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Does Junk Food Intake Vary With Immigration Status?

Kisha Thakur
Thomas Wootton High School, Rockville, MD

Introduction

This study examines the variation in junk food intake with immigration status. Due to the increasing prevalence of obesity related health problems, obesity has become a major public health policy issue in the United States (Hook, Balistreri, and Baker, 2009). Moore and colleagues (2009) cited a number of studies demonstrating that the consumption of junk food leads to obesity. Identifying subpopulations with higher junk food consumption will better target the intervention and prevention efforts aimed at alleviating the prevalence of obesity and will thereby efficiently reduce overall health-care costs and health problems in the United States. The immigrant population, comprised of those born in a foreign country and who do not automatically receive US citizenship, is the fastest growing segment of the United States population (Kendal, 2011). The question thus arises to whether the growing number of obesity cases in the United States is related to the increasing influx of immigrants into the United States. This study seeks to identify whether junk food intake, a risk factor of obesity, differs between immigrants and nonimmigrants in order to help shed light on whether or not public health interventions for obesity should be more focused on immigrant or nonimmigrant populations in the United States. 

Alarming levels of obesity in the United States have led to its classification as one of the most serious public health problems of the 21st century (Hook, Balistreri, and Baker, 2009). In the United States, 35.7 percent of adults and 16.9 percent of children were obese in 2009-2010 (Ogden, Caroll, Kit, and Flegal, 2012). Obesity increases the risk of a number of health conditions including hypertension, coronary heart disease, type 2 diabetes, cancer, gallstones, and disability. In the year 2000, 17 percent of all deaths in the US were attributed to being overweight (Goel, McCarthy, Phillips, and Wee, 2004). Obesity-related health conditions are associated with a higher use of health care services and greater health related costs among obese patients (Moyer, 2012). Treating obesity and obesity-related conditions costs billions of dollars a year. By one estimate, the U.S. spent $190 billion on obesity related health care expenses in 2005 (Cawley and Myerhoefer, 2012).  To deal with the alarming obesity problem, the United States Preventive Services Task Force recommended that physicians screen adults for obesity and either offer or refer those found obese for intensive, multicomponent behavioral interventions (Moyer, 2012).  Growing concern about obesity in the United States has also drawn public health researchers' attention toward identifying factors related to obesity in the United States.

Moore and colleagues (2009) list a number studies linking fast food consumption to obesity and suggest a relationship between the rise in fast food consumption and the increase in obesity rates in the United States. Most junk food items and fast food products provide little nutritional value and high calorie value because they are high in fats, sugars, and salts. Many studies have found that junk food consumption varies with age (Dave, An, Jeffery, and Ahluwalia, 2009; Moore, Diez Roux, Nettleton, Jacobs, and Franco, 2009; and Paeratakul, Ferdinand, Champagne, Ryan, and Bray, 2003). Akresh (2007) cited past research and suggested that immigrants tend to be healthier than the native population upon their arrival to the United States but that, over time, their risk of being obese increases due to changes in their dietary behaviors and lifestyles. In other words, when immigrants settle in the United States, they start to consume more and more junk food, increasing their risk of obesity.

Past studies focusing on the relationship between junk food intake and immigration status investigated specific immigrant racial/ethnic groups and age groups (adults, adolescents, or young children). Akresh (2007) studied the effect of the length of time spent in United States on dietary changes among adult Hispanic immigrants. Duffey and colleagues (2008) explored the relationship between the percent of energy consumption, birthplace (foreign vs. U.S. born), and ethnicity among adult Hispanics. Their study found that U.S. born Hispanics consumed a higher percentage of energy from non-Mexican fast food, snacks, and desserts. Ayala, Baquero, and Klinger (2008) examined the relationship between the length of time spent in the United States and dietary consumption behaviors among Hispanics and found that those who had spent more time in the United States had worse dietary behaviors. Many of these studies focused on the effect of the length of time spent in the United States on junk food consumption. However, none examined the difference in junk food intake between immigrants, as a combined entity (all ethnic groups in the US), and their native United States counterparts. Therefore, studying the variation in junk food consumption behavior between immigrants as a combined entity, rather than as a function of their country of origin or of their past eating habits, in comparison with the native United States population will add to the current published literature and will help to establish stronger and tailored intervention methods for obesity in the United States.

Method

The sample of the study was a purposive sample and persons of ages 10 and above were included in this study. The data were collected from July 10 until July 24, 2012 at Lakeforest and White Flint Malls and at Studio X. All subjects were required to sign an informed consent form before participating in the survey. For those aged 17 and younger, their parents were also required to sign the consent form. The survey consisted of four questions.

