AMERICAN DREAMS ASKEW: HEALTH-RELATED ADAPTATIONS OF U.S. TRANSNATIONAL IMMIGRANTS FROM THE CARIBBEAN Analysis of Emotional, Social and Structural Factors Shaping Diet and Physical Activity Practices

Migration represents a critical period during which individual behaviors, practices, social networks and circumstances are established anew. Moreover, as a persistent gradient between health and social position has been noted over centuries, immigrant health amidst sometimes poor or unstable economic and social conditions foregrounds lessons about optimizing health and well-being with limited resources. U.S. immigrants represent an increasing share of the U.S. population, have influence over growing numbers of U.S. citizens (as parents, grandparents and partners), and embody an unknown portion of the future’s health related risks and burdens associated with chronic diseases. Using a sociological lens to analyze the lived experiences of US immigrants, this study seeks to identify the range of factors that contribute to immigrant adaptation in the areas of diet and physical activity, two risk factors for myriad health conditions and outcomes. This dissertation extends migration and lifestyles scholarship through theorizing about relationships between migration, health, adaptation, and citizenship based on the analysis of the personal, social, and institutional processes that comprise immigrant adaptation to U.S. notions of health within a Caribbean diaspora population. Weaving together complementary research from sociology, psychology, social geography and epidemiology, this project theorizes a sociological concept of immigrant health adaptation or health acculturation—constellations of factors and processes associated with immigrant adaptation to dominant (US) notions of health and health care—a potentially productive lens through which social integration and wellbeing may be examined. Building on lessons about the complexity of immigrant adaptation as well as growing interest in social and environmental determinants of health, this study proposes two innovations to immigration and sociology of health and illness research: 1) breaking down the “black box” of acculturative processes into more specific steps or phases which may be targeted for future research; and 2) using everyday practices and norm re-formation related to diet and physical activity to illuminate health-relevant pathways of adjusting to new environments including meso-level (non-individual) contextual factors. This research draws upon in-depth interviews, surveys, observation and archival review in order to shed light on acts and ideas that constitute immigrant adaptation in the U.S. More specifically, in-depth study of how specific elements of diet, physical activity, and sedentary behavior interact with contextual circumstances describes immigrant experiences of adaptation, health degradation and health maintenance. This study advances understanding of various contextual factors that shape to practices and routines when one’s geographic or political environment changes. Peering beyond economic and political experiences of migration and adaptation, this study highlights emotional, sociocultural and structural factors influencing Caribbean immigrants’ quotidian practices and examines how those practices relate to health and citizenship. Specific factors influencing immigrant health adaption as well as diet and activity practices and processes instigated by their migrations were identified. Health is presented as effortful achievement rather than a general state of being to which everyone is entitled. Health was regarded as multifaceted and described as interacting with many systems including: medicine, media, economic, labor, social, political, housing and transportation. While participants were generally knowledgeable about the ways in which food and physical activity are considered risks across the health professions, participant identified risks to health were more complex. Diet and activity are embedded within social, cultural and environmental relationships and are not necessarily easily modified. Moreover, the low salience of health at individuals’ point of decision about food and eating suggests moving beyond touting the health benefits of foods as a means of behavior change for this population