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Dietary acculturation of recent immigrants from West Africa to New York City

Anne Paxton, Aravind Pillai, Kevin P.Q Phelan, Nicole Cevette, Fatimatou Bah and Sharon Akabas

Abstract

We conducted in-depth interviews with recent immigrants from West Africa to New York City, an under-researched immigrant population, in order to describe and analyze changes in dietary patterns. Participants describe diets before emigration as high in vegetables, fruits, root tubers (such as cassava or yam), and vegetable oils; moderate in meat and fish; and remarkably low in sugar (for example, in sodas or desserts). Study participants reported efforts to maintain a traditional diet, but signs of dietary acculturation were evident. Study participants ate outside the home regularly especially at lunch when at school or work.  Children of immigrants were most likely to adopt elements of a standard American diet. Many study participants reported a sharp increase in weight after the first few years of living in the United States, and all expressed concern about weight gain. In this study population, education appeared protective against adopting the least healthful aspects of the American diet.   

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Introduction

1Of the various adjustments new immigrants to New York City must make upon arrival is navigating a dramatically different food and activity environment, one that promotes high-energy intake and sedentary behavior. For many immigrant families, the Western diet of large amounts of processed foods, foods high in saturated fats and refined sugars, combined with low consumption of fruits, vegetables and whole grains [1], represents a stark departure from the foods and diet habits common in their home countries. A recent study, for example, found that consumption of seven unhealthful foods and nutrients (unprocessed red meats, processed meats, sugar-sweetened beverages, saturated fat, trans-fat, dietary cholesterol, and sodium) known to promote non-communicable diseases was lower in several West African countries than in many other parts of the world, including the United States, where consumption of these seven items was found to be among the highest. [2]

2 Numerous studies have demonstrated that immigrants to the United States tend to be in better general health upon arrival than their US-born counterparts, but both weight-gain and related health challenges have been shown to increase the longer immigrants stay in the US, even when adjusted for age, thus diminishing any previously held health advantages [3, 4, 5, 6, 7, 8, 9, 10].The immigrant population contributed to more than 30% of the population increase between 2000-2008 and foreign-born individuals now account for approximately 12.5% of the U.S. population [11]. Despite representing a significant and growing portion of the U.S. population, relatively few studies have looked at immigrants’ changing health and dietary status, and most of these have focused on East Asian and Hispanic populations.

3In recent years, however, the number of immigrants from Africa has increased significantly [12] [13]. By 2012, 36% of the 1.6 million foreign born from Africa in the US were from West Africa, with the largest African-born populations from Nigeria and Ghana. [14] Furthermore, New York was the metropolitian area with the largest African-born population in the US, and more than half were from countries in West Africa. [14] Our aim in this research is to describe and better understand changes in dietary patterns of recent immigrants to New York City from West Africa.

Methods

Participants and Data Collection

4Participants were recruited from community centers for West African immigrants throughout New York City, through responses to posted informational sheets, through professional networks, and at an informal West African food market in Staten Island based on the recommendation of one of our key informants. An incentive of $ 25 was offered for participation.

5Study participants were limited to adult immigrants (18 years or older) who arrived in the United States in the previous six years from a West African country and who were proficient enough in English to participate in the interview without the assistance of a translator. Only one subject per household was interviewed. The open-ended part of the interview was audio recorded and transcribed, and no personally identifying information was collected from study participants.

6In-depth interviews were conducted with West African immigrants based on a two-part questionnaire. The first part consisted of closed-answer social and demographic questions such as age, sex, marital status, education level attained, employment both in the birth country and the U.S., and reason for migration. The second part consisted of open-ended questions which were grouped into five sections based on the following themes: diet and food before immigration; current dietary patterns; family composition, role and responsibilities in food preparation; attitudes towards West African and American diets; and thoughts on nutrition and health. The interviews lasted for 45 minutes to slightly over one hour.

7The IRB at Columbia University approved the study as exempt.

