Annals of Behavioral Medicine

, Volume 41, Issue 3, pp 324–332 | Cite as

Stress Is Associated with Unfavorable Patterns of Dietary Intake Among Female Chinese Immigrants

  • Marilyn Tseng
  • Carolyn Y. Fang
Original Article



Chinese immigrants experience increased risk for weight gain and chronic disease after US migration. Whether psychosocial stress affects their eating behavior is unknown.


The purpose of this study is to examine psychosocial stress and dietary intake among 426 Chinese immigrant women in the Philadelphia region.


Participants completed 4 days of dietary recalls and questionnaires assessing positive and negative life events in the past year and migration-related stressors.


In hierarchical linear regression models, positive life events were associated with higher energy intake (β = 21.1, p = 0.04). Migration-related stress was associated with lower total gram (β = −11.3, p < 0.0001) and overall grain (β = −0.18, p = 0.03) intake and higher energy density (β = 0.002, p = 0.04) and percent energy from fat (β = 0.06, p = 0.05).


Migration-related stress did not increase overall intake in terms of energy and total grams but selectively increased fat intake and energy density. Such dietary habits may have implications for future chronic disease risk in this immigrant population.


Stress Asian Dietary intake Acculturation 



The authors are indebted to Ms. Wanzi Yang, Ms. Qi He, Ms. Rong Cheng, Ms. Bingqin Zheng, Dr. Zemin Liu, and Ms. Yun Song for their crucial work in the collection and management of data for this study. The authors also thank Mr. Andrew Balshem and the Fox Chase Cancer Center Population Studies Facility for their data management support, Dr. Eric Ross and Dr. Brian Egleston for their statistical guidance, Dr. Philip Siu and Dr. Thomas Yuen of Chinatown Medical Services for their generous assistance in participant recruitment, and Dr. Yu-Wen Ying for her guidance on the use of the Migration–Acculturation Stressor Scale and General Ethnicity Questionnaire measures. This work was supported by grants R01 CA106606 and P30 CA006927 from the National Institutes of Health.

Conflict of Interest

The authors have no conflict of interest to disclose.


