Diet, Physical Activity, and Cardiovascular Disease Risk Factors Among Older Chinese Americans Living in New York City

Is duration of residence a proxy for acculturation? The case of health risk behaviors among international immigrants

AIMS

Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants' health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation.

METHODS

Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting.

RESULTS

The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates.

CONCLUSIONS

Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.

Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis

Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence.

Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence.

Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I² = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I² = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I² = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence.

Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.

The Evaluation of IDEAL-REACH Program to Improve Nutrition among Asian American Community Members in the Philadelphia Metropolitan Area

Objective Asian Americans' food purchasing, cooking, and eating patterns are not well understood. Greater insight into these behaviors is urgently needed to guide public health interventions of dietary behaviors in this population. The present study aims to examine the effects of a community-level intervention on food purchasing and preparation, nutrition knowledge, and health awareness in Asian Americans. Methods From 2015 to 2017, we conducted the Improving Diets with an Ecological Approach for Lifestyle (IDEAL-REACH) intervention to increase access to healthy food or beverage options for the Asian-American population in the Philadelphia metropolitan area. Participants (1110 at pre- and 1098 at post-assessment) were recruited from 31 community-based organizations (CBOs). We assessed Asian Americans' dietary behaviors, nutrition knowledge, and awareness of heart health. Results The results of pre-post intervention comparisons showed that the IDEAL-REACH intervention was successful in promoting whole grains consumption, reducing sodium consumption, and raising knowledge and awareness related to nutrition and heart health. Conclusions To our knowledge, this is one of the first initiatives in the U.S. to engage CBOs to promote healthier dietary behaviors. The findings show that CBOs serve as a powerful platform for community-level interventions to improve healthy nutrition behaviors in Asian-American communities.

A cross-sectional analysis of dietary protein intake and body composition among Chinese Americans

Favourable body composition has been associated with higher dietary protein intake. However, little is known regarding this relationship in a population of Chinese Americans (CHA), who have lower BMI compared with other populations. The aim of the present study was to assess the relationship between dietary protein intake, fat mass (FM) and fat-free mass (FFM) in CHA. Data were from the Chinese American Cardiovascular Health Assessment (CHA CHA) 2010-2011 (n 1707); dietary intake was assessed using an adapted and validated FFQ. Body composition was assessed using bioelectrical impedance analysis. The associations between protein intake (% energy intake) and BMI, percentage FM (FM%), percentage FFM (FFM%), FM index (FMI) and FFM index (FFMI) were examined using multiple linear regression adjusted for age, sex, physical activity, acculturation, total energy intake, sedentary time, smoking status, education, employment and income. There was a significant positive association between dietary protein and BMI (B = 0·056, 95 % CI 0·017, 0·104; P = 0·005), FM (B = 0·106, 95 % CI 0·029, 0·184; P = 0·007), FM% (B = 0·112, 95 % CI 0·031, 0·194; P = 0·007) and FMI (B = 0·045, 95 % CI 0·016, 0·073; P = 0·002). There was a significant negative association between dietary protein and FFM% (B = -0·116, 95 % CI -0·196, -0·036; P = 0·004). In conclusion, higher dietary protein intake was associated with higher adiposity; however, absolute FFM and FFMI were not associated with dietary protein intake. Future work examining the relationship between protein source (i.e. animal) and body composition is warranted in this population of CHA.

Educational Interventions to Promote Healthy Nutrition and Physical Activity Among Older Chinese Americans: A Cluster-Randomized Trial

OBJECTIVES

To evaluate the efficacy of an in-language intervention of 2 lectures plus printed materials versus printed materials alone on knowledge and adherence to nutrition and physical activity guidelines among older Chinese Americans in San Francisco, California.

METHODS

From August 2010 to September 2013, we randomized 756 Chinese Americans aged 50 to 75 years to either lectures plus print (n = 361) or print (n = 357). Clusters were the participants recruited by each lay health worker. Intervention outcomes were changes in knowledge of recommended vegetable intake, fruit intake, and physical activity level and adherence to those recommendations from pre- to 6 months postintervention.

RESULTS

The retention rate was 99%. At baseline, knowledge and adherence to recommendations were low. Print yielded increases in knowledge of recommended vegetable intake and physical activity level and adherence to fruit intake and physical activity recommendations. Lectures plus print had significant increases in all 6 outcomes. In multivariable models, lectures plus print was superior to print for knowledge of vegetable (adjusted odds ratio [AOR] = 12.61; 95% confidence interval [CI] = 6.50, 24.45) and fruit (AOR = 16.16; 95% CI = 5.61, 46.51) intake recommendations and adherence to vegetable intake recommendations (AOR = 5.53; 95% CI = 1.96, 15.58).

CONCLUSIONS

In-language print materials, alone and combined with lectures, increased nutrition and physical activity knowledge and behaviors among older Chinese Americans.

