Los Angeles Family And Neighborhood Survey Research Articles

Community social environments and cigarette smoking

Cigarette smoking remains a primary contributor to health disparities in the United States, and significant evidence suggests that smoking behavior is socially influenced. Though residential neighborhoods are important for health disparities, recent evidence suggests that people spend the majority of their waking time away from the residential neighborhood. We advance research on neighborhoods and smoking by using individual, neighborhood, and activity space data for adults in the Los Angeles Family and Neighborhood Survey (L.A.FANS). Moving beyond socioeconomic indicators of neighborhoods, we investigate the ways in which residential neighborhood social cohesion, neighborly exchange, and perceived danger impact smoking behavior after accounting for confounding factors in both the residential neighborhood and other activity spaces in which adults spend their days. We find that perceptions of danger in the residential neighborhood is robustly associated with the likelihood of smoking cigarettes. Further, measures of community social organization interact with perceived danger to influence smoking behavior. Adults with high levels of perceived danger are twice as likely to smoke if residing in communities with lower levels of social organization in the form of helpful, trusting, and supportive relationships. Understanding how the social organization of communities contributes to smoking disparities is important for curbing smoking's impact on population health.

The Weight of Being Unauthorized? Legal Status Variation in the Association between US Exposure and Obesity among Hispanic Immigrants in Los Angeles.

We examine whether exposure to the US, experienced under certain conditions of disadvantage, namely immigrant legal status, is associated with body weight. Using the pooled, cross-sectional 2001 and 2008 Los Angeles Family and Neighborhood Survey (LAFANS) (n = 2063), we examine whether body mass index (BMI) and obesity vary by Hispanic immigrants' legal status and time exposure to the US. The increased risk of obesity associated with greater US exposure is more pronounced among unauthorized Hispanic immigrants compared to their legally resident coethnic peers, after adjusting for age and age-at-arrival. It is not only residing in the US that is associated with increases in body weight, but residing in the US as an unauthorized immigrant. Improved data and methods are needed to facilitate research of greater policy significance and a refined understanding of how health integration processes vary by legal status.

Comparison of Use of Health Care Services and Spending for Unauthorized Immigrants vs Authorized Immigrants or US Citizens Using a Machine Learning Model

Knowledge about use of health care services (health care utilization) and expenditures among unauthorized immigrant populations is uncertain because of limitations in ascertaining legal status in population data. To examine health care utilization and expenditures that are attributable to unauthorized and authorized immigrants vs US-born individuals. This cross-sectional study used the data on documentation status from the Los Angeles Family and Neighborhood Survey (LAFANS) to develop a random forest classifier machine learning model. K-fold cross-validation was used to test model performance. The LAFANS is a randomized, multilevel, in-person survey of households residing in Los Angeles County, California, consisting of 2 waves. Wave 1 began in April 2000 and ended in January 2002, and wave 2 began in August 2006 and ended in December 2008. The machine learning model was then applied to a nationally representative database, the 2016-2017 Medical Expenditure Panel Survey (MEPS), to predict health care expenditures and utilization among unauthorized and authorized immigrants and US-born individuals. A generalized linear model analyzed health care expenditures. Logistic regression modeling estimated dichotomous use of emergency department (ED), inpatient, outpatient, and office-based physician visits by immigrant groups with adjusting for confounding factors. Data were analyzed from May 1, 2019, to October 14, 2020. Self-reported immigration status (US-born, authorized, and unauthorized status). Annual health care expenditures per capita and use of ED, outpatient, inpatient, and office-based physician care. Of 47 199 MEPS respondents with nonmissing data, 35 079 (74.3%) were US born, 10 816 (22.9%) were authorized immigrants, and 1304 (2.8%) were unauthorized immigrants (51.7% female; mean age, 47.6 [95% CI, 47.4-47.8] years). Compared with authorized immigrants and US-born individuals, unauthorized immigrants were more likely to be aged 18 to 44 years (80.8%), Latino (96.3%), and Spanish speaking (95.2%) and to have less than 12 years of education (53.7%). Half of unauthorized immigrants (47.1%) were uninsured compared with 15.9% of authorized immigrants and 6.0% of US-born individuals. Mean annual health care expenditures per person were $1629 (95% CI, $1330-$1928) for unauthorized immigrants, $3795 (95% CI, $3555-$4035) for authorized immigrants, and $6088 (95% CI, $5935-$6242) for US-born individuals. Contrary to much political discourse in the US, this cross-sectional study found no evidence that unauthorized immigrants are a substantial economic burden on safety net facilities such as EDs. This study illustrates the value of machine learning in the study of unauthorized immigrants using large-scale, secondary databases.

