Elsevier

Health & Place

Volume 68, March 2021, 102514
Health & Place

Neighbourhood migrant composition and tobacco-related cancer mortality: A census-linked study among five origin groups in urban Belgium

https://doi.org/10.1016/j.healthplace.2021.102514Get rights and content

Highlights

  • Higher same group presence decreases tobacco-related cancer mortality.

  • Turkish men have higher tobacco-related cancer mortality with higher Turkish presence.

  • Men are more susceptible to same-origin effects then women.

  • Different indicators for same group presence capture other aspects.

  • Same group effects on cancer mortality are not always linear.

Abstract

We studied the role of ‘ethnic density’ in the neighbourhood for tobacco-related cancer mortality among five migrant origin groups in urban Belgium. Using full population linked census data, multilevel Poisson models were applied to model effects of three linear and categorical indicators of same-origin presence for each origin group, and to test effect mediation by migrant generation and educational level. We first of all found that increased same migrant-origin presence in the neighbourhood had protective effects on tobacco-related cancer mortality for men in most groups. Second, only Turkish men had a mortality disadvantage when Turkish concentration was higher. Third, effects were not detected across all indicators of same-origin presence, nor among most groups of women. Finally, for several groups, neighbourhood effects were mediated by generational status and educational level.

Introduction

European cities have become more ethnically diverse due to international immigration (de Haas, 2010). Urban settings are important destinations for international migrants due to job and housing options (Borjas et al., 1999) and the existing local clusters of peers from the same country of origin (Logan et al., 2002; Grimmeau et al., 2015). The thus established local migrant networks contain social capital that members can draw on to navigate life in the country of destination (de Haas, 2010).

Social capital can broadly be understood as the sum of actual or potential resources (e.g. economic, cultural) that are linked to the possession of a durable network of relationships, or membership in a group (Bourdieu and Richardson, 1985). This form of capital has been linked to psychological benefits and decreased stress and risk behaviour such as tobacco smoking, alcohol consumption, and detrimental dietary habits (Ferlander, 2007). Especially social capital that consists of ties with a variety of people from different backgrounds has been thought to promote healthy behaviour and was associated with better survival among those that were already ill. This, because their network ties provided them with new information, support, and instrumental resources otherwise unavailable to the individual (Ferlander, 2007). More homogeneous networks of close relationships, in contrast, might limit the amount of new information and resources that are available to network members and illicit high levels of social influence. Lifestyle traits in such networks were shown to be more similar across members (Ferlander, 2007).

Connecting local social capital to the health of migrants or ethnic minority group members has been a subject of the so-called ‘ethnic density’ literature. In this body of research, ‘ethnic density’ is referred to as the proportion of racial or ethnic group members in a given neighbourhood. It is traditionally thought of in relation to negative ties between residential segregation, deprivation, and health in cities in the United States (US), but might also be interpreted as ‘living among other migrants and ethnic minority members’ with particular social capital effects (Bécares et al., 2012). Most studies on effects of ethnic density were so far conducted in the US and the United Kingdom (UK). They have focused on mental and subjective health benefits of living in a high ethnically dense neighbourhood through social cohesion among group members. Other studies in these countries have also pointed to protective effects on health behaviour (Bécares, 2009). However, studies that focus on the health behaviour and physical health of migrants in Europe are scarce and mostly find null or protective associations with ethnic density (Bécares et al., 2012). More specifically, protective ties between ethnic density were more common in the research on mortality, physical morbidity, and health behaviour, especially for tobacco consumption (Bécares et al., 2012). Focusing on a specific health outcome, namely cancer, the predominantly US oriented literature finds both detrimental and positive ethnic density effects. Studies found higher risks of infection-related cancer sites (e.g. liver, cervix), later stages at diagnosis, and lower survival for Hispanics living in more Hispanic-concentrated areas (Gomez et al., 2015; Von Behren et al., 2018). Cancer mortality was found higher with higher ethnic density among Black individuals, and was attributed to cultural norms and beliefs that might affect cancer risk and health-care seeking behaviour (Fang and Tseng, 2018). Specific pathways that either positively or negatively connect ethnic density to these cancer outcomes are, however, rarely formulated and tested.

The findings for cancer are moreover inconsistent overall, but it is furthermore unclear how local migrant capital could have a different role for migrants of the first-versus second-generation (i.e. foreign versus host country-born migrants), and may depend on and interact with migrants' socio-economic resources (e.g. educational level, income, activity status). A study on low birthweight in the US, for example, found worse outcomes for children of second-generation Mexican migrant women than for children of first-generation Mexican migrant women (Osypuk et al., 2010). The authors suggested that ethnic density translates into social support for first-generation migrants, whereas it may reflect social and residential blockage for the second generation (Osypuk et al., 2010). A similar logic may apply to the utility of social capital for individuals with different socio-economic positions (SEP). Social capital effects that result from living among people with the same country of origin may allow individuals with low SEP to compensate for negative health outcomes by using health-relevant information and support obtained through their network (the ‘buffer hypothesis’) (Uphoff et al., 2013a; Cohen, 1988a). This would result in larger positive ethnic density effects for people in low SEPs. Larger social capital effects on child health and depression were previously identified for individuals with a lower compared to those with a higher SEP (Elgar et al., 2010; Haines et al., 2011), but the same line of reasoning could be extended to cancer mortality.

