Neighborhood Contexts Experienced by Young Mexican-American Women: Enhancing Our Understanding of Risk for Early Childbearing

Abstract

Young Mexican-American women are disproportionately affected by teen pregnancy and early childbearing. While many of the studies that have investigated this population’s high risk for early childbearing have focused predominantly on micro-level factors, a growing body of research has demonstrated the importance of neighborhood-level factors in shaping risk for this outcome. In order to elucidate the role of neighborhood context with regards to early childbearing among adolescent Mexican-American women, it is important to understand what these young women consider to be their neighborhood context and how they experience these contexts. This study utilized a mixed-methods design incorporating participatory photography, photo-elicitation, and focus groups in order to gain a more nuanced understanding of how neighborhood context is conceptualized and experienced by Mexican-American young women, and how these experiences may influence risk for early childbearing. Major findings include: (1) participants view the blocks on which they live as their neighborhood, but their exposure to neighborhood context extends beyond these blocks and includes the transient spaces they move through daily; and (2) within their neighborhood contexts, participants are influenced by experiences of discrimination and the presence of gangs and violence. These findings point to the importance of neighborhood-level factors in the lives of adolescent Mexican-American women, and may be used to inform future studies looking at the role of neighborhood context in shaping risk for early childbearing among this population.

Introduction

Young Mexican-American women are disproportionately affected by teen pregnancy and early childbearing: compared to all other racial and ethnic groups in the USA, the Mexican-American adolescent birth rate of 92.9/1,000 is the highest by far.¹ This is more than twice the rate for all US adolescents (41.9/1,000), more than three times that of non-Latino Whites (27.2/1,000), and one and a half times that of non-Latino Blacks (64.2/1,000).¹ Studies have considered a range of factors that may help explain the high risk of early childbearing among adolescent Mexican-American women.^2–5 While the majority of this research focuses on micro-level influences (i.e., individual factors, cultural practices, religious beliefs),^2–5 other studies have examined the role of neighborhood-level factors including limited educational and employment opportunities and the presence and strength of community co-ethnic ties.^6–11 Among Latino teens broadly, contextual factors such as concentrated poverty¹² and poverty level by zip code have also been associated with high birth rates.¹³ Elucidating the relationship between neighborhood context and early childbearing will help public health researchers to better target prevention efforts and enhance intervention impact.

While it is clear that neighborhood context may facilitate early childbearing risk, questions remain. First, what do these young women consider to actually be their neighborhood context? The assumption generally made is that the neighborhoods in which people live directly defines their risk exposure, but it is not clear that this is the case for all populations. Some recent studies indicate that the activity spaces of urban youth transcend traditionally demarcated boundaries (e.g., zip code, census tract).^14,15 Second, it is unclear how neighborhood context is experienced by these young women, making it difficult to determine how neighborhood-level factors shape vulnerability to early childbearing. To better understand how neighborhood context is conceptualized and experienced by Mexican-American young women, we conducted a qualitative study incorporating participatory photographic methods.

Visual methodologies have a long history of use in the social sciences.^16–18 In recent years, these methods have been increasingly used in public health research.^19–25 Studies employing these methods often utilize smaller sample sizes (e.g., studies using seven or eight participants)^19,23,24 and emphasize the importance of in-depth understandings of how particular contexts impact health. Participatory visual methods augment traditional research methods by encouraging active participant involvement and facilitating participants’ control of data, which enhances the validity of findings through participant engagement in the research process.^26,27 Furthermore, triangulating visual with qualitative data strengthens the validity and reliability of findings,^28,29 and in conjunction with photographs, qualitative data has been found to be vastly more detailed, vivid, and descriptive.^30–35

One prominent application of these methods is Photovoice, which blends a grassroots approach to photography with social action.³⁶ The Photovoice method draws from empowerment theory, feminist theory, and the tradition of documentary photography to achieve the following aims: (1) document and reflect on the needs and assets of the community; (2) promote critical dialogue about issues of importance to the community; and (3) promote social change via communication of issues to community and policy makers.³⁶ The photo-elicitation method has also been increasingly utilized by public health researchers. Photo-elicitation utilizes photographs, generated by the researcher or participant, in the context of qualitative research to stimulate dialogue.³³ While Photovoice and photo-elicitation methods each emphasize the unique role of imagery to help visualize participants’ experiences, photo-elicitation prioritizes the use of photographs for collecting “rich verbal data” as opposed to generating narratives aimed at promoting social change.²⁵ Given our research aims, a combined approach incorporating elements of both Photovoice and photo-elicitation was utilized.