Levels of Acculturation of Chinese Older Adults in the Greater Chicago Area - The Population Study of Chinese Elderly in Chicago

Acculturation is a difficult process for minority older adults for a variety of reasons, including access and exposure to mainstream culture, competing ethnic identities, and linguistic ability and preference. There is a paucity of research regarding overall level of acculturation for Chinese older adults in the United States. This study aimed to provide an overall estimate of level of acculturation of Chinese older adults in the United States and to examine correlations between sociodemographic characteristics, self-reported health measures, and level of acculturation. Data were collected through the Population Study of Chinese Elderly in Chicago (PINE) study. This community-based participatory research study surveyed 3,159 Chinese older adults aged 60 and older. The PINE Study Acculturation Scale was used to assess level of acculturation in three dimensions: language preference, media use, and ethnic social relations. Mean acculturation level for all items was 15.3 ± 5.1, indicating low levels of acculturation. Older age, more offspring, lower income, fewer years living in the United States, lower overall health status, and lower quality of life were associated with lower levels of acculturation. Level of acculturation was low in Chinese older adults, and certain subsets of the population were more likely to have a lower level of acculturation. Future research should investigate causality and effects of level of acculturation.

Accuracy of body weight perception and obesity among Chinese Americans

BACKGROUND

Accuracy of body weight perception is an individual's perception of their body weight in comparison with actual body weight and is associated with weight-related behaviors. Chinese Americans have increased risk for obesity but no studies have examined accuracy of body weight perception.

METHODS

This study was a descriptive and cross-sectional study, which was conducted in a community health center in New York. Study subjects were all Chinese-American adults. Demographic information, accuracy of perception of body weight, anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], hip circumference [HC], weight to height ratio, weight to hip ratio), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1C) and obesity-related diseases (hypertension, diabetes, heart disease, and stroke) were assessed.

RESULTS

A total of 162 Chinese Americans were recruited. 52 subjects (32%) did not perceive body weight correctly: 32 subjects had underestimation and 20 subjects had overestimation of body weight. Significant differences were found among subjects in the three groups of different accuracy of body weight perception in terms of gender (p=0.003), age (p=0.003), education years (p=0.047), WC (p<0.001), HC (p≤0.001), weight/height ratio (p=0.001), and BMI (p<0.001). Accuracy of perception of body weight significantly predicted WC (p<0.001), HC (p<0.001), weight to height ratio (p=0.001), BMI (p<0.001) and weight (<0.001) even after controlling for all demographic factors.

DISCUSSION AND CONCLUSION

The study identified that around one-third of Chinese Americans did not perceive their body weight correctly. Intervention studies for obesity management in Chinese Americans should address gender difference, target on older subjects, and focus on educating the normal values and significances of WC, HC and HbA1C among Chinese Americans.

Korean immigrant women's physical activity experience: a situation-specific theory

To develop successful physical activity promotion programs for midlife immigrant women, especially for Korean immigrant midlife women, concrete theoretical bases are needed. However, virtually no theoretical frameworks and/or theories exist that can explain the influences of immigration transition on the physical activity experience of midlife immigrant women in general or Korean immigrant midlife women in specific. The purpose of this article is to present a situation-specific theory on physical activity experience of Korean immigrant midlife women (SPAKIM) with its development process. An integrative approach was used to develop the theory based on the midlife women's attitudes toward physical activity (MAPA) theory, the transitions theory, a review of the relevant literature, and two studies on midlife women's attitudes toward physical activity. The proposed theory includes nature of transitions, nonmodifiable and modifiable transition conditions, contexts of daily life, patterns of response, and nursing therapeutics as major concepts, and each major concept includes several related subconcepts. Because several concepts of the theory were developed mainly based on the literature review, the major concepts and related subconcepts need to be further developed and evaluated in future studies.

Sociodemographic Correlates of Dietary Practices among Asian-Americans: Results from the California Health Interview Survey

OBJECTIVE

Studies show that Asian-American subgroups do not always meet dietary recommendations and are at high risk of cardiovascular diseases. The purpose of our research is to illustrate the various sociodemographic correlates of dietary habits for six subgroups of Asian-Americans in California.

DESIGN

The 2005 California Health Interview Survey (CHIS) was utilized. A total of 3772 Asian-Americans were included in this study, with the largest subgroup being Chinese (n = 1280; N = 913,798). The outcome variable for this study was dietary behavior defined as consuming five or more fruits and vegetables per day (5-a-day), provided by CHIS. Univariate and multivariable regression analyses were conducted accounting for complex survey design.

RESULTS

Being a female (Chinese, Filipina, Korean, and Vietnamese), not being married (Chinese), not being a college graduate (Chinese), living in poverty (South Asian), and speaking only English language at home (Chinese and Japanese) were associated with higher odds of not meeting a 5-a-day requirement.

CONCLUSION

Results highlighted several sociodemographic correlates to not meeting 5-a-day requirement among six Asian-American subgroups. Targeted health promotion measures for such at-risk groups should be implemented to improve dietary practices.