US Acculturation Is Associated with Health Behaviors and Obesity, but not Their Change, with a Hotel-Based Intervention among Asian-Pacific Islanders

Published:April 25, 2012DOI:



      Immigration to the United States has been associated with obesity, yet the relationship of acculturation to obesity and energy balance (ie, physical activity/dietary intake) in adults is a complex issue. Limited longitudinal data are available on immigrant Asians and Pacific Islanders.


      Analyses were conducted on baseline data and change data from baseline to 24 months in the hotel-based cluster-randomized Work, Weight and Wellness trial involving 15 control and 15 intervention hotels on the island of Oahu, Hawaii.


      Participants were adult employees of predominantly Asian and Pacific Islander ancestry who were assessed one or more times over the course of 24 months. The full sample consisted of 4,236 hotel workers (about 40% of hotel workforce) at baseline, 3,502 hotel workers at Year 1 and 2,963 hotel workers at the 24-month follow up. One thousand one hundred fifteen hotel workers had at least two measurements, and were included in the analysis.


      The Work, Weight, and Wellness trial was designed to promote weight loss via motivation and support for increases in physical activity and increased access to and consumption of healthy low-fat/low-energy foods. The measure of acculturation consisted of a score that was a compilation of a participant's age when he or she immigrated to the United States, country of birth, language spoken at home, and years of education.

      Statistical analyses

      We used mixed effect regression models for cross-sectional baseline models and longitudinal multilevel regression analysis of change in diet and physical activity behaviors and obesity over time using a random intercept. Estimates of the intervention effect are expressed as an annual rate of change for all study outcomes.


