Faculty Bibliography
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172
International journal of food sciences & nutrition. 2017:68(6):719-725.DOI: 10.1080/09637486.2016.1276519
Geospatial clustering in sugar-sweetened beverage consumption among Boston youth
The objective was to detect geospatial clustering of sugar-sweetened beverage (SSB) intake in Boston adolescents (age = 16.3 +/- 1.3 years [range: 13-19]; female = 56.1%; White = 10.4%, Black = 42.6%, Hispanics = 32.4%, and others = 14.6%) using spatial scan statistics. We used data on self-reported SSB intake from the 2008 Boston Youth Survey Geospatial Dataset (n = 1292). Two binary variables were created: consumption of SSB (never versus any) on (1) soda and (2) other sugary drinks (e.g., lemonade). A Bernoulli spatial scan statistic was used to identify geospatial clusters of soda and other sugary drinks in unadjusted models and models adjusted for age, gender, and race/ethnicity. There was no statistically significant clustering of soda consumption in the unadjusted model. In contrast, a cluster of non-soda SSB consumption emerged in the middle of Boston (relative risk = 1.20, p = .005), indicating that adolescents within the cluster had a 20% higher probability of reporting non-soda SSB intake than outside the cluster. The cluster was no longer significant in the adjusted model, suggesting spatial variation in non-soda SSB drink intake correlates with the geographic distribution of students by race/ethnicity, age, and gender.
PMID: 28095725
ISSN: 1465-3478
CID: 2413832
Energy contribution of sugar-sweetened beverage refills at fast-food restaurants
OBJECTIVE:To identify demographic and consumer characteristics associated with refilling a soft drink at fast-food restaurants and the estimated energy content and volume of those refills. DESIGN/METHODS:Logistic and linear regression with cross-sectional survey data. SETTING/METHODS:Data include fast-food restaurant receipts and consumer surveys collected from restaurants in New York City (all boroughs except Staten Island), and Newark and Jersey City, New Jersey, during 2013 and 2014. SUBJECTS/METHODS:Fast-food restaurant customers (n 11795) from ninety-eight restaurants. RESULTS:Thirty per cent of fast-food customers ordered a refillable soft drink. Nine per cent of fast-food customers with a refillable soft drink reported refilling their beverage (3 % of entire sample). Odds of having a beverage refill were higher among respondents with a refillable soft drink at restaurants with a self-serve refill kiosk (adjusted OR (aOR)=7·37, P<0·001) or who ate in the restaurant (aOR=4·45, P<0·001). KFC (aOR=2·18, P<0·001) and Wendy's (aOR=0·41, P<0·001) customers had higher and lower odds, respectively, of obtaining a refill, compared with Burger King customers. Respondents from New Jersey (aOR=1·47, P<0·001) also had higher odds of refilling their beverage than New York City customers. Customers who got a refill obtained on average 29 more 'beverage ounces' (858 ml) and 250 more 'beverage calories' (1046 kJ) than customers who did not get a refill. CONCLUSIONS:Refilling a beverage was associated with having obtained more beverage calories and beverage ounces. Environmental cues, such as the placement and availability of self-serve beverage refills, may influence consumer beverage choice.
PMID: 28485266
ISSN: 1475-2727
CID: 3830292
Identifying Local Hot Spots of Pediatric Chronic Diseases Using Emergency Department Surveillance
OBJECTIVE: To use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. METHODS: Using a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. RESULTS: We identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at prespecified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, P = .05 and 0.99, P < .01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, P < .01). Among adolescents, correlations by health districts were strong for obesity (0.95, P = .05), and depression estimates had a nonsignificant, but strong negative correlation with suicide attempts (-0.88, P = .12). Using SaTScan, we also identified local hot spots of pediatric chronic disease. CONCLUSIONS: For conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates.
