Journal of Immigrant and Minority Health

, Volume 15, Issue 2, pp 372–380 | Cite as

Food Insecurity Among Cambodian Refugee Women Two Decades Post Resettlement

  • Jerusha Nelson Peterman
  • Parke E. Wilde
  • Linda Silka
  • Odilia I. Bermudez
  • Beatrice Lorge Rogers
Original Paper


Resettled refugees have high rates of chronic disease, which may be partially due to persistent food insecurity. This study describes food experiences on arrival in the U.S. and current food security status and examines characteristics related to food insecurity in a well-established refugee community. Focus groups and a survey assessed food security status and personal characteristics of Cambodian women in Lowell, MA, USA. Multivariate logistic regression was used to examine relationships with food insecurity. Current rates of food insecurity are high. In multivariate models, food insecurity was positively associated with being depressed and being widowed, and negatively associated with higher income and acculturation. Early arrivers (1980s) had difficulty in the U.S. food system on arrival, while later arrivers (1990s–2000s) did not. Refugee agencies should consider strategically devoting resources to ensure successful early transition to the U.S. food environment and long-term food security of refugees.


Refugees Food insecurity Acculturation Depression 



The authors thank Botum Sokhieng, Jeanine Chhoeum, Saman Hing, Chanthyda Hout, Julie Hak, and Sam An Um, who administered the survey; Boroueth Chen and Timothy Mouth who provided written translations and backtranslations; Ronnie Mouth, Bophamony Vong, and Sengly Kong who translated focus group discussions; Robin Toof and Sidney Liang for input into the survey design and administration; and most of all, the study participants who generously shared their time and experiences. This research was funded by Cambodian Community Health 2010 (CDC Agreement Number U50/CCU122151), the Blue Cross and Blue Shield of Massachusetts Catalyst Fund, the Feinstein International Center at Tufts University, Project Bread, and the Cambodian Mutual Assistance Association of Greater Lowell, Inc.