Please choose one choice for each question listed below:

1. Do you think that junk food or food from a fast food restaurant is good for your health?

   a. Yes                             b.    No

2. In past week, how many times did you eat junk food or food at or from a fast food restaurant?
1. None
2. Only once
3. Two to three times
4. Four to six times
5. Seven or more times
    
3. How old are you?
1. Less than or equal to 17 years
2. 18 to 34 years
3. 35 to 54 years
4. 55 to less than 65 years
5. 65 years or older
    
4. Where were your parents born?

   a. Both in US                        c. One in US and other one foreign born

   b. None in US

The subjects were verbally told that any fast food restaurant meal and any amount of intake of chips, candy, and soda were considered junk food consumption. To minimize recall bias, the study subjects were asked the number of times they had eaten junk food in the past week. The control group was nonimmigrants. Immigrants were defined as individuals whose parents were born in a foreign country, and non-immigrants were defined as those individuals whose parents were born in the United States. Individuals who had one parent born in the United States and the other parent born in a foreign country were excluded from the analysis as past research has questioned the validity of grouping such persons in the above-defined categories (Acevedo-Garcia, Pan, Hee-Hin, Osypuk, and Emmons, 2005; and Ramakrishnan, 2004).  In addition to dividing the sample population by immigration status, the population was also divided into three different age groups: 17 years old and younger, 18 to 34 years old, and 35 years and above.  The independent variable was immigration status and age of the person, and the dependent variable was the consumption of junk food, which was determined by indicating whether the sample person had eaten junk food at least once in the past week or had not eaten any at all. The bivariate associations and regression analysis were performed to determine the presence of a relationship between the junk food intake and immigration status.

Results

Of the 219 subjects (excluding the 30 individuals whose immigration status cannot be determined because one of their parents was born in United States and another in a foreign country) , about 44.3 percent were immigrants, 37.9 percent were 17 years and younger, and 21.5 percent were 18 to 34 years old (see Table 1).  Nearly two-thirds of the respondents reported eating junk food at least once in the last 7 days. More than three-fourths (77.1%) of the respondents aged 17 years and younger reported eating junk food at least once in the last 7 days.  Among 18 to 34 year old respondents, 68.1 percent reported consuming junk food at least once in the last 7 days.  More than half (51.7%) of the respondents 35 years of age and above ate junk food one or more times in the last 7 days.  About 59 percent of immigrants (both parents foreign born), and 69.7 percent of non-immigrants (both parents born in US) reported eating junk food at least once in the last 7 days.

Table 1.  Descriptive statistics and bivariate associations between covariates and junk food intake (N=219)

	Sample persons		Percent of Persons had Junk food in last seven days
	(N)	Percent	At least once	None
Sample persons (N)	219		142	77
Sample persons (%)			64.8	35.2
Age(***)
17 years and below	83	37.9	77.1	22.9
18 to 34 years	47	21.5	68.1	31.9
35 and above	89	40.6	51.7	48.3
Immigrant?(**)
Yes	97	44.3	58.8	41.2
No	122	55.7	69.7	30.3

*Significant at 15% level, **significant at 10% level, and ***significant at 5% level

Bivariate analysis results indicate that the relationship between junk food intake and age is statistically significant (p<0.002), but the relationship between junk food intake and immigration status (p<0.093) is not significant at the five percent significance level. A logistic regression model was used to predict the effect of immigration status on junk food intake, after controlling for age. This model predicts the consumption of junk food as a bivariate outcome (1=eaten junk food or at fast-food restaurant at least once in last 7 days versus 0=never eaten junk food or at fast-food restaurant in last 7 days). All statistical analyses were conducted using SAS version 9.2 (SAS Institute, North Carolina) and results are presented below in Table 2.

Table 2 Correlates of junk food intake (N=219)

	Had Junk food at least once in last seven days
Age  17 years and below	0.506
Age 35 and above	-0.718**
Immigrants	-0.597***
Intercept	1.027***

*Significant at 15% level, **significant at 10% level, and ***significant at 5% level

The logistic regression results indicate that the overall model is appropriate and that at least one of the independent variables is statistically related to the junk food consumption in the past week (p<0.0008). Further, the results show that the likelihood of an average immigrant eating at least once in the last 7 days is less than that of an average non-immigrant (coefficient for the immigrant status=-0.597) and that this relationship is statistically significant at the 0.05 significance level (p<0.045). In this model, the likelihood of eating junk food decreases with age but the differences between the different age groups are not statistically significant at the 0.05 significance level.

Discussion

Bivariate analysis shows that junk food intake does not vary with immigration status at the 0.05 significance level. However, the regression results indicate that the average immigrant is less likely than the average non-immigrant, after adjusting for age, to eat junk food at least once in a week, and that this difference in junk food intake is statistically significant. Though these study results cannot be generalized to the entire United States population, this finding adds to the current literature regarding the junk food eating behaviors prevalent among United States' subpopulations. This finding suggests that, overall, immigrants consume less junk food and that, perhaps, efforts toward the reduction of junk food intake should be more focused on the nonimmigrant U.S. population. 

There are two further questions or experiments that should be considered. First, the study should be repeated with a more representative U.S. population sample in order to ensure that the results of this study are reliable. Second, a similar future study should examine the differences in junk food intake among immigrant subpopulations, so as to obtain a more detailed target population(s) for intervention efforts.

Bibliography

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Akresh, I. R. (2007). Dietary assimilation and health among Hispanic immigrants to the United States. Journal of Health and Social Behavior, 48(4), 404-417.

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