residents: whereas some authors characterize racial and ethnic minority neighborhoods through the lens of segregation and risk, others argue that these minority neighborhoods are ethnic enclaves that can improve the availability of resources to residents. In this study, we sought to assess two predominantly Latino New York City neighborhoods (one enclave neighborhood and one comparison) in the areas of structural resources (e.g., grocers, parks), cultural resources (e.g., botanicas, hair salons), and risks (e.g., empty lots, bars) by street-level coding in 20 census tracts (streets N = 202). We used Poisson generalized linear models to assess whether enclave status of a neighborhood predicted the numbers of risks and resources on streets within those neighborhoods. Enclave status did not predict the number of risks (Rate ratio = 1.08(0.83, 1.42), χ (2)(1, N = 202) = 0.35, p = n. s.) or cultural resources (Rate ratio = 0.87(0.54, 1.40), χ (2)(1, N = 202) = 0.34, p = n. s.), yet it was associated with a higher number of structural resources (Rate ratio = 1.90(1.48, 2.43), χ (2)(1, N = 202) = 25.74, p < 0.001). The results suggest that while living in an ethnic enclave may not reduce risks, it may help residents cope with those risks through an increased number of structural resources. These findings support theories that conceptualize ethnic enclaves as neighborhoods where greater resources are available to residents. The focus on resources within this work was instrumental, as no difference would have been found if a solely risk-focused approach had been employed.

Linkages in Ghana's gold mining industry: Challenging the enclave thesis

By 2009, Ghana was the second-ranked African producer after South Africa, and had become the world's ninth largest producer of gold, at some 3.8% of global production, up from 2.6% five years earlier. Gold production volumes and revenues rose significantly over the decade from 2000. Yet gold mining tends to be perceived negatively in Ghana, and is seen as providing far less than it should in terms of public revenue, employment, skills development and spillovers, and localised economic development. Gold mining is often depicted as having an enclave status, disconnected and isolated from the rest of the economy. In contrast, the research findings here demonstrate that after a period of strong investment and growth, gold mining can no longer be viewed as an enclave activity: it is in fact more deeply linked into the Ghanaian economy than hitherto understood, through a set of as yet under-researched but promising economic linkages, notably backward linkages, which can potentially be strengthened by policy and support measures.

How do social factors explain outcomes in non-small cell lung cancer among Hispanics/Latinos in California?

6050 Background: Hispanics in the United States have a lower age-adjusted incidence and mortality rate from non-small cell lung cancer compared with non-Hispanic whites. Previous studies have demonstrated the influence of nativity on survival among Hispanic patients but no studies have evaluated the interplay of nativity, clinical factors, social factors, and neighborhood factors on survival among Hispanic patients with non-small cell lung cancer. Methods: All Hispanic patients with non-small cell lung cancer between the years of 1988-2008 were identified in the California Cancer Registry (CCR). Kaplan Meier curves depict survival by nativity status among Hispanics with non-small cell lung cancer. Cox proportional hazard models estimate the hazard of mortality by race with adjustment for individual covariates (age, gender, marital status), clinical factors (histologic grade, surgery, radiation, and chemotherapy), and social and neighborhood factors (neighborhood and ethnic enclave status). Results: A total of 4,062 Hispanic patients with non small cell lung cancer were included. Overall, there was a 7% decreased risk of disease-specific mortality for foreign-born patients as compared with US-born patients (HR 0.93, p=0.08, 95% CI 0.87-1.00) although not-statistically significant. Adjustment for individual patient factors and clinical factors conferred a statistically significant 16% decreased risk of disease-specific mortality compared with US-born patients (HR 0.84, p&lt;0.0001, 95% CI 0.78-0.91). Adjustment for socioeconomic status and neighborhood socioeconomic and ethnic enclave status did not explain the differences in survival (HR 0.84, p &lt;0.001, 95% CI 0.78-0.91). Conclusions: Overall, foreign-born Hispanics with non-small cell lung cancer have a decreased risk of disease-specific mortality compared with US-born Hispanics with non-small cell lung cancer but social factors do not explain this survival advantage. Further investigation is needed to understand the drivers of the survival advantage outcomes in foreign-born populations.

Gastric cancer incidence among Hispanics in California: patterns by time, nativity, and neighborhood characteristics.

