Culture and Diet Among Chinese American Children Aged 9–13 Years: A Qualitative Study

doi:10.1016/j.jneb.2016.11.002

Journal of Nutrition Education and Behavior

Volume 49, Issue 4, April 2017, Pages 275-284.e1

https://doi.org/10.1016/j.jneb.2016.11.002 Get rights and content

Abstract

Objective

To examine Chinese American children's behaviors, food preferences, and cultural influences on their diet.

Design

Qualitative individual interviews using constructs from the proposed model of dietary acculturation.

Setting

Community centers and Chinese schools in Houston, TX.

Participants

Twenty-five Chinese American children aged 9–13 years.

Phenomenon of Interest

Diet, favorite restaurants, and parents' cooking and grocery shopping habits.

Analysis

Content analysis and thematic data analysis to identify code categories and themes. Coders also identified patterns based on demographic and acculturation factors.

Results

Overall, participants described their diets and associated behaviors as Asian and non-Asian. Key themes included preference for Asian and non-Asian foods; consumption of non-Asian foods for breakfast and lunch, but Asian foods for dinner; infrequent dining at restaurants; grocery shopping at Asian and non-Asian stores; and familial influences on diet. Acculturated children and children of higher socioeconomic status appeared to prefer and consume a more Westernized/non-Asian diet.

Conclusions and Implications

Results illustrate that Chinese American children in this study practiced both Asian and non-Asian dietary behaviors. Findings corroborated existing acculturation research with parents and caregivers; supported constructs in the model of dietary acculturation; and provide guidance for research and programs related to dietary behaviors, determinants, and culture among this population.

Introduction

Chronic diseases such as heart disease and cancer are major public health concerns and represented 7 of the 10 leading causes of death in the US in 2010.¹ Diet has an important role in many of these diseases.2, 3 Because dietary behaviors formed during childhood may carry into adulthood⁴ and influence risk for chronic diseases later in life,⁵ nutrition research and interventions among children are needed.

One crucial population for such research is that of Asian descent, the fastest-growing immigrant group in the US.⁶ Although rates of chronic diseases are relatively low among recent Asian immigrants,⁷ there is increasing disease risk among Asian American populations. For example, Asian American adolescents born in the US had greater obesity risk than did first-generation residents, with obesity rates similar to non-immigrant youth.⁸ Furthermore, the risk markers of type 2 diabetes and metabolic syndrome are evident at lower body mass index levels among Asian populations compared with non-Hispanic white peers.9, 10 Traditional Asian diets, which are rich in fruit and vegetables, may protect against many chronic diseases,¹¹ but qualitative research with Asian American primary caregivers showed that their children preferred and consumed more Western foods (eg, sweetened beverages, pizza) than did the primary caregivers.12, 13, 14

Of all Asian subgroups, the Chinese American subgroup is the largest and one of the longest-standing in the US. In 2013, Chinese American people accounted for 23.9% of the Asian-American population, with a population over 4.5 million.¹⁵ Previous research revealed that Chinese American individuals demonstrated changes in dietary patterns,12, 14, 16, 17 increased cardiovascular disease risks,¹⁸ and increased obesity risk¹⁹ across subsequent generations and over time. These patterns may be partially explained by dietary acculturation, or the process by which members of 1 group adopt the eating patterns of a new environment.17, 20

With increasing numbers of Chinese American people living in the US, it is important to understand their dietary behaviors and determinants, including those related to dietary acculturation and culture, at an early age. Prior research in this area sampled primary caregivers12, 13, 14; research directly involving Chinese American children is lacking and needed. Children's accounts may complement caregivers' accounts by providing insight into children's food preferences, perspectives about what they eat and who influences that, and understandings about food.21, 22, 23 In addition, parental observations about their children may differ from children's perceptions, so that proxy information may be inadequate or inaccurate.²⁴ Children may hide behaviors from their parents or have influences outside their parents and home environment.25, 26

The purpose of this study was to better understand Chinese American children's behaviors, food preferences, and cultural influences on diet through qualitative interviews. The proposed model of dietary acculturation (MDA), which was conceptualized and illustrated by Satia-Abouta et al,17, 20 provided a comprehensive framework for this study. Constructs of the MDA include socioeconomic and demographic factors (eg, sex, age, household income), cultural factors (eg, cultural beliefs, living in an ethnic neighborhood), psychosocial factors (eg, diet-related knowledge), taste preferences, and environmental factors (eg, shopping, restaurants), with interactions and changes in these constructs leading to different patterns of dietary intake.