Results

8Twenty participants from 7 countries in West Africa were interviewed: 5 from Guinea, 5 from Nigeria, 4 from Liberia, 2 each from Ghana and Mali and one each from Cameroon and Cote D’Ivoire. The range of time spent in the United States was from 4 days to 6 years, with the exception of one participant who initially told us she arrived in the U.S. less than five years ago but in fact had been living in New York for 11 years. The mean time in the U.S., excluding the one outlier, was 3 years. The mean age of our respondents was 30 years with a range in age from 19 to 68 years. Slightly more than half the study participants were women. Half of the participants were married and all to spouses of the same nationality. Most emigrated to improve their education or job prospects. Three moved for reasons of family ties (joining husband; living with adult children) and four - all from Liberia, which experienced a protracted civil war - for political reasons. All but 5 study participants had at least a bachelor’s degree, seven also completed graduate studies and one completed vocational school. Five participants reported being diagnosed with health conditions including hypertension, high cholesterol, arthritis, and/or diabetes. Only two participants took vitamins and none took herbal medications. All participants considered themselves healthy and all but four considered themselves to be physically active, although the range of time spent in activity varied greatly; two said they performed 2 hours of activity per week and one reported 28 hours of activity per week.

Participants’ Diet in Home Country

9Respondents discussed their food preferences and dietary habits before leaving their home country with a considerable amount of enthusiasm and detail. All respondents mentioned eating three meals, with breakfast being a smaller meal, and the heaviest meal being either the mid-day or the evening meal.

10Breakfast often consisted of tea or coffee, bread with butter, and occasionally eggs. A few respondents described a breakfast of a maize-based porridge with a bean cake (Liberia), fried yam or plantain (Nigeria) or porridge (Mali).

11The meals described for lunch and dinner always emphasized traditional foods. The main meal of the day typically had a staple tuber, root or grain (yam, rice, cassava, plantain, corn, sweet potatoes, and millet-based couscous in Mali) with a sauce (sometimes called soup or stew) made with a vegetable oil (palm oil was mentioned most frequently but also peanut and coconut oil, or imported corn or olive oil), and a wide assortment of vegetables (dark green leafy vegetables, tomato, onion, okra, peppers, carrot, or other vegetables). Smaller amounts of meat or dried fish, peanuts, or and legumes (cow peas, black beans) were often included in the sauce. Chicken was mentioned less often than beef, lamb or goat. Almost no mention was made of consuming dairy products such as cheese or milk (although one informant said northern ethnic groups like Hausa or Fulani eat dairy products).

12Virtually no one snacked between meals except on seasonal fruit (mango, banana, pineapple, avocado, etc.) and sometimes roast corn or plantain. Most said they regularly drank water only with meals. When asked about consumption of soda, many respondents said it was only consumed on special occasions. Men reported drinking alcohol, if at all, more often than women. “It’s looked down upon [for women to drink alcohol]; ‘it’s only bad women that drink’. That’s the opinion culturally . . . It’s more acceptable for men to drink.”.

13Many respondents spontaneously spoke of the excellent quality, taste, and freshness of produce in the meals prepared in their home countries. They spoke of purchasing vegetables and fruits daily at low cost from local markets but also growing much of their food in home gardens. Several referred to the food as “organic”. A few respondents emphasized that animals fed on fresh grass and were given no hormones or grain, which they claimed improved taste and healthfulness. Food was processed and cooked at home, mostly by women (although one man was the main chef in his family). Food appeared to have a very central role in family and community life.

14Everyone in the household - children and adults - ate the same foods. Infants were primarily breastfed but some reported that the use of formula was increasing rapidly especially in urban areas. Several mentioned home-made corn-based porridge as a weaning food given to infants after the first few months of life, in addition to breast milk. Two participants spoke of making their own baby food, blending rice with vegetables, or giving them fufu and okra.

15Only one respondent, from Nigeria, said diets were changing in their home country:

People are migrating to cities around the world. You can definitely see Westernization around you. Even when I go back to Nigeria there is always something new that is like what we do in New York and America. I think that sooner or later we will all have a similar diet. We have places like McDonald’s now so obviously we’re shifting towards the Western.

16Another respondent from Nigeria stressed urban and rural differences in diet with more imported foodstuffs (such as rice and wheat, more grain-based rather than root-based cuisine) eaten in urban areas.

