Language use affects food behaviours and food values among Mexican-origin adults in the USA

Dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast in Japanese adults: the JPHC-NEXT study

OBJECTIVE

To assess dietary behaviours and related lifestyles according to the presence or absence of skipping breakfast.

DESIGN

We analysed the cross-sectional data from a baseline survey of a large-scale population-based cohort study in Japan conducted in 2011-2016. Participants provided information on dietary behaviours and lifestyles through a self-administered questionnaire. Skipping breakfast was defined as not eating breakfast at least once a week and was classified according to the frequency of skipping breakfast as 1-2, 3-4 or ≥5 times/week.

SETTING

Sixteen municipalities in seven prefectural areas across Japan under the Japan Public Health Centre-based prospective study for the Next Generation.

PARTICIPANTS

112 785 residents (51 952 males and 60 833 females) aged 40-74 years.

RESULTS

After adjustment for age, socio-demographic status, drinking status and smoking status, individuals who skipped breakfast at least once a week, compared with those who ate breakfast every day, were more likely to have adverse dietary behaviours such as frequent eating out (multivariable OR = 2·08, 95 % CI (1·96, 2·21) in males and 2·15, 95 % CI (1·99, 2·33) in females), frequent eating instant foods (1·89, 95 % CI (1·77, 2·01) in males and 1·72, 95 % CI (1·56, 1·89) in females). They had late bedtime (1·85, 95 % CI (1·75, 1·95) in males and 1·98, 95 % CI (1·86, 2·11) in females) and living alone (2·37, 95 % CI (2·17, 2·58) in males and 2·02, 95 % CI (1·83, 2·21) in females), using the logistic regression model.

CONCLUSIONS

Both adult males and females who skipped breakfast were likely to eat out, to have a dietary habit of eating instant foods and have lifestyles such as late bedtime and living alone than those who ate breakfast.

Nosotros mismos nos estamos matando/We are the ones killing ourselves: Unraveling individual and network characteristics associated with negative dietary acculturation among Mexican Americans in New York City

BACKGROUND

Research on negative dietary acculturation among Mexican-Americans has mostly focused on individual-level processes and has largely ignored the role of social networks.

METHODS

This mixed-method study used an egocentric network approach and derived 1620 personal ties of self-identified Mexican adults in New York. 24-hour dietary recalls were used to derive a total Healthy Eating Index (HEI) and subscores. The qualitative portion generated narratives around who helps or hinders their efforts to eat healthfully.

RESULTS

At the individual level, age at which participants migrated to the U.S. was negatively associated with total HEI (β = -0.39, p < .01). An annual income below $30,000 was positively associated with total HEI (β = 0.25, p < .05) and with HEI fruit subscores (β = 0.25, p < .05). Acculturative stress was negatively associated with HEI fruit (β = -0.29, p < .05) and refined grain subscores (β = -0.34, p < .01). At the network level, the proportion of network members who consumed traditional Latino diets was negatively associated with total HEI and HEI refined grains subscores (β = -0.39, p < .001; and β = -0.23, p < .05; respectively). In contrast, the proportion of alters who lived in another country was positively associated with HEI dairy subscores (β = 0.25, p < .05). Juxtaposing qualitative participants' visual representation of their total HEI scores with their lay interpretations of healthy and unhealthy eating matched public health messages of reducing sugar, red meat intake, and processed foods. However, participants felt that this could only be achieved through restriction rather than balance. Qualitative narratives also elucidated how dietary acculturation and income could help shape dietary quality in unexpected ways.

CONCLUSIONS

This study found evidence of negative dietary acculturation and showcases the complex ways in which both individual- and network-level processes help shape dietary choices for Mexican-Americans.

Does Healthcare Provider Counseling for Weight Management Behaviors among Hispanic Adults Who Are Overweight/Obese Vary by Acculturation Level?

