Acculturation, Diet and Psychological Health of Asian International Students at the University of Delaware
Authors: Jiang Heng , Chai Sheau C , Papas Mia A , Fang Cheng‐Shun 
Published: November 2023

ObjectiveThe primary aim of this study was to assess changes in dietary nutrient intakes and psychological health status along the acculturation process of migrant Asian students at the University of Delaware, Delaware. The secondary aim was to examine the association between nutrient intakes, psychological health and acculturation.MethodsDietary nutrient intakes were collected using dietary screener questionnaire (DSQ). Acculturation to original and American culture were assessed by Asian American Multidimensional Acculturation Scale (AAMAS). Respondents rated how much (1 not very much; 6 very much) they participated in the activities of a particular culture regarding four construct domains: cultural identity, language, cultural knowledge and food consumption. Kessler 6 screening scale was administered to measure non‐specific psychological distress (SPD). DSQ, AAMAS and Kessler 6 surveys were administered online through Qualtrics®. Multivariate adjusted linear regressions were performed using SPSS.ResultsOne hundred seventy‐two international Asian students (85 male vs 87 female) completed the online survey, with an average age of 26.3 years and mean length of U.S. residence of 29.2 months. Chinese students comprised 61.0% of study participants. Since their arrival in the US, weight gain of >15 pounds was reported by 13.3% participants. Bicultural adoption to original and American culture was exhibited by 22.8% of study participants. Compared to males, females consumed less calcium (Beta −0.1; 95% CI −0.2, 0.0), added sugar (Beta −0.3; 95% CI −0.5, −0.2), fiber (p=0.03) and sugar sweetened beverages (p<0.01). Nutrient intakes measured by DSQ were not associated with either the original or American culture acculturation. However, behavioural adoption to American food (Beta 0.003; 95% CI −0.004, 0.009) and maintenance of original food (Beta 0.003; 95% CI 0.001, 0.005) both increased as the length of U.S. residence increased. American language adoption (Beta 0.008; 95% CI 0.003, 0.013) and cultural knowledge (Beta 0.008; 95% CI 0.002, 0.013) significantly increased with increased US residency, except in Chinese students who had the lowest language adoption. Furthermore, American language adoption (Beta −1.1; 95% CI −2.0, −0.1) and original language maintenance (Beta −1.5; 95% CI −2.6, −0.3) were both associated with lower score on Kessler 6.ConclusionNutrient intakes did not vary with adaptation to American food or maintenance of original diet. It is possible our study population have migrated long enough that a balance of nutrient intakes has been reached. Study population with more varied residency is warranted to determine the time point when changes of nutrient intakes occur. We also observed a negative association between American language acquirement and non‐SPD. In an efforts to improve psychological health of internationals Asian students, challenges specific to this population such as language barrier should be addressed, especially for Chinese students.
Demographic Characteristics of the Study Population (n=172)

Characteristics
Mean (sd)

Age (years)
26.3 (3.0)

Length of U.S. Residence (months)
29.2 (23.8)

Weight Gain (Ibs.)a
Median (Q1, Q3)

10.0 (5.0, 15.0)

N (%)

0
77 (44.8)

>0–15
72 (41.9)

16–30
19 (11.0)

>30
4 (2.3)

Weight (Gain Rate (Ibs./month)a
0.4 (0.2, 0.8)

Gender
N (%)

Male
85 (49.4)

Female
87 (50.6)

Country of Origin
N (%)

China
105 (61.0)

India
38 (22.1)

South Korea
9 (5.2)

Taiwan
3 (1.7)

Other
17 (9.9)

Current Education Level
N (%)

Master student
79 (45.9)

Ph.D. student
93 (54.1)

Monthly Food Expenses (S)
N (%)

100–200
24 (14.0)

200–300
72 (41.9)

300–400
56 (32.6)

>400
20 (11.6)

Non‐normally distributed, median and interquartile range Q1, Q3 were reported

Acculturation to American Culture and Original Culture and Their Association with Demographic Characteristics

AAMAS‐EA
Cultural Identity
Cultural Knowledge
Food consumption
Language
AAMAS‐COb
Cultural Identity
Cultural Knowledgeb
Food consumption
Languagec

Beta (95% CI)

Median (Q1, Q3)

Length of U.S. Residence (months)
0.02* (0.004, 0.036)
0.0
0.008** (0.002, 0.013)
0.003 (−0.004, 0.009)
0.008** (0.003, 0.013)
0.006** (0.002, 0.009)
−0.005* (−0.009, −0.001)
−0.006* (−0.01, −0.001)
0.003* (0.001, 0.005)
6.0 (5.8, 6.0)

China
Ref
Ref
Ref
Ref
Ref
Ref
Ref
Ref
Ref
6.0 (5.8, 6.0)

