Dietary Incorporation: Health Implications of Migration to the United States Restricted; Files Only
Jones, Rebecca (Spring 2020)
Abstract
Foreign-born individuals often see a deterioration of health after migrating to the US, particularly an increased prevalence of obesity. A leading explanation for increases in obesity amongst foreign-born individuals over time in the US is acculturation and in extension, changes in diet after migration. The aim of this dissertation was to describe changes in food items and subsequent associations with bodyweight in a nationally representative sample of foreign-born individuals in the U.S. in 2003. The New Immigrant Survey (NIS) is a nationally representative, longitudinal study of foreign-born adults who gained legal permanent residence (LPR) in 2003. First, I documented foreign-born adults’ food choices after migration as food items no longer eaten, which I called “abandoned” and food items starting to be eaten, which I called “adopted.” Abandoned and adopted foods were internally compared to individual’s reports of overall dietary change and externally compared to Food and Agriculture Organization Food Balance Sheet Data for each country of origin in the NIS. Next, we empirically derived patterns of abandoned and adopted foods consumed among individuals who reported some type of general change in foods items after migration. Then, I looked at associations of these food change measures with body mass index (BMI) at multiple time points. Lastly, I examined variation/clustering in BMI by national origin and US state of current residence. Foreign-born adults reported a varying degree of changes in foods after resettling in the United States. Abandonment and adoption were internally consistent with generally dietary change and were externally consistent with animal source foods and sweets availability by country of origin. Region of origin, region of current residence, visa type, and socioeconomic status were the main predictors of food changes. Among foreign-born adults who reported abandoning foods in general, three patterns of abandoned foods were derived with foods specific to an individual’s home country being the predominant pattern. Among foreign-born adults who reported adopting foods in general, three patterns of adopted foods were derived stratified by gender. Women’s highest contributing pattern consisted of fruits and vegetables, while men’s highest contributing pattern consisted of pizza and processed meats. General food changes were associated with foreign-born individual’s BMI across two time points in the US. Adopting foods after migration was associated with greater odds of obesity. Abandoning foods after migration was associated with lower BMI and lower odds of obesity. Subsequent patterns of abandoned and adopted foods consumed were not associated with BMI or obesity. Variation in BMI at 8 years on average since relocating to the US, was largely explained by individual characteristics; in addition, characteristics of the country of origin explained 13.3% of the variance while state of residence explained only 0.1%. Based on the results, abandoned and adopted foods among foreign-born adults reflect healthy and unhealthy transitions and subsequent healthy and unhealthy associations with BMI and obesity. When accounting for country of origin and state of residence, these results are consistent with the long-term importance of the context experience during the early stages of life.
Table of Contents
CHAPTER 1: Introduction…………………………………………..……………………...….1
Research Aim 1…………………………………………………...…………………........3
Research Aim 2……………………………………………………..………………...…..3
Research Aim 3……………………………………………………..………………...…..3
References…………………………………………………………...………………........5
CHAPTER 2: Background and Literature Review………………………..……………...…..8
Health of foreign-born people to the US………………………………..…………….…..8
Changes in health-relevant lifestyles with migration……………………..…………...….8
Relationships between acculturation and obesity among foreign-born people to the US.11
Dietary change among foreign-born people……………………………………………..12
Food choice……………………………………………………………………………...16
Relationships between foreign-born individuals’ diet and body mass index (BMI)…….17
Previous work using the New Immigrant Survey (NIS)…………………………………18
Life course perspective…………………………………………………………………..19
Multi-level perspective in the migration context………………………………………...21
Summary……………………………………………………………………...………….26
References………………………………………………………………………………..27
CHAPTER 3: Methods……………………………………………………………………...….36
Data source and population……………………………………………………………....36
Conceptual framework…………………………………………………………………...38
References………………………………………………………………………………..41
CHAPTER 4: Changes in Foods Consumed among Foreign-Born Adults in the US…...…42
Introduction……………………………………………………………………………....42
Methods…………………………………………………………………………………..45
Results………………………………………………………………………………...….49
Discussion………………………………………………………………………………..53
Conclusion……………………………………………………………………………….58
Tables and Figures……………………………………………………………………….59
References………………………………………………………………………………..64
CHAPTER 5: Patterns of Foods Consumed among Foreign-Born Adults in the US……...68
Introduction……………………………………………………………………………....68
Methods…………………………………………………………………………………..69
Results………………………………………………………………………………...….76
Discussion………………………………………………………………………………..82
Conclusion……………………………………………………………………………….87
Tables and Figures……………………………………………………………………….88
References…………………………………………………………………………….….97
CHAPTER 6: Changes in Dietary Behavior and Associations with BMI among Foreign-born Adults in the US……………………………………………………………………...….100
Introduction………………………………………………………………………….….100
Methods……………………………………………………………………………...….102
Results……………………………………………………………………………….….109
Discussion…………………………………………………………………………...….113
Conclusion………………………………………………………………………..…….117
Tables and Figures……………………………………………………………….…….119
References…………………………………………………………………………..….132
CHAPTER 7: Context of Emigration: The lingering effects on immigrant BMI………...135
Introduction…………………………………………………………………………….135
Methods………………………………………………………………………………...139
Results………………………………………………………………………………….145
Discussion…………………………………………………………………………..….152
Conclusion…………………………………………………………………………..….161
Tables and Figures………………………………………………………………..…….162
References…………………………………………………………………………..….185
CHAPTER 8: Summary and Conclusions…………………………………………………..190
Main findings………………………………………………………………………..….190
Limitations…………………………………………………………………………..….192
Strengths and Innovation……………………………………………………………….195
Implications…………………………………………………………………………….197
Future Directions………………………………………………………………….……199
Summary………………………………………………………………………….…….202
References………………………………………………………………………...…….203
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