Length of Residence and Its Association to Eating Practices, Physical Activity, and BMI among Latina Immigrants in Alabama

Special Article – Human Health

Austin J Nutri Food Sci. 2018; 6(3): 1108.

Length of Residence and Its Association to Eating Practices, Physical Activity, and BMI among Latina Immigrants in Alabama

Cedillo YE¹*, Fernandez JR¹, Cherrington AL² and Scarinci IC²

¹Department of Nutrition Sciences, University of Alabama at Birmingham, USA

²Division of Preventive Medicine, University of Alabama at Birmingham, USA

*Corresponding author: Cedillo YE, Department of Nutrition Sciences University of Alabama at Birmingham, USA

Received: June 20, 2018; Accepted: July 24, 2018; Published: July 31, 2018


The process of cultural assimilation may influence certain health outcomes among Hispanic/Latino immigrants due to the exposure to newly-acquired mainstream dietary and physical activity practices and, in turn, may increase obesity prevalence. The present study examines the effects of Length of Residence (LOR) on BMI among Latina immigrants living in a new-destination state (LINDS; n = 217) aged 20 to 50 years. Statistical analyses evaluated the associations between LOR and BMI, eating practices, physical activity, and demographic factors. LINDS consumed less fruit and vegetables, had higher intake of fried food and sweetened beverages, and their physical activity levels fluctuated below national recommendations. LOR was positively associated (p<0.05) with LINDS’ BMI, accounting for approximately 29.43% of the variance. Eating practices or physical activity was not significantly linked with BMI. Our findings suggest that prolonged exposure to the US environment plays a role when explaining BMI among Latina immigrants, particularly those living in newdestination states.

Keywords: Body mass index; Eating patterns; Physical activity; Latinas


Hispanics/Latinos in the US have contributed to the nation’s population growth, increasing from 22 million in 1990 to 55 million in 2014 [1]. The influx of this ethnic group is primarily due to immigrants from Mexico, followed by Puerto Rico, Cuba, El Salvador, Dominican Republic, Guatemala, Brazil and other South American countries. Currently, Hispanics/Latinos represent the largest minority group in the US totaling 17% of the US population [2].

Perhaps the most concerning non-communicable disease impacting Hispanics/Latinos is obesity, whose prevalence in the US has increased to an alarming 35% of the population [3]. Obesity heightens the risks for cardiovascular diseases, some cancers, hypertension, diabetes, and other diseases that are leading causes of death in the US [4-10]. Among Hispanics/Latinos, the prevalence of obesity has almost doubled from 23% in 1994 to 42.5% in 2014, documenting an increase that is higher than Non-Hispanic Whites (NHWs) (32.6%) but lower than Non-Hispanic Blacks (NHB) (47.8%) [3,11]. Flegal et al., [12] examined obesity trends between 1999-2008 and found that 18.9% of Hispanic women = 20 years of age had a BMI = 35 kg/m2 compared to 16.6% of NHW women. Gender differences have also been reported with 42.4% of Hispanic/ Latino women being obese (BMI = 30kg/m2) as compared to 36.5% of Hispanic/Latino men [13]. The disproportionate burden of obesity in the Hispanic/Latino community is a major issue considering the high rates of morbidity, mortality, and the high obesity-associated annual healthcare costs [14].

The etiology of obesity in the Hispanic/Latino community is complex. Despite country of origin, increased obesity prevalence in Hispanics/Latinos has been mostly associated with time of exposure to a new environment [15]. Research has documented that those living in the US for more than twenty years are more likely to be obese than US Hispanic/Latino immigrants who have been in the country for less time [13]. Evidence also supports that obesity-related factors such as dietary practices and physical activity are modified by the immigration experience [16,17]. For example, Batis et al., [18] used data from the Mexican National Nutrition Survey (1999) and the National Health and Nutrition Examination Survey (NHANES, 1999-2006) to evaluate differences of food intake. It was reported that Mexican Americans born in Mexico, Mexican Americans born in the US, and NHWs showed greater intakes of saturated fat, sugar, desserts, and salty snacks when compared to native Mexicans. Similar studies also show that immigrants who become more acculturated through increased LOR in the US reduce their diet quality by assimilating NHW’s eating practices, which tend to promote some unhealthy intake behaviors [19-21], despite engaging in higher levels of physical activity [22]. Evidently, other identified etiological aspects also contribute to the increased prevalence of obesity in the Hispanic/Latino immigrant population, including generational status, education, stress, cultural barriers, linguistic isolation, and socioeconomic factors. Overall, the LOR seems to modulate any changes in health behaviors, including diet and physical activity [16,23-28].

Migration of the Hispanic/Latino population has been evolving from states with traditionally higher rates of immigrants to other areas of the US Even though 55% of the Hispanics/Latinos in the US reside in California, Florida, and Texas, recent migration has more than doubled in what is considered “new-destination states”, particularly Southern and Midwest states, which have shown high rates of obesity prevalence [29]. This recent migration pattern may represent a challenge to state agencies committed to overall health of their residents, prompting the need for responsible research that can inform public health initiatives. Consequently, and given that increased time of residence could result in increased risk for obesity, this study evaluated how LOR influenced BMI, eating practices, and physical activity in a sample of Hispanic/Latino women who have migrated to Alabama, a non-traditional migratory state reported to have the fastest growing Latino population during the period of the study. Therefore, the purpose of this study was to test the hypothesis that BMI, eating practices, and physical activity would be positive associated with LOR. This research was guided by three specific aims examining the association of LOR with: 1) eating practices, 2) physical activity, and 3) BMI, considering the potential role of various sociodemographic factors in a group of women living in Alabama.


