Faculty Bibliography

OBJECTIVES: Restorative interventions for cleft lip and palate involve annual evaluations, adjunct treatment, and multiple surgeries. The purpose of this study was to investigate the longitudinal impact of cleft surgery on psychosocial functioning among youth with cleft. METHODS: Data were derived from a 5-year, multicenter, prospective longitudinal study of children with cleft (N = 1196). Children completed psychological inventories for self-concept, anxiety, depression, mastery, and relatedness. Multilevel mixed-effects models were used to analyze the effects of craniofacial surgery for cleft on psychosocial outcomes over time. RESULTS: There were 1196 participants at baseline, of whom 258 (27.5%) received a surgical intervention prior to their 1st follow-up visit. Approximately 78% of participants had cleft lip and palate, and 22% had cleft palate only. Surgery receipt was significantly associated with lower relatedness (beta = -1.48, 95% CI = -2.91, -0.05) and mastery (beta = -1.32, 95% CI = -2.49, -0.15) scores, although overall scores appeared to increase over time. Surgery was not related to anxiety (beta = -0.15, 95% CI = -1.08, 0.79), depression (beta = 0.18, 95% CI = -0.65, 1.01), and self-concept (beta = -0.84, 95% CI = -1.83, 0.15). The treatment-time interaction was not significant. Significant differences in psychosocial functioning were found across sex, race/ethnicity, and age groups. CONCLUSIONS: Surgery may have negative short-term impacts on psychosocial functioning, although effects may diminish over time. Given the limited postsurgical follow-up period, long-term change in psychological well-being and the moderating effects of surgery may not be fully realized. Further follow-up of children with cleft through adulthood to explore developmental trajectories of psychosocial functioning in more detail is recommended.

Purpose . Local food environments can influence the diet and health of individuals through food availability, proximity to retail stores, pricing, and promotion. This study focused on how small convenience stores, known in New York City as bodegas, influence resident shopping behavior and the food environment. Design . Using a cross-sectional design, 171 bodegas and 2118 shoppers were sampled. Setting . Small convenience stores in New York City. Subjects . Any bodega shopper aged 18+ who purchased food or beverage from a participating store. Measures . Data collection consisted of a store assessment, a health and behavior survey given to exiting customers, and a bag check that recorded product information for all customer purchases. Analysis . Descriptive statistics were generated for bodega store characteristics, shopper demographics, and purchase behavior. Multilevel models were used to assess the influence of product availability, placement, and advertising on consumer purchases of sugar-sweetened beverages (SSBs), water, and fruits and vegetables. Results . Seventy-one percent of participants reported shopping at bodegas five or more times per week, and 35% reported purchasing all or most of their monthly food allotment at bodegas. Model results indicated that lower amounts of available fresh produce were significantly and independently associated with a higher likelihood of SSB purchases. A second, stratified multilevel model showed that the likelihood of purchasing an SSB increased with decreasing varieties of produce when produce was located at the front of the store. No significant effects were found for water placement and beverage advertising. Conclusions . Small convenience stores in New York City are an easily accessible source of foods and beverages. Bodegas may be suitable for interventions designed to improve food choice and diet.

PURPOSE: Sugar-sweetened beverages (SSBs) contribute to weight gain and increase the risk of obesity. In this article, we determine the effects of an innovative SSB tax on weight and obesity in New York City adults. METHODS: Dynamic weight loss models were used to estimate the effects of an expected 5800-calorie reduction resulting from an SSB tax on weight and obesity. Baseline data were derived from the New York City Community Health Survey. One, five, and 10-year simulations of weight loss were performed. RESULTS: Calorie reductions resulted in a per-person weight loss of 0.46 kg in year 1 and 0.92 kg in year 10. A total of 5,531,059 kg was expected to be lost over 10 years when weighted to the full New York City adult population. Approximately 50% of overall bodyweight loss occurred within the first year, and 95% within 5 years. Results showed consistent but nonsignificant decreases in obesity prevalence. CONCLUSIONS: SSB taxes may be viable strategies to reduce obesity when combined with other interventions to maximize effects in the population.

