Heterogeneity in the Association between Acculturation and Adiposity among Immigrants to the United States.

U.S. birth and longer length of U.S. residence among immigrants have been associated with a higher risk of obesity. However, few studies have examined this pattern longitudinally or examined heterogeneity in this relationship. Doing so may inform how social processes that relate to different immigrant integration patterns impact obesity. Using prospective data from the Multi-Ethnic Study of Atherosclerosis (MESA) and repeated, cross-sections from the National Health and Nutrition Examination Survey (NHANES), this dissertation examined: 1) differences in rates of waist circumference (WC) increase among U.S. and foreign-born Hispanic and Chinese adults (MESA); 2) the role of the neighborhood environment in moderating the relationship between nativity/length of U.S. residence and WC among Hispanic and Chinese adults (MESA); and 3) variation over time in the relationship between nativity/length of U.S. residence and body mass index (BMI) and WC among Mexican-American adults (NHANES). Results demonstrated that longer exposure to the U.S. context does not have the same implications for weight gain for all immigrants. In MESA, Hispanic and Chinese immigrants did not have a greater rate of increase in WC over time relative to the U.S.-born; however, foreign-born Mexican Hispanics experienced an accelerated rise in WC compared to both U.S.-born Mexican Hispanics and foreign-born non-Mexican Hispanics. Hispanic immigrants living in neighborhoods with greater healthy food availability had a lower mean WC than immigrants in neighborhoods with poor healthy food availability. Among Chinese, more recent immigrants living in more walkable neighborhoods increased in WC more slowly than recent immigrants in less walkable areas. Among Mexican-Americans in NHANES, there was a graded relationship between longer length of U.S. residence and higher BMI and WC, and this relationship did not change substantially between 1988-1994 and 2005-2008. However, there were important variations in this patterning by gender and by socioeconomic status. The share of immigrants in the U.S. population continues to grow. A more nuanced understanding of the impact of the U.S context on the health of this vulnerable group will inform public health interventions, and address troubling health disparities.PhDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/89621/1/ssalb_1.pd