  1. 1.
    Report to the Congress: FY 2006. Washington, DC: Office of Refugee Resettlement, U.S. Department of Health and Human Services; 2006.Google Scholar
  2. 2.
    Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294:571–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Kinzie JD, Riley C, McFarland B, Hayes M, Boehnlein J, Leung P, Adams G. High prevalence rates of diabetes and hypertension among refugee psychiatric patients. J Nerv Ment Dis. 2008;196:108–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Mollica RF, Donelan K, Tor S, Lavelle J, Elias C, Frankel M, Blendon RJ. The effect of trauma and confinement on functional health and mental health status of Cambodians living in Thailand-Cambodia border camps. JAMA. 1993;270:581–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Grigg-Saito D, Och S, Liang S, Toof R, Silka L. Building on the strengths of a Cambodian refugee community through community-based outreach. Health Promot Pract. 2008;9:415–25.PubMedCrossRefGoogle Scholar
  6. 6.
    Pickwell SM. Health of Cambodian refugees. J Immigr Health. 1999;1:49–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Sorkin D, Tan AL, Hays RD, Mangione CM, Ngo-Metzger Q. Self-reported health status of Vietnamese and non-Hispanic white older adults in California. J Am Geriatr Soc. 2008;56:1543–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Clinton-Davis L, Fassil Y. Health and social problems of refugees. Soc Sci Med. 1992;35:507–13.PubMedCrossRefGoogle Scholar
  9. 9.
    Hadley C, Sellen D. Food security and child hunger among recently resettled Liberian refugees and asylum seekers: a pilot study. J Immigr Minor Health. 2006;8:369–75.PubMedCrossRefGoogle Scholar
  10. 10.
    Page WF, Ostfeld AM. Malnutrition and subsequent ischemic heart disease in former prisoners of war of World War II and the Korean conflict. J Clin Epidemiol. 1994;47:1437–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Kang HK, Bullman TA, Taylor JW. Risk of selected cardiovascular diseases and posttraumatic stress disorder among former World War II prisoners of war. Ann Epidemiol. 2006;16:381–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Uddin M, Aiello AE, Wildman DE, Koenen KC, Pawelec G, de Los Santos R, Goldmann E, Galea S. Epigenetic and immune function profiles associated with posttraumatic stress disorder. Proc Natl Acad Sci USA. 2010;107:9470–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Franzen L, Smith C. Acculturation and environmental change impacts dietary habits among adult Hmong. Appetite. 2009;52:173–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Willis MS, Buck JS. From Sudan to Nebraska: Dinka and Nuer refugee diet dilemmas. J Nutr Educ Behav. 2007;39:273–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Townsend MS, Peerson J, Love B, Achterberg C, Murphy SP. Food insecurity is positively related to overweight in women. J Nutr. 2001;131:1738–45.PubMedGoogle Scholar
  16. 16.
    Wilde PE, Peterman JN. Individual weight change is associated with household food security status. J Nutr. 2006;136:1395–400.PubMedGoogle Scholar
  17. 17.
    Chilton M, Black MM, Berkowitz C, Casey PH, Cook J, Cutts D, Jacobs RR, Heeren T, de Cuba SE, Coleman S, Meyers A, Frank DA. Food insecurity and risk of poor health among US-born children of immigrants. Am J Public Health. 2009;99:556–62.PubMedCrossRefGoogle Scholar
  18. 18.
    Casey P, Goolsby S, Berkowitz C, Frank D, Cook J, Cutts D, Black MM, Zaldivar N, Levenson S, Heeren T, Meyers A. Maternal depression, changing public assistance, food security, and child health status. Pediatrics. 2004;113:298–304.PubMedCrossRefGoogle Scholar
  19. 19.
    Gao X, Scott T, Falcon LM, Wilde PE, Tucker KL. Food insecurity and cognitive function in Puerto Rican adults. Am J Clin Nutr. 2009;89:1197–203.PubMedCrossRefGoogle Scholar
  20. 20.
    Nord M, Coleman-Jensen A, Andrews M, Carlson S. Household food security in the United States, 2009 Economic Research Report Number 108. Washington, DC: U.S. Department of Agriculture, Economic Research Service; 2010.Google Scholar
  21. 21.
    Hadley C, Zodhiates A, Sellen DW. Acculturation, economics and food insecurity among refugees resettled in the USA: a case study of West African refugees. Public Health Nutr. 2007;10:405–12.PubMedGoogle Scholar
  22. 22.
    Sellen DW, Tedstone AE, Frize J. Food insecurity among refugee families in East London: results of a pilot assessment. Public Health Nutr. 2002;5:637–44.PubMedCrossRefGoogle Scholar
  23. 23.
    Foley W, Ward P, Carter P, Coveney J, Tsourtos G, Taylor A. An ecological analysis of factors associated with food insecurity in South Australia, 2002–7. Public Health Nutr. 2010;13:215–21.Google Scholar
  24. 24.
    Gallegos D, Ellies P, Wright J. Still there’s no food! Food insecurity in a refugee population in Perth, Western Australia. Nutr Diet. 2008;65:78–83.CrossRefGoogle Scholar
  25. 25.
    World Food Programme: Our Work. United Nations. Accessed July 10, 2012.
  26. 26.
    Peterman JN, Wilde PE, Liang S, Bermudez OI, Silka L, Rogers BL. Relationship between past food deprivation and current dietary practices and weight status among Cambodian refugee women in Lowell, MA. Am J Public Health. 2010;100:1930–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Olson CM, Bove CF, Miller EO. Growing up poor: long-term implications for eating patterns and body weight. Appetite. 2007;49:198–207.PubMedCrossRefGoogle Scholar
  28. 28.
    Hadley C, Patil CL, Nahayo D. Difficulty in the food environment and the experience of food insecurity among refugees resettled in the United States. Ecol Food Nutr. 2010;49:390–407.PubMedCrossRefGoogle Scholar
  29. 29.
    Patil CL, Hadley C, Nahayo PD. Unpacking dietary acculturation among new Americans: results from formative research with African refugees. J Immigr Minor Health 2008.Google Scholar