Legal Status, Time in the USA, and the Well-Being of Latinos in Los Angeles.

In the USA, undocumented Latino immigrants may have poorer health because of barriers to health care, stressors, and detrimental effects of immigration enforcement. Previous immigrant health research, however, suggests that recently arrived Latino immigrants have better health than US-born Latinos and their health deteriorates over time. Given the current environments that undocumented immigrants face, legal status is a structural factor that likely influences the patterns of immigrant health. Therefore, the aim of this study was to examine the extent to which physical and mental health differed by legal status and duration in the USA for the Latino population in Los Angeles County, California. We conducted analysis of Latino respondents (n=1396) to the Los Angeles Family and Neighborhood Survey (L.A.FANS) Wave II. We examined self-reported health, depression measured by the Composite International Diagnostic Interview-Short Form, and blood pressure collected by trained interviewers. Respondents reported their legal status, time in the USA, and other sociodemographic characteristics. Regression models were used to test associations between each outcome and 1) legal status and 2) legal status by duration (≤15 and >15years) in the USA. Without taking duration into account, we found no significant differences in outcomes between undocumented, documented, or US-born Latinos. Taking duration into account, shorter duration undocumented immigrants had worse self-reported health than the US born. Undocumented immigrants, regardless of duration, had higher blood pressure than documented immigrants who had been in the USA for less time and the same level of blood pressure as the US born. In contrast, shorter duration documented immigrants had lower blood pressure compared to longer duration documented immigrants and US-born counterparts, and marginally lower blood pressure than shorter duration undocumented immigrants. The findings suggest that the "health advantage" generally presumed to exist among immigrants may not affect undocumented immigrants.

Who Moves Into what Kinds of Neighbourhoods: Spatial Sorting and Integration

AbstractThis paper asks the question – who moves into what kinds of neighbourhoods and what kind of residential sorting is occurring in the ethnically diverse metropolitan region of Los Angeles. The study examines residential selections across a typology of neighbourhood types in the Los Angeles metropolitan region using residential mobility data from the Los Angeles Family and Neighborhood Survey (LAFANS). Similar to recent work in the UK and Canadian contexts, ethnic groups demonstrate moderately strong relationships between their socio‐economic statuses and their neighbourhood contexts. Both behaviour, that is, actual moves and preferences, are consistent with a tendency to increased mixing and declining segregation in the residential mosaic. In particular, the expressed residential preferences and the choices of these households provide an explanatory context for the overall decline in segregation.

Home and away: Area socioeconomic disadvantage and obesity risk

Although residential context is linked to obesity risk, less is known about how the additional places where we work, shop, play, and worship may influence that risk. We employ longitudinal data from the Los Angeles Family and Neighborhood Survey (LAFANS) to derive time-weighted measures of exposure to home and activity space contexts to ascertain the impacts of each on obesity risk for adults. Results show that increased exposure to socioeconomic disadvantage in the residential neighborhood significantly increases obesity risk, and although activity space disadvantage does not directly influence obesity, it reduces the association between residential disadvantage and obesity. We further explore the ways in which residential and activity space disadvantages may interact to influence obesity and discuss the value of integrating personal exposure and activity space contexts to better understand how places contribute to individual health risks.

Modeling contextual effects using individual-level data and without aggregation: an illustration of multilevel factor analysis (MLFA) with collective efficacy.

Population health scientists increasingly study how contextual-level attributes affect individual health. A major challenge in this domain relates to measurement, i.e., how best to measure and create variables that capture characteristics of individuals and their embedded contexts. This paper presents an illustration of multilevel factor analysis (MLFA), an analytic method that enables researchers to model contextual effects using individual-level data without using derived variables. MLFA uses the shared variance in sets of observed items among individuals within the same context to estimate a measurement model for latent constructs; it does this by decomposing the total sample variance-covariance matrix into within-group (e.g., individual-level) and between-group (e.g., contextual-level) matrices and simultaneously modeling distinct latent factor structures at each level. We illustrate the MLFA method using items capturing collective efficacy, which were self-reported by 2,599 adults in 65 census tracts from the Los Angeles Family and Neighborhood Survey (LAFANS). MLFA identified two latent factors at the individual level and one factor at the neighborhood level. Indicators of collective efficacy performed differently at each level. The ability of MLFA to identify different latent factor structures at each level underscores the utility of this analytic tool to model and identify attributes of contexts relevant to health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-015-0045-1) contains supplementary material, which is available to authorized users.