PMCID:5385887
PMID: 28385326
ISSN: 1876-2867
CID: 2521642
The Introduction of a Supermarket via Tax-Credits in a Low-Income Area: The Influence on Purchasing and Consumption
Purpose . Interest and funding continue to grow for bringing supermarkets to underserved areas, yet little is known about their impact. Design . A quasi-experimental study was used to determine the impact of a new supermarket opening as a result of tax and zoning incentives. Setting . The study took place in the South Bronx, New York City, New York. SUBJECTS: Studied were residents of two South Bronx neighborhoods deemed high need. Measures . Food purchasing and consumption were examined via surveys and 24-hour dietary recalls before and at two points after the supermarket opened (1-5, 13-17 months). Analysis . Data were analyzed using difference-in-difference models controlling for gender, race and ethnicity, age, education, marital status, and self-reported income. Ordinary least squares and logistic regression models were estimated for continuous and binary outcomes, respectively. Results . At baseline, 94% to 97% of consumers shopped at a supermarket. There was a 2% increase in this behavior in the intervention community (p < .05) not seen in the comparison community. One year later there was a 7% net increase in eating at home (p < .1) and a 20% decrease in drinking sugary beverages (p < .05), but no appreciable change in fruit/vegetable consumption or overall dietary quality. Conclusion . The new supermarket did not result in substantial or broad changes in purchasing patterns or nutritional quality of food consumed, though smaller, positive changes were observed over a 1-year period. Future work should examine different contexts and a broader set of outcomes, including economic development.
PMID: 26389982
ISSN: 2168-6602
CID: 2451902
School Wellness Programs: Magnitude and Distribution in New York City Public Schools
BACKGROUND: Public schools provide students with opportunities to participate in many discretionary, unmandated wellness programs. Little is known about the number of these programs, their distribution across schools, and the kinds of students served. We provide evidence on these questions for New York City (NYC) public schools. METHODS: Data on wellness programs were collected from program websites, NYC's Office of School Food and Wellness, and direct contact with program sponsors for 2013. Programs were grouped into categories, nutrition, fitness, and comprehensive, and were combined with data on school characteristics available from NYC's Department of Education. Numbers of programs and provision of programs were analyzed for relationships with demographic and school structural characteristics, using descriptive statistics and multiple regression. RESULTS: Discretionary wellness programs are numerous, at 18 programs. Little evidence supports inequity according to student race/ethnicity, income, or nativity, but high schools, new schools, co-located schools, small schools, and schools with larger proportions of inexperienced teachers are less likely to provide wellness programs. CONCLUSIONS: Opportunities exist to further the reach of wellness programs in public schools by modifying them for high school adoption and building capacity in schools less likely to have the administrative support to house them.
PMCID:5142207
PMID: 27917485
ISSN: 1746-1561
CID: 2353902
Quantifying spatial misclassification in exposure to noise complaints among low-income housing residents across New York City neighborhoods: a Global Positioning System (GPS) study
PURPOSE: To examine if there was spatial misclassification in exposure to neighborhood noise complaints among a sample of low-income housing residents in New York City, comparing home-based spatial buffers and Global Positioning System (GPS) daily path buffers. METHODS: Data came from the community-based NYC Low-Income Housing, Neighborhoods and Health Study, where GPS tracking of the sample was conducted for a week (analytic n = 102). We created a GPS daily path buffer (a buffering zone drawn around GPS tracks) of 200 m and 400 m. We also used home-based buffers of 200 m and 400 m. Using these "neighborhoods" (or exposure areas), we calculated neighborhood exposure to noisy events from 311 complaints data (analytic n = 143,967). Friedman tests (to compare overall differences in neighborhood definitions) were applied. RESULTS: There were differences in neighborhood noise complaints according to the selected neighborhood definitions (P < .05). For example, the mean neighborhood noise complaint count was 1196 per square kilometer for the 400-m home-based and 812 per square kilometer for the 400-m activity space buffer, illustrating how neighborhood definition influences the estimates of exposure to neighborhood noise complaints. CONCLUSIONS: These analyses suggest that, whenever appropriate, GPS neighborhood definitions can be used in spatial epidemiology research in spatially mobile populations to understand people's lived experience.
