Acculturation and environmental factors influencing dietary behaviors and body mass index of Chinese students in the United States

International tertiary education students experienced difficulties in dietary transitions in Australia: A qualitative study

ISSUE ADDRESSED

More attention to the diet and nutritional status of international students in Australian universities is indicated. This qualitative research aimed to provide an in-depth understanding of dietary changes among international students after they arrived in Australia.

METHODS

Semi-structured interviews were conducted with international students from China and India who were studying at a large urban Australian university. An approach of interpretative phenomenological analysis was employed for coding and data analysis.

RESULTS

A total of 14 interviews were included. International students were able to consume more international foods, dairy products and animal proteins in Australia as a result of increased exposure to a larger variety of these foods compared with their home countries. However, they experienced some difficulties in eating vegetables and authentic traditional foods due to limited availability and higher prices in Australia. It was challenging for these students to live independently and cook for themselves for the first time and with a limited food budget and time, but many students improved their cooking skills over time. Less frequent main meals with more snacking sessions were reported. Weight fluctuations were commonly experienced and craving for traditional foods no longer accessible may negatively impact mental health.

CONCLUSIONS

International students adapted to the Australian food environment but believed the food choices available did not meet their food preferences or perhaps nutritional requirements.

SO WHAT

Some intervention from universities and/or government may be needed to ease the barriers to consumption of affordable and desirable meals in a time-saving manner for international students.

Dietary Acculturation and Food Habit Changes among Chinese Immigrants in Portugal

Chinese individuals who immigrate to a Western country tend to change their eating patterns and behaviors depending on how long they live in the host country. This is dietary acculturation, and it can have a positive or negative impact on eating habits. Thus, we aimed to characterize the dietary acculturation of the Chinese immigrant community in Portugal and check the trend of the direction of this acculturation. The study involved 213 immigrants and assessed food consumption, meal patterns, and dietary acculturation. A mean Western acculturation score of 70.1 ± 8.9. was identified and 71.4% had a high Western acculturation score. No one had low or very high Western acculturation. Participants who have a higher level of acculturation tend to have higher energy and fat intake. The likelihood of mixing meals, including, and combining, Chinese and Portuguese meals and foods is associated with time spent in Portugal. Efforts should be made to encourage Chinese immigrants to make a positive dietary transition during their acculturation process.

Health behavior changes associated with weight gain among first-year international students studying at an American university

Objectives: To characterize the health behaviors and outcomes of first-year international students (FYIS) studying in the U.S. Participants and methods: Three different cohorts of FYIS from a large midwestern university in the U.S. completed three laboratory visits between August and March. The study began in 2017 and ended in March 2020. Anthropometrics, acculturative stress, eating behaviors, sleep, physical activity, and eating habits were assessed. Results: Fifty-four students completed the study. Females had a significant increase in percent body fat (p = .036) and a decrease in sleep quality (p = .006) at the final visit vs. baseline, and uncontrolled (p = .006) and emotional (p < .001) eating behaviors were higher. FYIS who gained more than the median 1.2 kg over the study period experienced higher acculturative stress (p = .004) and a decline in sleep quality (p = .003). Conclusion: Reducing acculturative stress and improving sleep quality should be explored as interventions to protect against undesirable changes in adiposity among FYIS.

Food behaviours and eating habits among Sub-Saharan African migrant mothers of school-aged children in South Australia

Overweight, obesity and chronic conditions like diabetes, stroke and heart disease represent a significant burden to public health. Traditional foods and healthy dietary habits can reduce the risk of these conditions. Therefore, this study aimed to explore traditional food patterns and eating habits among Sub-Saharan African migrant mothers of school-aged children in South Australia. The study was a qualitative inquiry that used face-to-face interviews with 15 mothers of school-aged children in South Australia. Snowballing was used to sample participants, and data were audio-recorded, transcribed verbatim, coded, and analysed thematically. Four broad themes described participants' food behaviours and eating habits, including maintaining traditional food patterns, changes in traditional food patterns and eating habits, concerns with food environments in Australia, and challenges with traditional food availability and access in Australia. This study found that although mothers were committed to maintaining their traditional foods, they found it increasingly difficult to continue such habits. Participants reported challenges as their children are increasingly demanding westernised foods. While some parents pushed back against such demands from their children, others felt helpless and relented. Some views showed that food environments, food systems, access, and scarcity of traditional foods in Australia influenced the participants' food patterns and eating habits. Appropriately tailored healthy eating health promotion actions targeting school-aged children and mothers in this population need to consider their food contexts. Promoting the use of traditional foods, their preparation practices, and processing might be helpful in this community when developing healthy eating programs.

