Faculty Bibliography

BACKGROUND:Black communities, compared to White communities, are disproportionately targeted with more unhealthy food advertisements on television and social media. Exposure to unhealthy food and beverage marketing is associated with appetitive sensations, purchase intention, and intake behaviors, which may contribute to poor overall diet quality and worsening nutritional disparities in Black communities. Despite the negative effects, food and beverage companies are expanding their reach and harnessing advanced technology to create immersive experiences using virtual reality (VR). Black young adults may be uniquely vulnerable. OBJECTIVE:We aim to explore the effect of a VR-based fast-food marketing experience (compared with a VR-based nonfood control) on purchase intention, arousal, and hunger in a sample of Black and White young adults. METHODS:We will recruit 200 Black and White young adults (aged 18-24 years) from the New York City metropolitan area for a 1-time, 2-hour laboratory-based study. After screening and obtaining informed consent, eligible participants will be randomized to 1 of 2 VR conditions: a VR-based fast-food marketing experience (Wendyverse; experimental) or a VR-based nonfood control (Nikeland). In the Wendyverse, users can order from the restaurant operated by Wendy's, play games, meet others who may be visiting the Wendyverse, and access codes that can be used to obtain free food at physical restaurants. The control condition will be the Nikeland app, where participants can play sports, try on apparel, and engage with celebrity athletes. Study personnel will provide a 5-minute training session to participants before beginning the experiment to ensure that they feel comfortable in the VR environment. Participants will otherwise engage with the VR app independently. The primary outcomes will be fast-food purchase intention, assessed via a self-report questionnaire; arousal, assessed via electrodermal activity or skin conductance; and hunger, assessed via salivary reactivity. We will also conduct secondary analyses to examine interactions by race, ethnicity, and food or nutrition insecurity as a proxy for socioeconomic status. Analyses of covariance and multiple linear regressions will be conducted to examine the effects of VR-based fast-food marketing exposure on the relevant outcomes (compared to the control). RESULTS:This study was funded by the National Institute on Minority Health and Health Disparities in September 2024. Recruitment is expected to begin in September 2025. We expect to complete data collection by October 2026 and begin data cleaning and analysis in November 2026. CONCLUSIONS:On the basis of previous research and data, we anticipate that young adults randomized to view VR-based food and beverage marketing will self-report higher purchase intention and demonstrate stronger arousal and hunger. The data will be used to support future research and improve the understanding of the effects of digital forms of unhealthy food and beverage marketing on young people. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT06917391; https://clinicaltrials.gov/study/NCT06917391. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)/UNASSIGNED:PRR1-10.2196/69096.

INTRODUCTION/BACKGROUND:Menu labels were federally mandated in May 2018, but the authors are not aware of any work that has evaluated the impact of the national rollout of this legislation in restaurants using a comparison group to account for potential bias. METHODS:Using synthetic control methods, Taco Bell restaurants that implemented menu labels after nationwide labeling (n=5,060 restaurants) were matched to restaurants that added calorie labels to menus after local labeling legislation (and prior to nationwide labeling). The effect of menu labeling on calories purchased per transaction after nationwide labeling between groups (i.e., "later-treated" and "early-treated" restaurants) was estimated using a two-way fixed effects regression model, with time modeled as relative month from implementation and fixed effects for calendar month and restaurant. RESULTS:In the baseline period, average calories per transaction was 1,242 (SD=178) in the national menu labeling group and 1,245 (SD=183.9) in the comparison group, with parallel trends between groups. Difference-in-differences model results indicated that transactions from restaurants in the national menu labeling group included 7.4 (95% CI: 7.3, 7.5) more calories than was predicted based on the trend in the comparison group. Average number of total transactions per month decreased ∼2% more in the national menu labeling group relative to the comparison group. CONCLUSIONS:Negligible changes were observed in calories purchased and number of transactions in restaurants that added calorie labels due to national legislation, above and beyond secular changes. Other strategies may be necessary to promote meaningful decreases in daily calories purchased in restaurants going forward.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Recent studies highlight an increase in pediatric mental health disorders, amplified by COVID-19. This study examines changes in mental health-related emergency department visits among New York City public school students across the pandemic timeline. METHODS:We employed logistic regression to examine changes in the probability of a student's emergency department visit being mental health-related, and as a secondary outcome, we analyzed the difference in same-day discharge rates between mental health-related visits and other visits. For this analysis, we used the New York City Student Population Health Registry to link public school students' records to emergency department visit data. RESULTS:No significant linear trends were observed in the average monthly probability of a mental health-related visit before March 2020. From March 2020 through June 2021 there was an increase for all groups except male elementary school students. Female middle and high school students experienced the largest increase (0.031 (CI = [0.027, 0.034])) compared to pre-pandemic (0.103 (CI = [0.103, 0.104])). Post-June 2021, all groups experienced a lower probability except for female middle and high school students, who had a 0.009 (CI = [0.007, 0.011]) higher probability than during the pandemic. Compared to the pre-pandemic period and non-mental health-related visits, a 0.043 (CI = [0.029, 0.057]) lower probability of same-day discharge was observed for mental health-related visits during the pandemic period. CONCLUSIONS:The COVID-19 pandemic correlated with a significant increase in mental health-related emergency department visits and longer stays, particularly among female middle and high school students.

