Immigrant enclaves and risk of drug involvement among asylum-seeking immigrants in Sweden: A quasi-experimental study

Drug Alcohol Depend. 2019 Dec 1:205:107666. doi: 10.1016/j.drugalcdep.2019.107666. Epub 2019 Oct 25.


Background: Sweden is a major host nation for asylum-seeking immigrants, and residential placement of these immigrants is an important policy concern. This quasi-experimental study estimated of the impact of being placed into an "immigrant enclave" on risk of officially-recognized drug involvement (ORDI) among asylum-seeking immigrants over a 15-year period.

Methods: All data come from Swedish registries. The sample consisted of (a) asylum-seeking immigrants aged 5-35 years old at arrival (N = 51,017) that were subject to a nationwide policy (enforced 1987-1991) that dispersed asylum-seeking immigrants across municipalities, and (b) native-born Swedes aged 15 and older during this same period (N = 1,040,311). Neighborhood immigrant composition was quantified using the Reardon Index; residents of "immigrant enclave" neighborhoods (n = 960) were compared to residents of all other neighborhoods (n = 2,471). Cox proportional hazards models assessed the relationship between living in an enclave and risk of ORDI, identified by national registries, through 2015.

Results: Overall, 29.7% of immigrants were assigned to, and 25.5% of Swedes lived in, an enclave. Cumulative incidence of ORDI in enclaves was 6.34% as compared to 6.89% in other neighborhoods. Immigrants living in an enclave had lower risk of ORDI (Hazard ratio (HR): 0.86, 95% Confidence Interval (CI): 0.77 - 0.96). This protective association was marginally stronger in lower poverty areas. Native-born Swedes living in an enclave had higher risk of ORDI (HR: 1.05, 95% CI: 1.03-1.08), a relationship that was exacerbated by neighborhood poverty.

Conclusions: Neighborhood immigrant composition is associated with risk of ORDI, with differential associations for immigrants and native-born populations.

Keywords: Immigration; Neighborhood; Segregation; Substance abuse.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Poverty / statistics & numerical data
  • Proportional Hazards Models
  • Refugees / statistics & numerical data*
  • Registries
  • Residence Characteristics / statistics & numerical data*
  • Risk Factors
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / ethnology
  • Sweden / epidemiology
  • Young Adult