Section snippets

Participants and Recruitment

A convenience sample of Chinese American children aged 9–13 years was recruited through Houston-area community/cultural settings (ie, Chinese language schools, community centers) and the Children's Nutrition Research Center's volunteer database. For in-person recruitment, study staff distributed information packets to parents and/or children to review at home. For recruitment through the volunteer database, parents were contacted and then mailed an information packet. Information packets

Results

A total of 25 children completed the study. All children were aged 9–13 years; nearly one third (32%) were aged 10 years. Participants were about equal boys (52%) and girls (48%), and most were Chinese or Taiwanese alone (88%), born in the US or Canada (64%), self-identified as bicultural (52%), and lived in a household with at least 1 parent completing postgraduate study (60%). Three children were of multiple races/ethnicities, including Taiwanese/white and Chinese/Hispanic. Table 2 details

Discussion

This study investigated Chinese American children's behaviors, food preferences, and cultural influences on diet, using qualitative interviews framed by the MDA. Key themes included (1) identifying both Asian and non-Asian as favorite foods; (2) consuming non-Asian foods for breakfast and lunch, but Asian foods for dinner; (3) not eating frequently at restaurants; (4) shopping at both Asian and non-Asian grocery stores; and (5) identifying family as influences on diet. These findings verified

Implications for Research and Practice

The current study contributes to the limited research base on Chinese American children's behaviors, food preferences, and cultural influences on diet, using qualitative interviews framed by the MDA. Findings from this study can lead to the generation of hypotheses that could potentially inform the design of culturally appropriate nutrition education programs for the Chinese American population. Some of the themes and recommendations identified in this study (eg, choosing healthy Westernized

Acknowledgments

At the time of this study, CSD was supported fully by a Primary Care Research Training Grant from National Research Service Award (No. T32 HP10031). The authors thank all of the children and parents who participated in the study, as well as the staff members at the participating community/cultural centers. Thank you also to Tzu-An Chen for her help with recruitment, and Alicia Beltran for her help with NVivo.

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: Conflict of Interest Disclosures: The authors' conflict of interest disclosures can be found online with this article on www.jneb.org.

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Research ArticleCulture and Diet Among Chinese American Children Aged 9–13 Years: A Qualitative Study

Abstract

Objective

Design

Setting

Participants

Phenomenon of Interest

Analysis

Results

Conclusions and Implications

Introduction

Section snippets

Participants and Recruitment

Results

Discussion

Implications for Research and Practice

Acknowledgments

J Nutr Educ Behav

J Nutr Educ Behav

Nutr Res

J Am Diet Assoc

J Am Diet Assoc

Int J Nurs Stud

J Nutr Educ Behav

Pediatr Clin North Am

Appetite

Appetite

J Am Diet Assoc

Am J Clin Nutr

Am J Clin Nutr

Deaths: Final Data for 2010

Diet, nutrition and the prevention of excess weight gain and obesity

Public Health Nutr

Nutrition and cancer: a review of the evidence for an anti-cancer diet

Nutr J

The tracking of nutrient intake in young children: the Framingham Children's Study

Am J Public Health

Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation

CDC Health Disparities and Inequalities Report—United States, 2013

Immigration and generational trends in body mass index and obesity in the United States: results of the National Latino and Asian American Survey, 2002-2003

Am J Public Health

BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening

Diabetes Care

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies

Lancet

Indigenous crops of Asia and Southeast Asia: exploring health-promoting properties

HortScience

What are Asian-American youth consuming? A systematic literature review

J Immigr Minor Health

Associations of acculturation and socioeconomic status with subclinical cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis

Am J Public Health

Research Article
Culture and Diet Among Chinese American Children Aged 9–13 Years: A Qualitative Study