Overweight and Diabetes among the U.S. Foreign-Born Open Access
Oza-Frank, Reena Bharat (2009)
Published
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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