Determinants of eating behaviour in Black, Asian and Minority Ethnic (BAME) university students when living at and away from home: With a focus on the influence of food enculturation and food acculturation

For some students, university, can be a period of increased autonomy in food choice and for black, Asian and minority ethnic (BAME) and international students, the addition of culture may be a governing factor. This study aimed to examine the extent of dietary acculturation and dietary enculturation on the influence of student's food choices using a phenomenological approach. Sixty participants (forty-one home students and nineteen international students) recruited by purposive sampling, were included in the study. Data collection involved self-administered multiple choice and short answer questionnaires and semi structured interviews. The results were analysed using thematic analysis. When living away from home, six major themes influenced the eating behaviour of the studied population: social environment, individual factors, physical environment, university life, enculturation and acculturation. When at home, five major themes were influential: social environment, individual factors, physical environment, enculturation and acculturation. The main findings suggest dietary enculturation is a factor which influences the dietary behaviour of both international students and BAME home students.

Exploring the Determinants of Food Choice in Chinese Mainlanders and Chinese Immigrants: A Systematic Review

Determinants of food choice in Chinese populations have not been systematically synthesised using a cultural lens. This study reviewed qualitative studies exploring food choice determinants of both Chinese mainlanders and Chinese immigrants living in Western countries. Ovid Medline, CINAHL Plus, Web of Science, ProQuest, and China National Knowledge Infrastructure database (CNKI) were searched from database inception to 1 April 2021. Studies were included if they involved qualitative research methods, were written in English or Chinese, investigated the factors influencing food choices, and targeted Chinese mainlanders or Chinese immigrants living in Western countries. Twenty-five studies (24 in English, 1 in Chinese) were included, involving 2048 participants. Four themes were identified; (1) the principles of traditional Chinese medicine (TCM), (2) perceptions of a healthy diet in Chinese culture (e.g., regular eating, eating in moderation, and emphasis on food freshness), (3) the desire to maintain harmony in families/communities, and (4) physical/social environmental factors all significantly influenced Chinese people's food choices. It is important to acknowledge these factors when developing culturally appropriate nutrition programs for promoting health in Chinese mainlanders and Chinese immigrants.

Acculturation, food-related and general parenting, and body weight in Chinese-American children

Parents' food-related and general parenting behaviors may vary according to cultural background, with consequences for child eating behavior and weight. A better understanding of food-related and general parenting behaviors adopted by Chinese-American parents, and the relationships of all of these behaviors with child weight, is essential to aid the development of culturally appropriate interventions to prevent obesity in Chinese-American children. We investigated cross-sectional relationships of acculturation with parental feeding behaviors assessed with the Child Feeding Questionnaire, Parent Feeding Styles Questionnaire and Caregiver's Feeding Styles Questionnaire, and general parenting behaviors assessed with the Parenting Styles and Dimensions Questionnaire, in a sample of Chinese-American parents of 5-12 year-old children (n = 233). Parental level of acculturation was assessed using the Suinn-Lew Asian Self-Identity Acculturation scale. We performed generalized linear regressions to explore associations of acculturation levels with parental feeding and general parenting subscales and also associations of these factors with child body mass index (BMI) z-score. Acculturation was associated with higher scores on Responsiveness in feeding, lower scores on subscales assessing controlling feeding behaviors (Restriction, Pressure to eat, Demandingness in feeding), lower scores on non-nutritive feeding behaviors (Emotional feeding, Instrumental feeding), and greater likelihood of an indulgent feeding style. With regard to general parenting, acculturation was associated with lower scores on subscales assessing authoritarian parenting. Parental Prompting/Encouragement to eat was associated with lower child BMI z-score, while authoritarian parenting subscales were associated with higher BMI z-score. An appreciation of the impact of cultural variation on food-related and general parenting may help to inform the development of culturally-sensitive obesity prevention interventions.