This cross-sectional study explored differences in the receipt of health care provider (HCP) counseling to control/lose weight and adopt weight-related lifestyle behavior changes among Hispanic respondents according to acculturation level. Differences in reported action regarding HCP counseling were also examined. Data from four National Health and Nutrition Examination Survey (NHANES) cycles (2011-2018) were analyzed, with the analytic sample limited to Hispanic respondents who were overweight/obese. Respondents' acculturation levels were derived from their reported country of origin and the primary language spoken at home. Respondents who reported speaking only Spanish or more Spanish than English at home were classified as primarily speaking Spanish at home. In contrast, those who reported speaking Spanish and English equally, more English than Spanish, or only English were categorized as primarily speaking English at home. Weighted multivariate logistic regression models were utilized to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine if differences in acculturation levels existed regarding the likelihood of receiving HCP counseling to (1) control/lose weight, (2) increase exercise/PA, and (3) reduce fat/calorie intake. Similar analyses examined differences in reported action regarding HCP counseling according to acculturation level. The analysis found no significant differences in receiving HCP counseling according to acculturation level. However, non-US-born respondents who primarily spoke Spanish at home were less likely than US-born respondents to report acting to control/lose weight (p = 0.009) or increase exercise/PA (p = 0.048), but were more likely to report having taken action to reduce fat/calorie intake (p = 0.016). This study revealed differences between acting on recommendations of health care professionals according to acculturation level, indicating a need for interventions tailored to acculturation levels.

Acculturation and Associations with Ultra-processed Food Consumption among Asian Americans: NHANES, 2011-2018

BACKGROUND

Ultra-processed food (UPF) consumption is linked to adverse health outcomes, including cardiovascular disease and all-cause mortality. Asian Americans (AAs) are the fastest growing ethnic group in the United States, yet their dietary patterns have seldom been described.

OBJECTIVES

The aim was to characterize UPF consumption among AAs and determine whether acculturation is associated with increased UPF consumption.

METHODS

The NHANES is an annual, cross-sectional survey representative of the US population. We examined 2011-2018 NHANES data, which included 2404 AAs ≥18 y old with valid 24-h dietary recall. Using day 1 dietary recall data, we characterized UPF consumption as the percentage of caloric intake from UPFs, using the NOVA classification system. Acculturation was characterized by nativity status, nativity status and years in the United States combined, home language, and an acculturation index. We assessed the association between acculturation and UPF consumption using linear regression analyses adjusted for age, sex, marital status, education, income, self-reported health, and self-reported diet quality.

RESULTS

UPFs provided, on average, 39.3% (95% CI: 38.1%, 40.5%) of total energy intake among AAs. In adjusted regression analyses, UPF consumption was 14% (95% CI: 9.5%, 17.5%; P < 0.05) greater among those with the highest compared with the lowest acculturation index score, 12% (95% CI: 8.5%, 14.7%: P < 0.05) greater among those who speak English only compared with non-English only in the home, 12% (95% CI: 8.6%, 14.7%: P < 0.05) greater among US-born compared with foreign-born AAs, and 15% (95% CI: 10.7%, 18.3%: P < 0.05) greater among US-born compared with foreign-born AAs with <10 y in the United States.

CONCLUSIONS

UPF consumption was common among AAs, and acculturation was strongly associated with greater proportional UPF intake. As the US-born AA population continues to grow, UPF consumption in this group is likely to increase. Further research on disaggregated AA subgroups is warranted to inform culturally tailored dietary interventions.

Diet Quality Differs by Race/Ethnicity Among Mothers and Their Children from Supplemental Nutrition Assistance Program-Education Households

Purpose: To investigate diet quality by race/ethnicity among mothers and their children from low-income households throughout California.

Methods: Cross-sectional telephone surveys of mothers and their children from randomly sampled households using a validated 24-h dietary assessment. Healthy Eating Index-2015 (HEI-2015) scores were calculated.

Results: The mean HEI-2015 scores were lower for African American and white mothers and children compared with Latinx mothers and children.

Conclusion: Addressing poor levels of overall diet quality among African American and white mothers and children from low-income households is of public health importance. Reasons for Latinxs' superior diet quality may include limited acculturation to U.S. culture.

The psychometric properties of the Bidimensional Acculturation Scale for Marriage-Based Immigrant Women in Taiwan

Introduction

Marriage-based immigrant women are increasing around the world. Although bi-dimensional acculturation is important for immigrant women’s health, the existing scales have mainly been developed for immigrant women in Western countries and hence some items may not be suitable for Asian contexts. Thus, we developed and evaluated the Bidimensional Acculturation Scale for Marriage-Based Immigrant Women (BAS-MBIW) in Taiwan.

