Journal of Urban Health

, Volume 91, Issue 5, pp 928–939 | Cite as

A Multilevel Analysis of Gender, Latino Immigrant Enclaves, and Tobacco Use Behavior

  • Jennifer Cantrell


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.


Smoking Neighborhoods Immigrant Hispanic/Latino Gender Multilevel analysis 



The data for this study is from the Los Angeles Family and Neighborhood Survey (L.A. FANS), which is funded by a grant R01 HD35944 from the National Institute of Health and Child Development to Rand Corporation in Santa Monica, CA, USA. For more information, see


  1. 1.
    U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;2014.Google Scholar
  2. 2.
    Chuang YC, Cubbin C, Ahn D, Winkleby MA. Effects of neighbourhood socioeconomic status and convenience store concentration on individual level smoking. J Epidemiol Community Health. 2005; 59(7): 568–73.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Cubbin C, Hadden WC, Winkleby MA. Neighborhood context and cardiovascular disease risk factors: the contribution of material deprivation. Ethn Dis. 2001; 11(4): 687–700.PubMedGoogle Scholar
  4. 4.
    Cubbin C, Sundquist K, Ahlen H, Johansson SE, Winkleby MA, Sundquist J. Neighborhood deprivation and cardiovascular disease risk factors: protective and harmful effects. Scand J Public Health. 2006; 34(3): 228–37.PubMedCrossRefGoogle Scholar
  5. 5.
    Datta GD, Subramanian SV, Colditz GA, Kawachi I, Palmer JR, Rosenberg L. Individual, neighborhood, and state-level predictors of smoking among US black women: a multilevel analysis. Soc Sci Med. 2006; 63(4): 1034–44.PubMedCrossRefGoogle Scholar
  6. 6.
    Diez-Roux AV, Merkin SS, Hannan P, Jacobs DR, Kiefe CI. Area characteristics, individual-level socioeconomic indicators, and smoking in young adults: the coronary artery disease risk development in young adults study. Am J Epidemiol. 2003; 157(4): 315–26.PubMedCrossRefGoogle Scholar
  7. 7.
    Duncan C, Jones K, Moon G. Smoking and deprivation: are there neighbourhood effects? Soc Sci Med. 1999; 48(4): 497–505.PubMedCrossRefGoogle Scholar
  8. 8.
    Fagan AA, Wright EM, Pinchevsky GM. The protective effects of neighborhood collective efficacy on adolescent substance use and violence following exposure to violence. Journal of youth and adolescence. Oct 30 2013.Google Scholar
  9. 9.
    Karriker-Jaffe KJ. Neighborhood socioeconomic status and substance use by U.S. adults. Drug Alcohol Depend. 2013; 133(1): 212–21.PubMedCrossRefGoogle Scholar
  10. 10.
    Miles R. Neighborhood disorder and smoking: findings of a European urban survey. Soc Sci Med. 2006; 63(9): 2464–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Monden CW, van Lenthe FJ, Mackenbach JP. A simultaneous analysis of neighbourhood and childhood socio-economic environment with self-assessed health and health-related behaviours. Health Place. 2006; 12(4): 394–403.PubMedCrossRefGoogle Scholar
  12. 12.
    Ross CE. Walking, exercising, and smoking: does neighborhood matter? Soc Sci Med. 2000; 51(2): 265–74.PubMedCrossRefGoogle Scholar
  13. 13.
    Stimpson JP, Ju H, Raji MA, Eschbach K. Neighborhood deprivation and health risk behaviors in NHANES III. Am J Health Behav. 2007; 31(2): 215–22.PubMedCrossRefGoogle Scholar
  14. 14.