Assessment of Dietary Acculturation in East Asian Populations: A Scoping Review

East Asian immigrants face multiple challenges upon arrival in their destination country, including an increased risk of future diabetes and cardiovascular disease development. The adoption of food and eating patterns of their host country (i.e., dietary acculturation) may contribute to this increased disease risk. To effectively examine the dietary acculturation-disease risk relationship in East Asian immigrants, sensitive tools are necessary; however, there has been no systematic review of the methods used to assess dietary acculturation in this population. A systematic scoping review of the literature was undertaken to address this gap. A systematic search was conducted in December 2019 and returned a total of 6140 papers. Manuscripts were screened independently by 2 reviewers, resulting in the final inclusion of 30 papers reporting on 27 studies. Robust measures of dietary acculturation were lacking, with only 6 studies using validated tools. Most studies used self-reported cross-sectional surveys to determine how the individual's diet had changed since immigrating, with responses provided on Likert scales. Only 3 quantitative longitudinal studies used prospective measures of diet change, through serial food-frequency questionnaires. Qualitative studies explored dietary acculturation and factors influencing change in diet through semi-structured interviews and focus groups.  This review found there is no consensus in the literature on how to most effectively measure the magnitude and process of dietary acculturation in East Asian populations. There is a need for robust, longitudinal, and mixed-method study designs to address the lack of evidence and develop more comprehensive tools measuring dietary acculturation. Improving the assessment methods used to measure dietary acculturation is critical in helping to monitor the impact of interventions or policies aimed at reducing diet-related disease risk in East Asian immigrant populations.

Food access, dietary acculturation, and food insecurity among international tertiary education students: A scoping review

The number of international students within tertiary education facilities continues to increase globally, but the challenges for this population in achieving a healthy diet in an unfamiliar environment receives insufficient attention. This scoping review aimed to synthesize current literature that investigated dietary changes and food security status of this student population. We followed a five-stage methodological framework developed by Arksey and O'Malley. Six electronic databases were searched. All types of research methods, including qualitative, quantitative, and mixed methods, were considered for inclusion. This review included 30 articles reporting dietary changes and 12 articles reporting food insecurity in international students. The students were able to explore novel foods in their host country without totally abandoning their original diet, thus developing a hybrid diet. Dietary habits oscillated between the new and traditional dietary cultures with many students consuming foods from their new food environment but less so in the long term. Changes in diet may contribute to weight change and some negative health impacts, but none of the included studies investigated the effects on academic performance. Additionally, international students appeared to be more vulnerable to food insecurity, but the contributing factors and impacts of this issue were insufficiently researched. International students often experienced dietary acculturation and faced more challenges in food security than their domestic peers. More specific support should be provided by tertiary institutions and governments to international students including regular culturally appropriate nutrition education programs.

Food access, dietary acculturation, and food insecurity among international tertiary education students: a scoping review protocol

OBJECTIVE

This scoping review aims to synthesize existing evidence on dietary changes and food security status of international students who attend tertiary education facilities. Factors affecting nutrition and health, academic and psychological outcomes will also be examined.

INTRODUCTION

More and more students choose to complete higher education in a foreign country, and these international students often have to establish new dietary habits in an unfamiliar culture and food environment. Nutritional status and food insecurity for college students have been frequently discussed, but similar issues for international students receive less attention.

INCLUSION CRITERIA

Quantitative and qualitative studies that investigate international students within tertiary education institutions in any country will be considered for inclusion. Eligible studies should include changes in dietary behaviors and food patterns, with associated factors, after students arrive in the host country. Studies that assess food insecurity among international students will also be included.

METHODS

The electronic databases, including MEDLINE, CINAHL, ERIC, Global Health, CENTRAL and PsycINFO, will be searched. The language of articles will be limited to English. A three-step strategy will be employed for screening. Two reviewers will conduct screening and data extraction. A draft data charting form will be used to extract data from included studies and modified as required for the final extraction. The patterns of dietary changes and food security status with influencers will be charted and summarized.