      At baseline acculturation was positively associated with body mass index; physical activity level; and fruit, meat, and sweetened drink intake level. In analyses of change across 24 months, acculturation did not significantly influence change in dietary intake or indexes of obesity (ie, body mass index or waist-to-height ratio). However physical activity increased significantly more in the intervention group during the course of the intervention compared with the control group, which decreased activity, when sociodemographic factors (including acculturation) and food intake behavior were controlled for.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Population profile of the United States: Dynamic version.
        (US Census Bureau Web site) (Accessed February 22, 2012)
        • Caballero B.P.
        • Popkin B.M.
        The Nutrition Transition: Diet and Disease in the Developing World.
        in: Academic Press, Elsevier Science Ltd, Amsterdam, The Netherlands2002: 1-6
        • Sundquist J.
        • Winkelby M.
        Country of birth, acculturation status and abdominal obesity in a national sample of Mexican-American women and men.
        Int J Epidemiol. 2000; 29: 470-477
        • Bennett G.G.
        • Wolin K.Y.
        • Askew S.
        • et al.
        Immigration and obesity among lower income blacks.
        Obesity (Silver Spring). 2007; 15: 1391-1394
        • State and County QuickFacts
        Data derived from Population Estimates, Census of Population and Housing, Small Area Income and Poverty Estimates, State and County Housing Unit Estimates, County Business Patterns, Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits, Consolidated Federal Funds Report Last Revised: Friday, 03-Jun-2011 15:23:14 EDT.
        (US Census Bureau: State and County QuickFacts Web site) (Accessed March 16, 2012.)
        • Williams A.E.
        • Vogt T.M.
        • Stevens V.J.
        • et al.
        Work, Weight, and Wellness: The 3W Program: A worksite obesity prevention and intervention trial.
        Obesity (Silver Spring). 2007; 15: 16S-26S
        • Lutsey P.L.
        • Diez Roux A.V.
        • Jacobs Jr, D.R.
        • et al.
        Associations of acculturation and socioeconomic status with subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis.
        Am J Public Health. 2008; 98: 1963-1970
        • Novotny R.
        • Williams A.
        • Vinoya A.
        • et al.
        US acculturation, food intake, and obesity among Asian-Pacific hotel workers.
        J Am Diet Assoc. 2009; 109: 1712-1718
        • Pratt C.A.
        • Lemon S.C.
        • Fernandez I.D.
        • et al.
        Design characteristics of worksite environmental interventions for obesity prevention.
        Obesity (Silver Spring). 2007; 15: 2171-2180
        • Martinez-Gonzalez M.A.
        • Fernandez-Jarne E.
        • Serrano-Martinez M.
        • Wright M.
        • Gomez-Gracia E.
        Development of a short dietary intake questionnaire for the quantitative estimation of adherence to a cardioprotective Mediterranean diet.
        Eur J Clin Nutr. 2004; 58: 1550-1552
        • Serdula M.
        • Coates R.
        • Byers T.
        • et al.
        Evaluation of a brief telephone questionnaire to estimate fruit and vegetable consumption in diverse study populations.
        Epidemiology. 1993; 4: 455-463
        • Block G.
        • Gillespie C.
        • Rosenbaum E.H.
        • Jenson C.
        A rapid food screener to assess fat and fruit and vegetable intake.
        Am J Prev Med. 2000; 18: 284-288
        • Godin G.
        • Shephard R.J.
        A simple method to assess exercise behavior in the community.
        Can J Appl Sport Sci. 1985; 10: 141-146
        • Howarth N.C.
        • Murphy S.P.
        • Wilkens L.R.
        • Hankin J.H.
        • Kolonel L.N.
        Dietary energy density is associated with overweight status among 5 ethnic groups in the multiethnic cohort study.
        J Nutr. 2006; 136: 2243-2248
        • Scott S.G.
        • Bruce R.A.
        Decision-making style: The development and assessment of a new measure.
        Educational and Psychological Measurement. 1995; 55: 818-831
        • Singer J.D.
        • Willett J.B.
        Applied Longitudinal Data Analysis: Modelling Change and Event Occurrence.
        Oxford University Press, New York, NY2003
      2. Global recommendations on physical activity for health: 18-64 years old.
        (World Health Organization Web site) (Accessed February 22, 2012)
      3. The Food Guide Pyramid 1992.
        (US Department of Agriculture Web site) (Accessed February 22, 2012)
        • Browning L.M.
        • Hsieh S.D.
        • Ashwell M.
        A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0-5 could be a suitable global boundary value.
        Nutr Res Rev. 2010; 23: 247-269
      4. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective.
        World Cancer Research Fund/American Institute for Cancer Research, Washington, DC2010
        • Park J.
        • Myers D.
        • Kao D.
        • Min S.
        Immigrant obesity and unhealthy assimilation: Alternative estimates of convergence or divergence, 1995-2005.
        Soc Sci Med. 2009; 69: 1625-1633
        • Wang S.
        • Quan J.
        • Kanaya A.M.
        • Fernandez A.
        Asian Americans and obesity in California: A protective effect of biculturalism.
        J Immigr Minor Health. 2011; 13: 276-283
        • Hosper K.
        • Klazinga N.S.
        • Stronks K.
        Acculturation does not necessarily lead to increase in physical activity during leisure time: A cross-sectional study among Turkish young people in the Netherlands.
        BMC Public Health. 2007; 7: 230
        • Caperchione C.M.
        • Kolt G.S.
        • Mummery W.K.
        Physical activity in culturally and linguistically diverse migrant groups to Western society: A review of barriers, enablers and experiences.
        Sports Med. 2009; 39: 167-177
        • Mekary R.A.
        • Feskanich D.
        • Hu F.B.
        • Willet W.C.
        • Field A.E.
        Physical activity in relation to long-term weight maintenance after intentional weight loss in premenopausal women.
        Obesity (Silver Spring). 2009; 18: 167-174
      5. Hutchinson AD, Wilson C. Improving nutrition and physical activity in the workplace: A meta-analysis of intervention studies [published online ahead of print July 6, 2011]. Health Promot Int. doi:10.1093/heapro/dar035.

        • Perez-Escamilla R.
        • Putnik P.
        The role of acculturation in nutrition, lifestyle, and incidence of type 2 diabetes among Latinos.
        J Nutr. 2007; 137: 860-870


      R. Novotny is a professor, Department of Human Nutrition Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii, Honolulu, Kaiser Permanente Center for Health Research, Honolulu, HI, and University of Hawaii Cancer Center, Honolulu.


      C. Chen is a senior analystis, Kaiser Permanente Center for Health Research, Portland, OR.


      V. J. Stevens is a senior investigator, Kaiser Permanente Center for Health Research, Portland, OR.


      A. E. Williams is an investigator, Kaiser Permanente Center for Health Research, Honolulu, HI.


      C. E. S. Oshiro is a research associate, Kaiser Permanente Center for Health Research, Honolulu, HI.


      C. L. Albright is an associate professor, University of Hawaii Cancer Center, Honolulu.


      C. R. Nigg is an associate professor, Department of Public Health Sciences, University of Hawaii, Honolulu.