  1. 1.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010; 303: 235–241.Google Scholar
  2. 2.
    Goel MS, McCarthy EP, Phillips RS, Wee CC. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004; 292: 2860–2867.PubMedCrossRefGoogle Scholar
  3. 3.
    Pan Y, Dixon Z, Himburg S, Huffman F. Asian students change their eating patterns after living in the United States. J Am Diet Assoc. 1999; 99: 54–57.PubMedCrossRefGoogle Scholar
  4. 4.
    Satia JA, Patterson RE, Kristal AR, et al. Development of scales to measure dietary acculturation among Chinese-Americans and Chinese-Canadians. J Am Diet Assoc. 2001; 101: 548–553.PubMedCrossRefGoogle Scholar
  5. 5.
    Lv N, Cason KL. Dietary pattern change and acculturation of Chinese Americans in Pennsylvania. J Am Diet Assoc. 2004; 104: 771–778.PubMedCrossRefGoogle Scholar
  6. 6.
    Liu A, Berhane Z, Tseng M. Improved dietary variety and adequacy but lower dietary moderation with acculturation in Chinese women in the United States. J Am Diet Assoc. 2010; 110: 457–462.PubMedCrossRefGoogle Scholar
  7. 7.
    Kandula NR, Diez-Roux AV, Chan C, et al. Association of acculturation levels and prevalence of diabetes in the multi-ethnic study of atherosclerosis (MESA). Diabetes Care. 2008; 31: 1621–1628.PubMedCrossRefGoogle Scholar
  8. 8.
    Park SY, Murphy SP, Sharma S, Kolonel LN. Dietary intakes and health-related behaviours of Korean American women born in the USA and Korea: The Multiethnic Cohort Study. Public Health Nutr. 2005; 8: 904–911.PubMedCrossRefGoogle Scholar
  9. 9.
    Pierce BL, Austin MA, Crane PK, et al. Measuring dietary acculturation in Japanese Americans with the use of confirmatory factor analysis of food-frequency data. Am J Clin Nutr. 2007; 86: 496–503.PubMedGoogle Scholar
  10. 10.
    Yang EJ, Chung HK, Kim WY, Bianchi L, Song WO. Chronic diseases and dietary changes in relation to Korean Americans' length of residence in the United States. J Am Diet Assoc. 2007; 107: 942–950.PubMedCrossRefGoogle Scholar
  11. 11.
    Rogler LH, Cortes DE, Malgady RG. Acculturation and mental health status among Hispanics: Convergence and new directions for research. Am Psychol. 1991; 46: 585–597.PubMedCrossRefGoogle Scholar
  12. 12.
    Berry J, Kim U, Minde T, Mok D. Comparative studies of acculturative stress. Int Migrat Rev. 1987; 21: 491–511.Google Scholar
  13. 13.
    Ying Y. Immigration satisfaction of Chinese Americans: An empirical examination. J Community Psychol. 1996; 24: 3–16.Google Scholar
  14. 14.
    Dohrenwend B, Dorhrenwend B. Stressful life events: Their nature and effects. New York: Wiley; 1967.Google Scholar
  15. 15.
    Paykel E, Cooper Z. Life events and social stress. In E. Paykel (ed), Handbook of affective disorders, 2nd edition. New York: Guilford; 1992, 149–170.Google Scholar
  16. 16.
    Hwang WC, Ting JY. Disaggregating the effects of acculturation and acculturative stress on the mental health of Asian Americans. Cultur Divers Ethnic Minor Psychol. 2008; 14: 147–154.PubMedCrossRefGoogle Scholar
  17. 17.
    Ng DM, Jeffery RW. Relationships between perceived stress and health behaviors in a sample of working adults. Health Psychol. 2003; 22: 638–642.PubMedCrossRefGoogle Scholar
  18. 18.
    Nishitani N, Sakakibara H. Relationship of obesity to job stress and eating behavior in male Japanese workers. Int J Obes (Lond). 2006; 30: 528–533.CrossRefGoogle Scholar
  19. 19.
    O’Connor DB, Jones F, Conner M, McMillan B, Ferguson E. Effects of daily hassles and eating style on eating behavior. Health Psychol. 2008; 27: S20–31.PubMedCrossRefGoogle Scholar
  20. 20.
    Sims R, Gordon S, Garcia W, et al. Perceived stress and eating behaviors in a community-based sample of African Americans. Eat Behav. 2008; 9: 137–142.PubMedCrossRefGoogle Scholar
  21. 21.
    Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007; 23: 887–894.PubMedCrossRefGoogle Scholar
  22. 22.
    Toyoshima H, Masuoka N, Hashimoto S, et al. Effect of the interaction between mental stress and eating pattern on body mass index gain in healthy Japanese male workers. J Epidemiol. 2009; 19: 88–93.PubMedCrossRefGoogle Scholar
  23. 23.
    Hellerstedt WL, Jeffery RW. The association of job strain and health behaviours in men and women. Int J Epidemiol. 1997; 26: 575–583.PubMedCrossRefGoogle Scholar
  24. 24.
    Wardle J, Steptoe A, Oliver G, Lipsey Z. Stress, dietary restraint and food intake. J Psychosom Res. 2000; 48: 195–202.PubMedCrossRefGoogle Scholar
  25. 25.
    Conner M, Fitter M, Fletcher W. Stress and snacking: A diary study of daily hassles and between-meal snacking. Psychol Health. 1999; 14: 51–63.CrossRefGoogle Scholar
  26. 26.
    O’Connor DB, O’Connor RC. Perceived changes in food intake in response to stress: The role of conscientiousness. Stress Health. 2004; 20: 279–291.CrossRefGoogle Scholar
