UCLA

Living in an ethnic enclave, or a socially and economically distinct geographic area with a large concentration of people of the same ethnic group, is hypothesized to decrease preterm births (PTB) by reducing interpersonal racism experiences and providing access to culturally-specific resources and social support. However, research on enclave-health effects has typically only used crude population measures—like percent Latino or percent foreign-born—to define these areas, which overlooks the structural and material differences between enclaves and how disparate environments influence PTB.

In this national cross-sectional study, a county-level ethnic enclave classification scheme with social, economic, and geographic dimensions was devised to investigate the association between living in an ethnic enclave and PTB among Latina mothers in the U.S (N=1,084,867). The classification generated nine enclave types across 232 counties where Latino density was above 13.75%. Enclaves were categorized as: connected advantage and disadvantage; concentrated advantage and disadvantage; disconnected advantage and disadvantage; detached disadvantage; and anchored advantage and disadvantage. To test the classification, multivariate logistic regression models were fit to two years (2017-2018) of U.S. birth records and merged with census, health, and policy datasets. Differences by nativity, Latino origin, and immigration enforcement policies were assessed.

Enclaves were significantly different across all study measures (p<0.001). Compared to Latina mothers residing in anchored advantage enclaves (i.e., moderate Latino density, large foreign-born concentration, suburban, low economic disadvantage), Latina mothers in all other enclave types reported 5%-25% higher odds of PTB, net of covariates. Similar patterns held across nativity status and Latino origin. Regardless of where they lived, foreign-born mothers reported lower odds of PTB than U.S.-born mothers. Latino origin modified the association between enclave type and PTB, such that the effect of living in particular areas differed for Mexican, Puerto Rican, and Cuban origin mothers. However, as immigration enforcement policies increased, PTB significantly decreased in most areas.

The ethnic enclave classification moves beyond crude population measures and provides a complex picture of the association between living in an ethnic enclave and PTB. Findings from this study may allow program planners and policymakers to better tailor health programs and policies for different areas.