Dietary pattern change and acculturation of Chinese Americans in Pennsylvania

RESEARCH Current Research

Dietary Pattern Change and Acculturation of Chinese Americans in Pennsylvania NAN LV, MS; KATHERINE L. CASON, PhD, RD

ABSTRACT Objective To obtain information about dietary pattern change of Chinese Americans in Pennsylvania and its relationship with demographic characteristics and acculturation indicators. Design A cross-sectional self-administered survey. Subjects A convenience sample of 399 Chinese Americans. Statistical Analyses Performed t Tests, analysis of variance with Tukey post-hoc tests, Spearman rank correlation, and ␹2 test. Results After immigration, Chinese Americans increased consumption frequency of all seven food groups (grains, vegetables, fruits, meat/meat alternatives, dairy products, fats/sweets, and beverages) and Western foods while consumption frequency of traditional Chinese foods decreased. Dietary variety also increased after immigration. Higher education and higher income levels were associated with a larger increase in consumption frequency of grains, vegetables, and fruits. Persons who resided in the United States for a longer period of time shared a greater increase in their consumption frequencies of vegetables, fats/sweets, and beverages. Persons with better English proficiency had a greater increase in their consumption frequency of grains, fruits, meat/meat alternatives, and fats/sweets. Conclusions This study can help nutrition educators design appropriate educational programs for first-generation Chinese Americans that can facilitate the adoption of more healthful dietary practices. Nutrition educators should consider the dietary changes of Chinese-American participants, such as skipping breakfast and increased consumption frequency of fats, sweets, and soft drinks, which were observed in this study. For example, acculturated first-generation Chinese Americans should be encouraged to decrease fats, sweets, and soft-drink consumption. Less-acculturated persons should be encourN. Lv is a graduate research assistant with the Department of Food Science, The Pennsylvania State University, University Park, PA. K. L. Cason is with the Department of Food Science and Human Nutrition, Clemson University, Clemson, SC. Address correspondence to: Nan Lv, MS, Department of Food Science, 8L Borland Laboratory, The Pennsylvania State University, University Park, PA 16802. E-mail: [email protected] Copyright © 2004 by the American Dietetic Association. 0002-8223/04/10405-0011$30.00/0 doi: 10.1016/j.jada.2004.02.032

© 2004 by the American Dietetic Association

aged to maintain their healthful dietary pattern and increase consumption of vegetables and fruits. J Am Diet Assoc. 2004;104:771-778.

I

n 2000, there were approximately 2.4 million Chinese Americans, the largest Asian population in the United States (1). Chinese Americans have higher rates of chronic diseases such as diabetes, heart disease, and certain kinds of cancers than Chinese persons in Asia (2-4). Research indicates that the differences in disease rates among people from different countries are partly due to differences in dietary patterns (5-8). Improving the health of minority groups is critical for progression toward a more healthful US population (9). Special preventive efforts are needed to improve the health of these population groups. These efforts require understanding the particular needs of minority groups at national and state levels. However, this kind of information is limited (9). Because of this lack of information about population food consumption, and factors affecting food choices, many educational initiatives may not be culturally appropriate for the specific minority group (10). Ethnic Chinese are very culturally and linguistically diverse and therefore present a distinct challenge to educators (10). For thousands of years, the yin-yang principle has been influencing Chinese persons’ health-seeking behaviors and dietary habits, especially among Chinese elders (11). “The traditional Chinese diet is well-balanced, high in fiber and low in saturated fats” (12). It includes a carbohydrate staple, usually rice, noodles, or steamed buns, as well as accompanying vegetable stir fries and soups that represent other food groups. Hot tea, fresh fruit, and nuts—instead of sweets—are typically served after the meal. After Chinese persons immigrate to the United States, they adopt Western eating habits while maintaining traditional Chinese eating habits, rather than rejecting either one of them (13). Researchers indicate that acculturation is associated with changes in dietary behaviors within the Chinese-American population (10,14-17). However, few current studies used large sample size to obtain information on the changes in dietary patterns and their relation with acculturation among Chinese Americans in the eastern United States. The objective of this research was to obtain information about dietary pattern change of Chinese Americans in Pennsylvania and its relationship with demographic characteristics and acculturation factors. The results of this study may be used to develop appropriate nutrition education programs for Chinese Americans.