  27. 27.
    Teegarden SL, Bale TL. Effects of stress on dietary preference and intake are dependent on access and stress sensitivity. Physiol Behav. 2008; 93: 713–723.PubMedCrossRefGoogle Scholar
  28. 28.
    Rowland NE, Antelman SM. Stress-induced hyperphagia and obesity in rats: A possible model for understanding human obesity. Science. 1976; 191: 310–312.PubMedCrossRefGoogle Scholar
  29. 29.
    Dallman MF, Pecoraro NC, la Fleur SE. Chronic stress and comfort foods: Self-medication and abdominal obesity. Brain Behav Immun. 2005; 19: 275–280.PubMedCrossRefGoogle Scholar
  30. 30.
    Pecoraro N, Reyes F, Gomez F, Bhargava A, Dallman MF. Chronic stress promotes palatable feeding, which reduces signs of stress: Feedforward and feedback effects of chronic stress. Endocrinology. 2004; 145: 3754–3762.PubMedCrossRefGoogle Scholar
  31. 31.
    Greeno CG, Wing RR. Stress-induced eating. Psychol Bull. 1994; 115: 444–464.PubMedCrossRefGoogle Scholar
  32. 32.
    Ying Y. Psychometric properties of the Migration–Acculturation Stressor Scale in Chinese Taiwanese international students. 2003Google Scholar
  33. 33.
    Ying YW, Han M. The contribution of personality, acculturative stressors, and social affiliation to adjustment: A longitudinal study of Taiwanese students in the United States. Int J Intercult Relat. 2006; 30: 623–635.CrossRefGoogle Scholar
  34. 34.
    Sarason IG, Johnson JH, Siegel JM. Assessing the impact of life changes: Development of the Life Experiences Survey. J Consult Clin Psychol. 1978; 46: 932–946PubMedCrossRefGoogle Scholar
  35. 35.
    Munoz RF, Ying Y. The prevention of depression: Research and practice. Baltimore: The Johns Hopkins University Press; 1993.Google Scholar
  36. 36.
    Tsai JL, Ying Y, Lee P. The meaning of “being Chinese” and “being American”: Variation among Chinese American young adults. J Cross Cult Psychol. 2000; 31: 302–332.CrossRefGoogle Scholar
  37. 37.
    Ying Y. Migration and cultural orientation: An empirical test of the psychoanalytic theory in Chinese Americans. J Appl Psychoanal Stud. 2001; 3: 409–430.CrossRefGoogle Scholar
  38. 38.
    US Department of Health and Human Services, US Department of Agriculture. Dietary guidelines for Americans, 2005, 6th edition. Washington, DC: US Government Printing Office; 2005.Google Scholar
  39. 39.
    US Department of Agriculture. Retrieved December 8, 2009, from
  40. 40.
    Food and Drug Administration. Food and drugs: Food labeling. 21Google Scholar
  41. 41.
    Kornblith AB, Herndon JE, 2nd, Zuckerman E, et al. Social support as a buffer to the psychological impact of stressful life events in women with breast cancer. Cancer. 2001; 91: 443–454.PubMedCrossRefGoogle Scholar
  42. 42.
    Aiken LS, West SG. Multiple regression: Testing and interpreting interactions. Newbury Park: Sage; 1991.Google Scholar
  43. 43.
    Oliver G, Wardle J. Perceived effects of stress on food choice. Physiol Behav. 1999; 66: 511–515.PubMedCrossRefGoogle Scholar
  44. 44.
    Oliver G, Wardle J, Gibson EL. Stress and food choice: A laboratory study. Psychosom Med. 2000; 62: 853–865.PubMedGoogle Scholar
  45. 45.
    Mikolajczyk RT, El Ansari W, Maxwell AE. Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutr J. 2009; 8: 31PubMedCrossRefGoogle Scholar
  46. 46.
    Takeda E, Terao J, Nakaya Y, et al. Stress control and human nutrition. J Med Investig. 2004; 51: 139–145.CrossRefGoogle Scholar
  47. 47.
    Prentice AM, Jebb SA. Fast foods, energy density and obesity: A possible mechanistic link. Obes Rev. 2003; 4: 187–194.PubMedCrossRefGoogle Scholar
  48. 48.
    Perez-Escamilla R. Dietary quality among Latinos: Is acculturation making us sick? J Am Diet Assoc. 2009; 109: 988–991.PubMedCrossRefGoogle Scholar
  49. 49.
    Escobar JI. Immigration and mental health: Why are immigrants better off? Arch Gen Psychiatry. 1998; 55: 781–782.PubMedCrossRefGoogle Scholar
  50. 50.
    Freedman LS, Guenther PM, Dodd KW, Krebs-Smith SM, Midthune D. The population distribution of ratios of usual intakes of dietary components that are consumed every day can be estimated from repeated 24-hour recalls. J Nutr. 2010; 140: 111–116.Google Scholar
  51. 51.
    Guenther PM, Dodd KW, Reedy J, Krebs-Smith SM. Most Americans eat much less than recommended amounts of fruits and vegetables. J Am Diet Assoc. 2006; 106: 1371–1379.PubMedCrossRefGoogle Scholar
  52. 52.
    Poslusna K, Ruprich J, de Vries JH, Jakubikova M, van't Veer P. Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br J Nutr. 2009; 101 Suppl 2: S73–85.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2011

Authors and Affiliations

  1. 1.Department of KinesiologyCalifornia Polytechnic State UniversitySan Luis ObispoUSA
  2. 2.Fox Chase Cancer CenterPhiladelphiaUSA

Personalised recommendations