Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel.
Int J Equity Health. 2020 Dec 9;19(1):218. doi: 10.1186/s12939-020-01339-5.
Residential segregation can foster health inequality mechanisms by increasing stress related to neighborhood violence and disorder.
We studied the association between neighborhood violence and disorder and inequalities in anxiety between two groups of perinatal Israeli women (Jewish, Palestinian-Arab) living in ethno-nationally segregated neighborhoods, and explored the influence of neighborhood characteristics; social support and chronic stress to this inequality.
We linked survey data on neighborhood violence and disorder, neighborhood social characteristics (collective efficacy, social capital and social support) and aggregate discrimination to neighborhood SES census data. The survey data was obtained from the "Family Relations, Violence and Health" study (2014-2015) and included a stratified national sample of women (Palestinian-Arab = 436, Jewish = 965) residing in 63 segregated neighborhoods. We conducted multi-variable logistic regression analysis for anxiety (measured based on State-trait Anxiety Inventory) using generalized estimating equation (GEE) to estimate odds ratios of the association with neighborhood violence and disorder (total score for 10 problems) while considering neighborhood characteristics (SES; social characteristics; aggregate discrimination), social support and chronic stress in different models for the total sample, and separately for Palestinian-Arab and Jewish women.
Palestinian-Arab women had higher anxiety (60.5% vs. 42.1%, respectively) and higher severity of neighborhood violence and disorder (49.5% vs. 16.2%, respectively) compared to Jewish women. After considering individual and neighborhood variables, adjusted odds ratio (AOR) and 95% confidence intervals (CI) = 1.63, 1.04-2.56. The association between neighborhood violence and disorder and anxiety was significant for low vs. no problems in the final model for the total sample (AOR, 95%CI = 1.28, 1.00-1.64). Similarly, significant association was found only for low severity vs. no problems for Jewish women (1.40, 1.07-1.86). While among Palestinian-Arab women the association between neighborhood violence and disorder and anxiety rendered insignificant in the final model. Neighborhood social cohesion and social support were protective factors from anxiety in both groups, high neighborhood SES was protective factor only among Jewish women, and neighborhood aggregate discrimination was a risk factor only in Palestinian-Arab women.
Inequalities in anxiety related to neighborhood violence and disorder in ethno-national perinatal groups of women likely reflect residential segregation. Policies entrenching segregation might have affected neighborhood mechanisms (SES inequalities, aggregate discrimination and low social cohesion) that lead to higher stress and ethno-national inequalities in anxiety among perinatal women.
居住隔离会通过增加邻里暴力和混乱相关的压力，促进健康不平等机制。
我们研究了邻里暴力和混乱与居住在民族隔离社区的两组以色列围产期妇女（犹太人和巴勒斯坦阿拉伯人）之间焦虑不平等之间的关联，并探讨了邻里特征；社会支持和慢性压力对这种不平等的影响。
我们将邻里暴力和混乱、邻里社会特征（集体效能、社会资本和社会支持）和总体歧视与邻里社会经济地位普查数据相关联，调查数据来自“家庭关系、暴力与健康”研究（2014-2015 年），包括分层全国范围内的妇女样本（巴勒斯坦阿拉伯人=436，犹太人=965）居住在 63 个隔离社区。我们使用广义估计方程（GEE）对焦虑（基于状态特质焦虑量表测量）进行多变量逻辑回归分析，以估计与邻里暴力和混乱（10 个问题的总分）的关联的比值比，同时考虑邻里特征（SES；社会特征；总体歧视）、社会支持和不同模型中的慢性压力对于总样本，以及分别为巴勒斯坦阿拉伯妇女和犹太妇女。
与犹太妇女相比，巴勒斯坦阿拉伯妇女的焦虑症（分别为 60.5%和 42.1%）和邻里暴力和混乱的严重程度（分别为 49.5%和 16.2%）更高。在考虑个体和邻里变量后，调整后的比值比（AOR）和 95%置信区间（CI）=1.63、1.04-2.56。对于总样本的最终模型，低与无问题之间的邻里暴力和混乱与焦虑之间的关联具有统计学意义（AOR，95%CI=1.28、1.00-1.64）。同样，对于犹太妇女，低严重程度与无问题之间的关联也具有统计学意义（1.40、1.07-1.86）。然而，在巴勒斯坦阿拉伯妇女中，邻里暴力和混乱与焦虑之间的关联在最终模型中变得不显著。邻里社会凝聚力和社会支持是两组妇女焦虑的保护因素，高邻里社会经济地位是犹太妇女的保护因素，而邻里总体歧视只是巴勒斯坦阿拉伯妇女的风险因素。
与围产期民族群体妇女邻里暴力和混乱相关的焦虑不平等可能反映了居住隔离。巩固隔离的政策可能影响邻里机制（SES 不平等、总体歧视和低社会凝聚力），从而导致围产期妇女的压力和民族焦虑更高。