Methods

The BAS-MBIW was developed based on a literature review and clinical observations. Bi-dimensional acculturation involves “adaptation to host culture (acculturation)” and “maintenance of heritage culture (enculturation).” The initial scale included two 24-item subscales. The validation samples were 310 marriage-based immigrant women who were pregnant for at least twelve weeks in Taiwan. The BAS-MBIW was assessed and modified by experts. Data analyses included factor analysis, Pearson’s correlation, and Cronbach’s alpha coefficient.

Results

Expert reviews and factor analysis indicated that the scale had acceptable content and construct validity. The validated scale includes two 19-item subscales, encompassing six domains: language, media, food preference, cultural heritage, social interaction, and shopping and merchandise preference, with good internal consistencies (Cronbach’s alpha coefficient is 0.88 for acculturation and 0.83 for enculturation). Acculturation was positively related to local language ability and duration of immigration but negatively related to age at immigration, stress, and depression; whereas enculturation was positively related to age at immigration, stress, and depression but negatively related to duration of immigration, indicating convergent validity.

Conclusions

The BAS-MBIW offers reliable and valid assessments of pregnant immigrant women’s level of acculturation and enculturation in Taiwan. The BAS-MBIW could be used to assess bi-dimensional acculturation among marriage-based immigrant women.

Crispness, the Key for the Palatability of "Kakinotane": A Sensory Study with Onomatopoeic Words

Crispness is among the most important food textures that contribute significantly to palatability. This study investigated the association between the perceived crispness and palatability of five types of Japanese rice crackers known as “kakinotane.” Two experiments were conducted using the temporal dominance of sensations (TDS) and temporal drivers of liking (TDL) methods. As descriptors for the TDS evaluation, we used 10 Japanese onomatopoeias to indicate various attributes of crispness. We also measured the mastication sounds and electromyography (EMG) activity during mastication. Principal component analysis data revealed that principal component 1, representing moisture characteristics, contributed more than 60% in both experiments. The palatability of the stimulus, which was described as having a very soft, moist, and sticky texture, BETA-BETA, was significantly lower than the others. However, there was no significant relationship between the amplitude of mastication sound or EMG activity and palatability. We demonstrated that naïve university students can discriminate the fine nuances of the crispness of “kakinotane” using the TDS and TDL methods. Our findings also suggested that the onomatopoeias used as descriptors in the TDS method had a greater influence on describing the nuances of food texture than the physiological data.

The impact of acculturation to the US environment on the dietary share of ultra-processed foods among US adults

This study examined the association between measures of acculturation to the US environment including place of birth, and language spoken at home and proportion of life in the US among foreign-born, in relation to the dietary contribution of ultra-processed foods. Ultra-processed foods, as defined by the NOVA food classification system, are formulations of macronutrients (starches, sugars, fats and protein isolates) with little, if any, whole food and often with added flavors, colors, emulsifiers and other cosmetic additives. We studied 14,663 participants from the National Health and Nutrition Examination Survey 2011-2016, aged 20+ years, who completed a 1-day 24-h dietary recall. Food items were classified using NOVA into ultra-processed or non-ultra-processed foods. Linear regression models adjusted for age, sex, family income, education and race/ ethnicity, showed significant associations between general acculturation measures and dietary contribution of ultra-processed foods. Foreign-born adults consumed less ultra-processed foods than US-born adults (45 vs. 58%, p < 0.001). Within foreign-born adults, ultra-processed food consumption increased with English permeation at home from 40% among individuals speaking non-English languages only to 50% among those speaking English only (p for linear trend <0.001). In addition, ultra-processed food consumption increased from 41% among foreign-born adults who spent less than 30% of their life in the US to 48% among those who lived in the US for more than 50% of their lives (p for linear trend <0.001). Race/ethnicity emerged as an important effect modifier for the observed associations.

Time Spent Eating, by Immigrant Status, Race/Ethnicity, and Length of Residence in the United States

Introduction

Time spent eating is associated with obesity and diet-related diseases. We examined the association between time adults spent eating, immigrant status, race/ethnicity, and race/ethnicity among adults in the United States.

Methods

We used multivariate linear regression to analyze a cross-sectional, nationally representative sample of respondents aged 19 years or older (N = 192,486) from the 2016 American Time Use Survey. The outcome measures were time spent per day on primary eating and drinking and secondary eating. The predictors were immigrant status, race/ethnicity, and years spent living in the United States.