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METHODS A cross-sectional, self-administered questionnaire was administered to a convenience sample of 399 first-generation Chinese Americans in Pennsylvania who were aged 18 years or older and were permanent residents or citizens of the United States, or were applying for a green card. This study was approved by the Behavior and Social Science Committee of the Institutional Review Board at The Pennsylvania State University. Subjects provided an informed consent form prior to the survey. The questionnaire contained three parts. Section A consisted of 11 questions assessing sociodemographic and acculturation characteristics. Basic personal background questions were adapted from previous studies (18,19). Acculturation was measured using three acculturation indicators: length of residency in the United States (2022), English proficiency (14,18,23), and number of congenial American friends (18). These indicators were considered to be associated with acculturation and were used in the previous studies. Section B included 10 questions about general food habits. Section C, a food frequency questionnaire (FFQ), was used to obtain information on consumption frequency of 97 food items 1 year before immigration and within the past 12 months in the United States. The FFQ used in this study was modeled after a study of Chinese immigrants by Newman and Linke (22), which was tested for content validity and reliability. Five frequency categories (daily, weekly, monthly, yearly, and never) were used in the FFQ to measure food consumption frequencies and their definitions were given. The food items included in the FFQ were selected mainly from the FFQ developed by Newman and Linke (22) and revised based on previous relevant Chinese food habit studies (18,19,24-26); direct observation of food items in Chinese food stores in Philadelphia, PA, Pittsburgh, PA, and State College, PA; and informal interviews with 10 Chinese persons about food items they commonly consume. This method was also used by Lee and colleagues (27) to select food items. For this survey, participants were asked to provide information on consumption frequency for grain products, vegetables, fruits, animal products, dairy products, fats/sweets, and beverages before and after immigration. Participants were required to use their memory to retrieve and report consumption information before immigration. Categorical food frequency indicators were used because participants were better at measuring relative frequencies than absolute frequencies (28). The purpose of this study was not to obtain nutrient intake of Chinese Americans but to measure the trend in changing their dietary pattern. The questionnaire was provided in English, simplified Chinese, and traditional Chinese. Respondents could select whichever version they preferred. The Chinese versions were translated by the researcher and were reviewed for translation content accuracy by a Chinese American who has resided in the United States for 10 years and is fluent in both English and Chinese. The survey was pilot tested with 30 Chinese Americans residing in State College, PA. The questionnaire was revised according to comments received from the pilot test participants. Various Chinese organizations in Pennsylvania were the main sources for recruiting partici-

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pants in the final study. The survey was administered to 399 Chinese Americans utilizing two different methods. For the Chinese organizations, the presidents were provided copies of the instrument and consent form, and were asked to distribute questionnaires to their members. Each participant obtained a package containing the consent forms, questionnaire, and an envelope with prepaid postage. After the participants mailed back the completed questionnaires, they would receive an $8 check. The other method of survey administration was utilized in the Chinese schools. The principals of Chinese schools agreed to offer the study to parents as an activity to participate in while they waited for their children to finish their classes. The researcher went to the schools and provided eligible, interested parents with a package containing the consent forms, the questionnaire, and a pen. The participants completed the questionnaire in the waiting room and were provided an $8 cash incentive when the survey was completed. No significant difference existed between these two different methods of administration of questionnaires. Because it was assumed that the dietary patterns of people residing in the same household would be similar, only one person per household was allowed to complete the questionnaire. STATISTICAL ANALYSIS Changes on dietary pattern and dietary variety were assessed. In the food frequency section, consumption frequencies of 97 food items were coded using 5⫽daily, 4⫽weekly, 3⫽monthly, 2⫽yearly, and 1⫽never. Consumption frequency of the food items within each group was summed and divided by the number of food items in this food group to calculate mean consumption frequency of each food group before immigration and after immigration. The scores of the respondents who had missing data on one of these food items were deleted when calculating the mean consumption frequencies of each food group. French fries were excluded from the vegetable group when the mean consumption frequency of vegetable group was calculated. Mean consumption frequency of each food group did not indicate real consumption frequency, but it was used as a means to estimate the trend of the change. Mean consumption frequency difference of each food group was obtained by subtracting mean consumption frequency before immigration from that after immigration. Dietary variety was measured using a similar method as in a study of Lee and coworkers (23). Dietary variety score was determined by total number of food items consumed weekly or more in the FFQ (possible maximum⫽97). Dietary variety scores calculated from FFQs are usually higher than those calculated from food records or dietary recalls (29). SPSS statistical software (version 10.0 for Windows, 1999, SPSS Inc, Chicago, IL) was used to conduct t tests, analysis of variance with Tukey post-hoc tests, Spearman rank-order correlation (r), and ␹2 test. Analysis of variance and Tukey post-hoc tests were used to test the relationships between nominal level demographic variables and change in consumption frequency of each food group. Spearman’s rank-order correlation statistic (r) was used to test the relationship between ordinal level demographic variables/three acculturation indicators and change in consumption frequency of each food group.