Participants’ Diet in the United States

17Upon moving to New York city, most interviewees described efforts to maintain continuity in their diet. Dinner was cooked and eaten at home and was usually an African dish although made with slightly different ingredients (canola oil instead of palm oil, powdered fufu instead of fresh pounded fufu, and locally available vegetables instead of vegetables available in the country of origin). Study participants found it fairly easy to buy foods at African specialty stores like pounded yam powder, beef skin, dried vegetables, and spices, although several mentioned this was expensive. Foods such as yams, plantains, and cow peas could also be purchased at bodegas (convenience stores in Hispanic neighborhoods). A few respondents said they didn’t know how to make anything “American”.

18Almost no one had eaten meals away from home on a regular basis prior to emigration. After moving to New York, dinner was invariably the main meal of the day, and was typically still eaten at home. Lunch was often bought and consumed outside the home, especially among those who did not work at home. Those who ate lunch outside the home most frequently mentioned consuming fast foods and Chinese food, although a few mentioned buying sandwiches. Although they knew fast foods were unhealthy, several respondents said they ate it two to three times per week.

19Many interviewees spontaneously commented on the quality of food being worse in the U.S., especially the freshness (and cost) of fruits and vegetables, and beef and chicken. A number of interviewees suggested that people were consuming fewer fruits in the U.S. than they had in their country of origin, both because of the high cost as well as the lower quality and freshness. “Fruits, vegetables . . . and even when you can get them they are too expensive and look too horrible for us to eat them.”

20A number of respondents spoke, without prompting by the interviewer, of rapid weight gain-- and in a few cases, corresponding health problems -- since arriving in the U.S. These negative health changes were attributed to the quality as well as the quantity of the foods consumed in the U.S.

21Several participants associated weight gain upon arrival in the U.S. with the amount of processed and non-organic foods.

Because we are from a poor country . . . we don’t have so sophisticated chemical product to help our food in growing even our beef, meats, and everything are organic. So when I came here, for 3-5 first months, I started gaining weight.

I never had to bother about my weight until I came to America. It is like today you lose the weight and tomorrow you gain it back… There is a lot of processed food..

22Some mentioned diabetes and hypertension, and that their physicians were expressing concern.

23Responding to an open-ended question about which foods they consider healthy and which unhealthy, most answered easily and, generally speaking, expressed accurate concepts surrounding diet and health. A consensus emerged about the unhealthful aspects of the American diet: that people ate too much --“everything is large”-- and that the diet was too salty, sugary and fatty. “Food availability at low price makes people eat too much”. “Too much sugar, too much fat, and too much salt. That is why I stay away from their food and I don’t eat it so much”.

24Parents reported that their children were changing to an American diet more rapidly than adults. These respondents said their children were influenced by peers and by advertising.

We spend a lot of money to buy the things that we grew up eating because they are pretty expensive here since they’re available only in specialty stores . . . and the kids don’t really want to eat them because they and their friends in school are influenced by the media and advertising and music and films and so on to eat in particular ways.

25Several people reported that their children did not want to take food from home to school. The American foods that people said their children were drawn to included pizzas, hamburgers, macaroni and cheese, spaghetti and meatballs, biscuits (cookies), and sandwiches.

26Of the six participants who spoke about regularly eating fast foods at McDonalds, Wendy’s and Burger King, four only completed high school and two received benefits from the Supplemental Nutrition Assistance Program (SNAP), two indicators of lower socioeconomic status. By contrast, of the nine participants who spoke at length about their concerns over the quality of food in the U.S. (freshness of fruits and vegetables, use of antibiotics and hormones in beef and chicken, GMOs and “chemicals”) only 1 was of lower SES.

Discussion

27The West African immigrants we interviewed are attempting to maintain their traditional diet – a diet high in vegetables, fruits, grains and tubers, with few snacks, desserts, and sweetened beverages -- but finding it difficult as they adapt to their new environment. As in other studies, respondents reported that it was possible to find ingredients to cook African dishes, although specialty stores were expensive [15], and that when they ate at home they tended to eat dishes from their home country. Among the dietary changes people reported were eating outside the home more often, especially at lunch, a change noted in other studies of immigrants [16]; eating more fast foods and processed foods, and drinking soda; and, at least in some cases, decreasing consumption of fruits. None of these dietary changes are likely to improve the health of these immigrants and, indeed, many respondents expressed dismay at their increased body weight and, in some cases, worsened health.

