Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Public Health (DPH)


Community Health and Social Sciences


Terry T-K. Huang

Committee Members

Sandra E. Echeverria

Katazyna Wyka

May May Leung

Melissa Fuster Rivera

Subject Categories

Epidemiology | Public Health


Obesity, Diabetes Mellitus Type 2, Emigrants and Immigrants, African Continental Ancestry Group, Africa, Caribbean


Background: Black immigration to the US quadrupled between 1980 and 2000, and between 2000 and 2013 it further increased by 56%. The US Census estimates that by 2060, 16.5% of the US Black population will be foreign-born. Half of all foreign-born Blacks (FBBs) in the US, or more than 1.9 million people, are from the Caribbean, and of those, 682,000 were born in Jamaica alone. Besides the Caribbean, there are 1.36 million immigrants from sub-Saharan Africa. In New York City, non-Hispanic black Caribbean and West African immigrants constitute 19% and 4%, respectively, of the total foreign-born population. Research is limited on the health of FBBs, as they are often grouped with African Americans.

In the US, 56.6% of all Black women and 37.1% of Black men are obese, compared to 36.1% and 33.5% for women and men, respectively, in the overall US population. In NYC, obesity prevalence is significantly lower for African FBBs (20.9%) and Caribbean FBBs (28.7%) compared to US-born Blacks (USBBs) (36.4%). In the US Black population Type 2 Diabetes (T2D) is prevalent, 12.7%, compared to 9.4% in the overall population. Self-reported T2D shows the greatest disparity between the FBBs of African and Caribbean origin. Among those from Africa, 5.6% of women and 6.9% of men report having T2D, compared to 10.6% of women and 9.3% of men from the Caribbean.

This dissertation sough to uncover the intra-ethnic variation in obesity and T2D odds among FBBs and US-born Blacks, as well as comparing the odds between FBBS from Africa and the Caribbean. A qualitative component aimed to identify intergenerational differences in risk profile, cultural practices and acculturation experiences that may contribute to any difference in odds in Ghanaian and Jamaican immigrant families.

Quantitative methods: Analyzing the 2009-13 NYC Community Health Survey, weighted multivariate logistic regression analyses examined odds of obesity and diabetes, adjusting for age, gender, education, income, marital status, children

Qualitative Methods: Conducting focus groups and interviews with 25 Ghanaian and 24 Jamaican immigrants, interviews and focus groups used open-ended questions, were digitally recorded and lasted between 45 and 90 minutes. Recordings were transcribed, and transcripts analyzed using Dedoose 7.0. Utilizing Grounded Theory Methodology (GTM), we used in-vivo codes and identified emerging themes. An intake survey collected information about socio-demographics, health behaviors and health outcomes. Statistical analysis was completed with Statistical Package for the Social Sciences (SPSS) version 23.

Results: When comparing FBBs to USBBs, FBBs had lower odds of obesity and greater odds of diabetes. FBBs had 1.4 times the odds of diabetes at overweight status, compared to USBBs. Living in the US ≥10 years was not associated with odds of obesity and diabetes.

When comparing African FBBs to Caribbean FBBs, prevalence of obesity and diabetes was lower among African FBBs. African FBBs also had significantly lower odds of obesity but only marginally lower odds of diabetes compared to Caribbean FBBs. Furthermore, African and Caribbean FBB women experienced higher odds of obesity compared to their male counterparts.

For Ghanaian and Jamaican FBBs, the effects of globalization, nutrition transition and remote acculturation were significant contributors to dietary acculturation and health outcomes. Dietary acculturation began in the home country and was perceived as a positive process by the families who participated in the study. In fact, dietary acculturation experienced in Ghana and Jamaica was an active process by which families accessed and provided increased intake of energy, fat, sugar, sodium and animal protein, and more meals away from home. Once in the US, the dietary acculturation experience continued, but was different between youth, parents and grandparents. One surprising finding was that cultural enclaves, which have been shown to protect immigrants against acculturative stress and dietary acculturation, may have different effects on youth and adults.

Conclusion: Despite prior findings that FBBs are healthier than USBBs, these three studies demonstrate that the healthy immigrant effect may no longer apply to FBBs in NYC. Most importantly, this dissertation illustrates the heterogeneity of risk within populations of African origin living in the US. FBBs experience lower odds of obesity, but higher odds of T2D than USBBs, yet Caribbean FBBS experience greater odds of both obesity and T2D than African FBBs. Furthermore, Ghanaian and Jamaican immigrants experienced the effects of dietary acculturation beginning in the home countries and facilitated by globalization of food and transnational families. Intergenerational differences in both populations manifested in the exposures to and acceptance of American foods. These findings point to the danger of drawing conclusions about public health risks by examining all Black populations as one group. In addition, this illustrates that dietary acculturation is a global phenomenon which affects diet and diet-related health before FBB populations migrate to the US.

Included in

Epidemiology Commons



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