Table 1. Demographic characteristics of Chinese Americans in Pennsylvania

Table 2. Acculturation indicators of Chinese Americans in Pennsylvania

Variable

Variable

Age 18-24 years 25-34 years 35-44 years 45-54 years 55-64 years Above 65 years Total Sex Male Female Total Marital status Never married Married, not separated Divorced Widowed Separated Total Last grade of school completed Less than 12th grade (third grade in high school) Graduated high school Some college or vocational training Graduated vocational/technical college Graduated college (4-year bachelor’s degree) Graduate or professional school (masters, PhD, MPA, lawyer) Total Annual income per household Under $10,000 $10,000-$24,999 $25,000-$49,999 $50,000-$100,000 Above $100,000 Total Children in household Yes No Total Place of origin Mainland China Taiwan Hong Kong Other Total Involved in US educational programs about nutrition and food safety Yes No Total

n

%

19 52 223 84 14 7 399

4.8 13.0 55.9 21.1 3.5 1.8 100.0

145 254 399

36.3 63.7 100.0

38 343 9 5 3 398

9.5 86.2 2.3 1.3 0.8 100.0

15 28 18 33 70

3.8 7.1 4.5 8.3 17.6

233 397

58.7 100.0

21 52 53 153 112 391

5.4 13.3 13.6 39.1 28.6 100.0

342 57 399

85.7 14.3 100.0

276 90 17 16 399

69.2 22.6 4.3 4.0 100.0

29 367 396

7.3 92.7 100.0

RESULTS Sociodemographic characteristics and three acculturation indicators of the respondents are summarized in Tables 1 and 2, respectively.

Length of residency in the United States 0-5 years 6-10 years 11-15 years ⬎15 years Total English level Poor Fair Good Excellent Total No. of congenial American friends None Some (1-5) Many (⬎5) Total

n

%

79 115 109 94 397

19.8 29.0 27.5 23.7 100.0

25 158 162 52 397

6.3 39.8 40.8 13.1 100.0

77 219 100 396

19.4 55.3 25.3 100.0

General Food Habits Change About one fifth (22.6%) of participants reported decreasing the number of meals consumed daily and 64.6% reported skipping breakfasts. About one fifth (16.0%) increased the number of meals consumed. When asked if their eating habits changed since immigrating to the United States, more than half (56.9%) reported yes. The main explanations provided for why this change occurred were not having time to prepare Chinese traditional foods (32.6%) and access to traditional Chinese foods was limited (30.8%). Chinese Americans reported significantly decreasing their grocery shopping frequency after immigration (␹24⫽20.107; P⬍.001). The places where Chinese persons reported going to shop for groceries significantly changed from independent vendors in open markets (66.9%) and large supermarkets (36.1%) before immigration to large supermarkets (83.0%) and Asian markets (71.4%) after immigration. Participants were asked to provide their perception of the healthfulness of their overall diet. One third (33.3%) and 10.8% of the participants indicated that their overall diet in the United States was more healthful and much more healthful, respectively, compared with before immigration. One third (33.8%) thought their overall diet stayed the same. About one fifth of the subjects (19.5%) believed their diet was less healthful. Only 1.5% reported that their current diet was much less healthful. Dietary Pattern Change The consumption frequency of food items from all seven food groups increased after Chinese immigrated to the United States. Grain products had the highest level of consumption frequency increase, followed by dairy products, fats/sweets, beverages, fruits, vegetables, and meat/ meat alternatives. Within each food group, consumption frequency of traditional foods decreased whereas con-

