Understanding the Rise of Obesity among Immigrants: A Pilot Study

描述(申请人提供)：本R21申请的目的是响应PA-06-256(肥胖症的探索性/发展性临床研究资助)，评估在移民中进行一项纵向的、跨国肥胖研究的可行性。尽管移民的肥胖率比土生土长的人低，但随着移民在美国居住的时间越长，肥胖率就会趋于一致。这种趋同表明，移民的体重增加速度更快。移民的体重增加可能是由于饮食、体力活动和压力的变化。然而，以前大多数关于移民体重增加的研究都是横断面的，缺乏国际比较组，也不包含移民前的信息。因此，研究可能被“美国”食品和生活方式全球化带来的世俗趋势搞糊涂了。这项拟议的先导性研究考察了一项自然实验，将迁徙本身作为“治疗”。试点的目的是：(1)证明招募三组移民的可行性；(2)收集饮食和体力活动模式的基线信息；(3)在一年多的时间里跟踪三组移民，评估将随访损失降至最低的战略，并评估保留率。这三个群体包括：(1)移民，从菲律宾跟随到美国；(2)非移民，在年龄、性别和教育方面与移民匹配，并在菲律宾境内跟随；(3)非移民，由希望移民但尚未获得必要许可的个人组成。将在一年内收集三波数据，初步测量在菲律宾进行。这些数据包括来自加速计的读数、拟人化评估、自我报告的测量，以及来自手机的新奇信息。手机将配备全球定位系统(GPS)技术来跟踪参与者的位置，并配备摄像头，以便拍摄参与者吃的食物以及他们的体重和腰围的自我测量。参与者中的一小部分将在所有波中进行护士管理的评估。总而言之，这项拟议的试点研究提供了一项独特的研究，可以检验移民到美国后体重实际上是如何增加的。与大多数调查移民抵达美国后的研究相比，这项研究的主要创新包括对移民前经历的评估，母国非移民的对比组，以及使用手机技术来验证自我报告的衡量标准。最终，这项研究可能会为了解移民体重增加的本质和潜在的干预途径提供见解。与公共健康相关：美国和世界范围内不断上升的肥胖率是一个重大的公共健康问题，因为与肥胖相关的许多健康问题。移民是美国人口中增长最快的部分之一，而且，他们的体重增加速度可能比普通人口更快。确定导致移民体重增加的因素可能会为初级预防计划的发展提供关键信息。

DESCRIPTION (provided by applicant): The goal of this R21 application, in response to PA-06-256 (Exploratory/Developmental Clinical Research Grants in Obesity), is to evaluate the feasibility of conducting a longitudinal, transnational study of obesity among immigrants. Although immigrants have lower rates of obesity than the native-born, these rates converge the longer immigrants reside in the U.S. This convergence suggests that weight gain is occurring faster among immigrants. Weight gain among immigrants likely results from changes in diet, physical activity and stress. However, most prior studies of weight gain among immigrants were cross-sectional, lacked an international comparison group, and did not contain pre-migration information. Thus, studies may have been confounded by secular trends arising from the globalization of "American" foods and lifestyles. This proposed pilot study examines a natural experiment, with migration itself as the "treatment." The pilot aims to: (1) demonstrate the feasibility of enrolling three cohorts of migrants; (2) collect baseline information of dietary and physical activity patterns; (3) follow three cohorts over one year, assess strategies to minimize loss-to-followup, and evaluate retention rates. The three cohorts consists of: (1) migrants, followed from the Philippines to the U.S.; (2) non-migrants, matched on age, gender and education to the migrants, and followed within the Philippines; (3) non-migrants comprised of individuals who wish to migrate, but do not yet have the necessary clearances. Three waves of data will be collected over one year, with initial measurements taken in the Philippines. This data consists of readings from accelerometers, anthropomorphic assessments, self-reported measures, and novel information from cell phones. The cell phones will be equipped with global positioning systems (GPS) technology to track participants' locations and with cameras to allow photographs of the foods participants eat and their self- measurements of weight and waist circumference. A subsample of participants will have nurse-administered assessments across all waves. In sum, the proposed pilot study provides a unique examination of how weight gain may actually occur among immigrants to the U.S. Compared to most studies that examine immigrants after arrival in the U.S., major innovations of this study include the assessment of pre-migration experiences, a comparison group of non-immigrants in the parent country, and the use of cell phone technology to validate self-reported measures. Ultimately, this research may provide insights into the nature of weight gain among immigrants and potential avenues for intervention. PUBLIC HEALTH RELEVANCE: Rising rates of obesity in the United States and worldwide are a significant public health concern because of the many health problems associated with obesity. Immigrants are among the fastest segments of the U.S. population and further, may be gaining weight at faster rates than the general population. The identification of factors that contribute to weight gain among immigrants may provide key information for the development of primary prevention programs.