Individual and neighborhood differences in diet among low-income foreign and US-born women

Background. Research on the "immigrant" or "Latino health paradox" has demonstrated that Latinos exhibit better health than U.S.-born whites, for multiple health outcomes, despite adjusting for socioeconomic status. However, little empirical research has focused on women and even less has focused on how the neighborhood residential environment is associated with these health differences, particularly in the area of diet. Methods. We analyzed baseline data from 641 low-income women, nested within 184 census tracts, enrolled in a nutrition intervention trial for postpartum women. Individual-level variables, including race/ethnicity, nativity, duration of time in the United States, language acculturation, emotional and instrumental support, and socioeconomic position, were merged with tract-level variables from U.S. Census data (2000) based on residential address. We assessed daily fruit and vegetable servings through a semiquantitative food frequency questionnaire. Using MLW in 2.0 software, we employed a 2-level linear regression model to ascertain associations of neighborhood immigrant, racial, and socioeconomic composition with individual diet, adjusting for individual-level sociodemographic characteristics. Results. In our fully adjusted model, we observed a statistically significant increase of 1/3 of fruit and vegetable daily servings for each 10-percentage point increase in the tract foreignborn population. Each 10-percentage point increase in the tract Black population was associated with a significant 1/5 serving decrease in individual daily fruit and vegetable intake. Conclusions. Among this population of U.S. and foreign-born women, neighborhood composition was associated with individual diet, above and beyond individual-level characteristics, illuminating neighborhood context, immigrant health, and diet.