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Table 3. Food items with significantly increased consumption frequency by Chinese Americans in Pennsylvania after immigration: paired t tests resultsa Food group Grains Bagels Pizza Breakfast cereal Sandwiches Pasta Bread Tortillas Vegetables Broccoli French fries Lettuce Asparagus Corn Onion Squash Carrots Potatoes Tomatoes Snow beans (Snow peas) Mushrooms Bell pepper (Green pepper) Fruits Grapes Strawberries Cantaloupe Cherries Bananas Apples Grapefruit Oranges Peaches Mangoes Watermelon Pears Meat/meat alternatives Hamburger Hot dog Turkey meat Ham Beef Shrimp Chicken meat Bacon Crab Dairy products Low-fat milk Cheese Yogurt Ice cream Fats/sweets Doughnuts Butter Pies Chocolate Cookies Cakes Cooking oil (for cooking) Beverages Coffee Regular Sodas

n

Before immigration meanb

After immigration meanb

Mean differencec

308 386 374 382 387 382 377

1.30 1.45 1.69 1.93 1.35 3.11 1.16

2.81 2.89 3.06 3.24 2.55 3.91 1.88

1.51 1.44 1.37 1.31 1.20 0.80 0.72

387 388 387 386 399 395 386 394 392 391 389 390 396

2.27 1.83 2.52 2.06 2.77 2.97 2.34 3.25 3.11 3.61 2.73 3.35 3.28

3.53 2.98 3.50 2.57 3.09 3.24 2.61 3.51 3.37 3.82 2.91 3.52 3.41

1.26 1.15 0.98 0.51 0.32 0.27 0.27 0.26 0.26 0.21 0.18 0.17 0.13

391 392 393 385 396 394 395 395 397 393 397 397

3.05 2.31 2.35 1.92 3.42 3.56 2.12 3.48 2.73 2.21 2.93 3.00

3.67 2.89 2.91 2.46 3.89 4.01 2.54 3.74 2.96 2.38 3.08 3.09

0.62 0.58 0.56 0.54 0.47 0.45 0.42 0.26 0.23 0.17 0.15 0.09

394 394 389 391 396 395 389 396 398

1.64 1.50 1.38 2.17 2.81 3.00 3.60 1.82 2.23

2.87 2.60 2.26 2.69 3.28 3.40 3.90 2.04 2.35

1.23 1.10 0.88 0.52 0.47 0.40 0.30 0.22 0.12

380 389 392 395

1.90 1.44 2.23 2.70

3.41 2.74 3.05 3.11

1.51 1.30 0.82 0.41

395 392 394 394 392 394 394

1.59 1.65 1.52 2.56 3.16 2.68 4.64

2.58 2.47 2.30 2.97 3.40 2.88 4.74

0.99 0.82 0.78 0.41 0.24 0.20 0.10

396 395

1.98 2.63

3.01 3.27

1.03 0.64

a Food items are listed in descending order based on consumption frequency increase (see mean difference column for the consumption frequency increase). An ␣ level ⱕ0.05 was used for analyses. b 5⫽Daily, 4⫽weekly, 3⫽monthly, 2⫽yearly, 1⫽never. c After⫺before.

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Table 4. Food items with significantly decreased consumption frequency by Chinese Americans in Pennsylvania after immigration: Paired t tests resultsa

Food group Grains Steamed bun/ bread Dumpling Noodles Rice Vegetables Bean sprouts Bamboo shoots Eggplant Napa cabbage Spinach Fruits Lychee Persimmon Meat/meat alternatives Frog legs Soybeans Rabbit meat Tofu (bean curd) Duck meat Snake meat Dog meat Shark fin Pork Fish Dairy products Milk powder Beverages Tea