INTRODUCTION/BACKGROUND:Social media is the most prominent source of online food and beverage advertisements (ads) seen by adolescents. Companies target adolescent social media users with ads that feature calorie-dense, nutrient-poor products, and exposure to ads drives poor diet and risk for future diet-related diseases. Black, Hispanic and lower socio-economic status youth are exposed to significantly more ads than White peers. Several state-level policies in the USA have passed restricting youth from accessing social media without parental approval, and some policies have banned advertising to youth. This protocol paper describes a current study that aims to understand the impact of such policies in two states, Louisiana and Texas, as they were among the first to be implemented with racially/ethnically diverse populations. METHODS AND ANALYSIS/METHODS:This study employs a repeated cross-sectional difference-in-difference design in which 700 youth ages 13-17 years are being recruited each year for 5 years (Louisiana n=175, Texas n=175, matched comparisons from other states n=350). Youth screen record their mobile devices for 60 minutes while they browse social media platforms (eg, TikTok, Instagram) or use the internet. They also complete a brief survey about a variety of topics (eg, health behaviours, mental health). Adolescents are compensated for screen recording ($75) and the survey ($25). Study team members are coding recordings for several characteristics, including media platforms used, appearances of food or beverages, and food or beverage type. We will estimate the impact of policies on food and beverage ads seen per hour using Ordinary Least Squares regression models and heterogeneity-robust standard errors clustered at the state level (by year and cumulatively). We will run additional models with interaction terms with income and race/ethnicity, separately, to test the role of the policies on health disparities. ETHICS AND DISSEMINATION/BACKGROUND:Study procedures have been approved by the Institutional Review Board of the NYU Grossman School of Medicine. We will distribute findings in peer-reviewed journals and at local and national conferences. To complement traditional dissemination pathways, we will create infographics to share with relevant community stakeholders. We will also share findings with policymakers in states that have passed or considered similar policies.

OBJECTIVE:This study examined racial and ethnic differences in percent total weight loss (%TWL) and glycemic improvement following sleeve gastrectomy (SG) and explored the role of socioeconomic and psychosocial factors in postsurgical outcomes. METHODS:This longitudinal study included patients who underwent SG between 2017 and 2020, with follow-up visits over 24 months. RESULTS:Non-Hispanic Black (NHB) participants had lower %TWL at 3, 12, and 24 months compared with Hispanic (H) and non-Hispanic White (NHW) participants. Fat mass index was initially lower in NHB, with smaller reductions over time and significant group differences persisting at 24 months. NHB participants had higher baseline fat-free mass index values; by 24 months, fat-free mass index values were lower in H participants. Hemoglobin A1c decreased across all groups but remained consistently higher in NHB and H compared with NHW at 24 months. NHB participants reported higher perceived discrimination, sleep disturbance, and perceived stress than H and NHW participants at all time points. Employment status predicted %TWL at 12 months. There was a significant interaction between race and ethnicity and employment status observed at 12 and 24 months, suggesting that employment-related disparities could impact surgical outcomes. CONCLUSIONS:NHB participants experienced less favorable outcomes following SG, emphasizing the need for tailored interventions addressing socioeconomic and psychosocial disparities.

INTRODUCTION/BACKGROUND:Effective July 2018, the U.S. Department of Housing and Urban Development issued a rule requiring all public housing authorities to implement smoke-free housing (SFH) policies in their developments. We examined the differential impacts of SFH policy on hospitalizations for myocardial infarction (MI) and stroke among adults aged ≥50 years old living in New York City (NYC) Housing Authority (NYCHA) versus a matched-comparison population in NYC. AIMS AND METHODS/OBJECTIVE:We identified census block groups (CBGs) comprised solely of 100% NYCHA units (N = 160) and compared NYCHA CBGs to a selected subset of CBGs from all CBGs with no NYCHA units (N = 5646). We employed propensity score matching on distributions of key CBG-level sociodemographic and housing covariates. We constructed incident rates per 1000 persons by aggregating 3-month "quarterly" counts of New York State all-payer hospitalization data from October 2015 to December 2022 and dividing by the population aged ≥50 in selected CBGs, ascertained from 2016 American Community Survey 5-year estimates. We selected a difference-in-differences (DID) analytic approach to examine pre- and post-policy differences in incident hospitalizations between the intervention and matched-comparison groups. RESULTS:Matching results indicated a balanced match for all covariates, with standardized mean differences <0.10. In DID analyses, we observed small declines in both MI (DID = -0.26, p = .02) and stroke (DID = -0.28, p = .06) hospitalization rates for NYCHA CBGs compared to non-NYCHA CBGs from pre-to post-54 months' policy. CONCLUSIONS:SFH policies in NYC were associated with small reductions in CVD-related hospitalizations among older adults living in housing subject to the policy. IMPLICATIONS/CONCLUSIONS:Housing remains a key focal setting for interventions to reduce SHS exposure and associated morbidities. Ongoing monitoring is warranted to understand the long-term impacts of SFH policies in public housing developments.