Better understanding about gastric cancer incidence patterns among Hispanics by birthplace, socioeconomic status (SES), and acculturation can improve preventive strategies and disease models. Incidence rates, rate ratios, and estimated annual percent change (EAPC) in rates of anatomic and histologic subtype-specific gastric cancer were calculated by age, sex, and nativity among Hispanics using California Cancer Registry data from 1988 through 2004. Incidence rates in 1998 to 2002 were compared by neighborhood SES and Hispanic enclave status according to 2000 US Census data. Incidence rates of diffuse gastric cancer increased from 1988 through 2004 among foreign-born Hispanic men (EAPC: 3.5%, 95% CI: 1.5%-5.5%) and U.S.-born Hispanic women (EAPC: 3.0%, 95% CI: 0.7%-5.3%). During the same time period, incidence rates of intestinal gastric cancer declined significantly and both cardia and noncardia gastric cancer were steady or declined among foreign-born and U.S.-born Hispanic men and women. Noncardia and both intestinal and diffuse gastric cancer were more common in foreign-born than U.S.-born Hispanic men and women, and in those from lower SES, higher enclave neighborhoods. By contrast, among younger and middle-aged Hispanic men, cardia tumors were more common in the U.S.-born than the foreign-born, and in higher SES, lower enclave neighborhoods. Varying gastric cancer risk factors among Hispanic subgroups and increasing rates of diffuse gastric cancer in foreign-born Hispanic men and U.S.-born Hispanic women merit further investigation to identify separate disease etiologies. Age, sex, birthplace, SES, and acculturation modify gastric cancer incidence in Hispanics and should be considered when examining disease risk and prevention.

Lymphoid Malignancies in U.S. Asians: Incidence Rate Differences by Birthplace and Acculturation

Malignancies of the lymphoid cells, including non-Hodgkin lymphomas (NHL), HL, and multiple myeloma, occur at much lower rates in Asians than other racial/ethnic groups in the United States. It remains unclear whether these deficits are explained by genetic or environmental factors. To better understand environmental contributions, we examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, and residential neighborhood socioeconomic status (SES) and ethnic enclave status. We obtained data about all Asian patients diagnosed with lymphoid malignancies between 1988 and 2004 from the California Cancer Registry and neighborhood characteristics from U.S. Census data. Although incidence rates of most lymphoid malignancies were lower among Asian than white populations, only follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis (NS) HL rates were statistically significantly lower among foreign-born than U.S.-born Asians with incidence rate ratios ranging from 0.34 to 0.87. Rates of CLL/SLL and NS HL were also lower among Asian women living in ethnic enclaves or lower SES neighborhoods than those living elsewhere. These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL. Studying specific lymphoid malignancies in U.S. Asians may provide valuable insight toward understanding their environmental causes.

Highlights of This Issue

Lymphoid malignancies occur at lower rates in Asians than other racial/ethnic groups in the United States. To explore this further, Clarke and colleagues examined incidence patterns of lymphoid malignancies among populations characterized by ethnicity, birthplace, residential neighborhood socioeconomic status, and ethnic enclave status. The authors used data from the California Cancer Registry and the U.S. Census. They found that incidence rates of follicular lymphoma (FL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), and nodular sclerosis Hodgkin lymphoma (NS HL) were significantly lower among foreign-born than U.S.-born Asians. These observations support strong roles of environmental factors in the causation of FL, CLL/SLL, and NS HL.Few studies have evaluated the impact of following recommended lifestyle behaviors on cancer, cardiovascular disease and all-cause mortality. McCullough and colleagues evaluated diet and lifestyle questionnaires from over 111,000 nonsmoking men and women from the Cancer Prevention Study (CPS)-II Nutrition Cohort and assessed subjects′ adherence to cancer prevention guidelines of the American Cancer Society. They report that the relative risk of all-cause mortality was lower for participants with high guideline adherence versus low. Similar inverse associations were found with cardiovascular disease and cancer mortality. This large study indicates that following cancer prevention guidelines for diet, exercise and alcohol consumption may substantially lower risk of premature mortality in older adults.It is hypothesized that exercise can lead to a decrease in breast cancer risk through several hormonal and nonhormonal mechanisms. Smith and colleagues used data from the Women in Steady Exercise Research (WISER) study to investigate the effects of aerobic exercise on premenopausal sex hormone levels. They report that while exercisers experienced significant increases in aerobic fitness, lean body mass, and decreases in percent body fat, there were no significant changes in sex hormone levels. These studies indicate that any favorable effects that moderate aerobic exercise may have on breast cancer risk are unlikely to be the consequence of changes in sex hormone levels.TGF-β acts as a suppressor of tumor initiation but can also promote later malignant stages. Scollen and colleagues evaluated 354 SNPs in seventeen TGF-β signaling pathway genes for their association with invasive breast cancer risk. Three SNPs were found to be associated with invasive breast cancer risk. Tumor subtype analysis revealed that one of the SNPs may be associated with increased risk of developing progesterone receptor negative (PR−) tumors. This large study agrees with previous reports and indicates that it is unlikely that other common variants in the TGF-β signaling pathway contribute significantly to breast cancer risk.

