摘要：Objectives. We investigated Cambodian refugee women's past food experiences and the relationship between those experiences and current food beliefs, dietary practices, and weight status. Methods. Focus group participants (n = 11) described past food experiences and current health-related food beliefs and behaviors. We randomly selected survey participants (n = 133) from a comprehensive list of Cambodian households in Lowell, Massachusetts. We collected height, weight, 24-hour dietary recall, food beliefs, past food experience, and demographic information. We constructed a measure of past food deprivation from focus group and survey responses. We analyzed data with multivariate logistic and linear regression models. Results. Participants experienced severe past food deprivation and insecurity. Those with higher past food-deprivation scores were more likely to currently report eating meat with fat (odds ratio [OR] = 1.14 for every point increase on the 9-to-27–point food-deprivation measure), and to be overweight or obese by Centers for Disease Control and Prevention (OR = 1.28) and World Health Organization (OR = 1.18) standards. Conclusions. Refugees who experienced extensive food deprivation or insecurity may be more likely to engage in unhealthful eating practices and to be overweight or obese than are those who experienced less-extreme food deprivation or insecurity. Since 2000, almost 500 000 refugees have resettled in the United States, with tens of thousands arriving annually. 1 In addition to their high rates of mental health disease resulting from the turmoil they are fleeing, 2 – 4 refugees have higher rates of heart disease, hypertension, and diabetes than do other immigrant groups and native-born Americans. 2 , 3 , 5 , 6 The high rates of chronic disease are likely related to multiple factors. Refugees may have suffered physiological damage during stress and war, 7 and traumatic stress may have increased their risk of cardiovascular disease and stroke. 8 The increased rates of chronic disease may also be related to changes in food consumption. In a postconflict environment with plentiful food, people may adopt harmful eating behaviors that affect health both directly and through increased weight. 9 – 14 World War II prisoners of war who experienced highest trauma and food deprivation also reported the highest rate of binge-eating behaviors 50 years after the war. 15 Holocaust survivors reported lifelong binge eating and preoccupation with food, including worrying about food availability and hoarding. 16 Uneven access to food is associated with higher rates of overweight and obesity and weight gain in the United States, 9 – 13 possibly because it may lead to excessive consumption of food in times of plenty. 9 , 11 , 13 , 14 Refugees who experienced food deprivation or insecurity and who currently have abundant access to food may approach food in ways that increase risk for overweight and obesity. African refugees reported eating high-status foods, such as meat and steak, more often in the United States than in their native countries. 17 Hmong refugees indicated that they purchased and ate food they knew to be unhealthful because it was very affordable in the United States. 18 Studies of Vietnamese, Hmong, and Cambodian refugees reported high preference for steak. 19 – 21 Although food security has been well-defined, 22 to our knowledge, there is no existing quantitative measure of variation in the past food deprivation experiences of refugees. Cambodian refugees stand out as a potential refugee model for examining how past experiences of food deprivation or food insecurity affect current food beliefs, dietary practices, and weight. Cambodian refugees survived high levels of trauma and food deprivation in their home countries, 3 and both trauma 23 and food deprivation or insecurity are experienced by most refugees. 24 Cambodian refugees also have disproportionately high rates of chronic disease, 5 as do other refugee groups. 3 , 6 , 25 Our research sheds some light on the food experiences of Cambodian refugees from 1975 through arrival in the United States (1980s through mid-1990s), develops and validates a measure of past food deprivation to allow measurement of potential effects on current dietary practices, and tests for relationships between severity of past food deprivation and current food beliefs. We also discuss implications for refugee communities.