Results

Multivariate adjusted minutes per day spent on primary eating and drinking were 66.4 for noncitizens, 66.5 for naturalized citizens, and 60.1 for US-born individuals. Multivariate adjusted minutes per day spent on secondary eating were 11.1 for noncitizens, 12.2 for naturalized citizens, and 12.9 for US-born individuals. Minutes per day spent on primary eating and drinking for immigrants by length of residence in the United States was 69.7 minutes for 5 years or less of residence, 67.9 minutes for 6 to 10 years of residence, 63.6 minutes for 11 to 15 years of residence, and 63.6 minutes for more than 15 years of residence. Minutes per day spent on secondary eating for immigrants by length of residence was 5.5 minutes for 5 years or less of residence, 9.7 minutes for 6 to 10 years of residence, 8.4 minutes for 11 to 15 years of residence, and 12.6 minutes for more than 15 years of residence.

Conclusion

Time spent eating varied by immigrant status and length of residence in the United States.

Body Composition, Physical Activity, and Convenience Food Consumption among Asian American Youth: 2011-2018 NHANES

The primary purpose of this study was to describe obesity, body composition, convenience food consumption, physical activity, and muscle strength among Asian American youth compared to other racial/ethnic groups. The secondary purpose was to examine whether obesity, body composition, convenience food consumption, physical activity, and muscle strength differed by acculturation levels among Asian American youth. A secondary analysis was conducted using data from 12,763 children aged 2 to 17 years that participated in the 2011-2018 US National Health and Nutrition Examination Survey (NHANES). In the NHANES interview, acculturation, dietary behavior, and physical activity questionnaires were administered. The acculturation level was indicated by the language spoken at home. In the NHANES examination, anthropometry, dual-energy X-ray absorptiometry (DXA), and muscle strength assessments were conducted. Compared to non-Hispanic White American boys, Asian American boys had similar levels of obesity, central obesity, and fat mass. Among the five racial/ethnic groups examined, lean body mass, muscle mass, convenience food consumption, and daily physical activity were the lowest in the Asian group. More acculturated Asian American boys, but not girls, were more likely to be obese (OR = 3.28 (1.63, 6.60)). More acculturated Asian American youth more frequently consumed convenience food (1.4 more meals/month (1.2, 1.6)). This study highlights the obesity problem among Asian American boys, which worsens with acculturation to America. The study results also suggest that although Asian American youth consume less convenience food overall than non-Hispanic White American youth, increasing acculturation may negatively influence food choices.

Differences in Diet Quality and Snack Intakes Among Non-Hispanic White and Mexican American Adolescents from Different Acculturation Groups

Mexican American adolescents have an increased risk for obesity compared to non-Hispanic whites (NHWs), especially as their degree of acculturation increases. Snack intakes can impact diet quality and may affect obesity risk, yet little is known about differences in snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study compared diet quality and snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study used cross-sectional data from 3636 Mexican American and NHW adolescents in the 2005-2014 National Health and Nutrition Examination Survey. Acculturation was defined based on generational status and language use. Outcomes were Healthy Eating Index-2015 (HEI-2015) score, daily energy intake from snacks, snack frequency, energy value of snacks, and percent contribution of snacks to total daily energy. Analysis of covariance was used to compare outcomes across groups, after adjustment for sex and income. In the full sample, mean HEI-2015 score was 45 ± 0.4. Non-Hispanic white adolescents had modestly poorer diet quality compared to US-born adolescents with a foreign-born parent and Mexican-born adolescents (P < 0.001). Mean daily snack intake was 583 ± 16 kcal. Items in the Snacks and Sweets and Beverages categories contributed more than half of the energy provided by snacks. Non-Hispanic white adolescents had a greater total snack intake compared to all language use at home groups, except equal Spanish and English use. Improving the types of foods consumed as snacks has the potential to partially mitigate differences in snack intakes and diet quality among non-Hispanic white and Mexican American adolescents.

"Men like to Eat More Rice and Beans and Things like That": The Influence of Childhood Experience and Life Course Events on Dietary Acculturation

Life course perspective provides a framework for examining the immigrant experience within the context of globalization and transnationalism. Life course perspective states that individuals develop food choice trajectories based on childhood experiences with food. This study examined the influence of childhood experiences and life events on eating behaviors of Dominican born women in Santo Domingo, Dominican Republic, and New York City. Findings revealed that women developed traditional or non-traditional food choice trajectories. These food choice trajectories remained stable through transition points, such as immigration, marriage, and divorce. Women discussed changes in the amount of food that was eaten, which may explain weight gain after immigration. These findings highlight the limitations of acculturation theory in understanding the eating behaviors of immigrants and provide an alternative explanation for weight gain after immigration.

