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Research

Influence of country of birth and ethnicity on body mass index among Canadian youth: a national survey

Atif Kukaswadia, William Pickett and Ian Janssen
August 19, 2014 2 (3) E145-E152; DOI: https://doi.org/10.9778/cmajo.20130088
Atif Kukaswadia
1Department of Public Health Sciences, Queen’s University, Kingston, Ont.
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William Pickett
1Department of Public Health Sciences, Queen’s University, Kingston, Ont.
2Clinical Research Centre, Kingston General Hospital, Kingston, Ont.
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Ian Janssen
1Department of Public Health Sciences, Queen’s University, Kingston, Ont.
3School of Kinesiology and Health Studies, Queen’s University, Kingston, Ont.
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    Figure 1:

    Process for selecting study population from respondents to the Canadian Health Behaviour in School-Aged Children, cycle 6 (2010) study.

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    Table 1: Mean BMI percentile of grade 6–10 students by immigration status and additional covariables based on the 2010 Canadian Health Behaviour in School-aged Children study (weighted sample n = 19 272)*
    Characteristics of the study populationWeighted sample, no. (%)BMI percentileSignificance of difference, p†
    Mean (95% CI)Difference from reference group
    (95% CI)
    Country of birth
    Canadian born17 659 (91.6)58 (57 to 58)Reference
    Foreign born1 613 (8.4)54 (52 to 55)−4 (−6 to −2)< 0.001
    Time since immigration, yr
    Canadian born17 659 (91.6)58 (57 to 58)Reference
    ≥ 6891 (4.6)52 (50 to 54)−6 (−8 to −4)< 0.001
    3–5 396 (2.1)56 (53 to 59)−2 (−5 to 1)0.30
    1–2 325 (1.7)55 (52 to 59)−2 (−6 to 1)0.23
    Ethnicity
    Canadian host culture15 071 (78.2)57 (57 to 58)Reference
    Arab and West Asian 300 (1.6)58 (54 to 61)1 (−3 to 4)0.78
    African737 (3.8)60 (58 to 62)3 (0 to 5)0.028
    East Indian and South Asian 559 (2.9)52 (49 to 55)−5 (−8 to −3)< 0.001
    East and Southeast Asian1 089 (5.7)53 (51 to 56)−4 (−6 to −2)< 0.001
    Latin American 187 (1.0)60 (56 to 65)3 (−2 to 7)0.24
    Other‡ 1 330 (6.9)59 (57 to 60)1 (0 to 3)0.15
    Individual-level covariables
    Sex
    Male9 567 (49.6)61 (60 to 62)Reference
    Female9 705 (50.4)53 (52 to 54)−8 (−9 to −7)< 0.001
    Perceived family wealth
    Well off11 064 (57.4)56 (55 to 57)Reference
    Average6 436 (33.4)58 (57 to 59)2 (1 to 3)< 0.001
    Worse off1 772 (9.2)61 (59 to 63)5 (3 to 6)< 0.001
    Area-level covariables
    Median annual household income, $
    Quartile 4: > 67 6054 512 (23.4)56 (55 to 58)Reference
    Quartile 3: 53 115–67 6054 440 (23.0)56 (54 to 58)0 (−2 to 2)0.85
    Quartile 2: 43 571–53 1144 311 (22.4)56 (55 to 58)0 (−2 to 2)0.99
    Quartile 1: < 43 5716 008 (31.2)59 (58 to 61)3 (1 to 5)0.002
    Immigrants in the community, %
    Quartile 4: ≥ 176 399 (33.2)55 (54 to 56)Reference
    Quartile 3: 9 to < 175 095 (26.4)58 (57 to 60)3 (1 to 5)< 0.001
    Quartile 2: 3 to < 94 319 (22.4)58 (57 to 60)3 (1 to 5)< 0.001
    Quartile 1: < 33 459 (18.0)58 (56 to 60)3 (1 to 5)0.008
    Statistics Canada population centre category
    Large urban centre6 275 (32.6)56 (54 to 57)Reference
    Medium centre3 501 (18.2)57 (55 to 59)1 (−1 to 3)0.24
    Small centre8 898 (46.2)58 (57 to 59)2 (0 to 4)0.015
    Rural597 (3.1)60 (57 to 64)5 (1 to 8)0.019

    Note: CI = confidence interval. 
*n values were weighted according to the Canadian Health Behaviour in School-aged Children study protocol.22 Totals in a category may vary slightly due to rounding.
†We compared the levels of the variables for significant differences while controlling for the clustering effect of school.
‡The “other” ethnic group includes youth who identified with more than 1 of the 6 ethnic groups.