Study design and participant recruitment

217 Latina immigrants living in a New-Destination State (LINDS), aged 20 to 50 years were recruited as part of the control group of a larger randomized community based intervention trial in Alabama to assess the efficacy of a cervical cancer prevention program [30]. An intervention addressing eating practices and physical activity was implemented in the control group given that the community considered these topics important to discuss. Participantes self - identified as Latina immigrants from Mexico, Central America (El Salvador, Guatemala, Honduras, Nicaragua) and Peru. According to the US, Census Bureau, 66% of Latinos in Alabama are of Mexican origin [31]. However, our data showed that this percentage is over 80% which is similar than previously documented estimates [32,33]. This difference may be due to the large undocumented Latino population who may not be captured by census estimates. The participants in this study completed an interviewer-administered questionnaire in Spanish as part of the baseline assessments after consenting in their native language. This study was approved by the Institutional Review Board (IRB) at UAB and all participants provided written informed consent. Only participants in the control group were included in the analysis because BMI was not assessed among participants in the cervical cancer prevention intervention group.

Socio demographic data

Information about age, country of origin, LOR, educational attainment, income, number of children, marital and employment status were included. LOR was collected as years in Alabama (LORAL) - indicating time in new-destination state – and years living in the US (LORUS). Both LOR were measured in years and independently evaluated as a continue variable to assess its association with eating practices, physical activity, and BMI.

Eating practices and physical activity

Eating practices was assessed with these questions: “In an average day, how many portions of fruit and vegetables do you eat?”, “How often do you eat deep fried food?”, and “In an average day, how many cans/glasses of sweetened beverages do you drink?” Variables were categorized according to the number of portions (fruit/vegetables, and sweetened beverages) or times per week (fried food). Portions were measured by providing participants with a cup and bowl to aid in their estimation of portion sizes. The engagement in physical activity was measured with the question “In an average week, how many days do you get at least 30 minutes of moderate physical activity? Examples of activities considered as moderate were running, walking, cycling, swimming, and gardening.

Body mass index

Body mass index was calculated as weight in kilograms divided by height in meters squared. Height and weight were measured by research personnel using standardized protocols. The height of Latinas was measured to the nearest centimeter (cm) on a stadiometer (Seca 217, Seca, Columbia, MD) and body weight was measured in kilograms (kg) using an electronic scale (Health-OMeter Professional 349KLX, Health-O-Meter, Boca Raton, FL) and recorded to the nearest 0.1kg. BMI was used as a continuous variable in linear regression analysis. Additionally, BMI was categorized based on the World Health Organization (WHO) classification [34]: Underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5 - 24.99 kg/m2), overweight (BMI 25 - 29.99 kg/m2), and obese (BMI > 30 kg/ m2).

Statistical analysis

Descriptive statistics (mean, standard deviation, and frequencies) were calculated to summarize sociodemographic information including age, LOR in the US (LORUS), LOR in Alabama (LORAL), educational attainment, income, number of children, country of origin, marital status, and employment status. Eating practices included measures of fruit and vegetable intake, sweetened beverages consumption, and fried food intake. Physical activity included measure of days per week of moderate exercise. Simple linear regression models adjusted for age were used to evaluate the association between LOR and 1) eating practices (fried food, sweetened beverages, and fruit/vegetables consumption), 2) physical activity, and 3) BMI. A multiple regression model was applied to predict BMI based on LOR after adjusting for the following covariates: eating practices, physical activity, educational attainment, income, marital status, number of children, and employment status.To fulfill the assumption of regression modeling, residuals were visually evaluated for normality removing those deviating more than three standard deviations. Mean differences of BMI were also evaluated considering LORAL as a categorical variable to evaluate recent (<5 years), medium (=5 and <10 years), and longer term (>10 years) immigrants using an Analysis of Variance (ANOVA) F - test with Tukey’spost-hoc.The significance level was considered a = 0.05 for all statistical analyses. All analyses were performed with SAS statistical software (version 9.4, 2002 - 2012 by SAS Institute Inc., Cary, NC).


Table 1 describes population characteristics of the sample. Most of the participants were from Mexico, with a mean US residence of 6.30 ± 4.12 years (range of < 1 to 20 years) and a mean Alabama residence of 4.94 ± 2.89 years (range < 1 to 18 years). Seventy percent of the Latinas reported that Alabama had been the only place of residence. The majority of participants were married or cohabiting and 47% reported having a full time or part time job, mainly in housekeeping, restaurants, or babysitting. Less than 2% of the participants had college education, and the average monthly family income was $1,690.87 ± 902.54. According to the BMI classifications, only 23.96% were considered normal weight, 29.95% overweight, and 46.08% obese.