CONSUMPTION OF SUGAR-SWEETENED BEVERAGES AMONG CALIFORNIA ADULTS: ROLE OF NEIGHBORHOOD ETHNIC DENSITY, ACCULTURATION, AND DISPARITIES
Au, Maria C
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This dissertation aims to explore whether ethnic disparities exist with sugar-sweetened beverages (SSBs) consumption among adults living in California, and to explore how acculturation and neighborhood ethnic density are associated with SSB consumption. Special attention was given to Asians and their subpopulations in the analyses to assess the disparate risk profiles among these subgroups. First, we examined 47,397 non-institutionalized adults on the total SSB consumption frequencies and the types of beverages consumed based on the 2009 California Health Interview Survey. Subsequent analyses were conducted among the 5,062 Asian subpopulations. The odds of Asians who consumed any SSB in the past week were similar to Whites (OR: 1.2, 95% CI: 0.9-1.4, p<0.05), while it was significantly higher for African Americans, Hispanics, and Other Races. Significant differences in the frequency and the types of SSB consumed among the Asian subpopulations were observed. The odds of Filipino (OR: 1.9, 95% CI: 1.3, 2.8, p<0.01), Vietnamese (OR: 1.6, 95% CI: 1.0-2.4, p<0.05), and South Asian (OR: 2.0, 95% CI: 1.3-2.9, p<0.01) adults consuming a total of >3 SSB per week were significantly higher compared to Chinese. The predicted marginals also suggest that coffee/tea appears to be the driver of SSB consumption among Asians. The second study examined the various dimensions of acculturation and how they are associated with SSB consumption frequency among Asian and the Asian subpopulations. Three dimensions, 1) age of arrival in the U.S., 2) language use/media preference, and 3) time exposure to U.S. were identified and used to assess the associations with SSB. Differential associations were observed with the three dimensions. The U.S. age of arrival dimension resulted in the most number of significant findings in this study. The odds of consuming any SSB were 1.8 (95% CI: 1.2-2.7, p<0.01) times higher among all Asians born in the U.S. or have arrived in the U.S. before the age of 18 compared to those who arrived in the U.S. after age 18. These higher odds of total SSB consumption were significant for Chinese- and Japanese-origin Asians: OR=2.8 (95% CI: 1.3-6.0, p<0.01) and 2.4 (95% CI: 1.1-4.6, p<0.05), respectively. The third study explored the association between neighborhood ethnic density and SSB consumption among non-Hispanic White, Hispanic, African American, and Asian adults, in addition to a stratified analysis among six Asian sub-populations. Our findings suggest that living in a typical neighborhood where more than 25% of the population comprised of Hispanics is associated with increased soda consumption compared to those who do not live in these neighborhoods, regardless of race/ethnicity (White: OR 1.3, 95% CI: 1.2-1.5, p<0.01; Hispanic: OR 1.3, 95% CI: 1.0-1.6, p<0.05; Asian: OR 1.5, 95% CI: 1.1-2.0, p<0.01; African American: OR 1.8, 95% CI: 1.2-2.7, p<0.01). Findings in ethnic Asian neighborhoods were equivocal in which the only significant results were among Hispanic residents who had decreased odds of soda consumption (OR: 0.72, 95% CI: 0.5-1.0, p<0.05), but they also had increased odds of flavored/sports drinks (OR: 1.3, 95% CI: 1.1-1.7, p<0.05) compared to their Hispanic counterparts. In conclusion, our results suggest that ethnic differences in SSB consumption exist with Asians having lower odds of SSB consumption occasions compared to Hispanics and African Americans. Differential associations also exist among the Asian subpopulations. Moreover, acculturation and ethnic neighborhoods are associated with increased odds of SSB consumption in some segments of the studied populations.