n

After Before immigration immigration Mean meanb differencec meanb

383 394 384 396

3.58 3.10 3.67 4.92

2.85 2.94 3.55 4.81

⫺0.73 ⫺0.16 ⫺0.12 ⫺0.11

392 3.57

3.26

⫺0.31

386 394 393 397

2.90 3.28 3.62 3.39

2.65 3.08 3.47 3.25

⫺0.25 ⫺0.20 ⫺0.15 ⫺0.14

395 2.22 397 2.23

1.89 1.93

⫺0.33 ⫺0.30

397 1.80 391 3.26 394 1.41

1.41 2.95 1.20

⫺0.39 ⫺0.31 ⫺0.21

398 394 395 397 394 395 395

4.08 2.68 1.25 1.22 1.50 4.30 3.72

3.90 2.50 1.07 1.04 1.36 4.20 3.62

⫺0.18 ⫺0.18 ⫺0.18 ⫺0.18 ⫺0.14 ⫺0.10 ⫺0.10

388 2.13

1.34

⫺0.79

394 3.82

3.66

⫺0.16

a Food items are listed in descending order based on consumption frequency decrease (see mean difference column for the consumption frequency decrease). An ␣ level ⱕ0.05 was used for analyses. b 5⫽Daily, 4⫽weekly, 3⫽monthly, 2⫽yearly, 1⫽never. c After⫺before.

sumption frequency of Western and some inexpensive and available common foods was increased. Tables 3 and 4 list food items whose consumption frequency was significantly increased and decreased after immigration in each food group. Food items that had a large increase (mean difference⬎.5) included bagels, pizza, breakfast cereal, sandwiches, pasta, bread, and tortillas in the grain food group; broccoli, french fries, lettuce, and asparagus in the vegetable group; grapes, strawberries, cantaloupe, and cherries in the fruit group; hamburger, hot dogs, turkey meat, and ham in the meat/meat alternatives group; low-fat milk, cheese, and yogurt in the dairy products group; doughnuts, butter, and pies in the

fats/sweets group; and coffee and regular sodas in the beverage group. Food items that showed large decrease (mean difference⬎.5) included steamed bun/bread in the grain food group and milk powder in the dairy products group. Demographics, socioeconomic information, and acculturation indicators had a significant influence on Chinese Americans’ dietary pattern change. Table 5 shows the significant relationships among consumption frequency increase of each food group and demographic and socioeconomic factors. No significant relationships exist between the consumption frequency increase of dairy products, fats/sweets, and beverages and the demographic variables. Table 6 summarizes the significant relationships between consumption frequency increase of each food group and acculturation indicators. The number of congenial American friends was not associated with the consumption frequency increase in any food group. Consumption frequency increase of dairy products was not associated with any acculturation indicators. Dietary Variety The mean dietary variety scores were 26.14 and 32.06 before immigration and after immigration, respectively. Dietary variety (t398⫽⫺11.298; P⬍.001) significantly increased after participants immigrated into the United States. DISCUSSION Chinese Americans in this study reported changes in some of their general food consumption habits. For example, the frequency of grocery shopping significantly decreased from daily or several times per week to weekly after immigration. Similarly, Neilson (30) found that the Chinese persons shopped much less frequently after they immigrated to Canada. The consumption frequency of items from all seven food groups increased after Chinese Americans immigrated to the United States. This observation could be attributed to an overall improvement in economic status after immigration. These results also appear to support Newman and Linke’s (22) study, which found that Chinese Americans increased consumption frequency of items from all 10 food groups (breads/cereals, vegetables, fruits, meats, fish, egg, dairy products, beverages, nuts, and legumes) after immigration, with the meat group showing the largest increase. The authors suggested that foods are more accessible and available year round in American supermarkets whereas in other countries some foods are available only on a seasonal basis (21). The results from this survey also support the findings from Pan and colleagues (31), who reported a significant increase in fat and sweets intake among Asian students in the United States. However, the results conflict with these authors’ finding of a decrease in vegetable consumption after immigration (31). Based on these results, Chinese Americans may have higher risk of cardiovascular disease and some kinds of cancer than Chinese in China because higher consumption frequency of red meat, dairy products, and fats/sweets may result in higher intake of fat (14,19,32). Within all seven food groups, a consumption frequency trend was observed. The consumption frequency of tradi-

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Table 5. Relationship between demographic characteristics of Chinese Americans in Pennsylvania and mean consumption frequency change of food groups Food group

Demographic variable related to food group

Grain

Educationb Incomec Place of origind

Vegetablee

Agef Educationb Incomec Marital statusg

Fruit

Educationb Incomec Presence of childrenh Place of origind Meat/meat alternative

Educationb Place of origind

Spearman’s r /ANOVAa (F )