We focused our study in the Fruitvale neighborhood in Alameda County, California, where Mexican-Americans comprise 16.1% of the total population.³⁷ Latino teens living in Alameda County have the highest rates of teen birth rate, at 66/1,000 compared with the countywide rate of 31/1,000.³⁸ Within the zip code associated with the Fruitvale neighborhood, the Latino teen birth rate is 70.8/1,000.³⁸ By honing in on one highly dense population-specific area, the authors aimed to conduct an in-depth qualitative analysis utilizing participatory photography in order to better understand the lived and social experience of neighborhood context.

Methods

Study Design

This study utilized a qualitative, mixed-methods descriptive design to allow for multiple avenues by which neighborhood could be described by the young women, particularly since the use of visual methods has been found to advance standard qualitative methods.²³ Data was collected over 4 weeks using focus groups, participatory photography, and photo-elicitation in order to gain a more nuanced understanding of how neighborhood context is conceptualized and experienced by Mexican-American young women. Over the course of this 4-week study, participants engaged in two focus groups and one group-based photo-elicitation session.

Participant Recruitment

Participants were recruited from the Community Health Education (CHE) arm of a large community-based clinic in the Fruitvale neighborhood in Alameda County, California that provides extensive health-related services to the Mexican and Mexican-American population. A purposive sampling strategy was used to recruit young women via peer health educators who met the following criteria: female, Mexican-American, ages 15–17, non-pregnant, and non-parenting. An initial target sample size of ten was sought.³⁹ Of the ten young women who expressed interest, all were eligible to participate and invited to join.

Data Collection and Analysis

This study included four 2-hour sessions. At the initial session, participants completed an ethics and safety training incorporating Photovoice guidelines.⁴⁰ After completing this training, participants were each given a 27-exposure, single-use disposable camera, which was returned at the beginning of the third week. Focus group discussions were conducted during the second and third week, and the photo-elicitation discussion was held the final week. In order to conduct the photo-elicitation discussion, participants’ photographs were developed and displayed. Following Photovoice procedures, participants selected photographs of most significance (n = 50), and as a group, participants discussed the photographs, explaining the images’ significance utilizing a modified SHOWeD method (What do you “See” here? What is really “Happening” here? How does this relate to “Our” lives? “Why” is this happening? What can we “Do” about this issue?).⁴¹

Focus groups were conducted using guides designed to identify what participants consider to be their neighborhood context and how they experience neighborhood context. All sessions were digitally recorded and transcribed. ATLAS.TI was used to manage the coded data. A coding scheme was developed using directed content analysis, initially guided by key concepts based on the research objectives and the literature on neighborhood factors important in the lives of young Mexican-American women.⁴² From these key concepts, coding categories were developed, and coding began with these pre-determined categories. Within each coding category subcategories were developed as necessary. While the coding was not entirely inductive, the analysis was an iterative process, allowing data to drive the development of codes in addition to the pre-determined coding structure.

Results

Ten non-parenting, never-pregnant young Mexican-American women 15–17 years of age participated in this study. Eight of the participants were born to parents who had immigrated to the USA from Mexico. The other two participants immigrated to the USA from Mexico with their parents when they were infants less than 1 year of age. All study participants grew up in the San Francisco Bay area and spent the majority of their adolescence in Alameda County, California.

What is Neighborhood Context?

In describing how their neighborhoods are bounded and defined, participants said that it “goes by blocks…and it goes by gangs.” This point was illustrated by one participant sharing that she lives in “the 60s,” but since this is the territory of a well-known gang, some people may simply refer to the block as “Norteno territory” instead of specifying the block number (see Figures 1 and 2). Groups of blocks that share very similar characteristics are thought of as one neighborhood, independent of zip code or other externally imposed designations. For example, all streets numbering in the 80s are called “The Deep” based on their location “deep in Oakland, far away.” Furthermore, one’s neighborhood/block is not necessarily where the young woman lives or what she considers to be her “turf”: “Yeah. ’Cause I live in the 30s, but I’m, like, from the Dubs [the 20s].” Expanding on this point, participants explained that the neighborhood/block of residence may not be where they spend the majority of their time. For some, time spent inside their homes is the only time spent on their block and since “home is lame,” participants try to limit the time spent there. Several participants identified the place where they hang out as distinct from the block where they live.