28We were struck that at least half of those interviewed expressed dissatisfaction with the quality and freshness of food in the United States, a perception that may affect consumption patterns within these immigrant communities. There was suspicion of the food in the U.S., especially genetic modification of foods and use of chemicals and preservatives, and a sense of surprise that Americans were not more concerned where their food was coming from. Most of the participants also mentioned that American food was too sugary, too salty, and in some cases too fatty. Several participants felt that these quality issues, as well as portion sizes of restaurant food, were responsible for their weight gain over the first several months of living in New York. Similar concerns have been identified in literature on immigrants from other communities who said they had less time to prepare meals, felt more stress and had less social support than in their home countries [17, 18].

29In our study, participants with higher educational attainment and professional employment appeared to adopt more healthful aspects of the American diet, while those from lower SES, as indicated by eligibility for SNAP benefits and lower educational attainment, were most likely to be eating fast foods. All respondents reported concern about gaining weight, regardless of their education attainment or employment status. The participants with lower SES reported more weight-related illnesses – hypertension, diabetes and arthritis – as well.

30Studies have shown that immigrants with higher educational attainment are less likely to experience substantial weight gain [5] although it is unclear if the protection lies in individual level decision making, availability of healthy food in a community, economic resources, or a combination of these factors. Resource-poor communities have been shown to lack access to affordable fruits, vegetables, and other healthful foods [19, 20] while simultaneously having easy access to lower-quality, energy-dense foods that are high in fat and calories [21, 22]. Economic factors are at play, as well, as it costs less to consume food and sugar-sweetened beverages low in nutritional quality than highly nutritious foods and beverages [23].

31Of note, respondents who were parents reported that their children were quickly adopting the least healthful aspects of the American diet and showing less interest in their traditional cuisine, a phenomenon found in other studies [24, 25, 15]. Numerous researchers have found that those who are younger when they immigrate are more likely to adopt their host culture’s patterns of eating [26, 27, 5, 28, 29, 30]. Several participants attributed their children’s dietary preferences, at least in part, to media influence on children, which, in fact, has skyrocketed in the past two decades in the U.S. [31]. In 2009, 86% of television advertisements directed at children were for products high in saturated fat, sugar, or sodium [32]. The number of respondents in this study with children was too limited to determine whether children of more highly educated parents were less likely to adopt poor dietary habits, although it seems likely. As noted in recent research, “The children of immigrants adopt health behaviors typical of Americans in their socioeconomic group” [33]. This study indicates directions for future research and programming about how West African immigrants to New York City, and their children, can successfully navigate a new food and diet environment.

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References

Electronic reference

Anne Paxton, Aravind Pillai, Kevin P.Q Phelan, Nicole Cevette, Fatimatou Bah and Sharon Akabas, « Dietary acculturation of recent immigrants from West Africa to New York City », Face à face [Online], 13 | 2016, Online since 09 April 2016, connection on 25 June 2017. URL : http://faceaface.revues.org/1023

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About the authors

Anne Paxton

Dr. Anne Paxton has worked for 20 years in public health programs in low income countries, with a particular focus on maternal mortality prevention, nutrition in pregnancy, and blindness prevention. She is currently the Director of the Global Health Certificate of the Mailman School of Public Health, Columbia University, as well as the Director of the Department of Epidemiology’s Master’s Program.

Aravind Pillai

Aravind Pillai is a public health physician trained in India. He is a doctoral candidate in epidemiology at Columbia University’s School of Public Health in New York and coordinates the School’s global health certificate program. 

Kevin P.Q Phelan

Kevin P.Q. Phelan worked with Médecins Sans Frontières (MSF) for thirteen years before joining the Alliance for International Medical Action (ALIMA) as nutrition advisor. He earned his MSc from Columbia University’s Institute for Human Nutrition.

Nicole Cevette

Nicole Cevette earned her MSc in nutritionfrom Columbia University’s Institute for Human Nutrition.

Fatimatou Bah

Fatimatou Bah is a public health researcher who has with community-based organizations in New York City. She earned her MPH from Columbia University and is currently in her first year of medical school at SUNY Upstate Medical University.

Sharon Akabas

Dr. Sharon Akabas earned her Ph.D. in Nutrition Science and Exercise Physiology from Columbia University.  She is currently the Director of the MS in Nutrition program at Columbia University’s Institute of Human Nutrition, and Associate Director for Educational Initiatives. Dr. Akabas edited the recently released Textbook of Obesity.

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