Restricted Movement: Nativity, Citizenship, Legal Status, and the Residential Crowding of Latinos in Los Angeles

Residential crowding is linked with the well-being of children and adults. Although extensive U.S. research indicates variation in crowding by race/ethnicity and nativity, far less work investigates differences in crowding by immigrants’ citizenship and legal status. Data from the Los Angeles Family and Neighborhood Survey (L.A.FANS) are used to focus on Latinos, the group most likely to experience crowding in the United States. The analyses examine heterogeneity in crowding among four distinct groups of Latinos: U.S.-born naturalized citizens, authorized noncitizen immigrants, and unauthorized noncitizen immigrants. Theories of locational attainment and immigrant assimilation are used to develop hypotheses about whether intra-Latino variation in crowding is explained by differences in individual, household, and other characteristics, and which structural factors also interfere in this process. Multivariate analyses indicate that neither nativity nor citizenship status are linked with residential crowding, net of other variables. In contrast, lacking legal status does have residual impacts on the outcome: unauthorized noncitizen immigrants are more crowded than authorized noncitizens and all other groups. The results offer support for the spatial assimilation and place stratification perspectives on locational attainment. These findings contribute to emerging scholarship documenting the unique structural challenges that unauthorized Latino immigrants experience in residential outcomes and other domains in the United States.

Neighborhoods and adolescent health-risk behavior: An ecological network approach

This study integrates insights from social network analysis, activity space perspectives, and theories of urban and spatial processes to present an novel approach to neighborhood effects on health-risk behavior among youth. We suggest spatial patterns of neighborhood residents' non-home routines may be conceptualized as ecological, or “eco”-networks, which are two-mode networks that indirectly link residents through socio-spatial overlap in routine activities. We further argue structural configurations of eco-networks are consequential for youth's behavioral health. In this study we focus on a key structural feature of eco-networks – the neighborhood-level extent to which household dyads share two or more activity locations, or eco-network reinforcement – and its association with two dimensions of health-risk behavior, substance use and delinquency/sexual activity. Using geographic data on non-home routine activity locations among respondents from the Los Angeles Family and Neighborhood Survey (L.A.FANS), we constructed neighborhood-specific eco-networks by connecting sampled households to “activity clusters,” which are sets of spatially-proximate activity locations. We then measured eco-network reinforcement and examined its association with dimensions of adolescent health risk behavior employing a sample of 830 youth ages 12–17 nested in 65 census tracts. We also examined whether neighborhood-level social processes (collective efficacy and intergenerational closure) mediate the association between eco-network reinforcement and the outcomes considered. Results indicated eco-network reinforcement exhibits robust negative associations with both substance use and delinquency/sexual activity scales. Eco-network reinforcement effects were not explained by potential mediating variables. In addition to introducing a novel theoretical and empirical approach to neighborhood effects on youth, our findings highlight the importance of intersecting conventional routines for adolescent behavioral health.

Can We Measure Immigrants' Legal Status? Lessons from Two U.S. Surveys.

This research note examines response and allocation rates for legal status questions asked in publicly available U.S. surveys to address worries that the legal status of immigrants cannot be reliably measured. Contrary to such notions, we find that immigrants' response rates to questions about legal status are typically not higher than response rates to other immigration-related questions, such as country of birth and year of immigration. Further exploration of two particular surveys - the Los Angeles Family and Neighborhood Survey (LAFANS) and the Survey of Income and Program Participation (SIPP) - reveals that these data sources produce profiles of the unauthorized immigrant population that compare favorably to independently estimated profiles. We also find in the case of the SIPP that the introduction of legal status questions does not appear to have an appreciable "chilling effect" on the subsequent survey participation of unauthorized immigrant respondents. Based on the results, we conclude that future data collection efforts should include questions about legal status in order to (a) improve models of immigrant incorporation and (b) better position assimilation research to inform policy discussions.

