Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Amber J. Hromi-Fiedler


Mexican Americans experience a disproportionate burden of type 2 diabetes in the United States, but it is unclear how acculturation influences diabetes risk in this Hispanic subgroup. We studied the influence of acculturation on diabetes risk in a large cohort of Mexican Americans. Acculturation was assessed at baseline by means of language use, birth country, and duration of residence in the U.S. (among Mexico-born participants). Self-reported diabetes status was ascertained during annual follow-up interviews. Cox proportional hazards regression was used to model the influence of each acculturation proxy variable on incident diabetes. Interactions with each acculturation measure were also tested for gender and education level. In bivariate analyses, greater acculturation was associated with older age, higher education, higher BMI, lower physical activity levels, and a greater likelihood of current/former smoking and alcohol consumption. In multivariate adjusted analyses, diabetes risk was higher among immigrants with 15-19 years (HR=1.40; 95% CI 1.01, 1.93) and 20+ years (HR=1.55; 95% CI 1.15, 2.09) of U.S. residence, relative to those with less than 5 years. Diabetes risk was not significantly associated with either language use or birth country overall, but gender was found to modify these relationships. A greater risk was observed among English-dominant males relative to Spanish-dominant males (HR= 5.67, 95% CI=1.63-19.69) and U.S.-born males relative to Mexico-born males (HR=4.01, 95% CI=1.53-10.49). Future studies of acculturation and health should examine multiple proxy measures or use multi-dimensional acculturation scales. Gender-specific relationships should also be considered in future studies of acculturation as a risk factor for diabetes.


This is an Open Access Thesis.