Sedentary Behavior and Consumption of Sugar Sweetened Beverages Across Immigrant Generation Among Urban Adolescents in Boston, MA

Background: Obesity among youth has important implications for health and well-being, including risk of chronic diseases and psychological and social disorders. While obesity markedly increases from 1^st to 2^nd generation, recent research has shown that convergence of weight between foreign and US-born youth occurs within a generation not between generations. However, little is known about the factors that underlie the increase in weight shortly after immigrants migrate to the US; few studies have explored if and how obesogenic behaviors such as diet and sedentary activities, that are precursors of obesity, change after arrival in the US. Because immigrant children and children of immigrant parents are among the fastest growing segments of the US population, the need to understand how obesogenic behaviors change after arrival in the US is urgent. Modifying these behaviors presents an opportunity to prevent the stark increase in weight among immigrant youth. This study examined the effects of immigrant generation on consumption of sugar sweetened beverages (SSB) and sedentary behaviors (TV, video game, computer use) among a sample of Boston public high school students.

Methods: We conducted secondary analysis on data from the 2008 Boston Youth Survey, a representative sample of 9th-12th-graders in public high schools in Boston, MA. Outcomes of interest were sedentary behaviors (n=1409), and consumption of soda or other sweetened fruit drinks (n=1438). The main predictor was immigrant generation: 1^st (foreign-born in US <4 years); 1.5 (foreign-born in US >4 years); 2^nd (US-born with >1 foreign-born parent) and 3^rd (US- born with 2 US-born parents). We used generalized estimated equation models and accounted for clustering of students within schools to generate the relative risk (RR) of SSB consumption and sedentary behaviors among each immigrant generation group relative to 3^rd generation youth.

Results: 1^st and 1.5 generation youth were significantly less likely to consume soda (RR=0.57, 95% CI=0.36, 0.91 and RR=0.69, 95% CI=0.54, 0.90) and other SSB (RR=0.43, 95% CI=0.27, 0.69 and RR=0.53, 95% CI=0.36, 0.78) relative to 3^rd generation; risk of SSB consumption among 2^nd generation was indistinguishable from the referent group. Only 1^st generation youth were significantly less likely than 3^rd generation to view >2 hours of TV per day (RR= 0.65, 95% CI=0.45, 0.93); risk among 1.5 and 2^nd generation youth were equal to 3^rd generation. For video game and computer use, there were no significant differences in risk across immigrant generation groups.

Conclusions: Consumption of SSB may help explain the increase in obesity among immigrant youth shortly after arrival in the US.  Adolescence is a critical period for establishing dietary and behavior patterns which endure into adulthood. The first few years after immigrant youth arrive in the US are crucial for the adoption of obesogenic behaviors, especially SSB consumption. Targeted marketing of SSB to poor, racial/ethnic minority youth, many of whom are immigrants, needs to be challenged. There is a window of opportunity when social workers in schools and communities can intervene to prevent an impending burden of obesity, and the associated adverse health and social sequelae among immigrant youth.