    Tseng M, Yeatts K, Millikan R, Newman B. Area-level characteristics and smoking in women. Am J Public Health. 2001; 91(11): 1847–50.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    van Lenthe FJ, Mackenbach JP. Neighbourhood and individual socioeconomic inequalities in smoking: the role of physical neighbourhood stressors. J Epidemiol Community Health. 2006; 60(8): 699–705.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Virtanen M, Kivimaki M, Kouvonen A, et al. Average household income, crime, and smoking behaviour in a local area: the Finnish 10-Town study. Soc Sci Med. 2007; 64(9): 1904–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Cagney KA, Browning CR, Wallace DM. The Latino paradox in neighborhood context: the case of asthma and other respiratory conditions. Am J Public Health. 2007; 97(5): 919–25.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Chuang YC, Chuang KY. Gender differences in relationships between social capital and individual smoking and drinking behavior in Taiwan. Soc Sci Med. 2008; 67(8): 1321–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Eschbach K, Ostir GV, Patel KV, Markides KS, Goodwin JS. Neighborhood context and mortality among older Mexican Americans: is there a barrio advantage? Am J Public Health. 2004; 94(10): 1807–12.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Li S, Horner P, Delva J. Social capital and cigarette smoking among Latinos in the United States. Subst Abus Rehabil. 2012; 3(Supplement 1): 83–92.CrossRefGoogle Scholar
  21. 21.
    Osypuk TL, Roux AV, Hadley C, Kandula NR. Are immigrant enclaves healthy places to live? The Multi-ethnic Study of Atherosclerosis. Soc Sci Med. 2009; 69(1): 110–20.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Becares L, Shaw R, Nazroo J, et al. Ethnic density effects on physical morbidity, mortality, and health behaviors: a systematic review of the literature. Am J Public Health. 2012; 102(12): e33–66.PubMedCrossRefGoogle Scholar
  23. 23.
    Portes A. Social capital: its origins and applications in modern sociology. Annu Rev Sociol. 1998; 24: 1–24.CrossRefGoogle Scholar
  24. 24.
    Sampson RJ. Neighborhood-level context and health: lessons from sociology. In: Kawachi I, Berkman LS, eds. Neighborhoods and Health. New York, NY: Oxford University Press; 2003.Google Scholar
  25. 25.
    Ahern J, Galea S, Hubbard A, Syme SL. Neighborhood smoking norms modify the relation between collective efficacy and smoking behavior. Drug Alcohol Depend. 2009; 100(1–2): 138–45.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Alexander CS, Allen P, Crawford MA, McCormick LK. Taking a first puff: cigarette smoking experiences among ethnically diverse adolescents. Ethn Health. 1999; 4(4): 245–57.PubMedCrossRefGoogle Scholar
  27. 27.
    Bethel JW, Schenker MB. Acculturation and smoking patterns among Hispanics: a review. Am J Prev Med. 2005; 29(2): 143–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Castro Y, Reitzel LR, Businelle MS, et al. Acculturation differentially predicts smoking cessation among Latino men and women. Cancer Epidemiol Biomark Prev. 2009; 18(12): 3468–75.CrossRefGoogle Scholar
  29. 29.
    del Pilar S-LM, Cuellar-Flores I, Dresch V. The impact of gender roles on health. Women Health. 2012; 52: 182–96.CrossRefGoogle Scholar
  30. 30.
    Foraker RE, Patten CA, Lopez KN, Croghan IT, Thomas JL. Beliefs and attitudes regarding smoking among young adult Latinos: a pilot study. Prev Med. 2005; 41(1): 126–33.PubMedCrossRefGoogle Scholar
  31. 31.
    Marin BV, Perez-Stable EJ, Marin G, Sabogal F, Otero-Sabogal R. Attitudes and behaviors of Hispanic smokers: implications for cessation interventions. Health Educ Q. 1990; 17(3): 287–97.PubMedCrossRefGoogle Scholar
  32. 32.
    McCleary-Sills JD, Villanti A, Rosario E, Bone L, Stillman F. Influences on tobacco use among urban Hispanic young adults in Baltimore: findings from a qualitative study. Prog Commun Health Partner. 2010; 4(4): 289–97.Google Scholar
  33. 33.
    Pleck JH, O'Donnell LN. Gender attitudes and health risk behaviors in urban African American and Latino early adolescents. Matern Child Health J. 2001; 5(4): 265–72.PubMedCrossRefGoogle Scholar
