Overweight and Diabetes among the U.S. Foreign-Born Open Access

Oza-Frank, Reena Bharat (2009)

Permanent URL: https://etd.library.emory.edu/concern/etds/5138jf03x?locale=en
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Abstract

In 2007, the U.S. foreign-born population reached a record of 38 million (13% of the population). Previous research has shown that foreign-born individuals are generally in better health compared to native born. However, health outcomes such as overweight and diabetes have been largely understudied among immigrants despite these conditions being at the forefront of public health concern.

Using nationally representative data, we estimated the magnitude of overweight and diabetes among the U.S. foreign-born and examined the relationships between migrant-specific characteristics and these conditions. We found considerable heterogeneity in both prevalence of overweight and diabetes by region of birth. We found that overweight prevalence is consistently associated with length of residence and that immigrants who arrive at younger ages are more likely to be overweight with increasing length of residence than immigrants who arrive at later ages. In addition, depending on region of birth, length of U.S. exposure appears to have a differential impact on overweight prevalence. Diabetes prevalence increases with longer length of residence, independent of age and obesity, and this relationship is consistent across different ages at immigration. Finally, using Asian Americans as a case study, we further show the importance of specific country of birth in highlighting heterogeneity when examining overweight and diabetes.

The U.S. foreign-born population comes from a range of countries, creating a multicultural society with multifaceted needs, not to mention the different genetics and cultures that interplay with the environment in potentially diverse ways. Our findings contribute to the understanding of migration and health, specifically in the context of overweight and diabetes. Public health prevention efforts will be improved by responding in the following ways: promoting healthy lifestyles soon after migration to prevent excess weight gain; tailoring interventions to target young immigrants; and responding to the needs of diverse immigrants by tailoring interventions to be specific by place of birth.

Table of Contents

Table of Contents
CHAPTER 1: INTRODUCTION 1
CHAPTER 2: LITERATURE REVIEW - THE GROWING BURDENS OF OVERWEIGHT AND DIABETES 5
Characterization and epidemiology of overweight and obesity 5
Characterization and epidemiology of diabetes 8
Diabetes Prevention 11
Summary 12
CHAPTER 3: LITERATURE REVIEW - MIGRATION AND HEALTH 14
International migration to the U.S. 14
Characteristics of the U.S. foreign-born population 16
Health of the U.S. Foreign-Born 17
Acculturation 23
Summary 27
CHAPTER 4: METHODS 28
Survey designs and sample populations 28
National Health Interview Survey 28
New Immigrant Survey 31
Data Issues 33
Statistical issues 34
CHAPTER 5: THE WEIGHT OF U.S. RESIDENCE AMONG IMMIGRANTS 36
Abstract 38
Introduction 39
Methods 40
Data sources 40
Literature Screening 40
Results 41
Discussion 45
Conclusions 51
References 54
Summary 66
CHAPTER 6: OVERWEIGHT AND DIABETES PREVALENCE AMONG U.S. IMMIGRANTS 67
Abstract 69
Introduction 70
Methods 71
Data Source 71
Definition of Immigrant and Region of Birth 72
Outcomes of Interest 72
Covariates of Interest 73
Statistical Analysis 74
Results 75
Discussion 78
References 85
Summary 97
CHAPTER 7: AGE AT ARRIVAL AND RISK OF OBESITY AMONG US IMMIGRANTS 98
Abstract 100
Introduction 101
Methods and Procedures 102
Data source 102
Variables of interest 103
Statistical analysis 104
Results 106
Discussion 108
References 114
Summary 125
CHAPTER 8: EFFECT OF LENGTH OF RESIDENCE ON OVERWEIGHT BY REGION OF BIRTH AND AGE AT ARRIVAL 126
Abstract 128
Introduction 130
Methods 131
Data Source 131
Definition of Immigrant and Region of Birth 132
Outcome of Interest 132
Length of Residence and Age at Arrival 133
Covariates of Interest 133
Statistical Analysis 134
Results 134
Discussion 136
References 142
Summary 150
CHAPTER 9: DIABETES PREVALENCE AMONG U.S. IMMIGRANTS BY LENGTH OF RESIDENCE 151
Abstract 153
Research Design and Methods 155
Sample 155
Covariates of Interest 157
Results 158
Conclusions 160
References 166
Summary 175
CHAPTER 10: ASIAN AMERICANS: DIABETES PREVALENCE BY U.S. AND WHO WEIGHT CLASSIFICATIONS 176
Abstract 178
Research Design and Methods 180
Data Source 180
Statistical Analysis 181
Results 182
Discussion 183
References 189
CHAPTER 11: SUMMARY AND CONCLUSIONS 197
Main findings 197
Limitations 200
Strengths 205
Challenges to studying immigrant health 205
Public health significance and policy implications 210
Data Gaps 210
Prevention 212
Future Studies 212
Summary 214
CHAPTER 12: LITERATURE CITED 215
APPENDIX A: Characteristics and Results of Clinical Trials that Assessed Effect of Lifestyle Interventions with Diet and/or Exercise on Type 2 Diabetes Prevention 227
APPENDIX B: National Health Interview Survey Questions 228
APPENDIX C: New Immigrant Survey Questions 239
APPENDIX D: Asian-Americans: Diabetes prevalence across U.S. and WHO weight classifications 245