The intersection of homeownership, race and neighbourhood context: Implications for neighbourhood satisfaction

This study contributes to the growing body of literature on the multifaceted consequences of homeownership for households and their communities, which has seldom focused on neighbourhood satisfaction, an important predictor of neighbourhood quality. Existing studies on the relationship between homeownership and neighbourhood satisfaction have not considered whether homeownership varies in its consequences depending on local context or racial background. Homeownership may render residents more responsive to neighbourhood conditions, to their benefit and to their detriment, depending on local context. Patterns may further vary across racial groups, given vast interracial inequalities in the attainment of desirable neighbourhood outcomes and homeownership. Employing a sample of 1897 respondents from the 2001 Los Angeles Family and Neighborhood Survey (LAFANS), as well as data from the 2000 Census, this study uncovers a complex set of interrelationships among homeownership, neighbourhood characteristics and race. Homeownership makes residents more sensitive to the desirability of local characteristics, proving beneficial in advantaged communities and disadvantageous in distressed communities. These conclusions are broadly applicable to blacks, Latinos and whites, though homeownership is more salient among blacks and Latinos in determining their response to neighbourhood conditions. Given differential access to desirable neighbourhoods and asset accumulation across racial groups, findings raise new and important questions regarding the meaning of homeownership for minority households and their communities.

Abstract 98: Discount Food Stores in High Disadvantage Los Angeles County Neighborhoods Explain Most Individual Difference in Body Mass Index

Introduction: Poor diet and physical inactivity is the second leading cause of mortality in the US after smoking. Cross-sectional, ecologic studies have associated specific obesogenic food environments (OFE examples: smaller distance to fast food restaurants, higher counts of fast food per population, larger distance to grocery stores, lower counts of grocery stores per population) to higher rates of poor diet or higher body mass index (BMI). OFEs are more prevalent in some low-income and racial/ethnic minority neighborhoods potentially contributing to widening health disparities. Recent analyses of two longitudinal cohorts (CARDIA; Framingham Offspring Cohort), found no associations between ecologic measures of OFEs and poor diet or BMI, possibly because they do not capture the characteristics of the OFEs associated with poor diet or BMI. Hypothesis: We assessed the hypothesis that current ecologic OFE measures do not capture the link between food environments and BMI because they ignore variability in food store types and actual distance traveled to purchase food. Populations defined by store type or distance may better describe the potential causal link. Methods: The Los Angeles Family and Neighborhood Survey (LAFANS) is a longitudinal cohort of 2619 households in Los Angeles County. In 2001-2, households were asked where they shopped for groceries (store name/location) and self-reported BMI. A six-category food environment measure based on store name and frequency was developed: high-frequency (HF) English-language named stores (“major chain”), discount stores (“less”, “value”, etc. in the name), HF Spanish-language stores, English-language specialty stores, multi-purpose or bulk purchase stores, other HF stores, and other low frequency stores of any language. We analyzed associations of this food environment measure with self-reported BMI, controlling for individual, household, and neighborhood characteristics. Results: In LAFANS households, 2297 (88%) reported both BMI and a valid store name. Of these, 37% of households shop at the nearest grocery store and only 13% shop in their home census tract. In adjusted models, discount store shoppers have substantially higher BMI than the referent group, major chain store shoppers in low disadvantage neighborhoods (BMI difference 1.40 points, (95% CI 0.62 - 2.18, p = 0.004), equivalent to a weight difference of 8.4 lbs. for an individual of median height and weight (5’5”,160 lbs.). Conclusions: In conclusion, distinguishing between store types may better describe the causal link between individuals, stores and BMI than ecologic measures. In L.A. County, discount stores, found almost exclusively in high disadvantage and racial/ethnic minority neighborhoods are associated with individual differences in BMI. Further research should assess whether the association between discount stores and BMI is related to unmeasured elements of store content or individual characteristics. Current policy efforts focused on modifying small markets or building major chain stores in high disadvantage neighborhoods may inadequately address food environment based racial/ethnic and income based health disparities in BMI.

A tale of two cities: Residential context and risky behavior among adolescents in Los Angeles and Chicago

This article evaluates whether the at-risk behavior of adolescents is differentially influenced by community context across two metropolitan areas. Our focus is on Latino youth in particular. The data come from the Los Angeles Family and Neighborhood Survey (L.A.FANS) and the Project on Human Development in Chicago Neighborhoods (PHDCN). Multi-level models are employed to estimate the effects of community-level influences on adolescent risky behavior in Los Angeles and Chicago. Neighborhood-level influences on the at-risk behavior of youth are found to operate similarly across the two cities, such that native-born children of Latino immigrants are at greatest risk of problem behavior in co-ethnic highly segregated neighborhoods in both Los Angeles and Chicago. Similar patterns are observed for African-Americans, particularly in Chicago and Non-Latino Whites in both cities. We argue that the findings are best interpreted through a segregation framework. Members of each racial/ethnic group appear to exhibit negative health risk behaviors when they reside in areas that are disproportionately populated with their co-ethnic peers.

