Diet quality and hypertension in ethnically diverse U.S.-born and foreign-born Blacks: Quantitative and qualitative approaches
to existing epidemiological data, the morbidity and mortality of non-Hispanic Blacks
(referred to as 'Blacks' hereafter) from diet-related diseases are higher than other
racial/ethnic groups in the United States. Blacks in the U.S. are also generally
reported to have poor diet quality and are less likely to meet national dietary
recommendations. A major limitation of this ... read moreepidemiological evidence, however, is the
lack of consideration of the ethnic heterogeneity within the Black population. For
example, this broad category includes African Americans, Sub-Saharan Africans (e.g.,
Kenyans and Nigerians), or Afro-Caribbeans such as Haitians and Jamaicans. Combined,
Caribbean-born, self-identified Black immigrants and African-born immigrants make up an
estimated 8.7% of the U.S. Black population and the Census Bureau projects that by 2060,
16.5% of U.S. Blacks will be immigrants. With this ethnic diversity among Blacks
includes heterogeneity of cultures and social realities that would potentially influence
lifestyle behaviors, food and taste preferences, diet, and ultimately disease risk.
Using quantitative and qualitative methods, this proposed research considered
nativity/place of birth among Blacks in the examination of diet quality and the
likelihood of having hypertension among this demographic. Aims 1 and 2 were based on
pooled data from a nationally representative, cohort study of a sample drawn from the
U.S. population, the National Health and Nutrition Examination Survey (NHANES) study.
Aim 1 examined the association between nativity among Blacks and adherence to the
Alternative Healthy Eating Index (AHEI)-2010 and the Dietary Approaches to Stop
Hypertension (DASH) diet, while Aim 2 explored the association between nativity and the
likelihood of having hypertension. Informed by Satia-Abouta's model of dietary
acculturation, the final qualitative aim used focus groups and in-depth interviews to
examine the influence of nativity and culture on dietary practices among ethnically
heterogeneous Blacks in Boston. The results from Aim 1 showed that foreign-born,
non-Hispanic Blacks had significantly higher AHEI-2010, and DASH diet scores and more
favorable intakes of fruit (excluding fruit juice), vegetables (excluding potatoes),
whole grains, nuts, seeds, and legumes, and omega-3 fatty acids, and lower intakes of
processed/red meat and sugar-sweetened beverages compared to U.S.-born Blacks after
adjusting for covariates such as education and income. Among foreign-born Blacks,
AHEI-2010 scores or its individual components did not significantly differ by length of
residency. The results from Aim 2 found that nearly half (43.5%) of U.S.-born Blacks and
only 27.8% of foreign-born Blacks had hypertension. After adjusting for major
covariates, foreign-born Blacks were 39.0% less likely to have hypertension than their
U.S.-born counterparts. Among foreign-born Blacks, length of U.S. residency was not
significantly associated with risk of hypertension. In the qualitative analysis,
Caribbean/Latin American-born and African-born Blacks in Boston cited the important role
of their cultural identity in influencing their dietary preferences, while U.S.-born
Blacks demonstrated a variation of preferences for traditionally African American foods.
Themes around availability, accessibility, and cost of culturally appropriate foods
varied by place of birth. Among foreign-born Blacks, themes related to dietary
preferences and values also varied by age of migration, length of residency, and income.
This study demonstrates that in the U.S. foreign-born Blacks generally have better diet
quality and more favorable hypertension outcomes than their U.S.-born counterparts, and
highlights the potential cultural influences of these differences. These study findings
underscore the need for public health and nutrition research to consider the differences
in nativity and ethnicity among the U.S. Black population and explore the underlying
cultural, social, behavioral, and environmental factors contributing to these
differences. Ultimately, this research helps to fill gaps in the literature and extend
knowledge necessary to help address racial/ethnic health disparities among Blacks in the
U.S. through the development of more culturally appropriate public health
Thesis (Ph.D.)--Tufts University, 2017.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Sara Folta.
Committee: Robert Houser, Alice Lichtenstein, and Josiemer Mattei.
Keywords: Nutrition, Public health, and African American studies.read less