Disparities in Liver Cancer Incidence by Nativity, Acculturation, and Socioeconomic Status in California Hispanics and Asians

Asians and Hispanics have the highest incidence rates of liver cancer in the United States, but little is known about how incidence patterns in these largely immigrant populations vary by nativity, acculturation, and socioeconomic status (SES). Such variations can identify high-priority subgroups for prevention and monitoring. Incidence rates and rate ratios (IRR) by nativity among 5,400 Hispanics and 5,809 Asians diagnosed with liver cancer in 1988-2004 were calculated in the California Cancer Registry. Neighborhood ethnic enclave status and SES were classified using 2000 U.S. Census data for cases diagnosed in 1998-2002. Foreign-born Hispanic males had significantly lower liver cancer incidence rates than U.S.-born Hispanic males in 1988-2004 (e.g., IRR = 0.54, 95% confidence interval [CI] = 0.50-0.59 in 1997-2004), whereas foreign-born Hispanic females had significantly higher rates in 1988-1996 (IRR = 1.42, 95% CI = 1.18-1.71), but not 1997-2004. Foreign-born Asian males and females had up to 5-fold higher rates than the U.S.-born. Among Hispanic females, incidence rates were elevated by 21% in higher-enclave versus lower-enclave neighborhoods, and by 24% in lower- versus higher-SES neighborhoods. Among Asian males, incidence rates were elevated by 23% in higher-enclave neighborhoods and by 21% in lower-SES neighborhoods. In both racial/ethnic populations, males and females in higher-enclave, lower-SES neighborhoods had higher incidence rates. Nativity, residential enclave status, and neighborhood SES characterize Hispanics and Asians with significantly unequal incidence rates of liver cancer, implicating behavioral or environmental risk factors and revealing opportunities for prevention. Liver cancer control efforts should especially target foreign-born Asians, U.S.-born Hispanic men, and residents of lower-SES ethnic enclaves.

Enclaves and Development: An Empirical Assessment

In this paper we investigate empirically whether or not the notion of an enclave adds substantially to existing knowledge of the determinants of long-run economic, political, or institutional development. We discuss the prominent place of enclaves in historical accounts in the dependent development literature, particularly in the work of Cardoso and Faletto (1966, 1979) and the large difficulties of determining in practice whether or not a country was or was not an enclave. We find little evidence for a relationship between past enclave status and long-run growth, inequality, or the size of the government. However, there does seem to be some preliminary evidence that countries that were enclaves have greater state capacity than non-enclaves and have been less democratic in the post-WWII period.

The effect of trade liberalisation on export-oriented output and FDI: a case study of the Mauritian EPZ, 1971-1998

The export-processing zone in Mauritius has existed side-by-side with a highly protected importcompeting sector. The enclave status of an EPZ is supposed, in theory, to insulate the zone against the extra-zone protectionist regime. In that case, will trade liberalization affect EPZ activity? This is the question that the paper seeks to investigate: theoretically, by constructing models of exported-oriented FDI and an EPZ-based economy a la Heckscher-Ohlin and considering the feedback effects between the two when trade is liberalized and empirically using data from the Mauritian economy over the period 1971-1998. It is shown that a tariff cut leads to an initial expansion of EPZ activity that is subsequently magnified by induced FDI flows and domestic investment in the zone. The paper finds that the most important phase of trade reform – that started in 1984 – had a marked impact on both domestic and foreign investment in the EPZ, resulting in a significant increase in EPZ production and export in line with the predictions of the theoretical model. Keywords : Foreign Direct Investment, Trade Liberalization, Export-Processing Zone, Mauritius JEL Classification : F13 F14 F21