  30. 30.
    Rondinelli AJ, Morris MD, Rodwell TC, Moser KS, Paida P, Popper ST, Brouwer KC. Under- and over-nutrition among refugees in San Diego County, California. J Immigr Minor Health. 2011;13:161–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Peterman JN, Silka L, Bermudez OI, Wilde PE, Rogers BL. Acculturation, education, nutrition education, and household composition are related to dietary practices among Cambodian Refugee Women in Lowell, MA. J Am Diet Assoc. 2011;111:1369–74.PubMedCrossRefGoogle Scholar
  32. 32.
    Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365:1309–14.PubMedCrossRefGoogle Scholar
  33. 33.
    Stuff JE, Casey PH, Szeto KL, Gossett JM, Robbins JM, Simpson PM, Connell C, Bogle ML. Household food insecurity is associated with adult health status. J Nutr. 2004;134:2330–5.PubMedGoogle Scholar
  34. 34.
    Heflin CM, Siefert K, Williams DR. Food insufficiency and women’s mental health: findings from a 3-year panel of welfare recipients. Soc Sci Med. 2005;61:1971–82.PubMedCrossRefGoogle Scholar
  35. 35.
    Siefert K, Heflin CM, Corcoran ME, Williams DR. Food insufficiency and the physical and mental health of low-income women. Women Health. 2001;32:159–77.PubMedCrossRefGoogle Scholar
  36. 36.
    Laraia BA, Siega-Riz AM, Gundersen C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr. 2006;136:177–82.PubMedGoogle Scholar
  37. 37.
    CCH 2010 Survey: Cambodian Community Health 2010 Survey Results. Lowell, MA: Lowell Community Health Center, 2005.Google Scholar
  38. 38.
    Belle D, Doucet J. Poverty, inequality, and discrimination as sources of depression among U.S. women. Psychol Women Quart. 2003;27:101–13.CrossRefGoogle Scholar
  39. 39.
    Gorton D, Bullen CR, Mhurchu CN. Environmental influences on food security in high-income countries. Nutr Rev. 2010;68:1–29.PubMedCrossRefGoogle Scholar
  40. 40.
    Coleman-Jensen A, Nord M, Andrews M, Carlson S. Household food security in the United States in 2010. Economic Research Report Number 125. Washington, DC: U.S. Department of Agriculture Economic Research Service; 2011.Google Scholar
  41. 41.
    Barnes DM, Almasy N. Refugees’ perceptions of healthy behaviors. J Immigr Health. 2005;7:185–93.PubMedCrossRefGoogle Scholar
  42. 42.
    Carroll J, Epstein R, Fiscella K, Volpe E, Diaz K, Omar S. Knowledge and beliefs about health promotion and preventive health care among somali women in the United States. Health Care Women Int. 2007;28:360–80.PubMedCrossRefGoogle Scholar
  43. 43.
    Kaiser LL, Melgar-Quinonez H, Townsend MS, Nicholson Y, Fujii ML, Martin AC, Lamp CL. Food insecurity and food supplies in Latino households with young children. J Nutr Educ Behav. 2003;35:148–53.PubMedCrossRefGoogle Scholar
  44. 44.
    Kalil A, Chen JH. Mothers’ citizenship status and household food insecurity among low-income children of immigrants. New Dir Child Adolesc Dev. 2008;2008:43–62.PubMedCrossRefGoogle Scholar
  45. 45.
    Garasky S, Stewart SD. Evidence of the effectiveness of child support and visitation: examining food insecurity among children with nonresident fathers. J Fam Econ Iss. 2007;28:105–21.CrossRefGoogle Scholar
  46. 46.
    Wilde PE. Measuring the effect of food stamps on food insecurity and hunger: research and policy considerations. J Nutr. 2007;137:307–10.PubMedGoogle Scholar
  47. 47.
    Chan S. Survivors Cambodian refugees in the United States. Chicago: University of Illinois Press; 2004.Google Scholar
  48. 48.
    Koch-Weser S, Liang SL, Grigg-Saito DC. Self-reported health among Cambodians in Lowell, Massachusetts. J Health Care Poor Underserved. 2006;17:133–45.PubMedGoogle Scholar
  49. 49.
    U.S. Household Food Security Survey Module: Six-Item Short Form. Washington, DC: U.S. Department of Agriculture, Economic Research Service, 2008.Google Scholar
  50. 50.
    Studdert LJ, Frongillo EA Jr, Valois P. Household food insecurity was prevalent in Java during Indonesia’s economic crisis. J Nutr. 2001;131:2685–91.PubMedGoogle Scholar
  51. 51.
    Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180:111–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Tropp LR, Sumru E, Coll CG, Alarcon O, Garcia HAV. Psychological acculturation: development of a new measure for Puerto Ricans on the U.S. Mainland. Educ Psychol Meas. 1999;59:351–467.PubMedCrossRefGoogle Scholar
  53. 53.
    Poverty thresholds Poverty: U.S. Census Bureau, U.S. Department of Commerce, 2012.Google Scholar
  54. 54.
    Nord M, Andrews M, Carlson S. Household Food Security in the United States, 2007. Washington, DC: Economic Research Service, U.S. Department of Agriculture, 2008.Google Scholar
  55. 55.
    Sellen DW, Tedstone A. Nutritional needs of refugee children in the UK. J R Soc Med. 2000;93:360–4.PubMedGoogle Scholar
  56. 56.
    USDA National Nutrient Database for Standard Reference, Release 23.: U.S. Department of Agriculture, Agricultural Research Service, 2010.Google Scholar
  57. 57.
    Dookeran NM, Battaglia T, Cochran J, Geltman PL. Chronic disease and its risk factors among refugees and asylees in Massachusetts, 2001–2005. Prev Chronic Dis. 2010;7:A51.PubMedGoogle Scholar
  58. 58.
    History of UNHCH: United Nations High Commissioner for Refugees. United Nations. Accessed July 10, 2012.

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jerusha Nelson Peterman
    • 1
  • Parke E. Wilde
    • 2
  • Linda Silka
    • 3
  • Odilia I. Bermudez
    • 4
  • Beatrice Lorge Rogers
    • 2
  1. 1.Department of NutritionThe University of MassachusettsAmherstUSA
  2. 2.Friedman School of Nutrition Science and PolicyTufts UniversityBostonUSA
  3. 3.Margaret Chase Smith Policy CenterUniversity of MaineOronoUSA
  4. 4.Tufts Medical School of MedicineBostonUSA

Personalised recommendations