The association between baseline acculturation level and 5-year change in adiposity among Puerto Ricans living on the mainland United States

While it is recognized that acculturation influences adiposity risk, the direction and magnitude of this relationship remain unclear. Previous studies' use of proxy acculturation measures and exclusively cross-sectional study designs have limited understanding of this research question. The aim of this study was to examine associations between acculturation and adiposity among Puerto Ricans (45-75 years) living on the mainland United States. We analyzed data from the longitudinal (baseline, 2-year, 5-year) Boston Puerto Rican Health Study (n = 1114). Language-based and psychological-based acculturations were assessed at baseline using questionnaires. Acculturation scores were divided into tertile categories; higher tertiles indicate greater English- and U.S.-based acculturation. Adiposity was assessed using BMI and waist circumference at baseline and each follow-up. Linear mixed effects regression models were fit with baseline acculturation tertile as the predictor and baseline or change in adiposity as the outcome. When examining baseline associations with language acculturation tertiles, participants in the middle acculturation tertile (bilingual) had 2.48 cm (95%CI: -4.64, -0.31) lower waist circumference compared to the more Spanish-based acculturation tertile. When examining the associations between baseline language acculturation tertiles and change in adiposity, those in the more English-based acculturation tertile had higher annual gains in BMI (0.13 kg/m² (95%CI: 0.01, 0.25)) and waist circumference (0.44 cm (95%CI: 0.01, 0.88)) over 5-years compared to those in the more Spanish-based acculturation tertile. No significant differences in adiposity were found across psychological-based acculturation tertiles. In conclusion, English language-based acculturation at baseline influences long-term adiposity. Psychological-based acculturation may capture distinct acculturation processes from the language-based construct.

Plant-Based Diets in Hispanic/Latino Adult Adventists in the United States and Their Association With Body Mass Index

PURPOSE

To characterize plant-based dietary practices and examine their relationship with body mass index (BMI) in Hispanic/Latino Seventh-day Adventists (SDA).

DESIGN

Cross-sectional analyses of data among Hispanics/Latinos in the Adventist Health Study-2 (AHS-2).

SETTING

The AHS-2 is a cohort of SDA adults (n = 96 592) in North America.

PARTICIPANTS

A total of 3475 Hispanics/Latinos who provided demographic, dietary, anthropometric, and lifestyle data at enrollment.

MEASURES

Plant-based dietary practices were determined from food frequency questionnaire; BMI, demographic, and lifestyle data were assessed by questionnaire.

ANALYSIS

In linear regression analysis, plant-based diets were modeled as dummy variables with nonvegetarian as the referent group and log(BMI) as the outcome adjusted for age, sex, education, exercise, nativity, alcohol use, smoking, and energy intake.

RESULTS

We identified 202 vegans, 664 vegetarians, 409 pesco-vegetarians, 227 semi-vegetarians, and 1973 nonvegetarians. Compared to the nonvegetarian referent (BMI = 27.50), estimated BMI were lower among vegans (23.58, P < .0001), vegetarians (25.24, P < .0001), pesco-vegetarians (26.36, P = .0002), and semi-vegetarians (26.69, P = .130). Other factors associated with lower BMI were being female (P = .001), nativity (Mexico, P = .002; South America, P < .0001; Caribbean, P = .004), having a college degree or higher (P = .01), exercise (P < .0001), and never smoked (P = .0006).

CONCLUSION

Hispanic/Latino SDAs who consumed plant-based diets had lower BMI than nonvegetarians. The application of a plant-based diet as practiced by the Hispanic/Latino Adventists in this population may have public health impact on US Hispanic/Latinos.

Beyond fatalism: Information overload as a mechanism to understand health disparities

BACKGROUND

Fatalism - beliefs about the causes and controllability of disease - has been negatively associated with prevention behaviors. Fatalism has been suggested as a mechanism for health disparities because ethnic minorities are especially likely to hold fatalistic beliefs. However, the construct has been criticized: Fatalism fails to account for structural barriers to health faced by vulnerable populations that also score highly on measures of fatalism. Another critique suggests that operationalizations of fatalism expose communication failures: "Fatalism" rather reflects information overload from an environment riddled with misinformation and contradictions. This study aimed to expand understanding of one mechanism through which communication may contribute to disparities by considering the context of nutrition among bicultural Latinas, who face increased risk from dietary acculturation.