  34. 34.
    L.A. FANS. The Los Angeles Family and Neighborhood Survey. 2003; Available at: Accessed October 10, 2010.
  35. 35.
    Sastry N, Pebley AR. Non-response in the Los Angeles Family and Neighborhood Survey. Los Angeles, C.A.: RAND Corporation; 2003. RAND Working Paper DRU-2400/7-LAFANS.Google Scholar
  36. 36.
    U.S. Census Bureau. Summary File 3. 2006; Available at: Accessed October 11, 2005.
  37. 37.
    STATA/IC for Windows (32-bit) [computer program]. Version 11.0. College Station, Texas: StataCorp; 2010.Google Scholar
  38. 38.
    Raudenbush SW. HLM 6: Hierarchical Linear and Nonlinear Modeling. Lincolnwood, Ill.: Scientific Software Int. Inc.; 2004.Google Scholar
  39. 39.
    Snijders T, Bosker R. Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modeling. Thousand Oaks, CA: Sage Publications, Inc.; 1999.Google Scholar
  40. 40.
    Winship C, Radbill L. Sampling weights and regression analysis. Soc Methods Res. 1994; 23(2): 230–57.CrossRefGoogle Scholar
  41. 41.
    Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System [online database]. Atlanta, Ga: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2000.Google Scholar
  42. 42.
    Centers for Disease Control and Prevention. Cigarette smoking among adults--United States 2000. MMWR Morb Mortal Wkly Rep. 2002; 51(29): 642–5.Google Scholar
  43. 43.
    Reitzel LR, Mazas CA, Cofta-Woerpel L, et al. Acculturative and neighborhood influences on subjective social status among Spanish-speaking Latino immigrant smokers. Soc Sci Med. 2010; 70(5): 677–83.PubMedCrossRefGoogle Scholar
  44. 44.
    Bottorff JL, Oliffe JL, Kelly MT, et al. Men’s business, women’s work: gender influences and fathers’ smoking. Sociol Health Illn. Feb 12 2010.Google Scholar
  45. 45.
    Canaan J. One thing leads to another: drinking, fighting and working class masculinities. In: Mac an Ghaill M, ed. Understanding Masculinities. Buckingham, UK: Open University Press; 1996.Google Scholar
  46. 46.
    Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med. 2000; 50(10): 1385–401.PubMedCrossRefGoogle Scholar
  47. 47.
    Majors R, Billson JM. Cool Pose: The Dilemmas of Black Manhood in America. New York, NY: Simon & Schuster; 1992.Google Scholar
  48. 48.
    O'Brien R, Hunt K, Hart G. ‘It’s caveman stuff, but that is to a certain extent how guys still operate’: men’s accounts of masculinity and help seeking. Soc Sci Med. 2005; 61(3): 503–16.PubMedCrossRefGoogle Scholar
  49. 49.
    Brown QL, Milam AJ, Smart MJ, et al. Objective and perceived neighborhood characteristics and tobacco use among young adults. Drug Alcohol Depend. 2014; 134: 370–5.PubMedCrossRefGoogle Scholar
  50. 50.
    Kandula NR, Wen M, Jacobs EA, Lauderdale DS. Association between neighborhood context and smoking prevalence among Asian Americans. Am J Public Health. 2009; 99(5): 885–92.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Peterson CE, Sastry N, Pebley AR, Ghosh-Dastidar B, Williamson S, Lara-Cinisomo S. The Los Angeles Family and Neighborhood Survey Codebook. Los Angeles, C.A.: RAND Corporation; 2004.Google Scholar
  52. 52.
    Diez-Roux AV. Estimating neighborhood health effects: the challenges of causal inference in a complex world. Soc Sci Med. 2004; 58(10): 1953–60.PubMedCrossRefGoogle Scholar
  53. 53.
    Duncan GJ, Connell JP, Klebanov PK. Conceptual and methodological issues in estimating causal effects of neighborhoods and family conditions on individual development. In: Brooks-Gunne J, Duncan GJ, Aber JL, eds. Neighborhood Poverty: Context and Consequences for Children, vol. 1. New York, NY: Russell Sage Press; 1997.Google Scholar
  54. 54.