FIGURE 1.

Tagged sidewalk depicting gang territory/block.

FIGURE 2.

Tagged telephone pole depicting gang territory/block.

Participants felt that the neighborhood context they experienced daily extended beyond the blocks where they live. For example, participants spent most of their time at school, but none of the participants live in the same neighborhood/block as their school. Additionally, young women spent a significant amount of their free time at malls and other shopping venues, but like schools these places were far from participants’ blocks and homes. Finally, the transient spaces between home, school, and other destinations comprise part of the young women’s contexts as well, even though they did not consider these transient spaces to be on their block or part of their turf (see Figures 3 and 4).

FIGURE 3.

Transient space between home and school.

FIGURE 4.

Transient space between home and shopping.

How is Neighborhood Context Experienced?

When discussing their experiences within these contexts and photographing different aspects of them, two themes emerged: the experience of discrimination, and the presence of gangs and violence.

Experiencing Discrimination Discrimination emerged as a major theme characterizing participants’ common experience across neighborhood spaces. Participants felt that the discrimination they experienced was related to both their perceived status as immigrants and their Mexican ethnicity. Being targeted as “immigrants” was particularly disturbing to the young women since they do not see themselves as immigrants. Participants all described being called derogatory names such as “beaners” or “wetbacks.” Participants explained that while they are officially “Americans,” they usually refer to themselves as Mexican, and they talked about feeling targeted due to their ethnicity.

I just say I’m Mexican. If they think I’m an immigrant, that’s on them. Honestly, I think it’s dumb calling someone an immigrant because being American…nobody was born here, except the Native-Americans, right?

Stores were discussed as places where participants felt particularly unwelcome and scrutinized because of their ethnicity. The young women felt that being a Mexican in a store where primarily White people shop makes you “a target,” and that when you go to these stores, “…all the white people, they just stare at you.” Participants said this experience happens most frequently in “…nice stores, kind of expensive…[where] they think you’re gonna steal something.” They speculated that the discrimination originated from others’ perception of Mexicans as gang-affiliated or associated:

When you hear of gangs, it’s usually the main gangs that are known here [Oakland area], which is mostly Mexicans. That’s why I think, like, people are racist towards us, because they believe that we’re the ones who started all the gangs and stuff. And like if they look at you, they like look down on you, ’cause of what, like, people do around here and whatever.

In addition to these encounters while shopping, participants experienced similar treatment in school settings, primarily by teachers who “discriminated against the Mexican people” or by gangs “targeting Mexican students.”

My friend, she was pregnant, and she was like 14, and it was in a classroom…the teacher, she was Black, she was talking about how my friend was pregnant, and she [the teacher] was like “Oh, she’s pregnant, huh? Well, she’s Mexican.”

Discrimination was not something the participants encountered while in their own neighborhood/block; however, they described incidents of discrimination that occurred as they traveled between their homes and other places:

Like one time I was at the bus stop and there was like Black people, this Black lady and this White lady talking about how like Mexicans shouldn’t even get jobs, and they always take away their jobs and stuff. And I was just sitting there and I was just looking at them. Like, I felt mad about it, and I was gonna start talking shit to them, but they were, like, old ladies so I was, like, let them talk shit.

Gangs and Violence Gangs were the predominant characteristic discussed regarding the character of the participants’ neighborhoods. Participants discussed their knowledge of gangs in depth, including the different gangs in the area, their respective turfs, and gang histories.

Like in the 30s, it’s all one specific gang, but if you go to the Deep, it’s one specific gang. So yeah, in Funktown, in the 50s it’s another specific gang. So they have, like, their territory.

While participants were instructed not to directly photograph gang members or gang activity, they did take numerous pictures of tagged property, gang symbols (e.g., rosaries, hand signals), and gang-associated places (see Figures 5 and 6). As one participant put it,

We live here. We know what’s going on. If you wear red, they’re going to regard you as a Norteno. If you wear a black rosie or purple rosie, you gonna be a Border Brother. So it’s like we know who gang bangers are by the way they look or by the way they act, and the way they dress.

