Date of Award




Document Type


Degree Name

Doctor of Public Health (DrPH)


Department of Epidemiology and Biostatistics



Content Description

1 online resource (x, 97 pages) : illustrations (some color)

Dissertation/Thesis Chair

Akiko S Hosler

Committee Members

Marie Allsopp, Kaydian Reid


Burmese refugees and immigrants, Food Acquisition, Food environment, Fruit and vegetable consumption, Immigrants, Socio-Ecological study, Burmese Americans, Burmese, Food preferences, Food habits, Nutrition, Fruit in human nutrition, Vegetables in human nutrition

Subject Categories

Food Science | Nutrition | Public Health


Background: Using the framework of the Socio-Ecological Model, the current study aimed to investigate the associations between nutritional knowledge, food environment, food acquisition behavior, and daily recommended fruit and vegetable consumption (≥5 cups of fruits and vegetables) among Burmese refugees and immigrants in the Capital Region, New York. Methods: During July - November 2018, a cross-sectional survey with face-to-face interviews was conducted among Burmese refugees and immigrants aged 18 years and older living in Albany and Rensselaer counties (n=173, 52.0% female, mean age = 42.8). Daily recommended fruit and vegetable consumption was determined as ≥5 cups of fruit and vegetable (≥2 cups of fruits and ≥ 3 cups of vegetable). We created Directed Acyclic Graphs (DAGs) to visualize the hypothesized relationships between the exposures and the outcome and identify confounding covariates for further analysis. Linear and multivariate logistic regression models determined the strength of associations between nutritional knowledge score, shopping frequency, perception on neighborhood food environment, proximity to preferred stores (walking network distance in kilometers), and fruit and vegetable consumption, adjusting for confounders. Results: Among the participants, 45.1% met the daily recommendation, and the prevalence of ≥5 cups of fruit and vegetable was high among those aged ≥45 years (56.4%) and the married (84.6%). Almost all participants reported that ethnic stores were their preferred stores (Pan-Asian, 37.6%; Halal/Indian, 9.8%; and Burmese, 52.6%) with four times/month as the average shopping frequency. The mean shopping distance to the preferred stores was 3.6 kilometers. Multivariate logistic regression showed that older age [OR=1.08, 95%CI: 1.044 – 1.115] and greater shopping frequency [OR=1.51, 95%CI: 1.013 – 2.258] were associated with higher odds of meeting the daily recommended fruit and vegetable consumption, while the longer distance to the preferred store [OR =0.812, 95%CI: 0.731 – 0.903] was associated with lower odds of meeting the daily recommended fruit and vegetable consumption. Conclusion: The current study's findings illustrated the importance of access to food shopping resources Burmese refugees and immigrants prefer for maintaining healthy dietary behavior. This study suggested various strategies to improve access to food resources at the community and policy levels.