Although the incidence and prevalence of overweight and obesity have long reached critical levels and mirror increases in the consumption of SSB and FFM, especially among Hispanic adults and children, this is apparently the first study to examine the association of nativity with two less-healthy eating behaviors among Mexican women who reside in colonias along the Texas-Mexico border, where the population is primarily Mexican-origin and Spanish speaking individuals with similar spatial access to food stores and food service places . Specifically, we examined the differences in SSB consumption and frequency of FFM between Mexican-origin women born in the United States and born in Mexico who were living in the same communities. This is also the first study that we are aware of that compared the influence of demographic characteristics on SSB and FFM consumption with Mexican-origin women born in the U.S. and in Mexico. There are three major findings related to nativity. First, U.S.-born women consumed more SSB and FFM than their Mexican-born counterparts. Second, in the combined sample and controlling for other population characteristics, being born in Mexico was independently associated with FFM (fewer FFM), but not with SSB. Third, in analyses stratified by nativity, FFM and SSB were associated with each other among both nativity groups. Possible reasons for observing an association between being born in Mexico and consuming fewer FFM include the higher proportion of Mexico-born with characteristics that represent lower socio-economic status, such as limited education, lower household income, employment status, and lack of transportation. The lack of association between nativity and SSB consumption may be explained by potentially distinct sources of SSB; U.S.-born may consume more SSB as purchased soft drinks while Mexico-born women may rely on aguas frescas de frutas (homemade fruit-flavored waters with added sugars).
Although similar proportions of U.S.- and Mexico-born Mexican women consumed at least one SSB each day or one FFM each week, U.S.-born women consumed a greater amount of SSB and greater number of FFM than their Mexico-born counterparts. Food and food habits have been linked to various measures of acculturation - single-item measures (e.g., country of birth or language), acculturation scores, and food-based assessments . Although other studies have found years in the United States and language spoken to be associated with consumption of sugar beverages, this is apparently the first study to introduce the dimension of country of birth as an influence on SSB consumption , especially in the context of the predominantly Mexican-origin, Spanish language communities along the Texas-Mexico border. As previously mentioned, one study of San Francisco Bay Area Hispanic women documented a relationship between country of birth and fast-food consumption . Notable demographic differences observed between Mexican women born in Mexico and those born in the U.S. suggests that country of birth may serve as a proxy measure for limited education, very low household income, being married, larger household composition, not having a car available during the day, and employment status outside the home. The results confirm prior reviews and research articles suggesting that less acculturation (e.g., country of birth) is associated with healthier diets [33, 34, 87]. This study is unique in that Hispanic subgroups (U.S.-born and Mexico-born) experience similar contextual exposures, such as density of Mexican population, colonia population characteristics, and locational access to food sources, which are considered a major influence on the acculturation process . Stratified multiple variable regression analyses confirmed nativity differences and similarities in the influence of sample characteristics and eating behaviors on SSB and FFM consumption.
The observation of co-occurring unhealthy eating and drinking behaviors such as higher consumption of SSB and FFM has been reported previously [24, 75]. Several studies document the association between both unhealthy dietary behaviors and adverse health incomes, including weight gain and obesity risk [17, 23], cardiometabolic risk [22, 88, 89], and type 2 diabetes . This study adds to the paucity of research documenting SSB and FFM consumption among Mexican-origin women [16, 27, 39], a population identified as at-risk for developing diet-related chronic-diseases [16, 27]. At present, Mexican-origin women have the highest rates of obesity in the U.S. and in Mexico [1, 2, 26].
There are a number of strengths to this study. First, this is a large study of hard-to-reach Mexican women in border colonias. This population is of increasing national importance because such colonias can be considered an archetype for the new destination Mexican immigrant communities that are now found in great numbers throughout the continental U.S. Second, there are few studies describing dietary factors associated with obesity, including consumption of SSB and FFM among a sample of Mexican-origin women [16, 27, 39]. Previous studies with men and women of Mexican-origin have included at least one of these unhealthy dietary behaviors, but only in the context of general dietary patterns [13–15]. Understanding risk markers for obesity in Mexican-origin women is a major public health focus on both sides of the border and a bi-national priority [5, 7, 19], which bolsters the importance of this study. A third strength is the identification of country of birth as a single-item measure of acculturation in a Mexican population, where Spanish is the predominant language.
There are several limitations to this study that warrant mention. First, the self-reported measures of SSB and FFM consumption may underreport actual frequency and amount consumed each day, which limits our ability to determine caloric intake from SSB or FFM. These measures of SSB and FFM, which did not identify a specific time frame, provided incomplete descriptions and did not specify culturally-appropriate SSB such as aguas frescas de frutas. As others have suggested, there is a need for specific prompts to better capture intakes of SSB and FFM [25, 69, 90]. Second, data were not available to describe seasonal variation in consumption of SSB and FFM. Third, data were not available to document type and amount of FFM consumed. Fourth, there were no additional measures of acculturation such as duration of residence in the U.S. Finally, the cross-sectional nature of this study prevents a temporal determination of predictors of consumption of SSB and FFM.
Despite these limitations, this research is highly relevant and timely given that the largest growing segment of the U.S. population is of Mexican origin and the concomitant increase in the number of new destination immigrant communities in interior and rural destinations including Iowa, North Carolina, and Tennessee [6, 7, 9, 91, 92]. Colonias are considered the archetype for new destination communities of Mexican-origin immigrants. Similar to new destination immigrant communities, colonias are smaller, more dispersed communities comprised of a disproportionately poor population of immigrants and their families with limited access to the kinds of resources necessary for facilitating economic and social mobility in a region characterized by adverse social conditions [9, 93]. A distinguishing characteristic of colonias is that colonias are not "new" and now include both native and immigrant residents of Mexican-origin. Given consideration of the prototypical character of colonias, these findings have implications for dietitians developing interventions focused on the reduction of FF and SSB meals among Mexican-origin residents in rapidly growing new destination communities.