METHOD

Mixed-methods (semi-structured in-depth interview, survey) with Mexican-American women ages 18-29 (n = 24) in rural California.

RESULTS

Contrary to previous studies, the majority of this sample of Mexican-American women did not endorse fatalistic beliefs; most demonstrated clear understanding of the link between diet and risk of diseases: Diabetes and heart disease were understood to result from behaviors within one's control. Yet despite articulating links between diet and disease, participants felt overloaded and confused about conflicting information from public and interpersonal sources. Moreover, despite reporting feeling inundated with information, participants noted critical information gaps, distinguishing between information available and information needed.

CONCLUSIONS

We found minimal support for fatalistic beliefs among a sample of Mexican-American women, but considerable information overload and confusion, together with a desire for specific knowledge and skills. Results extend understanding of how communication may influence disparities: Information overload may be conflated with fatalism, challenging the notion that fatalism is a cultural belief. Moreover, inequalities in access to and ability to process information compound overload effects. We discuss opportunities to improve the clarity of communication about nutrition science and dietary recommendations.

Dietary Acculturation among Puerto Rican Adults Varies by Acculturation Construct and Dietary Measure

Background

The role of acculturation in dietary behaviors among Hispanics/Latinos in the United States remains unclear. Discrepancies may be explained by variations in acculturation constructs or ethnicity-specific dynamics.

Objective

We aimed to compare relations between 3 different acculturation constructs with dietary quality and patterns among Puerto Ricans in the mainland United States.

Methods

We analyzed cross-sectional data with 1194-1380 Puerto Ricans, aged 45-75 y. Acculturation was measured with the use of a language-based scale (0-100; higher score denotes more English use), a psychological-based scale (0-50; higher score denotes stronger US orientation), and years living in the mainland United States. Diet quality scores (higher scores denote healthier diet) were defined with the use of the Alternate Healthy Eating Index-2010 (AHEI) and the Mediterranean Diet Score (MeDS). Three dietary patterns were previously derived with the use of principal components analysis. Adjusted multivariable regression models tested the association of each acculturation construct with diet quality score or pattern. Interaction terms were included for income or education status.

Results

Psychological-based acculturation, but not the other constructs, was positively associated with AHEI (β ± SE: 0.013 ± 0.004; P = 0.002) and MeDS (0.009 ± 0.005; P = 0.041). Income, but not education, moderated this association (P = 0.03), with higher diet quality observed with higher income (>$25,000) and stronger US orientation. All constructs were inversely associated with a traditional dietary pattern, with the language-based scale being stronger (z score β ± SE: -0.160 ± 0.032; P < 0.0001) than the psychological-based scale (-0.097 ± 0.028; P = 0.001) or years living in the mainland United States (-0.058 ± 0.028; P = 0.041). No associations were observed for the Western or sweets/desserts patterns.

Conclusions

In Puerto Rican adults, stronger psychological US orientation was associated with higher diet quality, particularly with higher income. More Spanish use, stronger psychological Puerto Rican orientation, and shorter length of mainland-US residency were associated with traditional dietary patterns. Appropriate diet-related acculturation constructs should be carefully considered among Hispanics/Latinos. This trial was registered at clinicaltrials.gov as NCT01231958.

Fruit and Vegetable Intake of US Hispanics by Food Store Type: Findings from NHANES

This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p < .001) greater fruit cup equivalents and 0.26 (p = .001) greater vegetable cup equivalents than those who only purchased from convenience stores. Research on the influence of shopping in multiple food store types is needed to develop targeted in-store intervention strategies to encourage healthier food purchases. Results provide support for policy-level research such as minimum stocking requirements for healthy foods in convenience stores.

