UC San Diego
Acculturation, the Built Environment, and Health-related Quality of Life: A Multi-level Study in Hispanic Americans
- Author(s): Mills, Sarah Denton
- Advisor(s): Malcarne, Vanessa L
- Klonoff, Elizabeth A
- et al.
Rationale. Studies demonstrate that acculturation is critical to the understanding of health and well-being among Hispanic Americans. Dependent on how acculturation is measured, however, the relationship between acculturation and health-related quality of life is inconsistent. In addition, studies often use proxy measures of acculturation that preclude an understanding of the complex process of acculturation and its relationship to health. Research using latent variables of acculturation based on several cultural indicators has been suggested as a way to advance the study of acculturation in the field. Furthermore, research is needed that goes beyond studying individual characteristics and their impact on health. Studies have shown that aspects of the neighborhood environment (e.g., park density, access to public transit) impact health-related quality of life, but few of these studies have been conducted in Hispanic Americans, or have considered neighborhood environment in combination with individual cultural variables. Studies that consider both individual cultural and environmental characteristics simultaneously allow for the assessment of interactions. Examination of cross-level interactions may provide information on whether cultural variables are more or less important to health-related quality of life in different contexts.
In an effort to advance the study of acculturation and health-related quality of life, the present study had four aims: 1) derive person-level latent acculturation variables from multiple individual indicators of acculturation using exploratory factor analysis; 2) identify person-level latent acculturation variables that are associated with health-related quality of life; 3) identify neighborhood-related variables (e.g., proximity to open spaces, food environment) that are associated with health-related quality of life; and 4) determine how person-level acculturation variables interact with neighborhood variables to predict health-related quality of life among Hispanic Americans.
Design. Exploratory factor analysis and multi-level modeling were used to explore correlates of mental and physical health-related quality of life in a sample of 383 Hispanic American men and women living in a metropolitan border city. Participants completed health-related questionnaires as part of a larger study developing a clinical trials education program for Hispanic Americans. For this study, person-level acculturation variables were included at the lowest level of the model, and were hierarchically nested within participants’ residential neighborhood data. Neighborhoods were defined using census tracts, considered to be relatively homogeneous units based on population characteristics. Individual acculturation and health-related quality of life data were gathered from participant responses on measures included in the survey packet from the parent study. Participants’ neighborhood-level data were obtained from the United States Census database, the Healthy Communities Data and Indicators Project, and the California State Board of Equalization.
Results. Exploratory factor analysis showed support for three acculturation latent variables named: Religiosity, Subjective Social Status, and Traditional Acculturation. The Subjective Social Status latent variable was significantly, positively associated with mental and physical health-related quality of life. The Religiosity and Traditional Acculturation latent variables were not significantly associated with mental or physical health-related quality of life. Neighborhoods with a greater percentage of the population within close proximity to an alcohol outlet were associated with better physical health-related quality of life. In addition, the relationship between the Subjective Social Status latent variable and physical health-related quality of life was stronger in neighborhoods with a higher density of tobacco retailers as compared to neighborhoods with a lower density of tobacco retailers.
Conclusions. This study suggests that subjective social status and neighborhood characteristics may play an important role in the health-related quality of life of Hispanic Americans. Subjective social status, or an individual’s belief about where he or she stands in a social hierarchy, was associated with mental and physical health-related quality of life. Findings from the present study suggest that this relationship was stronger in more disadvantaged neighborhoods. Although the study was cross-sectional, the findings identify potentially modifiable individual and neighborhood variables that may play important roles in determining overall quality of life.