University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School January 2011 An examination of diet, acculturation and risk factors for heart disease among Jamaican immigrants Carol Renee Oladele University of South Florida, [email protected] Follow this and additional works at: http://scholarcommons.usf.edu/etd Part of the American Studies Commons, Epidemiology Commons, and the Nutrition Commons Scholar Commons Citation Oladele, Carol Renee, "An examination of diet, acculturation and risk factors for heart disease among Jamaican immigrants" (2011). Graduate Theses and Dissertations. http://scholarcommons.usf.edu/etd/3735 This Dissertation is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. An Examination of Diet, Acculturation, and Risk Factors for Heart Disease among Jamaican Immigrants by Carol Williams Oladele A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Public Health Department of Epidemiology and Biostatistics College of Public Health University of South Florida Major Professor: Elizabeth Barnett Pathak, Ph.D. Getachew Dagne, Ph.D. David Himmelgreen, Ph.D. Thomas J. Mason, Ph.D. Wendy N. Nembhard, Ph.D. Sangita Sharma, Ph.D. Jimin Yang, Ph.D., RD Date of Approval: November 16, 2011 Keywords: Chronic Disease, Dietary Intake, Environment, Group Identity, Nutrition Copyright © 2011, Carol Williams Oladele Dedication I dedicate this dissertation to my family, Jean-David, Caleb, and Justin, who served as the motivation to complete this work. My loving husband, Jean-David, supported me financially throughout most of this time and always encouraged me to finish. Thank you for your support and the late nights you helped me debug programs and solve formatting problems. Thank you to my children, Caleb and Justin, who bore with me as I had less time for them while working on this dissertation. I said that it would be over soon and it is over boys. I love you both and look forward to spending more time with you. I would like to thank my mother, Angela Williams, for her support and prayers through the years. You were always there for me during the most stressful times. My in- laws, Afolabi and Justina Oladele, thank you for your prayers and encouragement to complete this work. Thank you to my sister, Camille, who listened to me almost daily talk about this dissertation. I would also like to thank my Auntie Janet whose time with me during Summer 2011 afforded me the time to work on my analysis and writing. Lastly, thank you to friends and family who offered support through their inquiries, provided helpful suggestions, and who were big cheerleaders for me finishing this work. I could not have done this without your love and support. I love you all. Table of Contents List of Tables .................................................................................................................. iv List of Figures ................................................................................................................. vi Chapter 1- Introduction ................................................................................................... 1 1.1 Introduction ................................................................................................... 1 1.2 Purpose of the Study ..................................................................................... 3 1.3 Study Rationale ............................................................................................. 3 1.4 Country Background ..................................................................................... 4 1.5 What is a Traditional Jamaican Diet? ............................................................ 5 1.5 a. Evolution of Jamaican Diet ............................................................ 5 1.5 b. Jamaican Foodways ...................................................................... 8 1.6 Migration of Caribbean Immigrants to the US ................................................ 9 1.7 Study of Acculturation ..................................................................................10 1.8 Nutrients Important in the Development of Chronic Diseases .......................11 1.9 Obesity.........................................................................................................12 1.10 Epidemiology of Diet-United States ............................................................13 1.11 Epidemiology of Diet-Jamaica ....................................................................17 1.12 Dietary Acculturation ..................................................................................18 1.13 Overview of Study Design ..........................................................................19 1.14 Data Sources .............................................................................................19 1.15 Public Health Importance ...........................................................................19 Chapter 2-Background and Literature Review ...............................................................26 2.1 History of Diet in Epidemiology ....................................................................26 2.2 Methods of Dietary Assessment ...................................................................29 2.3 History of Acculturation Studies in Epidemiology ..........................................32 2.4 Conceptualization of Acculturation ...............................................................35 2.5 Dietary Findings Associated with Measures of Acculturation ........................37 2.6 Acculturation, Dietary Intake, and Chronic Disease ......................................41 2.6 a. Fat/Saturated Fat /Oil Intake .........................................................42 Early Evidence 1980’s to 1993 ....................................................42 Evidence from the 1994-1999 .....................................................44 Recent Evidence 2000+ ..............................................................47 2.6 b. Fiber Intake ..................................................................................50 Empirical Evidence .....................................................................51 2.6c. Vitamin A, C, E ..............................................................................57 2.7 Obesity.........................................................................................................59 i 2.8 Nutrient Intakes in Caribbean Immigrants to the UK .....................................62 2.9 Social Predictors of Dietary Intake ...............................................................64 2.10 Gaps in the Literature .................................................................................65 Chapter 3-Study Methodology .......................................................................................66 3.1 Purpose of Study .........................................................................................66 3.2 Conceptual Model ........................................................................................66 3.3 Specific Aims ...............................................................................................68 3.4 Research Questions and Hypotheses .........................................................68 3.5 Operational Objectives .................................................................................70 3.6 Study Design................................................................................................71 3.7 Target Population .........................................................................................71 3.8 Inclusion Criteria ..........................................................................................73 3.9 Inclusion Justification ...................................................................................73 3.10 Sample Size ...............................................................................................74 3.11 Sampling of Target Population ...................................................................75 3.12 Recruitment of Target Population and Study Protocol ................................76 3.13 Measurement of Exposure Variables .........................................................78 3.13a. Traditional vs. Less Traditional Eating Patterns ...........................79 3.13b. Acculturation ................................................................................81 3.14 Measurement of Outcome Variables ..........................................................83 3.14 a. Measurement of Dietary Intake and Development of QFFQ........84 3.15 Steps in the Development of the QFFQ ......................................................85 3.15 a. Food List .....................................................................................87 3.15 b. Nutrient Composition ..................................................................87 3.15 c. Design of the QFFQ ....................................................................88 3.16 Dietary Intake Pattern ................................................................................90 3.16 a. Obesity .......................................................................................90 3.16 b. Hypertension ..............................................................................90