A US/Mexico Study of Joint Associations of Physical Activity and Sedentary Behavior on Anthropometric Indicators, Migration Status, Country of Birth and Country of Residence

Background: This study examined the influence of migration status, nativity and country of residence on joint associations of physical activity (PA) and sedentary behavior (SB) in anthropometric indicators of Mexicans and Mexican-Americans living in the US and in Mexico. Methods: We examined data from two large national surveys, the National Health and Nutrition Examination Survey from the US (NHANES, 2011–2012) and Mexico (ENSANUT, 2012). Using self-reported minutes of moderate to vigorous physical activity and SB, we calculated four categories for analyses. Anthropometric measures consisted of body mass index (BMI) and waist circumference (WC). We used data of migration status, nativity and country of residence. Linear regression models examined how joint categories of PA and SB were associated with BMI and WC according to migration status, nativity and country of residence, controlling for health risk behaviors. Results: Analyses showed that even among those in the category with the lowest risk behavior, “physically active and low sedentary”, there were differences in BMI and WC by migration status, nativity and country of residence. Within this lower risk category, Mexican immigrants living in the US had the greatest association with high BMI, while US-born Mexican-Americans living in the US had the highest WC values when compared with the group of Mexicans living in Mexico. Conclusions: Joint categories of PA and SB were associated with BMI and WC by migration status, nativity and country of residence among populations with Mexican ethnicity.

Disparities in hospital smoking cessation treatment by immigrant status

Despite the efficacy of nicotine replacement therapy (NRT) in promoting smoking cessation, no studies have been done to evaluate NRT prescribing rates among immigrants, a vulnerable minority population in the United States. The aim of this study is to explore for differences in NRT prescribing behavior by immigrant status. Participants were enrolled in a smoking cessation trial for hospitalized patients between July 2011 and April 2014 at two NYC hospitals. For this analysis, we used baseline data from patient surveys and electronic medical-record reviews to examine associations between immigrant status and prescription of NRT in-hospital and on discharge, as well as acceptance of NRT in-hospital. We included age, gender, education, health literacy, race, ethnicity, English language ability, inpatient service, and site insurance in the models as potential confounders. Our study population included 1,608 participants, of whom 21% were not born in the United States. Bivariate analysis found that nonimmigrants were more likely than immigrants to be prescribed NRT in the hospital (46.1% vs. 35.7%, p = .0006) and similarly on discharge (19.4% vs. 15.3%, p = .09). Both groups were equally likely to accept NRT in-hospital when prescribed. On multivariable analysis, being an immigrant (OR 0.65), Black race (OR 0.52), and Hispanic ethnicity (OR 0.63) were associated with lower likelihood of being prescribed NRT in-hospital. Multivariable analysis for provision of NRT prescription at discharge showed no significant difference between immigrants and nonimmigrants. These findings show differences in in-hospital smoking cessation treatment between immigrants and nonimmigrants.

Questioning the Dietary Acculturation Paradox: A Mixed-Methods Study of the Relationship between Food and Ethnic Identity in a Group of Mexican-American Women

BACKGROUND

Epidemiological studies have described an "acculturation paradox." Increased acculturation to the United States is associated with increased consumption of dietary fat and decreased consumption of fruits/vegetables.

OBJECTIVE

To expand understanding of the dietary acculturation paradox, this study examined how bicultural Mexican-American women construct ethnic identity and how these identities and identity-making processes relate to perceptions of health and nutrition.

DESIGN

We utilized embedded mixed methods (in-depth interviews; survey).

PARTICIPANTS/SETTING

We analyzed a purposive sample of English-speaking Mexican-American women aged 18 to 29 years (n=24) in rural California to assess ethnic identity and diet beliefs.

RESULTS

Participants described food as central to expressing cultural identity, usually in terms of family interactions. Mexican food traditions were characterized as unhealthy; many preferred American foods, which were seen as healthier. Specifically, Mexican-American women perceived Mexican patterns of food preparation and consumption as unhealthy. In addition, traditional Mexican foods described as unhealthy were once considered special-occasion foods. Among the participants who expressed a desire to eat healthfully, to do so meant to reject Mexican ways of eating.

CONCLUSIONS

This study raises questions about the nature of the "dietary acculturation paradox." While food-the eating of Mexican foods-is central to the maintenance of ethnic identity throughout acculturation, negative perceptions about the healthfulness of Mexican foods introduce tension into Mexican-American women's self-identification. This study suggests a subtle contradiction that may help to explain the dietary acculturation paradox: While previous research has suggested that as Mexicans acculturate to the United States they adopt unhealthy diets, this study finds evidence that they do so at least in part due to perceptions that American diets are healthier than Mexican diets. Implications for interventions to improve Latinos' diets include an emphasis on the family and use of Spanish linguistic cues. Finally, messages that simply advocate for "traditional" diets should be reconsidered because that message is discordant with perceptions of the healthfulness of such foods.