Food, culture, and identity in multicultural societies: Insights from Singapore

The choice of food practices can be influenced by one's identity in many societies, but has mostly been evaluated in light of the maintenance of cultural identity in migrant populations. This study focused on understanding the influence of identity on food practices among individuals in multicultural societies. We conducted 18 focus group discussions (n = 130) among Indian, Chinese and Malay women in Singapore. Focus group transcripts were analysed using Thematic Analysis both inductively and deductively. Deductive analysis was framed within a Social Representations Approach, a social psychological theory that allows a deeper understanding of the contextual aspects of identity. Participants highlighted the central position of food in social events, cultural celebrations, and persistent traditional beliefs about health (such as 'hot-cold balance'). These beliefs extended to the perception of certain traditional foods possessing medicinal properties. Importantly, the consumption of these traditional foods was accepted as necessary for the maintenance of health by the women. We propose that while cultural food practices are integral to identity preservation and identity continuity for Singaporean women from all three racial groups, this is different to other multicultural societies such as Canada where communities preserve their cultural food practices, in part, due to fear of cultural identity loss. In addition, cross-cultural food practices are readily adopted in participants' daily lives for a number of reasons such as the promotion of health, convenience, and variety. At times, this adoption blurred boundaries between different cultural cuisines. Food practices in multicultural societies like Singapore are thus a reflection of everyday multiculturalism, multicultural social policies, and attitudes towards traditional healthful food practices, and these aspects need to be considered in the development of public health policies and interventions.

Problematic Eating Behaviors Are More Prevalent in African American Women Who Are Overweight or Obese Than African American Women Who Are Lean or Normal Weight

Problematic eating behaviors such as overeating and loss of control over consumption can lead to obesity. Problematic eating behaviors among women of differing body mass indexes were explored through focus group methodology, the Palatable Eating Motives Scale (PEMS), and a taste test in a sample of low-income African American women (n = 45). Women who were overweight or obese (W-O/O) reported more problematic eating behaviors including eating in the absence of hunger, frequent overeating, and increased food thoughts than women who were lean or normal weight (W-L/N). The W-O/O appear to possess more problematic eating behaviors than W-L/N.

Accuracy of self-reported heights and weights in a predominately low-income, diverse population living in the USA

OBJECTIVES

This study explored the accuracy of self-reported heights and weights and factors associated with self-reported bias in a diverse American sample.

METHODS

Demographic, self-reported, and measured height and weight data from different studies with the same PI were compiled into one SPSS file and analyzed with paired t-tests to detect differences between self-reported and actual values. Kruskal-Wallis tests followed by pairwise t-tests detected differences among age, ethnicity, sex, income, and education. Stepwise regression analyses were done using anthropometric differences as the dependent variable and age category, sex, and ethnicity as independent variables to explore which variable was most predictive of anthropometric differences.

RESULTS

Individuals over-reported height and under-reported weight leading to an under-calculated BMI from self-reported height and weight by 0.6-1 kg/m² . These under-calculations of BMI led to misclassifications of obesity by 3, 6, 8, and 4% for African American, Euro-American, Native American women, and total women, and by 5, 6, 8, and 8% by African American, Euro-American, Native American men, and total men. Older individuals and males over-reported height more than younger individuals and females. African American females over-reported height to a lesser extent than other ethnicities. Asian males over-reported height to a lesser extent than other ethnicities.

CONCLUSIONS

Self-reported heights and weights lead to invalid results. Most individuals over-report height and under-report weight, resulting in an inaccurate underweight and obesity prevalence. Being misclassified into the incorrect BMI category could result in inappropriate healthcare treatment. Age, ethnicity, and sex appear to influence the misreporting of height and weight.

Do environmental factors drive obesity? Evidence from international graduate students

International students offer a unique window into the role environmental factors play in driving obesity. Naïve estimates of the relationship between environmental factors and obesity are often plagued by reverse causation, sample selection, and omitted variable bias. In this study, we survey international students at 40 public universities across the United States. We use this unique data to link the weight gain of international students to the prevalence of obesity where they live. We argue that our estimates are less likely to be biased as international students have limited control over the environment to which they are exposed upon arrival in the United States. We find that students living in areas with a higher prevalence of obesity show a biologically important and statistically significantly greater increase in weight as compared to those living in areas with a lower prevalence of obesity. Results provide cautious evidence that environmental characteristics of a region can affect the weight gain of individuals.