Neighborhood Attachment in the Multiethnic Metropolis

In acknowledging that patterns of neighborhood attachment—a key component in the maintenance of neighborhood vitality—may shift as a result of growing racial and ethnic diversity, this study develops a multiethnic and multilevel framework to examine the link between racial diversity and attachment among Los Angeles residents. the expansion of the Asian and Hispanic populations may affect attachment patterns if group members exhibit different levels of attachment compared with blacks and whites, due to factors such as illegal citizenship and poorer neighborhood resources. Additionally, their presence in neighborhoods may influence other residents’ attachment by triggering racial prejudice or concerns about local resources. Using the 2001 Los Angeles Family and Neighborhood Survey (LAFANS), this analysis demonstrates that Asians and Hispanics modestly diverge from blacks and whites in the strength of their attachment, due in part to individual and neighborhood characteristics. Although the neighborhood presence of blacks and Hispanics moderately diminishes some aspects of residents’ attachment, regardless of individual race, in many instances neighborhood racial composition fails to exert a significant impact on neighborhood attachment.

Actual or potential neighborhood resources and access to them: Testing hypotheses of social capital for the health of female caregivers

This study considers three commonly overlooked aspects of neighborhood social capital: actual or potential network resources, access to such resources, and their potentially negative implications, as they bear on the health of adult female caregivers of children. Drawing upon Bourdieu's social capital theory and urban and community sociology research, two sets of related hypotheses are formulated and tested. The first set examines specific resources that inhere within neighborhood social relations by testing hypotheses concerning four forms of social capital (social support, social leverage, informal social control, and neighborhood organization participation) and their respective associations with daily smoking and perceived health. The second set assesses the importance of one's access to the neighborhood networks that possess such resources by testing hypotheses regarding how residents' neighborhood attachment moderates the association between social capital forms and these health outcomes in positive and negative ways. Analyses of the Los Angeles Family and Neighborhood Survey (L.A.FANS) linked with tract level census data indicate that specific social capital forms were directly associated with positive and negative health outcomes. Neighborhood attachment significantly moderated relationships between several social capital forms and health, indicating that a female caregiver's degree of network integration matters in both health promoting and health damaging ways. In addition to illustrating the utility of a Bourdieusian perspective for formulating explicit, testable hypotheses regarding how social capital may matter for health, these findings suggest that future public health studies of neighborhood social capital need to consider (1) the actual or potential resources that inhere within relationships, and (2) the role of access to such resources for promoting or compromising health.

PRENTICE ET AL. RESPOND

We thank Carter-Pokras and Zambrana for their comments and the opportunity to further discuss how the Los Angeles Family and Neighborhood Survey (LAFANS) protects sensitive information such as respondents’ legal status. Researchers who collect sensitive information have an obligation to protect respondents’ confidentiality, privacy, and safety. Yet there is another significant obligation—to science, the public interest, and the respondents themselves—to have the data used as broadly as possible for research and policymaking. Balancing these 2 obligations is a challenge. To protect respondents, we obtained a confidentiality certificate, which, in principle, protects LAFANS against being forced to divulge data in response to a subpoena. Projects collecting especially sensitive information have often gone further by turning over all private information to an “honest broker,” who may be outside the United States and hence cannot be subpoenaed. Releasing detailed information about the geography of respondents’ lives, such as where they reside, substantially increases the risk of indirect or deductive disclosure. However, this information is essential for developing a better understanding of contextual effects on health and for estimating multilevel models. The LAFANS solution was to provide only the household’s Service Planning Area in the public-use data files that are available through the project’s Web site. (There are 8 Service Planning Areas in Los Angeles County, each with approximately 1.2 million people.) Detailed geographic information is made available in the restricted-use data (see Peterson et al.1), of which there are 3 versions that provide successively greater precision about the respondents’ locations. Researchers requesting the restricted-use data must submit a research plan and a data safeguarding plan approved by their institutional review board. An important principle guiding the design of data release for LAFANS was that all data (except private identifying information such as respondents’ names and addresses) would be available to researchers. This policy actually provides additional protection because it allows researchers to control the release of the data. Researchers are mandated to release their data in response to a demand based on the Freedom of Information Act when data collection is supported by federal funds and the data have been used to support federal actions or regulations. Without data release procedures in place, it is difficult to specify requirements for data release after a Freedom of Information Act request has been made and researchers may lose control of their data.2 Researchers need to continually monitor legislation, such as the Freedom of Information Act and the Patriot Act, that can potentially undermine their best efforts to protect respondents’ confidentiality. Finally, we agree that it is dangerous to collect legal status in a clinical context where requests for such information may deter patients from seeking needed care.