Healthy eating patterns associated with acculturation, sex and BMI among Mexican Americans

OBJECTIVE

Examine relationships of healthy and unhealthy dietary patterns with BMI, sex, age and acculturation among Mexican Americans.

DESIGN

Cross-sectional. Participants completed culturally tailored Healthy and Unhealthy Eating Indices. Multivariable mixed-effect Poisson regression models compared food pattern index scores and dietary intake of specific foods by BMI, sex, age and acculturation defined by language preference and generational status.

SETTING

Participants recruited from the Cameron County Hispanic Cohort study, Texas-Mexico border region, between 2008 and 2011.

SUBJECTS

Mexican-American males and females aged 18-97 years (n 1250).

RESULTS

Participants were primarily female (55·3 %), overweight or obese (85·7 %), preferred Spanish language (68·0 %) and first-generation status (60·3 %). Among first-generation participants, bilingual participants were less likely to have a healthy eating pattern than preferred Spanish-speaking participants (rate ratio (RR)=0·79, P=0·0218). This association was also found in males (RR=0·81, P=0·0098). Preferred English-speaking females were less likely to consume healthy foods than preferred Spanish-speaking females (RR=0·84, P=0·0293). Among second-generation participants, preferred English-speaking participants were more likely to report a higher unhealthy eating pattern than preferred Spanish-speaking participants (RR=1·23, P=0·0114). Higher unhealthy eating patterns were also found in females who preferred English v. females who preferred Spanish (RR=1·23, P=0·0107) or were bilingual (RR=1·26, P=0·0159). Younger, male participants were more likely to have a higher unhealthy eating pattern. BMI and diabetes status were not significantly associated with healthy or unhealthy eating patterns.

CONCLUSIONS

Acculturation, age, sex and education are associated with healthy and unhealthy dietary patterns. Nutrition interventions for Mexican Americans should tailor approaches by these characteristics.

Nutrition activation and dietary intake disparities among US adults

OBJECTIVE

To introduce the concept 'nutrition activation' (the use of health and nutrition information when making food and diet decisions) and to assess the extent to which nutrition activation varies across racial/ethnic groups and explains dietary disparities.

DESIGN

Cross-sectional sample representative of adults in the USA. Primary outcome measures include daily energy intake and consumption of sugar-sweetened beverages (SSB), fast foods and sit-down restaurant foods as determined by two 24 h dietary recalls. We use bivariate statistics and multiple logistic and linear regression analyses to assess racial/ethnic disparities in nutrition activation and food behaviour outcomes.

SETTING

USA.

SUBJECTS

Adult participants (n 7825) in the 2007-2010 National Health and Nutrition Examination Survey.

RESULTS

Nutrition activation varies across racial/ethnic groups and is a statistically significant predictor of SSB, fast-food and restaurant-food consumption and daily energy intake. Based on the sample distribution, an increase from the 25th to 75th percentile in nutrition activation is associated with a decline of about 377 kJ (90 kcal)/d. Increased nutrition activation is associated with a larger decline in SSB consumption among whites than among blacks and foreign-born Latinos. Fast-food consumption is associated with a larger 'spike' in daily energy intake among blacks (+1582 kJ (+378 kcal)/d) than among whites (+678 kJ (+162 kcal)/d).

CONCLUSIONS

Nutrition activation is an important but understudied determinant of energy intake and should be explicitly incorporated into obesity prevention interventions, particularly among racial/ethnic minorities.

What influences Latino grocery shopping behavior? Perspectives on the small food store environment from managers and employees in San Diego, California

To inform the design of a multilevel in-store intervention, this qualitative study utilized in-depth semistructured interviews with 28 managers and 10 employees of small-to-medium-sized Latino food stores (tiendas) in San Diego, California, to identify factors within the tienda that may influence Latino customers' grocery-shopping experiences and behaviors. Qualitative data analysis, guided by grounded theory, was performed using open coding. Results suggest that future interventions should focus on the physical (i.e., built structures) and social (i.e., economic and sociocultural) dimensions of store environments, including areas where the two dimensions interact, to promote the purchase of healthy food among customers.