Wealthier but not healthier: Latino enclave effects on cancer screening

Latino adults living in racially-concordant ethnic enclaves may benefit from the amenities of familiar cultural and linguistic goods and services, and ethnically-bound neighborhood social capital. However, ethnic enclaves are also associated with concentrated economic disadvantage such as poverty, high unemployment and limited English language skills that abates an individual's access to healthcare. We explore whether ethnic enclaves confer an amenity or penalty to screening, and examine whether screening (mammograms and colorectal cancer tests) improve in wealthier Latino enclaves. We use from data from the 2003 California Health Interview Survey (CHIS 2003) linked to various area-level data sources.

We found that a high Latino concentration reflects concentrated disadvantage. Yet, in poorer neighborhoods, ethnic enclaves appear to be an amenity for Latinos, whereas in wealthier neighborhoods, Latino enclaves levy a penalty. Among our comparison group, non-Latino whites, there was an overall protective effect for whites living in mostly white neighborhoods, with no differential effect by neighborhood income.

Ethnic enclaves have a strong effect on cancer screening among Latinos, with amenities conferred in poorer neighborhoods. This suggests that Latinos living in poor Latino neighborhoods may extract health benefits from the high social capital and/or the availability of culturally and linguistically concordant healthcare providers in these neighborhoods. In contrast, residential mobility into wealthier neighborhoods may distance Latinos from these cultural and linguistic services associated with promoting uptake of screening. Neighborhoods therefore matter a lot for Latinos, and these neighborhood effects should be considered in efforts that aim to increase cancer screening among Latino older adults.