Foreign-born (first-generation) South Asians face a growing diet-related chronic disease burden. Little is known about whether the adult US-born (second-generation) children of South Asian immigrants can provide unique insights as changemakers in their parents' dietary behaviors. This study aims to assess how second-generation South Asians describe and influence the dietary behaviors of their parents. Between October and November 2020, 32 second-generation South Asians [mean age 22.4 (SD 2.9), 53% female] participated in online interviews centered around factors involved in their (and their parents) eating behaviors. Thematic analysis revealed three types of parental dietary drivers (socioecological factors that impact the dietary choices of parents): goal-oriented (i.e., parents' dietary intentionality), capacity-related (e.g., environmental barriers) and sociocultural (cultural familiarity, religion and traditions). Participants described three major mechanisms of influence: recommending new foods, cooking for parents, and bringing new foods home. These influences primarily occurred in the household and often involved participants leveraging their own nutritional knowledge and preferences to expand dietary diversity and healthier behaviors among their parents. Evidence suggests that second-generation South Asians may act as powerful agents of dietary change within their households and can provide novel insights to help address and overcome sociocultural, linguistic, and other structural barriers to better understanding and intervening in the health of the South Asian community. 

'We know what he likes, even if he doesn't know': how the children of South Asian immigrants characterize and influence the diets of their parents.

Challenging dietary research measures, concepts, and definitions to promote greater inclusivity of immigrant experiences: considerations and practical recommendations.

The Healthy Indonesia Program with Family Approach (PIS-PK) is a primary initiative enforced by the current government to enhance the quality of family life and public health. In this context, the assessment of the Healthy Family Index (IKS) is essential for implementing appropriate interventions and efforts to prevent chronic diseases at the family level. Measurement indicators of IKS include healthy, pre-healthy, and unhealthy family categories. Therefore, this study aimed to analyze IKS based on PIS-PK in Jeneponto Regency, South Sulawesi in Indonesia. A quantitative design with an analytical survey was used to measure IKS across the entire family population in the Jeneponto Regency Health Center working area, totaling 1,321 households. The total sampling method was applied, and data from 12 healthy family indicators were evaluated following the IKS formula. The results showed that the average IKS value ranged from 0.59 to 0.77, representing unhealthy, pre-healthy, and healthy family, which constituted 12%, 54.35%, and 33.5% of the examined population, respectively. High numbers of family fell in the pre-healthy and unhealthy categories due to limited participation in family planning program (55.11%), non-utilization of official facilities for childbirth (11.65%), lack of exclusive breastfeeding practices over 7–23 months (10.14%), and absence of weight monitoring at Posyandu (5.59%). Consequently, integrated efforts and cross-sectoral engagement are crucial for improving IKS status. 


Analysis of the Healthy Family Index: The Impact of Implementing the Healthy Indonesia Program with Family Approach

Family members of Asian Americans (AAs) hold enormous potential as health changemakers to help combat the growing non-communicable disease burden in the community. To inform the development of impactful family-based interventions, there is a need to disentangle the mechanisms behind family influences on health. This study aims to deconstruct how interactivity and closeness mediate the association of age and acculturation with how much AA young adults perceive themselves to influence the health behaviors of family members. 502 AA young adults (48.0% East Asian, 20.9% South Asian, 23.1% Southeast Asian) were recruited in March 2021 to participate in an online survey on family interaction patterns, providing data on 944 unique dyadic family relationships. Associations between age, acculturation, interactivity (shared family activities, living proximity, and interaction frequency), closeness (family connectedness and interaction quality), and family health influence (reflecting influence on diet, exercise, sleep, stress, substance use, and relationship building) were evaluated through structural equation modeling. The final model displayed strong fit (CFI:0.956, RMSEA:0.081, SRMR:0.041), and revealed that an increase in closeness compared to interactivity corresponded with a greater increase in family health influence, with both completely mediating the association between age and family health influence. Acculturation was not associated with closeness, and its effect on family health influence was only partially mediated through interactivity. In subgroup analyses, neither interactivity nor closeness mediated the relationship between age and family health influence among South Asians (unlike East and Southeast Asians). Findings suggest the importance of targeting interactivity and closeness separately when developing AA family-based health interventions, and considering how the age and acculturation profile of AA young adults may shape these dynamics.

How do Asian American young adults influence the health of family members? Structural equation modeling of age, acculturation, interactivity, and closeness

Abstract Objectives Asian Americans (AAs) experience a complex and growing non-communicable disease burden linked with dietary behaviors. Dietary norms, which significantly contribute to eating behaviors, face a complex set of Western and Asian socio-ecological influences in AA communities. However, little is known of how dietary norms (such as definitions of a “healthy diet”) are transmitted, intersect, and differ in a multigenerational family environment. Methods AA young adults and family members were recruited to participate in dyadic, 60-minute Zoom interviews (Jun - Dec 2021). Young adults and family members were interviewed separately on their respective eating behaviors, including perceived definition of a healthy diet. Recordings were inductively analyzed to identify themes related to different facets of a conceptualized healthy diet. Results A total of 41 AAs were interviewed (76% female, 61% US-born, age 19–69), including 20 young adults and 21 family members (10 parents, 9 siblings, 2 cousins). Diet healthfulness was defined in three dimensions: types of food, cooking methods, and intersection of diet with holistic wellbeing. Young adults consistently emphasized the role of their parents in shaping their idea of a healthy diet, particularly Asian-specific conceptualizations of balance (e.g., “yeet hay”). However, while these ideas were particularly influential among older participants, younger participants also emphasized the intersection of diet with emotional and spiritual well-being. Both stressed cooking methods as indicators of healthfulness. While a “healthy diet” was conceptualized through intake of food groups such as fruits, vegetables, and proteins, foreign-born and older participants put a larger emphasis on dietary restrictions (e.g., completely cutting out food groups, such as fast food), while US-born and younger participants stressed enjoying foods in moderation. Conclusions The differential understanding and impact of AA norms related to diet healthfulness highlights the need for a disaggregated understanding of dietary attitudes and behaviors in health-based interventions for AAs of different generations, particularly family-based programs. Findings call for future mixed-methods research to explore the complex dietary norms identified. Funding Sources South Asian Health and Research Group (SAHARA).

https://academic.oup.com/cdn/article-pdf/6/Supplement_1/100/44041037/nzac051.016.pdf

Disaggregating How Asian Americans Define a Healthy Diet: Exploring Generational and Intra-family Differences Through Dyadic Interviews

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other's persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family.

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Disaggregating How Asian Americans Define a Healthy Diet: Exploring Generational and Intra-family Differences Through Dyadic Interviews

A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family.