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Association Between Acculturation and Body Weight Status Among Migrant Children in Guangzhou, China: a Cross-Sectional Study Xiaoling Huang Old Dominion University ODU Digital Commons Community & Environmental Health Faculty Community & Environmental Health Publications 2018 Association Between Acculturation and Body Weight Status Among Migrant Children in Guangzhou, China: A Cross-Sectional Study Xiaoling Huang Wen Chen Yanwei Lin Qi Zhang Old Dominion University, [email protected] Li Ling Follow this and additional works at: https://digitalcommons.odu.edu/commhealth_fac_pubs Part of the Community Health and Preventive Medicine Commons Repository Citation Huang, Xiaoling; Chen, Wen; Lin, Yanwei; Zhang, Qi; and Ling, Li, "Association Between Acculturation and Body Weight Status Among Migrant Children in Guangzhou, China: A Cross-Sectional Study" (2018). Community & Environmental Health Faculty Publications. 61. https://digitalcommons.odu.edu/commhealth_fac_pubs/61 Original Publication Citation Huang, X., Chen, W., Lin, Y., Zhang, Q., & Ling, L. (2018). Association between acculturation and body weight status among migrant children in Guangzhou, China: A cross-sectional study. BMJ Open, 8(6), e018768. doi:10.1136/bmjopen-2017-018768 This Article is brought to you for free and open access by the Community & Environmental Health at ODU Digital Commons. It has been accepted for inclusion in Community & Environmental Health Faculty Publications by an authorized administrator of ODU Digital Commons. For more information, please contact [email protected]. Open access Research Association between acculturation and body weight status among migrant children in Guangzhou, China: a cross- sectional study Xiaoling Huang,1,2 Wen Chen,1,2 Yanwei Lin,1,2 Qi Zhang,2,3 Li Ling1,2 To cite: Huang X, Chen W, Lin Y, ABSTRACT Strengths and limitations of this study et al. Association between Objective To assess the association between acculturation and body weight acculturation and body weight status among internal status among migrant children ► This study controlled mental health, dietary and pri- migrant children in China. in Guangzhou, China: a cross- mary caregivers’ migrant background to assess the A cross-sectional sectional study. BMJ Open Design, setting and participants relationship between acculturation and overweight/ 2018;8:e018768. doi:10.1136/ study was conducted among 1154 pairs of migrant obesity among internal migrant children in a metro- bmjopen-2017-018768 children aged 11–17 years and their primary caregivers in politan area in China. Guangzhou, China, from April to May 2016. Prepublication history and ► One of the first efforts to link acculturation and child- ► Measures Migrant children’s body weight status was additional material for this hood obesity among migrants in China. paper are available online. To measured by body mass index. Acculturation was ► Self-reported data were used to calculate the body view these files, please visit measured by a questionnaire, developed and validated weight status, which may have recall bias and re- the journal online (http:// dx. doi. by the research team. The questionnaire had three porting bias. org/ 10. 1136/ bmjopen- 2017- dimensions with five factors, namely language, social ► Association, instead of causality, was examined. 018768). interaction, custom, dressing and diet. Social anxiety was measured by Social Anxiety Scale for Children. Food XH and WC contributed equally. intake was measured by the food frequency table that INTRODUCTIOn Received 19 July 2017 was developed from a previous study. Logistic regression Revised 25 May 2018 was performed to examine the association between With the rapid urbanisation and economic Accepted 29 May 2018 acculturation and overweight/obesity while controlling reform in China, internal migration has been 1 2 for migrant children’s and their caregivers’ demographic accelerated since the late 1950s. Under the characteristics, children’s social anxiety and food intake. permanent household registration (hukou) Results Seventy-six out of 1154 (6.6%) migrant children system in China, resident status is catego- were overweight, and 36 (3.1%) were obese. The overall rised as rural and urban residency. Due to the prevalence of overweight/obesity was 12.5% in boys, unbalanced economic development across and 6.1% in girls (p<0.001), respectively. The mean regions in China, residents move across scores of acculturation were 41.8 (SD=14.6). Migrant the country for a better life3 and form the children had the highest level of acculturation in the 247 million (18%) internal migrant popu- aspect of dressing (mean=61.7, SD=16.6), followed lation (2015), and the majority of them are by language (mean=47.9, SD=22.3), diet (mean=45.0, rural-to-urban migrants.4 Under the hukou SD=18.5), social interaction (mean=42.4, SD=21.3) and custom (mean=27.6, SD=19.2). After controlling system, the migration process creates social, economic and cultural challenges and for confounding factors, the levels of acculturation 2 was negatively associated with overweight/obesity barriers to internal migrant population. 