title: Neighborhood ethnic diversity and behavioral and emotional problems in 3 year olds: results from the Generation R Study.
abstract: BACKGROUND
  Studies suggest that neighborhood ethnic diversity may be important when it comes to understanding ethnic inequalities in mental health. The primary aim of this study was to investigate whether neighborhood ethnic diversity moderated the association between the ethnic minority status and child behavioral and emotional problems.
  
  
  METHODS
  We included 3076 preschoolers participating in the Generation R Study, a birth cohort study in Rotterdam, the Netherlands. At child age 3-years, parents completed the Child Behavior Checklist (CBCL/1,5-5). Individual-level data, assessed with questionnaires, was combined with neighborhood-level data. Multi-level logistic regression models predicted the Odds Ratios for the CBCL total problems score as a function of maternal ethnic background and neighborhood ethnic diversity, computed with the Racial Diversity Index and categorized into tertiles. Interaction on the additive scale was assessed using Relative Access Risk due to Interaction.
  
  
  RESULTS
  Being from an ethnic minority was associated with child behavioral and emotional problems in unadjusted (OR 2.76, 95% CI 1.88-4.04) and adjusted models (OR 2.64, 95% CI 1.79-3.92). Residing in a high diversity neighborhood was associated with child behavioral and emotional problems in unadjusted (OR 2.03, 95% CI 1.13-3.64) but not in adjusted models (OR 0.89, 95% CI 0.51-1.57). When stratifying by the three levels of neighborhood ethnic diversity, ethnic inequalities in behavioral and emotional problems were greatest in low diversity neighborhoods (OR 5.24, 95%CI 2.47-11.14), smaller in high diversity neighborhoods (OR 3.15, 95% CI 1.66-5.99) and smallest in medium diversity neighborhoods (OR 1.59, 95% CI 0.90-2.82). Tests for interaction (when comparing medium to low diversity neighborhoods) trended towards negative on both the additive and multiplicative scale for the maternal-report (RERI: -3.22, 95% CI -0.70-0.59; Ratio of ORs: 0.30, 95% CI 0.12-0.76).
  
  
  CONCLUSIONS
  This study suggests that ethnic inequalities in child behavioral and emotional problems may be greatest in ethnically homogeneous neighborhoods.
authors: The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands. i.flink@erasmusmc.nl
authors: Ilse J E
authors: IJ
authors: Flink
authors: Rick G
authors: RG
authors: Prins
authors: Johan J P
authors: JJ
authors: Mackenbach
authors: Vincent W
authors: VW
authors: Jaddoe
authors: Albert
authors: A
authors: Hofman
authors: Frank C
authors: FC
authors: Verhulst
authors: Henning
authors: H
authors: Tiemeier
authors: Hein
authors: H
authors: Raat
mesh_terms: D000293:Adolescent; D000328:Adult; D001519:Behavior; D002675:Child, Preschool; D004644:Emotions; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data*; D005190:Family / Q000208:ethnology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology / Q000706:statistics & numerical data; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D055815:Young Adult
references: J Abnorm Child Psychol. 2010 Nov;38(8):1151-64
references: 20495955
references: J Am Diet Assoc. 2009 Feb;109(2):218-25
references: 19167948
references: Soc Psychiatry Psychiatr Epidemiol. 2010 Jun;45(6):639-46
references: 19655079
references: J Abnorm Child Psychol. 1997 Aug;25(4):265-75
references: 9304443
references: Eur J Epidemiol. 2011 Jun;26(6):433-8
references: 21344323
references: Psychol Sci. 2006 May;17(5):393-400
references: 16683926
references: Soc Sci Med. 2003 Jul;57(2):253-61
references: 12765706
references: J Am Acad Child Adolesc Psychiatry. 2007 Oct;46(10):1333-1340
references: 17885575
references: Epidemiology. 2010 Jan;21(1):124-7
references: 19907336
references: Ethn Health. 2008 Sep;13(4):321-34
references: 18701992
references: J Abnorm Child Psychol. 1997 Apr;25(2):165-71
references: 9109033
references: Soc Sci Med. 2009 Nov;69(10):1476-83
references: 19765872
references: Am J Psychiatry. 2008 Jan;165(1):66-73
references: 18086750
references: Eur J Epidemiol. 2012 Sep;27(9):739-56
references: 23086283
references: Am J Public Health. 2010 Apr;100(4):707-13
references: 20167891
references: Psychol Med. 2007 Oct;37(10):1413-25
references: 17472758
references: Psychol Med. 2008 Aug;38(8):1083-94
references: 17988420
references: Child Dev. 2004 Nov-Dec;75(6):1632-56
references: 15566370
references: Epidemiology. 1992 Sep;3(5):452-6
references: 1391139
references: J Youth Adolesc. 2009 Feb;38(2):153-63
references: 19636714
references: BMC Public Health. 2012 Dec 19;12:1092
references: 23253397
references: Child Maltreat. 2003 May;8(2):84-97
references: 12735711
references: Infant Child Dev. 2011;20(3):272-287
references: 21731472
references: Am J Epidemiol. 1995 Dec 15;142(12):1255-64
references: 7503045
references: Scand J Public Health. 2006;34(5):544-54
references: 16990166
references: Int J Epidemiol. 2012 Apr;41(2):514-20
references: 22253321
references: Psychol Methods. 2012 Jun;17(2):215-27
references: 22309955
references: Am J Epidemiol. 1980 Oct;112(4):467-70
references: 7424895
references: Am J Public Health. 2013 Jun;103(6):1052-7
references: 23597369