Examining Neighborhood Influences on Substance Use in Immigrant and Non-Immigrant Populations

Background and Purpose: The prevalence of substance use disorder (SUD) remains a major public health concern in the United States. While previous studies have primarily focused on individual-level factors, there is growing interest in the impact of neighborhood structural characteristics on substance use, particularly among immigrant and non-immigrant populations. This study aims to explore the relationship between substance use and neighborhood structural characteristics, specifically Neighborhood Concentrated Disadvantage (NCD) and Neighborhood Immigrant Density (NID), and to examine the differential impact on immigrants and non-immigrants.

Methods: Data on substance use was collected using electronic medical records from 2,725 individuals at a large integrated care agency. Neighborhood structural characteristics were sourced from the American Community Surveys at the census level. The datasets were merged and analyzed using hierarchical linear modeling (HLM) with the HLM software. Relationships between neighborhood characteristics and substance use were visualized through heatmaps generated by ArcMap software.

Results: The study findings indicate that being an immigrant is associated with a lower likelihood of having a substance use disorder (Odds Ratio [O/R] =0.27, P<.05). Additionally, residing in neighborhoods with higher immigrant density correlates with a decreased likelihood of SUD diagnosis (O/R=0.96, P<.05). Individual factors such as increased age (O/R=1.02, P<.05) and identifying English as a preferred language (O/R=2.14, P<.05) were also associated with a higher likelihood of substance use disorder. Being Female (O/R=0.71, P<.05) and having higher income (O/R=0.83, P<.05) is associated with a decreased likelihood of SUD diagnosis. No significant association was found between concentrated neighborhood disadvantage and the likelihood of substance use disorder.

Conclusions and Implications: The results support the Immigrant Health Paradox, suggesting that immigrants generally have better health outcomes, likely benefiting from a protective effect against substance use when residing in neighborhoods with high immigrant density. These findings challenge negative stereotypes about immigrant populations and highlight the need for policies that recognize and address the specific needs of these communities. Further research should explore other neighborhood-level factors affecting substance use and investigate the mechanisms underlying the relationship between neighborhood immigrant density and substance use.