Participants described a number of gang-related experiences they were aware of or with which they had been directly involved, and all participants agreed that gangs were very present in their schools. One of the young women attending a military school photographed a friend who is a gang member attending the same school:

This is a gangbanger, from my school. I took it because it’s funny how it’s a gangbanger and it’s supposed to be a military, “good” school. [The teachers] started realizing that people with rosaries—the chains—were gang-related, and they can’t wear them at school no more (see Figure 7).

Participants talked in depth about their experiences with and knowledge of gang-related violence, describing incidents where they or others were in danger from gangs.

I stay on X Avenue and that’s supposedly Norteno territory. And one time I was going to walk to the store with my aunt…We were going to the store and we heard gun shots… (so) I didn’t go, but my aunt went. One of my friends said that the guy was a gangbanger. But then the guy at the store told us that it was a regular guy eating tacos and he just happened to have on this color blue.

Another participant took a photo that appeared to be a calm street scene yet was actually showing an intersection where she had narrowly escaped being shot by gang members.

Oh, that’s at my grandma’s house in West Oakland! And there’s like dope-dealers right there…I just took it, ’cause it’s like a liquor store and right there, there’s always shots. You remember I told you guys about…I almost got shot there (see Figure 8).

One of the young women knew of several people who had died as a result of gang violence, and in her photographs were multiple pictures of memorial tags:

RIP Little Freddy. It’s on my block. That dude—I didn’t know him…I guess they killed him on East 17th, and a lot of his homies are kickin’ it at that spot, and they just tagged it all up. This one too, like 6 years ago, they killed him too, like around there, and this is the spot where his homies were kickin’ it, and they wrote RIP Guerrito. It’s just something I see every day when I walk through my block (see Figures 9 and 10).

But despite these violent experiences, gangs were not seen as universally negative, and all of the participants stated that they had friends or family who are gang members. While participants acknowledged that gangs and gang violence were a major issue in their community, they also saw positive aspects of gangs:

It’s like, I think gangs are good. Gangs are when like, people comes together, and I think that’s good. You’re just trying to find somewhere to hang out…like little boys who don’t have a big brother, they kick it with like these people and then they just in a gang, so that’s the way they end up there. Or if you don’t got a mom or something like that. [‘It’s like another family on the street,’ a participant interjects.] Yeah, it’s like another family on the street, so that’s why I think that gangs are good, for that reason.

Furthermore, participants felt that gangs in the neighborhood are not necessarily an issue, “as long as you don’t get shot at” or if you avoided being “in the wrong place at the wrong time.”

FIGURE 5.

Gang rosary.

FIGURE 6.

Gang hand sign.

FIGURE 7.

Military school gang banger.

FIGURE 8.

“I almost got shot there”.

FIGURE 9.

RIP Little Freddy.

FIGURE 10.

RIP Guerrito.

Discussion

By combining participatory photography with traditional qualitative methods, we were able to collect rich, detailed data describing the neighborhood contexts experienced by this group of young Mexican-American women. The findings from this study contribute to the extant literature in two specific ways. First, we have clarified what constitutes the “neighborhood” for these young women. The participants of this study see their block as their neighborhood, regardless of their zip code or other traditional geographic designations commonly used by researchers (e.g., census-designated block groups). This finding is consistent with research showing that conventional delineations of neighborhood are not necessarily the same as those experienced by adolescent residents^14,15 and extends this research with a specific population in a particular context. Future studies investigating the relationship between neighborhood and the health of adolescent Mexican-American residents might consider the importance of determining specific neighborhood exposure when conceptualizing and assessing risk at the neighborhood level. One potential avenue could be to utilize residents’ definitions of their own neighborhood and block boundaries in order to gain an accurate understanding of adolescent experiences.

Obtaining residents’ definitions of their neighborhoods would address a related finding of this study, which is that participants’ social environments extend beyond the blocks on which they live and the neighborhoods where they reside. Our study found that the transient spaces between home, school, and turf play an important role in shaping risk as well. Using participants’ home addresses may be appropriate when investigating certain outcomes, but when considering risks in the social environment, a consideration of activity spaces could more adequately capture their exposure. Future studies researching neighborhood effects on the sexual health of Mexican-American adolescents might benefit from first determining the activity spaces of participants.

