This study examined the determinants of dietary
adequacy, nutritional status, and food insufficiency
among Hispanic Americans residing in the United
States between 1988 and 1994. The authors focused on
how acculturation, social integration, and Food Stamp
Program participation influenced these nutritional
outcomes. The results provide a foundation for future
research on health, dietary behaviors, and food insecurity
of U.S. Hispanics. In addition, these results can
assist public and private food assistance and social
service programs in providing services to improve the
health, nutritional status, and food security of low-income,
marginalized populations.
A primary goal of Healthy People 2010 is to decrease
the health disparities that exist between population
groups in the United States. Hispanic Americans have
higher rates of overweight and obesity than non-
Hispanic Whites, reaching 42 percent among adult
Hispanic women. Rates of some nutrition-related
chronic diseases, such as diabetes, are several times
higher among Hispanics than the general adult population.
The determinants of dietary patterns and disease
outcomes are complex. Cultural norms often support a
healthy diet. However, low income, poor education
and language skills, and a lack of social support,
among other factors, may undermine traditional
dietary patterns. In addition, lack of nutrition and
health services may place this population at increased
risk of poor nutritional status, disease and disease-related
complications, and mortality.
The authors use the NHANES III sample for their
analysis, including data on a total of 5,787 Hispanic
individuals. The outcome variables of interest include
dietary intake, food insufficiency, and body mass
index. Explanatory variables for these outcomes
included acculturation (language used at home, birthplace,
and age at arrival in the United States), social
integration (communication with social partners and
participation in church or club), food stamp receipt,
and individual and household characteristics.
Most sample individuals were married and lived in
metropolitan areas. One-fifth of sample households
were female-headed. Almost half of the sampled adults
completed high school, but 15 percent had no formal
education past fifth grade. The distribution of income
was nearly bi-modal, with most adults living in households
with incomes of less than 130 percent (43
percent of adults) or more than 185 percent of poverty
(42 percent of adults). Almost one-fifth of households
received food stamps at the time of the interview.
Nine percent of adults stated that they sometimes or
often did not have enough to eat. Fourteen percent had
cut the size of an adult’s meal and 8 percent a child’s
meal because of a lack of money to buy food.
Households receiving food stamps were more likely to
report not having enough food and cutting the size of
adults’ and children’s meals than nonrecipient households,
even when controlling for income.
Among individuals with incomes of less than 185
percent of poverty, less acculturation (i.e., a later age
at arrival in the United States) was associated with a
better diet. For individuals arriving as adults, both the
percent of energy as fat and saturated fat met Dietary
Guidelines recommendations. These percentages
increased, however, as time in the United States
increased. Among those with incomes greater than 185
percent of poverty, Spanish-speaking individuals who
came to the United States as children had the poorest
quality diets (highest intakes of energy, protein,
cholesterol, sodium, and percent of energy as saturated
fat). A later age at arrival was associated with a
decreased intake of grains but increased intake of
fruits and lower percentage of energy intake as fat and
saturated fat.
In regression models, the acculturation variables often
acted independently. Spanish language was associated
with lower intakes of energy, vitamin A, percent
energy as fat, and an improved diet. Arrival in the
United States as an adult was negatively related to
percent of energy as fat and saturated fat and to body
mass index. Spanish-speaking individuals who came to
the United States as adults had higher intakes of folate
and vitamin A. These results again show less acculturation
was associated with a better diet. Socioeconomic
status showed little association with dietary outcomes,
suggesting that economic effects may be captured by
other factors.
Social integration and use of food stamps also influenced
some nutrition outcomes. Church attendance was
associated with increased cholesterol and percent energy
as fat, and a poorer quality diet. However, no-involvement
in either church or clubs was associated with
lower intakes of energy calcium, folate, and vitamin A.
Living in a household that received food stamps was
associated with a small increase in intakes of energy,
protein, sodium, and zinc. However, BMI was also
higher for individuals in food stamp households.
Finally, the authors found increased risk of food insufficiency
among those with less than a high school
education, less social integration, low incomes, and
food stamps receipt. Risk factors for adult meal size
reduction included low education, low income, and
employment in agriculture. Cutting the size of a child’s
meal was related to low income, early age at arrival in
the United States, and weak-to-low social integration.
These results demonstrate the importance of education
and income and the probable role of social networks in
combating hunger and food insecurity.
This study demonstrates that within the Hispanic
population, acculturation, social integration, and Food
Stamp Program participation affect diet, nutritional
status, and food insufficiency. Other factors were also
important. Intakes of calcium and folate were generally
very low, demonstrating widespread deficiencies
of these nutrients in the Hispanic population at the
time of the study. Less acculturation was associated
with lower fat intakes, which is important in the fight
against obesity and chronic diseases. Low income was
a strong predictor of food insufficiency; being foreign-born
also increased the risk of child hunger. Although
the effects of socialization were less strong, they
suggest that being integrated into the community is
associated with better dietary outcomes. Food stamp
receipt was associated with food insufficiency;
however, further research would be necessary to determine
causality. The authors conclude that food and
nutrition assistance outreach should encourage individuals
and their social networks to maintain traditional
dietary patterns, as these were generally healthier.