Little work has been done on neighbourhood ethnic density or ‘same migrant group capital’ effects on cancer outcomes in Europe. Given the vastly different migration histories, origin groups and settlement patterns between the US and Europe, such work however contributes to a more comprehensive body of evidence about ethnic density effects on cancer. Belgium is an interesting study setting for this topic due to its diverse population with around 20% of the population having a migrant origin (Myria, 2017), and its high cancer risk levels compared to the rest of Europe (Ferlay et al., 2013). The country's largest cities are furthermore known to have comparatively high levels of ethnic and socioeconomic segregation that mainly result from housing policies and Belgium's immigration history (Costa and de Valk, 2018). Large-scale post-World War II suburbanisation of high-income households occurred simultaneously with the recruitment of international migrants from the Mediterranean to fill in ill-paid (mostly industrial) jobs. This combination of events has initially led Italian (1950s) and later also Turkish and Moroccan labour migrants (1960s) to settle in urban areas left behind by the Belgian middle-class, marked by cheap and low-quality dwellings on the private rental market. Family reunification during the 1970s economic crisis enhanced further clustering of these groups in more deprived areas. Parallel to this deliberate labour recruitment policy, immigration to Belgium is also characterised by European citizens who can freely move in the European context and many come to work in Belgium and Brussels as the 'political capital of Europe' in particular. Of these free movements in the European context, more recent Italian immigrants targets Brussels to settle, whereas steady flows of border migration through time are reflected by a substantial shares of Dutch migrants in Antwerp (and to lesser extent Liège), and French migrants in Charleroi and Liège.

Because the pathways by which ethnic density effects operate on health are generally poorly understood (Bécares et al., 2012) and studies rarely focus on a specific aspect of ethnic density, the aim of this study was to analyse the relationship between the neighbourhood's same migrant group presence and cancer mortality among the largest migrant origin groups in urban Belgium (also called ‘same-origin effects’ from here on). The presence of peers from the same origin country was used as a proxy for an individual's same-origin migrant capital in our analyses. We studied all ‘tobacco-related’ cancer (pooled), lung cancer, and tobacco-related cancer without including lung cancer to verify the role of lung cancer in the pooled results. These cancer sites were selected due to their combined ‘behavioural amenability’ and lower-than-average 5-year survival rates in Belgium (Belgian Cancer Registry., 2012). A condition with behavioural amenability was defined as ‘having a combined population-attributable fraction (PAF) of deaths for smoking, alcohol abuse, overweight, low fruit and vegetable intake, physical inactivity and unsafe sex >50% in the Global Burden of Disease study 2000’ (Mackenbach et al., 2015). In selecting these cancer sites, we argue that the same-origin effects found on cancer mortality were likely due to same-origin effects on major behavioural risk factors for the cancer sites considered (Vanthomme et al., 2016; Ellis et al., 2014).

We first examined same-origin effects for each group under study. We did so by using three indicators for ‘same-origin presence’ to verify if these yielded different study results. We furthermore aimed to investigate whether same-origin effects had differential effects depending on individual migrant generational status and SEP and did so by applying interaction effects. We expected that increases in same-origin presence would decrease cancer mortality less strongly among second-compared to first-generation migrants, and anticipated that decreases in cancer mortality due to higher same-origin presence would be larger among individuals with a lower versus a higher SEP (Phelan et al., 2004; Braveman et al., 2005; Macintyre et al., 1998). We used unique linked census- and registry data for Belgium between October 1st, 2001 and December 31st, 2014 to test these hypotheses.

Section snippets

Data and study population

Data for this study were derived from a linkage between the 2001 population census, containing socio-demographic information at baseline (October 1, 2001), and registry information on emigration, death, and cause of death until December 31st, 2014. A two-level data structure was used in which individuals were nested in statistical sectors, based on their legal address at census (2001).

We limited the study population to individuals aged 40 to 69 of Dutch, French, Italian, Turkish, and Moroccan

Results

Table 1 describes our study population. It includes Belgian natives for a more comprehensive view on how characteristics of the migrant origin populations compare to those of the majority population. In 2001, individuals with origins in neighbouring countries (i.e., the Netherlands and France) generally lived in less deprived neighbourhoods and had higher individual educational levels (min. 23% tertiary education) than the other three migrant origin groups. Moroccan and Turkish individuals, in

Discussion

This study aimed to understand the role of ethnic density in the neighbourhood for tobacco-related cancer mortality among different migrant origin groups in urban Belgium. We found mostly protective same-origin presence effects for tobacco-related cancer in general, and lung cancer in particular among migrant origin groups in Belgium. However, a consistently detrimental peer concentration effect on tobacco-related cancer mortality without lung cancer was observed for Turkish men. We also found

Strengths and limitations

The data of our study are both its strongest asset as well as subject to a range of limitations. First, we can include the full population of Belgium in our analyses. However, the neighbourhoods in this study were predefined. There is an ongoing debate about the appropriate delineation of neighbourhoods; Not only can the chosen spatial unit of analysis affect study results (Diez Roux et al., 2003; Cummins et al., 2007; Bernard et al., 2007; Wang and Hu, 2013; Gibbons and Yang, 2014), but

Conclusion

Our findings show that for several migrant origin groups in urban Belgium, mortality from cancers highly related to tobacco consumption was less likely for those living in ethnic dense neighbourhoods with many of the same origin. The main exceptions to this pattern are second-generation Turkish and Moroccan men, for whom mortality was higher when same-origin presence in the neighbourhood was increased. The local community network may play a crucial role for individual risk behaviour, and our

Declaration of competing interest

None.

Acknowledgements

We would like to thank the Vrije Universiteit Brussel for funding this research (Grant No. OZR2818BOF). We are grateful to the Flemish Agency for Care and Health for initial data preparation; to Statistics Belgium for supplying the mortality data; to Patrick Lusyne (Statistics Belgium) for performing the individual data linkage procedure; and to Didier Willaert and Johan Surkyn (Vrije Universiteit Brussel) for their significant data support.

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