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      Table 2: Mean BMI percentiles of Canadian youth predicted by three proposed models by country of birth and ethnicity*
      Main effectsBase modelAdjusted modelAdjusted with explanatory variables
      BMI percentile, mean (95% CI)Difference
      from reference,
      p
      BMI percentile, mean (95% CI)Difference
      from reference,
      p
      BMI percentile,
      mean (95% CI)
      Difference
      from reference,
      p
      Country of birth    
      Canadian born58 (57–59)Reference60 (58–61)Reference59 (57–60)Reference
      Foreign born54 (53–56)< 0.00156 (54–58)< 0.00155 (53–57)< 0.001
      Ethnicity
      Canadian host culture56 (55–57)Reference57 (56–59)Reference57 (56–59)Reference
      Arab and West Asian 57 (54–61)0.3659 (56–63)0.2959 (55–63)0.46
      African59 (57–61)0.0160 (58–63) 0.00759 (56–62)0.12
      East Indian and South Asian 51 (49–54)0.00354 (51–57) 0.01653 (50–56)0.005
      East and Southeast Asian53 (51–55)0.02355 (53–58) 0.07354 (51–56)0.005
      Latin American 60 (55–64)0.07662 (57–66) 0.06661 (56–66)0.14
      Other 57 (55–59)0.09759 (57–61) 0.07757 (55–59)0.91

      Note: CI = confidence interval.
*The base model did not control for any covariables. The adjusted model controlled for gender, age, individual-level perceived family wealth, median neighbourhood income, percentage of immigrants in the community and Statistics Canada’s population centre category. The adjusted model with explanatory variables controlled for all variables in the adjusted model, plus television watching, computer use, playing video games, physical activity, snacking while watching television, snacking while on the computer or playing video games and frequency of eating at fast-food restaurants.

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        Table 3: Interaction between ethnicity and country of birth among Canadian youth, controlling for level of physical activity and eating behaviours*
        EthnicityCountry of birthnBMI percentile,
        mean (95% CI)
        Difference between Canadian- and foreign-born youth
        Mean (95% CI)p value
        Canadian host cultureCanadian born14 65059 (58 to 60)Reference
        Foreign born 42153 (49 to 56)−6 (−9 to −3)< 0.001
        Arab and West AsianCanadian born 18265 (60 to 70)Reference
        Foreign born 11850 (45 to 56)−14 (−22 to −7)< 0.001
        AfricanCanadian born 56960 (57 to 63)Reference
        Foreign born 16860 (54 to 65)−1 (−6 to 5)0.84
        East Indian and South AsianCanadian born 34456 (53 to 60)Reference
        Foreign born 21448 (44 to 53)−8 (−14 to −3)0.003
        East and Southeast AsianCanadian born 61553 (50 to 56)Reference
        Foreign born 47555 (52 to 59)3 (−1 to 7)0.16
        Latin AmericanCanadian born 10261 (54 to 68)Reference
        Foreign born 8561 (54 to 68)0 (−9 to 10)0.96
        OtherCanadian born 1 20659 (57 to 61)Reference
        Foreign born 12458 (52 to 64)−1 (−7 to 5)0.72

        Note: CI = confidence interval. 
*The model controlled for gender, age, individual level perceived family wealth, median neighbourhood income, percentage of immigrants in the community and Statistics Canada population centre category, as well as television watching, computer use, playing video games, physical activity, snacking while watching television, snacking while on the computer or playing video games and frequency of eating at fast-food restaurants.

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        Influence of country of birth and ethnicity on body mass index among Canadian youth: a national survey
        Atif Kukaswadia, William Pickett, Ian Janssen
        Jul 2014, 2 (3) E145-E152; DOI: 10.9778/cmajo.20130088

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        Influence of country of birth and ethnicity on body mass index among Canadian youth: a national survey
        Atif Kukaswadia, William Pickett, Ian Janssen
        Jul 2014, 2 (3) E145-E152; DOI: 10.9778/cmajo.20130088
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