Results Those with a higher education increase consumption frequency more Those with a higher household income increase consumption frequency more Those from Mainland China increase consumption frequency more than those from Taiwan, Hong Kong, and other places; those from Taiwan increase consumption frequency more than those from other places Those who were older increase consumption frequency more Those with a higher education increase consumption frequency more Those with a higher household income increase consumption frequency more Those who are married increase consumption frequency more than those who are single Those with a higher education increase consumption frequency more Those with a higher household income increase consumption frequency more Those who have children increase consumption frequency more Those from Mainland China increase consumption frequency more than those from Taiwan and Hong Kong Those with a higher education increase consumption frequency more Those from Mainland China increase consumption frequency more than those from Taiwan

r⫽0.208** r⫽0.153* F⫽10.938*** r⫽0.118* r⫽0.127* r⫽0.178** F⫽6.096** r⫽0.163** r⫽0.203** F⫽8.872** F⫽11.817*** r⫽0.137* F⫽14.927***

a

ANOVA⫽analysis of variance. 1⫽Less than 12th grade (third grade in high school) (n⫽15); 2⫽graduated high school (n⫽28); 3⫽some college or vocational training (n⫽18); 4⫽graduated vocational/technical college (n⫽33); 5⫽graduated college (4-year bachelor’s degree) (n⫽70); 6⫽graduate or professional school (masters, PhD, MPA, lawyer) (n⫽233). c 1⫽Under $10,000 (n⫽21); 2⫽$10,000-$24,999 (n⫽52); 3⫽$25,000-$49,999 (n⫽53); 4⫽$50,000-$100,000 (n⫽153); 5⫽above $100,000 (n⫽112). d 1⫽Mainland China (n⫽276); 2⫽Taiwan (n⫽90); 3⫽Hong Kong (n⫽17); 4⫽other (n⫽16). e French fries were excluded from the vegetable group. f 1⫽18-24 years (n⫽19); 2⫽25-34 years (n⫽52); 3⫽35-44 years (n⫽223); 4⫽45-54 years (n⫽84); 5⫽55-64 years (n⫽14); 6⫽above 65 years (n⫽7). g 1⫽Never married (n⫽38); 2⫽married, not separated (n⫽343); 3⫽divorced (n⫽9); 4⫽widowed (n⫽5); 5⫽separated (n⫽3). h 1⫽Yes (n⫽342); 2⫽no (n⫽57). *P⬍.05. **P⬍.01. ***P⬍.001. b

tional Chinese foods decreased whereas the consumption frequency of certain Western foods increased. One possible explanation is limited availability and a perceived lower quality of traditional Chinese foods in the United States. This result coincides with the findings from other studies conducted with Chinese immigrants (26-30). Overall, despite the increase of American foods and the decrease of traditional Chinese foods, Chinese Americans still retain some core foods of grains, fruits, vegetables, and meat/meat alternatives, and introduce some American grain products, animal products, dairy products, fats/ sweets, and beverages into their dietary pattern. Participants in this study indicated that the two main reasons for changing their eating habits were convenience and availability. This finding corresponds with the findings of some earlier studies (10,30). Cost was also mentioned as an important factor affecting food consumption changes in the previous studies. However, in the current study only a small portion of participants mentioned cost. Cost may still be a variable that influences changes in food consumption frequency but was not observed probably because 66.4% of the participants had a yearly household income above $50,000. Demographic characteristics and acculturation influenced Chinese Americans’ dietary pattern changes. Dairy

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products were the only food group whose consumption change was not influenced by the demographic characteristics and acculturation indicators, despite its large consumption increase. One explanation could be that Chinese Americans began to increase their consumption frequency of dairy products quickly after immigration because dairy products are more readily accessible and available and are comparatively less expensive in the United States than in China. A higher socioeconomic status (higher education and higher income) was associated with larger increase in grain, vegetable, and fruit consumption frequency, which supports Newman’s results (21). Participants who were more acculturated, as measured by longer residency in the United States, had higher increase in consumption frequencies of vegetables, fats/sweets, and beverages. People with better English proficiency had a greater increase in their consumption frequency of grains, fruits, meat/meat alternatives, and fats/sweets. As suggested by Satia and coworkers (15,16), the higher increase of vegetable and fruit consumption frequency with increased acculturation and higher socioeconomic status might be explained by more access to nutrition education materials in English. In addition, higher increase in the consumption frequency of meat/meat alternative and fats/sweets