List of Tables

Table 2.1 The International Classification of Adult Underweight, Overweight and Obesity according to BMI 5

Table 2.2 Diagnosis of Diabetes 8

Table 4.1 NHIS Household and Sample Adult Response Rates 30

Table 5.1 Study Characteristics of Articles on the Association between Immigrant Duration of U.S. Residence and Body Mass Index (BMI) 61

Table 6.1 Characteristics of NHIS Sample by Region of Birth, 1997-2005 92

Table 6.2 Multivariable Adjusted Prevalence and Odds Ratios of Overweight among Immigrant Men and Women 93

Table 6.3 Multivariable Adjusted Prevalence and Odds Ratios of Diabetes Without and With Adjustment for BMI among Immigrant Men and Women 94

Table 7.1 Characteristics of Respondents by Duration of Residence in the United States, 2003 119

Table 7.2 Adjusted Prevalence and Odds Ratios of Overweight/Obesity Stratified by Sex 120

Table 7.3 Adjusted Odds Ratios of Overweight/Obesity Stratified by Age at Arrival 122

Table 8.1 Sample Characteristics by Region of Birth 146

Table 8.2 Adjusted Odds Ratios of Overweight Stratified by Region of Birth 147

Table 8.3 Adjusted Odds Ratios of Overweight Stratified Sex and Age at Arrival 148

Table 9.1 Characteristics of Immigrant Population by Length of Residence in the United States 170

Table 9.2 Adjusted Odds Ratios of Diabetes Overall and Stratified by Age at Arrival 172

Table 10.1 Sample Characteristics 193

Table 10.2 Prevalence of Normal Weight, Overweight, and Obese Individuals by Asian Subgroup 194
Table 10.3 Odds Ratios of Diabetes by Asian Subgroup 194

Table 11.1 Mean age at arrival by region of birth, NHIS 1997-2005 202

List of Figures

Figure 6.1 Overweight and Diabetes Prevalence by Region of Birth 95
Figure 6.2 Diabetes Prevalence by Region of Birth and Body Mass Index Category 96

Figure 7.1 Overweight/Obesity Prevalence by Duration of Residence and Age at Arrival in the U.S. 123

Figure 7.2 Dietary Change Level by Age at Arrival to the U.S. 124

Figure 8.1 Overweight Prevalence by Length of Residence and Region of Birth 149

Figure 9.1 Multivariable Adjusted Diabetes Prevalence by Length of Residence 173

Figure 9.2 Multivariable Adjusted Diabetes Prevalence by Length of Residence Stratified by Age at Immigration 174

Figure 10.1 Mean BMI by Ethnic Subgroup, Age Group, and Sex 195

Figure 10.2 Diabetes Prevalence by Ethnic Subgroup and BMI Categories 196

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