title: A focus group study of healthy eating knowledge, practices, and barriers among adult and adolescent immigrants and refugees in the United States.
abstract: BACKGROUND
  Immigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood. In this study, we describe the meanings of food, health and wellbeing through the reported dietary preferences, beliefs, and practices of adults and adolescents from four immigrant and refugee communities in the Midwestern United States.
  
  
  METHODS
  Using a community based participatory research approach, we conducted a qualitative research study with 16 audio-recorded focus groups with adults and adolescents who self-identified as Mexican, Somali, Cambodian, and Sudanese. Focus group topics were eating patterns, perceptions of healthy eating in the country of origin and in the U.S., how food decisions are made and who in the family is involved in food preparation and decisions, barriers and facilitators to healthy eating, and gender and generational differences in eating practices. A team of investigators and community research partners analyzed all transcripts in full before reducing data to codes through consensus. Broader themes were created to encompass multiple codes.
  
  
  RESULTS
  Results show that participants have similar perspectives about the barriers (personal, environmental, structural) and benefits of healthy eating (e.g., 'junk food is bad'). We identified four themes consistent across all four communities: Ways of Knowing about Healthy Eating ('Meanings;' 'Motivations;' 'Knowledge Sources'), Eating Practices ('Family Practices;' 'Americanized Eating Practices' 'Eating What's Easy'), Barriers ('Taste and Cravings;' 'Easy Access to Junk Food;' 'Role of Family;' Cultural Foods and Traditions;' 'Time;' 'Finances'), and Preferences for Intervention ('Family Counseling;' Community Education;' and 'Healthier Traditional Meals.'). Some generational (adult vs. adolescents) and gender differences were observed.
  
  
  CONCLUSIONS
  Our study demonstrates how personal, structural, and societal/cultural factors influence meanings of food and dietary practices across immigrant and refugee populations. We conclude that cultural factors are not fixed variables that occur independently from the contexts in which they are embedded.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tiedje
authors.affiliation: Department of Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA. wieland.mark@mayo.edu.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wieland
authors.forename: Sonja J
authors.initials: SJ
authors.lastname: Meiers
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Mohamed
authors.forename: Christine M
authors.initials: CM
authors.lastname: Formea
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ridgeway
authors.forename: Gladys B
authors.initials: GB
authors.lastname: Asiedu
authors.forename: Ginny
authors.initials: G
authors.lastname: Boyum
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Weis
authors.forename: Julie A
authors.initials: JA
authors.lastname: Nigon
authors.forename: Christi A
authors.initials: CA
authors.lastname: Patten
authors.forename: Irene G
authors.initials: IG
authors.lastname: Sia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002755:Choice Behavior; D055812:Community-Based Participatory Research; D003469:Culture; D054242:Emigrants and Immigrants; D005247:Feeding Behavior / Q000208:ethnology*; D005260:Female; D017144:Focus Groups; D005518:Food Preferences / Q000208:ethnology; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D012036:Refugees; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D012998:Somalia; D014481:United States; D055815:Young Adult