    Duncan GJ, Raudenbush S. Assessing the effects of context in studies of child and youth development. Educ Psychol. 1999; 34(1): 29–41.CrossRefGoogle Scholar
  55. 55.
    Coggins CR, Murrelle EL, Carchman RA, Heidbreder C. Light and intermittent cigarette smokers: a review (1989–2009). Psychopharmacology (Berl). 2009; 207(3): 343–63.CrossRefGoogle Scholar
  56. 56.
    Fagan P, Moolchan ET, Lawrence D, Fernander A, Ponder PK. Identifying health disparities across the tobacco continuum. Addiction. 2007; 102(Suppl 2): 5–29.PubMedCrossRefGoogle Scholar
  57. 57.
    Reitzel LR, Costello TJ, Mazas CA, et al. Low-level smoking among Spanish-speaking Latino smokers: relationships with demographics, tobacco dependence, withdrawal, and cessation. Nicotine Tob Res. 2009; 11(2): 178–84.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Trinidad DR, Perez-Stable EJ, Emery SL, White MM, Grana RA, Messer KS. Intermittent and light daily smoking across racial/ethnic groups in the United States. Nicotine Tob Res. 2009; 11(2): 203–10.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Trinidad DR, Perez-Stable EJ, White MM, Emery SL, Messer K. A nationwide analysis of US racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors. Am J Public Health. 2011; 101(4): 699–706.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Shiffman S, Paty J. Smoking patterns and dependence: contrasting chippers and heavy smokers. J Abnorm Psychol. 2006; 115(3): 509–23.PubMedCrossRefGoogle Scholar
  61. 61.
    Browning CR. The span of collective efficacy: extending social disorganization theory to partner violence. J Marriage Fam. 2002; 64(4): 833–50.CrossRefGoogle Scholar
  62. 62.
    Browning CR, Cagney KA. Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting. J Health Soc Behav. 2002; 43(4): 383–99.PubMedCrossRefGoogle Scholar
  63. 63.
    Browning CR, Cagney KA. Moving beyond poverty: neighborhood structure, social processes, and health. J Health Soc Behav. 2003; 44(4): 552–71.PubMedCrossRefGoogle Scholar
  64. 64.
    Browning CR, Olinger-Wilbon M. Neighborhood structure, social organization, and number of short-term sexual partnerships. J Marriage Fam. 2003; 65(3): 730–45.CrossRefGoogle Scholar
  65. 65.
    Shaw RJ, Atkin K, Becares L, et al. Impact of ethnic density on adult mental disorders: narrative review. Br J Psychiatr J Ment Sci. 2012; 201(1): 11–9.CrossRefGoogle Scholar
  66. 66.
    Morrow M, Barraclough S. Gender equity and tobacco control: bringing masculinity into focus. Glob Health Promot. 2010; 17(1 Suppl): 21–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Frank R, Cerda M, Rendon M. Barrios and burbs: residential context and health-risk behaviors among Angeleno adolescents. J Health Soc Behav. 2007; 48(3): 283–300.PubMedCrossRefGoogle Scholar
  68. 68.
    Kulis S, Marsiglia FF, Sicotte D, Nieri T. Neighborhood effects on youth substance use in a southwestern city. Sociol Perspect. 2007; 50(2): 273–301.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Osypuk TL, Bates LM, Acevedo-Garcia D. Another Mexican birthweight paradox? The role of residential enclaves and neighborhood poverty in the birthweight of Mexican-origin infants. Soc Sci Med. 2010; 70(4): 550–60.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Roy AL, Hughes D, Yoshikawa H. Intersections between nativity, ethnic density, and neighborhood SES: using an ethnic enclave framework to explore variation in Puerto Ricans’ physical health. Am J Community Psychol. 2013; 51(3–4): 468–79.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2014

Authors and Affiliations

  1. 1.Research & Evaluation Department at the American Legacy FoundationWashingtonUSA

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