1Faculty of Medical Statistics (adjusted OR (aOR)=0.98, 95% CI 0.97 to 1.00, p=0.030). For instance, internal migrants have limited and Epidemiology, School of Furthermore, migrant children who had urban-to-urban access to the local education, public health Public Health, Sun Yat-sen migrant caregivers were more likely to be overweight/ service and social welfare, which are provided University, Guangzhou, China obese (aOR=2.07, 95% CI 1.16 to 3.69, p=0.014) than for local residents by governments.2 2 Sun Yat-sen Center for Migrant their counterparts living with rural-to-urban migrant Internal migrant children are generated by Health Policy, Sun Yat-sen caregivers. University, Guangzhou, China tailing with their caregivers who migrated from Conclusions The low levels of acculturation was 3School of Community and developing areas to relatively developed areas 5 Environmental Health, Old associated with overweight/obesity among migrant within China. They are a critical subgroup Dominion University, Norfolk, children in Guangzhou, China. Promoting healthy of the migrants and experience significant Virginia, USA acculturation and social campaign on healthy body weight socioeconomic and cultural changes and may help prevent childhood overweight/obesity. Young challenges.5 Chinese census data showed that Correspondence to migrant children, boys and children living with urban-to- internal migrant children aged 0–17 years old Dr Li Ling; urban migrant caregivers should be the target subgroups. lingli@ mail. sysu. edu. cn had increased from 2.45 million in 2000 to Huang X, et al. BMJ Open 2018;8:e018768. doi:10.1136/bmjopen-2017-018768 1 Open access 35.81 million in 2010, accounted for 12.84% of children Acculturation, as a multifaceted concept, reflects the in China.6 7 Under the hukou system, internal migrant overall adaptation to a new society when contacting with children were defined as those younger than 18 years old individuals and groups from another culture, including and living in a place, rather than registered permanent the complex and dynamic nature of cultural identity, social residence for at least 6 months.2 6 connection and preferences in the residence culture (eg, Worldwide, childhood obesity is an emerging public language, history, foods and holiday).25 26 Particularly, health concern, because it has been proven as a signifi- during the migration, the change of environment and cantly early life risk factor for adult obesity and chronic adaptation process may influence their diet, physical diseases.8 9 Based on a systematic analysis of the data activity and other life behaviours, which may further be from 188 countries and 21 regions, the prevalence of bidirectionally associated with health status. On the one overweight and obesity in developing countries has hand, it may contribute to overweight and obesity among increased from 8.1% to 12.9% for boys and from 8.4% migrant children when they formed bonds with natives to 13.4% for girls from 1980 to 2013, while the preva- and adapt to the obesogenic dietary, behaviours and lence in developed countries has grown up from 16.9% environment in a receiving society.22 On the other hand, to 23.8% and from 16.2% to 22.6% for boys and girls, migration into the healthy environment may reduce the respectively.10 There also have been sustained increases risk of being overweight or obese. As a study showed that in the rate of overweight/obesity among children aged the acculturated parents of migrant children were aware 7–18 years old in China from 2000 to 2014, especially of the health issues associated with obesity as received for boys, rising from 15.68% to 28.19% and from 5.88% local attitudes and practices of a healthy lifestyle in main to 20.26% in urban and rural areas, respectively.11 society.27 However, the body weight status among children varies In the current study, inconsistent associations between across regions in China. In general, southern China has acculturation and childhood obesity among children of a lower prevalence of overweight/obesity than other immigrants have been reported. For instance, previous regions.12 Guangzhou, as a metropolis in southern literature reported that high levels of acculturation was China, had the lower body mass index (BMI) (19.3) related to high BMI among adolescents, particularly among children than other regions like Shanghai (21.0) among immigrant children from developing countries and Beijing (21.5).11 13 to developed countries.22 28 Jennifer and Baker found The spatial disparity in childhood overweight and that immigrant children with low degrees of accultura- obesity has also been observed among internal migrant tion were likely to gain weight.29 30 Moreover, there was children. A study in Guangzhou showed the prevalence also research demonstrating no significant relationship of overweight/obesity among migrant children aged between acculturation and body weight among immi- 5–12 years was 14.3% in 2014,14 which was lower than grant children in the USA.31 No consistent acculturation figures found among migrant children in Shanghai measure was used in related studies.
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