Disentangling the roles of generational status and acculturation on dietary behaviors in disaggregated Asian American subgroups
Introduction
Understanding and addressing the complex health and social needs of Asian Americans (AAs), now the fastest growing racial and ethnic group in the United States (US) (Budiman & Ruiz, 2021), has become an area of increased research and policy focus. Non-communicable diseases (NCDs), such as diabetes and heart disease, represent major causes of death for AAs (Hastings et al., 2015), although disparities in health outcomes become apparent when disaggregating this subpopulation into country-of-origin subgroups. For example, Filpina/x/o, Asian Indian/South Asian, and Korean American adults have a high prevalence of diabetes (Wyatt et al., 2021), while heart disease represents a leading cause of death for Filipino, Japanese, and Asian Indian men (Hastings et al., 2015).
Disparities in NCDs may be, in part, linked to differences in diet practices (e.g., consumption of sweet and fried foods) (Beasley et al., 2019), but food group consumption data disaggregated by AA subgroup is limited or dated. However, preliminary data point to significant differences in AA dietary behaviors compared to other US populations and across different AA ethnic subgroups. The 2005 California Health Interview Survey, for example, indicates that the prevalence of consuming five or more fruit and vegetables (FVs) per day among both AA men (50%) and women (34%) was lower than Non-Hispanic White adults (59%; 41%), and ranged from 29% among Filipina women to 59% among Korean men (Maxwell et al., 2012). Previous work using national dietary recall data has also highlighted that key sources of salt and sugar in diets are different in AA adults compared to other ethnic subgroups (Firestone et al., 2017; Russo et al., 2020). Many AA subgroups report high seafood consumption (Sechena et al., 2003), and some AA subgroups (e.g., Japanese men and women in Hawaii) report higher red meat intake and lower fiber intake than Non-Hispanic adults (Steinbrecher et al., 2011). Importantly, lacking from the literature are studies assessing food and nutrient intake in national samples of AAs that provide information on AAs overall and on disaggregated AA subgroups.
While the degree of acculturation has been linked with unique dietary patterns among AA adults (Kirshner et al., 2020), what has been less explored is the role that generational status plays in the adoption of certain dietary practices. About 59% of AAs are foreign-born (i.e., first-generation / 1st-Gen Americans), and the remaining 41% of AAs are either second-generation / 2nd-Gen (US-born with at least one Asian-born parent) or third-generation / 3rd-Gen (US-born, with US-born parents and at least one Asian-born grandparent) (Pew Research Center, 2012). Prior research has shown that 2nd-Gen AAs are more than twice as likely to be obese than 1st-Gen AAs (Popkin & Udry, 1998), which suggests that obesity is linked to being born in the US. However, a recent review on youth in US immigrant families demonstrated that obesity was associated with lower levels of acculturation (Dondi et al., 2020). Such findings support the need for critical examination of generational status in parallel to acculturation in deconstructing differences in AA dietary practices.
In response to a growing call for more observational research related to NCD outcomes and lifestyle behaviors – including diet practices – observed in 2nd-Gen/3rd-Gen AA adults (Ali et al., 2020), we sought to explore dietary behaviors of a nationwide sample of AAs and their association with generational status and acculturation using a validated dietary screener adapted for AA adults, focusing on 11 key food and nutrient groups and disaggregating by Asian ethnic subgroup. To our knowledge, no research has collected data from a national sample of AA adults using a validated diet screener specifically designed or adapted to be culturally relevant across AA populations.
Section snippets
Underlying conceptual framework
The diet of AAs is influenced by unique and multi-faceted social, cultural, and economic factors related to access to and selection of foods (Becerra et al., 2018; Kirshner et al., 2020; Serafica, 2014). Upon immigrating to the US, many AAs integrate both Western and Asian cultural traits or practices into their daily lives (i.e., acculturation) (Suinn, 2010), and may also specifically experience dietary acculturation (adopting aspects of both Asian and Western dietary patterns) (Serafica, 2014
Results
Overall, the study sample had high educational attainment (71.1% had a Bachelor's degree or graduate/professional degree), and 86.6% had a household income of $20,000 or more (Table 1). In terms of generational status, 42.2% of participants were 1st-Gen, 34.0% were 2nd-Gen, and 20.9% were 3rd-Gen adults. The average acculturation score was 36.0 (SD = 8.0) in the full sample, ranging from a low of 33.2 (SD = 8.1) among SAA to a high of 37.0 (SD = 7.9) among EAA (not displayed); and ranging from
Discussion
Overall, we found both generational status and acculturation level were associated with key differences in dietary intake across multiple food and nutrient groups, particularly increased intake of red meat and processed meat among 2nd-Gen and 3rd-Gen participants, and decreased vegetable, fiber, and seafood intake among participants with higher acculturation. When compared with the overall US population, our findings suggest that AA adults in our sample had slightly higher vegetable intake
Funding
This project was supported by the NYU Center for the Study of Asian American Health under the NIH National Institute on Minority Health & Health Disparities grant award # U54MD000538-15.
Ethics approval
All study procedures were reviewed and exempted by the New York University Grossman School of Medicine Institutional Review Board.
Consent to participate
Informed consent was obtained online directly prior to a screen-questionnaire.
Availability of data and material
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Code availability
Not applicable.
Authors' contributions
Shahmir H. Ali: Conceptualization, Methodology, Formal analysis, Writing - Original Draft, Funding acquisition. Stella S. Yi: Methodology, Writing - Review & Editing, Funding acquisition. Julie Kranick: Formal analysis, Writing - Review & Editing. Matthew Lee: Writing - Review & Editing. Lorna E. Thorpe: Writing - Review & Editing, Funding acquisition. Pasquale E. Rummo: Conceptualization, Methodology, Writing - Review & Editing, Funding acquisition, Supervision.
Declaration of competing interest
None to declare.
Acknowledgements
We would like to thank Stella Chong, Lily Divino, Mary Joy Garcia, Alka Kanaya, Simona Kwon, Stephanie Liu, Binh Lu, Deborah Min, Rhea Naik, Chorong Park, MD Taher, Sameer Talegawkar, Kosuke Tamura, Tracy Vo, and Jennifer Wong for their feedback on our survey questions related to acculturation, diet, and grocery shopping.
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