OBJECTIVE:This study examined associations between access to leisure-time physical activity (LTPA) facilities and parks and repeated measures of glycated hemoglobin (A1C) over time, using follow-up tests among United States Veterans with newly diagnosed type-2 diabetes (T2D). METHODS:Data were analyzed from 274,463 patients in the Veterans Administration Diabetes Risk cohort who were newly diagnosed with T2D between 2008 and 2018 and followed through 2023. Generalized estimating equations with a logit link function and binomial logistic regression were used to examine associations. RESULTS:Patients were on average 60.5 years of age, predominantly male (95.0 %) and white (66.9 %), and had an average of 11.7 A1C tests during the study follow-up period. In high- and low-density urban communities, a one-unit higher LTPA facility density score was associated with 1 % and 3 % greater likelihood of in-range A1C tests during follow-up, respectively, but no association was observed among patients living in suburban/small town and rural communities. Across community types, closer park distance was not associated with subsequent greater odds of in-range A1C tests. Unexpectedly, in low-density urban areas, the likelihood of in-range A1C tests was 1 % lower at farther park distances. CONCLUSIONS:These results suggest that broader access to LTPA facilities, but not park proximity, may contribute in small ways to maintaining glycemic control after T2D diagnosis in urban communities. Tailored interventions may be needed to promote patients' effective use of LTPA facilities and parks.

OBJECTIVE:The objective of this study was to evaluate potential sources of heterogeneity in the effect of calorie labeling on fast-food purchases among restaurants located in areas with different neighborhood characteristics. METHODS:In a quasi-experimental design, using transaction data from 2329 Taco Bell restaurants across the United States between 2008 and 2014, we estimated the relationships of census tract-level income, racial and ethnic composition, and urbanicity with the impacts of calorie labeling on calories purchased per transaction. RESULTS:Calorie labeling led to small, absolute reductions in calories purchased across all population subgroups, ranging between -9.3 calories (95% CI: -18.7 to 0.0) and -37.6 calories (95% CI: -41.6 to -33.7) 2 years after labeling implementation. We observed the largest difference in the effect of calorie labeling between restaurants located in rural compared with those located in high-density urban census tracts 2 years after implementation, with the effect of calorie labeling being three times larger in urban areas. CONCLUSIONS:Fast-food calorie labeling led to small reductions in calories purchased across all population subgroups except for rural census tracts, with some subgroups experiencing a greater benefit.

BACKGROUND:Online ordering in food pantries may support food security among adults with low socioeconomic status. PURPOSE/OBJECTIVE:Determine the impact of a transition from in-person ordering to online ordering on the food security status of food pantry clients. METHODS:For this quasi-experimental study, we recruited participants from Met Council's Kosher Food Network in New York City, including one pantry in Staten Island (intervention) and three pantries in the Bronx, Queens, and Brooklyn (comparison). The final sample included 114 and 90 adults in the intervention and comparison groups, respectively, at baseline (April-July 2023); and 77 and 58 adults in those groups during follow-up (October-December 2023). Using a six-item survey, we assessed food security status, where scores range from zero to six points and higher points indicate lower food security. Secondary outcomes included nutrition security status, fruit and vegetable intake, and pantry wait time. We used a difference-in-differences approach to assess differences in outcomes between conditions, including testing for differences by age (18-64 vs. ≥65 years). RESULTS:Food security scores decreased in the intervention and comparison groups over time, with no difference in the decrease between groups (P = .87). Yet, among younger adults in the intervention group, wait time decreased during follow-up, and increased in the comparison group (difference-in-differences = -12.1 minutes (95% CI: -21.9, -2.4); P = .02). We did not observe similar differences among older adults (P = .83), nor significant changes in other outcomes. CONCLUSIONS:The transition to online ordering did not influence food security status among food pantry clients but may help to save time, especially among younger adults. CLINICAL TRIALS REGISTRATION/BACKGROUND:NCT05752721.