In addition to better understanding what adolescent Mexican-American young women consider their neighborhoods to be, the second contribution of this study is to point to specific, salient aspects of the neighborhood context. Participants’ experiences in and perceptions of their neighborhoods point us in new and exciting theoretical directions and can help guide the selection of contextual variables in our modeling of neighborhood effects on the sexual health related outcomes in this population.

The finding that these participants experience discrimination as part of their various neighborhood contexts is consistent with numerous studies showing that Latinos—both adults and adolescents—encounter discrimination frequently, both related to their ethnicity and their immigration status.^43,44 Among Latinos, 83% report that discrimination is a major issue, referencing incidents similar to those described by participants involving personally mediated racism including name-calling and receiving poor service in restaurants and public shops.⁴⁵ Of course, these studies look at the over-arching pan-ethnic group of Latinos and do not restrict their findings to Mexican-Americans or Mexican-American youth specifically. But we do know that among people of color, experiences of racial/ethnic discrimination are harmful to physical and mental health,^46–50 and that perceived discrimination may influence individual-level risk behaviors.^51,52 Given the prominence of this theme among participants, future research on neighborhood context might consider how these experiences influence vulnerability to the outcome of early childbearing among this population.

Gangs and gang activity was the other theme running through both the focus group and photographic data with regards to how participants experience their neighborhoods. Studies show that adolescent involvement with gangs is associated with risky sexual behaviors, including lower use of condoms.^53–57 While much of this research has focused on African-American adolescents, a small number of studies have considered the relationship of gang presence to early childbearing and sexual risk among Latino and Mexican-American youth. One study found that among Mexican-Americans, pregnancy risk was increased based on the gang involvement of a young woman’s sexual partner.⁵⁸ Another study found that among Latina young women more broadly, the incidence of pregnancy was higher among those with gang-involved partners.⁵⁹ Gang violence further exacerbates the effects of discrimination and limited opportunity structures on these young women, and among Latino immigrants (of which Mexicans are a substantial majority), 65% settle in urban neighborhoods characterized by poverty, violence, and instability.³ Thus, the emerging relationship between gang presence and early childbearing could be one additional aspect of neighborhood context to consider when investigating factors driving risk for this outcome.

One of the strengths of this study was the use of mixed methods. Using participant photography in conjunction with multiple focus groups allowed for a richer understanding of the characteristics of places experienced by the participants. Additionally, the photos highlighted different aspects of context than what was discussed in the focus group. For example, while gangs and gang activity were discussed in depth during the focus groups, it was not until the photo-elicitation discussion that participants described their specific relationships and experiences with gang members and gang violence. Photos also helped clarify neighborhood context by capturing the transient spaces where the participants spent time, e.g., bus stops, that were not discussed in previous discussions about blocks and turf.

This study relied on a small sample from a specific urban area. While the young women who participated in this study are representative of the population at risk for early childbearing given their age, ethnicity, immigration status, and area of residence, the findings are not generalizable given the sample size. However, the purpose of this study was to conduct an in-depth exploration of one specific context and how it is experienced and perceived by a specific population, so the non-generalizability of the findings is not seen as a limitation but rather a function of the study design. A limitation of this study is that, despite making use of mixed methods in the research design to capture nuanced information on neighborhood context, participants may have felt uncomfortable taking pictures of certain elements of their neighborhood experiences, e.g., violence. In other photography-based research studies using these methods with adolescents, participants have generated very similar images,⁶⁰ lending support to the validity of these findings. Regardless of these limitations, our findings highlight contextual factors at the neighborhood level that warrant further attention by health researchers examining how neighborhood context may influence risk environments for early childbearing among young Mexican-American women. More generally, this study offers guidance on defining neighborhood experiences and incorporating these participant-defined social spaces into future research.

Conclusion

Via participatory photographic methods combined with qualitative methods, this study provides a nuanced understanding of how young Mexican-American women conceptualize and experience their various neighborhood contexts. While the current study does not establish whether the identified factors are associated with or predictive of early childbearing, this research does provide insight into the neighborhood context of one setting where early childbearing rates are extremely high. Additional qualitative or ethnographic work should be done to investigate how specific experiences with these different contextual factors relate to sexual risk taking or pregnancy intentions, and subsequent early childbearing. These findings point to the importance of neighborhood-level structural factors in the lives of young Mexican-American women and may be used to inform future studies looking at the relationship of neighborhood contextual to early childbearing among this population.