Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health
Introduction
First and second generation immigrants comprise the fastest growing segment of the US child population, including approximately 60% of all Hispanic-American children (Zhou, 1997). Language barriers, low socioeconomic status (SES), cultural differences, and limited health care access (Wolfe, 1994) place immigrants at risk for low SES (Gordon, 1964; Lieberson, 1980), diminished health and well being. These difficulties decrease with each generation (Hirschman, 1996). However, immigrant populations are diverse and there are paradoxes in health by acculturation across populations (Park, 1950; Portes, 1996). For some populations and some health outcomes, first generation immigrants have better health despite lower SES [e.g., low birth weight, perinatal mortality (Guendelman, 1988; Guendelman & Abrams, 1995; Scribner & Dwyer, 1989; Scribner, 1996; Harris, 1998)] than the native population. Where this paradox is shown, the relative advantage declines with length of residence in the US (Committee on the Health and Adjustment of Immigrant Children and Families, 1998).
Over time, immigrant children adopt American behavioral norms for health status and risk (Harris (1999a), Harris (1999b). However, reinforcement of native ethnic group values and norms can slow the acculturation process (Harris (1999a), Harris (1999b)). While these studies offer insights into the role that acculturation might play in enhancing health inequality, they do not identify potential mechanisms. Despite difficulties faced by US immigrant children, little research has examined the effects of immigration on health status (e.g., Harris (1999a), Harris (1999b); Hernandez, 1993; Jasso & Rosenzweig, 1990; Lieberson, 1980; Portes & Zhou, 1993).
Adolescent obesity has important health, social, and economic consequences and is a major antecedent of adult obesity (e.g., Dietz, 1994; Serdula et al., 1993; Siervogel, Roche, Guo, Mukherjee, & Chumlea, 1991). The acculturation process is related to a striking increase in obesity between first and second generation Hispanic (Popkin & Udry, 1998) and Mexican-American (Mendoza & Dixon, 1999) adolescents. Furthermore, CVD and CVD-related risk factors are higher in US-born relative to foreign-born immigrants and particularly higher in immigrants who are more acculturated [e.g., in Mexican-Americans (Sundquist & Winkleby, 1999)].
Low physical activity levels and high inactivity, important biological determinants of obesity (Gortmaker, Sobal, Peterson, Colditz, & Dietz, 1996; Epstein et al., 1995; Epstein, Saelens, Myers, & Vito, 1997; USDHHS, 1996) that track over the lifecycle (Raitakari et al., 1994), tend to be high in Hispanic-Americans (Gordon-Larsen, McMurray, & Popkin, 1999). Although there is minimal dietary data on Hispanic immigrants (Hernandez & Charney, 1998), researchers have generally found healthier dietary intakes among foreign- versus US-born Hispanics (Schaffer, Velie, Shaw, & Todoroff, 1998; Guendelman & Abrams, 1995; Winkleby, Albright, Howard-Pitney, Lin, & Fortmann, 1994).
Although there is limited literature on this topic, structural factors, such as income and education may determine level of access to an American lifestyle, with decreased physical activity opportunities and increased availability of high-fat energy-dense foods, and thus higher obesity among low SES populations. Where immigrants settle has substantial implication for dietary and activity patterns, given availability of markets that supply foreign versus American goods and services. Furthermore, the contextual setting to which immigrants acculturate will have considerable impact on socioeconomic attainment (Portes & Zhou, 1993), particularly given the spatial concentration of affluence and poverty (Massey, 1996).
The objective of our study was to explore mechanisms that may explain the overweight differential across immigrant generations among three large subpopulations of Hispanic (Mexican, Puerto Rican, and Cuban) youth in the US. We define acculturation as the acquisition of dominant cultural norms by members of a non-dominant group. We aim to understand how the acculturation process affects differences in overweight and its proximate determinants as immigrants acculturate to American society. In addition, we aim to understand the role of underlying structural factors in generation differences in overweight prevalence.
Section snippets
Data
Survey design. The study population included over 20,000 adolescents enrolled in the National Longitudinal Study of Adolescent Health (Add Health), a longitudinal, nationally representative, school-based study of US adolescents in grades 7–12, supplemented with minority special samples and collected under protocols approved by the Institutional Review Board of the University of North Carolina-Chapel Hill. The survey design and sampling frame have been described in detail elsewhere (Popkin &
Analysis plan
We examined differentials in structural characteristics and acculturation by generation for Mexican, Puerto Rican, and Cuban youth. Then we documented differentials in overweight status and its proximate determinants (e.g., physical activity, inactivity, diet, and smoking) across generation in our three ethnic groups.
Logistic regression models of overweight were used to investigate ethnicity and generation interactions in relation to acculturation, sociodemographic, contextual, physical
Descriptive results: determinants of overweight
We examined overweight and its proximate, acculturation, and structural determinants by generation and ethnicity. These descriptive analyses revealed the extent to which there was apparent acculturation in these correlates of overweight that explained the differential in overweight by generation of US residence.
Structural and acculturation-related characteristics varied by ethnicity and generation (Table 2). First generation adolescents had lower income and maternal education and lived in urban
Discussion
This study capitalized upon a large sample of Hispanic immigrant adolescents and detailed sociodemographic and contextual data. We investigated within-ethnicity generation differences in overweight among three important Hispanic subpopulations (Mexicans, Puerto Ricans, and Cubans). We specifically investigated the relationship between overweight, acculturation factors, structural factors, and proximate determinants in the process of acculturation to an American lifestyle. We found that
Conclusion
We have demonstrated the importance of structural, acculturation, and proximate determinants in the increase in overweight with generation of US residence. These results suggest that there are several avenues for prevention of overweight through modifications in dietary and physical activity patterns. In addition, this paper has shown that there are specific patterns of acculturation and structural factors that may encourage the development of overweight and are thus important in delineating
Acknowledgements
Funds for the research reported in this article were provided by the National Institute of Child Health and Human Development (R01-HD39183). This paper is based on data from the Add Health project, a program project designed by J. Richard Udry (PI) and Peter Bearman, and funded by grant P01-HD31921 (and P01-HD31921-01) from the National Institute of Child Health and Human Development to the Carolina Population Center, University of North Carolina at Chapel Hill. The authors would like to thank
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