Table 6. Relationship between acculturation indicators of Chinese Americans in Pennsylvania and mean consumption frequency change of food groups Food group

Acculturation indicator related to food group

Grain Vegetableb

English proficiencya Length of residencyc

Fruit Meat/meat alternative Fats/sweets

English proficiencya English proficiencya

Beverage

Length of residencyc English proficiencya Length of residencyc

Results

Spearman’s r

Those with a higher English proficiency increase consumption Those residing in the United States for a longer time increase frequency more Those with a higher English proficiency increase consumption Those with a higher English proficiency increase consumption

frequency more consumption

0.179** 0.164**

frequency more frequency more

0.182** 0.137*

Those residing in the United States for a longer time increase consumption frequency more Those with a higher English proficiency increase consumption frequency more Those residing in the United States for a longer time increase consumption frequency more

0.142** 0.128* 0.198**

a

1⫽Poor (n⫽25); 2⫽fair (n⫽158); 3⫽good (n⫽162); 4⫽excellent (n⫽52). French fries were excluded from the vegetable group. c 1⫽0-5 years (n⫽79); 2⫽6-10 years (n⫽115); 3⫽11-15 years (n⫽109); 4⫽above 15 years (n⫽94). *P⬍.05. **P⬍.01. b

by more acculturated Chinese Americans may be explained by their greater access to the mainstream culture. The presence of children in the household may have an influence on Chinese Americans’ dietary pattern change. Participants with children at home had a higher increase in the consumption frequency of fruit. This corresponds with the literature, which indicates that immigrants with children tend to adopt Western dietary patterns (33). However, caution should be utilized when comparing Chinese Americans with children and those with no children because our study only included a small number of participants with no children. Dietary variety was significantly increased after immigration, probably because foods are more available year round in American supermarkets than in China and Chinese Americans still retained some Chinese core foods after immigration. A large portion of the Chinese Americans who participated in this study were middle aged and from Mainland China and Taiwan. It is possible that the sample did not include enough participants from Hong Kong to make meaningful comparisons among places of origin. A large number of participants had a high level of education and high income. Those with a lower educational level and lower income may not have similar dietary patterns. In addition, subjects might not be able to accurately recall details of their diet in China, especially for those who have resided in the United States for a long time. Recall of previous dietary habits has found to be less accurate than the recall of current dietary habits (18). CONCLUSIONS This study indicated that very few Chinese Americans participated in nutrition education programs. This lack of participation may be due in part to the lack of culturally appropriate educational programs. When designing nutrition education programs for first-generation Chinese Americans, nutrition educators should consider their di-

etary changes—such as skipping breakfast and increased consumption frequency of fats, sweets, and soft drinks— as observed in this study. For example, acculturated firstgeneration Chinese Americans should be encouraged to decrease their fats, sweets, and soft-drink consumption. Less-acculturated people may be encouraged to maintain their healthful dietary pattern and increase consumption of vegetables and fruits. Nutrition educators may suggest alternative, less-expensive vegetable and fruit options to persons of lower socioeconomic status. Because convenience and availability are the two main reasons for changing eating habits, recipes of convenient and nutritious Chinese-like American foods could also be created to help Chinese Americans include healthful and convenient American foods into their diet. Nutrition education materials in Chinese should be designed. The authors thank the Pennsylvania Chinese organizations and Chinese schools for assistance in distributing the questionnaires; J. Lynne Brown, PhD, RD; Catherine N. Cutter, PhD; and Cathy Kassab, PhD for their suggestions. This study was funded through the Department of Food Science at the Pennsylvania State University and Nutrition, Health and Food Management Division Student Grant from the American Association of Family and Consumer Sciences. References 1. US Census Bureau. Census 2000 Summary File 1, Matrices P3, P4, PCT4, PCT5, PCT8, and PCT11. QT-P3. Race and Hispanic or Latino: 2000. Available at: http:// factfinder.census.gov/bf/_lang⫽en_vt_name⫽DEC_ 2000_SF1_U_QTP3_geo_id⫽01000US.html. Accessed August 28, 2002. 2. Campbell TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: The Cornell China study. Am J Cardiol. 1998;82:18T-21T.

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