Environmental Health Disparities in the Home and Neighborhood By Nativity, Race/Ethnicity, and Socioeconomic Status

Abstract

Access to healthy housing and neighborhood conditions has been declared a human right. However, housing and neighborhood conditions vastly differ across sociodemographic groups, depending on their socioeconomic status (SES), race/ethnicity, and country of origin. In addition, hazardous environmental exposures within the home are influenced by factors at the individual, building, and neighborhood levels. As such, research addressing environmental health disparities needs to adopt a multi-level approach that addresses both the source of these hazards and the social determinants that drive disproportionate risks across groups. The objective of this dissertation is to investigate the sources and social determinants of environmental health disparities across nested levels of the home, building, and neighborhood environments. Given the paucity of data on immigrant populations in environmental health research and the rapid growth of first and second-generation immigrants in the United States (U.S.), we focus on disparities by nativity status and its intersections with race/ethnicity and SES. First, we conduct a cross-sectional analysis of the 2015 American Housing Survey to characterize indoor environmental and housing conditions among U.S. households, and identify disparities by nativity status, race/ethnicity, SES, and the interactions of these social positions. We quantify the contribution of residential contextual factors, which may be more amenable to intervention, in explaining these disparities. Second, we conduct a field experiment of the home microenvironment in a low-income, urban community with dense immigrant populations. We investigate drivers of indoor air pollution with an explicit emphasis on homeownership (a marker of wealth), and behavioral and building-level factors contributing to these exposure disparities. Third, we conduct an epidemiological study in a cohort of low-income and urban women to examine the role of immigrant enclaves and environmental exposures in the immigrant birthweight paradox. Across these three studies, we employ multiple methodological approaches at various geographic scales and within diverse immigrant populations. We demonstrate significant disparities in residential environmental exposures by nativity status, race/ethnicity, SES, and their intersections. Further, we discuss the role of residential contextual factors in explaining or modifying these disparities and the implications for public health interventions. Together, these three studies yield key expected and surprising findings that provide insights for future research.