PMCID:5272798
PMID: 28063754
ISSN: 1873-2585
CID: 2423812
Using behavioral economics to improve dietary intake : alternatives to regulation, bans, and taxation
Abingdon, Oxon ; New York, NY : Routledge, an imprint of the Taylor & Francis Group, 2017
pp. 91-105
ISBN: 9781315637938
CID: 2738602
Adults Who Order Sugar-Sweetened Beverages: Sociodemographics and Meal Patterns at Fast Food Chains
INTRODUCTION: Approximately 30% of adults consume sugar-sweetened beverages (SSBs) daily, many at fast food restaurants. Researchers examined fast food purchases to better understand which consumers order SSBs, particularly large SSBs. METHODS: Fast food customers in New York City and New Jersey provided receipts and participated in a survey during 2013-2014 (N=11,614). Logistic regression analyses predicted three outcomes: ordering no beverage or a non-SSB, a small/medium SSB, or a large SSB. Among respondents who ordered a beverage (n=3,775), additional analyses predicted number of beverage calories and odds of ordering an SSB. Covariates included demographic and behavioral factors. RESULTS: Respondents aged 18-29 years were 88% more likely to order a large SSB than a non-SSB or no beverage, as compared with respondents aged >/=50 years (p<0.001). Among respondents who purchased a beverage, respondents ordered more beverage calories with a large combination meal (+85.13 kcal, p=0.001) or if the restaurant had a large cup size >30 ounces (+36.07 kcal, p=0.001). Hispanic and Asian respondents were less likely to order a large SSB (AOR=0.49 and 0.52, respectively, both p
PMCID:5118120
PMID: 27662697
ISSN: 1873-2607
CID: 2255062
A Comparison of Measured and Self-Reported Blood Pressure Status among Low-Income Housing Residents in New York City
ORIGINAL:0012807
ISSN: 2166-5222
CID: 3206302
Effects of Subsidies and Prohibitions on Nutrition in a Food Benefit Program: A Randomized Clinical Trial
Importance: Strategies to improve the nutritional status of those participating in the Supplemental Nutrition Assistance Program (SNAP) are of interest to policymakers. Objective: To evaluate whether the proposed policy of incentivizing the purchase of fruits and vegetables and prohibiting the purchase of less nutritious foods in a food benefit program improves the nutritional quality of participants' diets. Design, Setting, and Participants: Lower income participants (n = 279) not currently enrolled in SNAP were randomized to 1 of 4 experimental financial food benefit conditions: (1) incentive (30% financial incentive for fruits and vegetables purchased using food benefits); (2) restriction (not allowed to buy sugar sweetened beverages, sweet baked goods, or candies with food benefits); (3) incentive plus restriction (30% financial incentive on fruits and vegetables and restriction of purchase of sugar sweetened beverages, sweet baked goods, or candy with food benefits); or (4) control (no incentive or restrictions on foods purchased with food benefits). Participants in all conditions were given a study-specific debit card where funds were added every 4 weeks for a 12-week period. Outcome measures were collected at baseline and in the final 4 weeks of the experimental period. Main Outcomes and Measures: Primary outcomes (from 24-hour dietary recalls) included intake of energy, discretionary calories, and overall diet quality. Results: A number of favorable changes were observed in the incentive plus restriction condition that were significantly different from changes in the control condition. These included (1) reduced intake of energy (-96 kcal/d, standard error [SE], 59.9); (2) reduced intake of discretionary calories (-64 kcal/d, SE 26.3); (3) reduced intake of sugar sweetened beverages, sweet baked goods, and candies (-0.6 servings/d, SE 0.2); (4) increased intake of solid fruit (0.2 servings/d, SE 0.1); and (5) improved Healthy Eating Index score (4.1 points, SE 1.4). Fewer improvements were observed in the incentive only and restriction only arms. Conclusions and Relevance: A food benefit program that pairs incentives for purchasing more fruits and vegetables with restrictions on the purchase of less nutritious foods may reduce energy intake and improve the nutritional quality of the diet of participants compared with a program that does not include incentives or restrictions. Clinical Trial Registration: clinicaltrials.gov Identifier: NCT02643576.
PMCID:5988257
PMID: 27653735
ISSN: 2168-6114
CID: 2318002
