Abstract
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.
Similar content being viewed by others
References
Report to the Congress: FY 2006. Washington, DC: Office of Refugee Resettlement, U.S. Department of Health and Human Services; 2006.
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.
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.
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.
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.
Pickwell SM. Health of Cambodian refugees. J Immigr Health. 1999;1:49–52.
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.
Clinton-Davis L, Fassil Y. Health and social problems of refugees. Soc Sci Med. 1992;35:507–13.
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.
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.
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.
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.
Franzen L, Smith C. Acculturation and environmental change impacts dietary habits among adult Hmong. Appetite. 2009;52:173–83.
Willis MS, Buck JS. From Sudan to Nebraska: Dinka and Nuer refugee diet dilemmas. J Nutr Educ Behav. 2007;39:273–80.
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.
Wilde PE, Peterman JN. Individual weight change is associated with household food security status. J Nutr. 2006;136:1395–400.
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.
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.
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.
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.
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.
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.
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.
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.
World Food Programme: Our Work. United Nations. Accessed July 10, 2012. http://www.wfp.org/our-work.
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.
Olson CM, Bove CF, Miller EO. Growing up poor: long-term implications for eating patterns and body weight. Appetite. 2007;49:198–207.
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.
Patil CL, Hadley C, Nahayo PD. Unpacking dietary acculturation among new Americans: results from formative research with African refugees. J Immigr Minor Health 2008.
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.
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.
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.
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.
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.
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.
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.
CCH 2010 Survey: Cambodian Community Health 2010 Survey Results. Lowell, MA: Lowell Community Health Center, 2005.
Belle D, Doucet J. Poverty, inequality, and discrimination as sources of depression among U.S. women. Psychol Women Quart. 2003;27:101–13.
Gorton D, Bullen CR, Mhurchu CN. Environmental influences on food security in high-income countries. Nutr Rev. 2010;68:1–29.
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.
Barnes DM, Almasy N. Refugees’ perceptions of healthy behaviors. J Immigr Health. 2005;7:185–93.
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.
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.
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.
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.
Wilde PE. Measuring the effect of food stamps on food insecurity and hunger: research and policy considerations. J Nutr. 2007;137:307–10.
Chan S. Survivors Cambodian refugees in the United States. Chicago: University of Illinois Press; 2004.
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.
U.S. Household Food Security Survey Module: Six-Item Short Form. Washington, DC: U.S. Department of Agriculture, Economic Research Service, 2008.
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.
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.
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.
Poverty thresholds Poverty: U.S. Census Bureau, U.S. Department of Commerce, 2012.
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.
Sellen DW, Tedstone A. Nutritional needs of refugee children in the UK. J R Soc Med. 2000;93:360–4.
USDA National Nutrient Database for Standard Reference, Release 23.: U.S. Department of Agriculture, Agricultural Research Service, 2010.
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.
History of UNHCH: United Nations High Commissioner for Refugees. United Nations. Accessed July 10, 2012. http://www.unhcr.org/pages/49c3646cbc.html.
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Peterman, J.N., Wilde, P.E., Silka, L. et al. Food Insecurity Among Cambodian Refugee Women Two Decades Post Resettlement. J Immigrant Minority Health 15, 372–380 (2013). https://doi.org/10.1007/s10903-012-9704-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10903-012-9704-5