South Korea
2.2* (0.2, 4.2)
0.3 (−0.3, 0.8)
0.3 (−0.4, 1.0)
0.6 (−0.2, 1.5)
0.6* (0.08, 1.2)
0.4* (0.01, 0.8)
−0.6* (−1.2, −0.05)
−0.6* (−1.2, −0.03)
0.2 (−0.1, 0.4)
5.8 (5.0, 6.0)

India
22** (1.2, 3.2)
0.5** (0.2, 0.8)
0.02 (−0.4, 0.4)
0.7** (0.3, 1.1)
1.0** (0.7, 1.3)
0.08 (−0.1, 0.3)
−0.07 (−0.4, 0.2)
0.05 (−0.3, 0.4)
0.04 (−0.1, 0.2)
6.0 (5.6, 6.0)

Other
0.5 (−0.9, 1.9)
0.2 (−0.2, 0.6)
−0.3 (−0.9, 1.2)
−0.1 (−0.7, 0.5)
0.8** (0.4, 1.2)
−0.08 (−0.4, 0.2)
−0.3 (−0.7, 0.1)
0.3 (−0.2, 0.7)
−0.1 (−0.3, 0.09)
6.0 (5.9, 6.0)

AAMAS‐EA: acculturation to American culture: AAMAS‐CO: acculturation to original culture
Values were natural log transformed prior to linear regression;
Language was not normally distributed and Kruskal‐Wallis was performed
p<0.05;
p<0.01

The association between Acculturation Level and Dietary Nutrient Intakes

Calcium (mg)
Added Sugar (tsp)
Whole Grains (ounce equivalents)
Fruits and Vegetables (cup equivalents)
Fruits and Vegetables (no French fries) (cup equivalents)
Fiber (g)
Diary (cup equivalents)
Added Sugar from Sugar Sweetened Beverages (tsp)

Beta (95% CI)

AAMAS‐EA1
0.01 (−0.01, 0.03)
0.01 (−0.02, 0.04)
0.06 (−0.02, 0.1)
0.01 (−0.01, 0.03)
0.01 (−0.01, 0.03)
13.9 (11.5, 17.2)
1.6 (1.0, 2.0)
3.8 (1.1, 7.6)

AAMAS‐EA2
−0.02 (−0.05, 0.02)
0.03 (−0.03, 0.08)
−0.1 (−0.3, 0.02)
−0.03 (−0.07, 0.01)
−0.03 (−0.07, 0.01)
−0.16 (−0.35, 0.04)
−0.12 (−0.3, 0.1)
−03 (−1.6, 0.9)

AAMAS‐EA‐3
−0.01 (−0.06. 0.04)
0.03 (−0.04, 0.1)
0.2 (−0.01, 0.4)
0.03 (−0.02, 0.08)
0.04 (−0.01, 0.09)
0.02 (−0.03, 0.07)
0.01 (−0.07, 0.09)
−0.1 (−0.5, 03)

AAMAS‐CO1
0.006 (−0.02, 0.03)
−0.002 (−0.04, 0.04)
−0.06 (−0.15, 0.04)
0.01 (−0.02, 0.03)
0.01 (−0.01, 0.04)
13.9 (11.5, 17.2)
1.6 (1.0, 2.0)
3.8 (1.1, 7.6)

AAMAS‐CO2
−0.003 (−0.05, 0.05)
0.06 (−0.01, 0.1)
0.05 (−0.1, 0.2)
0.02 (−0.03, 0.07)
0.02 (−0.03, 0.07)
0.01 (−0.04, 0.06)
−0.06 (−0.1, 0.02)
0.3 (−0.2, 0.7)

AAMAS‐CO3
0.01 (−0.05, 0.07)
0.05 (−0.04, 0.1)
0.01 (−0.2, 0.2)
0.03 (−0.03, 0.08)
0.02 (−0.04, 0.08)
0.04 (−0.01, 0.1)
−0.03 (−0.1, 0.06)
0.5 (−0.04, 1.0)

Independent variable: AAMAS‐EA (CO);
Independent variable: AAMAS‐EA (CO), gender and AAMAS‐EA (CO)*gender;
Independent variable: AAMAS‐EA (CO), country of origin and AAMAS‐EA (CO)*couniry of origin.
All models were multivariable adjusted

Kessler 6 and Acculturation

Kessler 6 Beta (95% CI)

AAMAS‐EA
−0.04 (−0.3, 0.2)

Cultural Identity
−0.9 (−1.9, 0.09)

Language
−1.1 (−2.0, −0.1)*

Cultural Knowledge
0.2 (−0.6, 0.9)

Food Consumption
0.5 (−0.1, 1.1)

AAMAS‐CO
1.1 (−0.3, 2.4)

Cultural Identity
−0.4 (−1.4, 0.6)

Language
−1.5 (−2.6, −0.3)*

Cultural Knowledge
−0.1 (−1.0, 0.8)

Food Consumption
1.5 (−0.4, 3.4)

Adjusted for age, gender, length of residence and country of origin
p<0.05