The obesity epidemic and excessive consumption of sugar-sweetened beverages have led to proposals of economics-based interventions to promote healthy eating in the United States. Targeted food and beverage taxes and subsidies are prominent examples of such potential intervention strategies. This paper examines the differential effects of taxing sugar-sweetened beverages by calories and by ounces on beverage demand. To properly measure the extent of substitution and complementarity between beverage products, we developed a fully modified distance metric model of differentiated product demand that endogenizes the cross-price effects. We illustrated the proposed methodology in a linear approximate almost ideal demand system, although other flexible demand systems can also be used. In the empirical application using supermarket scanner data, the product-level demand model consists of 178 beverage products with combined market share of over 90%. The novel demand model outperformed the conventional distance metric model in non-nested model comparison tests and in terms of the economic significance of model predictions. In the fully modified model, a calorie-based beverage tax was estimated to cost $1.40 less in compensating variation than an ounce-based tax per 3,500 beverage calories reduced. This difference in welfare cost estimates between two tax strategies is more than three times as much as the difference estimated by the conventional distance metric model. If applied to products purchased from all sources, a 0.04-cent per kcal tax on sugar-sweetened beverages is predicted to reduce annual per capita beverage intake by 5,800 kcal.

The purpose of this study was to evaluate the feasibility of using global positioning system (GPS) methods to understand the spatial context of obesity and hypertension risk among a sample of low-income housing residents in New York City (n = 120). GPS feasibility among participants was measured with a pre- and post-survey as well as adherence to a protocol which included returning the GPS device as well as objective data analysed from the GPS devices. We also conducted qualitative interviews with 21 of the participants. Most of the sample was overweight (26.7%) or obese (40.0%). Almost one-third (30.8%) was pre-hypertensive and 39.2% was hypertensive. Participants reported high ratings of GPS acceptability, ease of use and low levels of wear-related concerns in addition to few concerns related to safety, loss or appearance, which were maintained after the baseline GPS feasibility data collection. Results show that GPS feasibility increased over time. The overall GPS return rate was 95.6%. Out of the total of 114 participants with GPS, 112 (98.2%) delivered at least one hour of GPS data for one day and 84 (73.7%) delivered at least one hour on 7 or more days. The qualitative interviews indicated that overall, participants enjoyed wearing the GPS devices, that they were easy to use and charge and that they generally forgot about the GPS device when wearing it daily. Findings demonstrate that GPS devices may be used in spatial epidemiology research in low-income and potentially other key vulnerable populations to understand geospatial determinants of obesity, hypertension and other diseases that these populations disproportionately experience.

Consuming less sodium and more potassium are components of a healthy diet and reduced cardiovascular disease risk. Racial/ethnic segregation and poverty are both associated with dietary habits, but data linking dietary intake to neighborhood characteristics are limited, particularly in Hispanic and Asian American ethnic enclaves. This study presents relationships between neighborhood-level segregation, poverty and biologic indicators of sodium and potassium consumption. Data were from the 2010 Heart Follow-Up Study, a cross-sectional health survey, which included 24-h urine collections and self-reported health status (n = 1656). Black, Hispanic, and Asian segregated areas and neighborhood poverty were defined for aggregated zip-code areas. Multivariable models assessed the association between neighborhood segregation and poverty and sodium and potassium intake, after adjustment for individual-level covariates. In unadjusted models, potassium intake (a marker of fruit and vegetable consumption) was lower in high-versus low-Hispanic segregated neighborhoods, and the sodium-potassium ratio was higher in high-versus low black and Hispanic segregated neighborhoods, and in high-versus low-poverty neighborhoods; the sodium-potassium ratio was lower in high-versus low Asian segregated neighborhoods. Segregation and poverty were not independently associated with nutrition biomarkers after adjustment for demographics and for each other; however, practical consideration of neighborhood race/ethnic composition may be useful to understand differences in consumption.

OBJECTIVE: Incidental forms of physical activity such as stair use offer frequent opportunities for energy expenditure and may contribute to the prevention and control of chronic diseases. This study analyzes the associations between building characteristics, stair prompts, and stair use in large urban worksites. METHODS: Bootstrapped generalized mixed models were used to analyze self-reported stair use, using data from 1348 surveys of city employees and fourteen building assessments conducted in New York City in 2012. RESULTS: 57% of respondents reported climbing >/=1 flights of stairs daily at the workplace. Model results show that stair prompts were associated with a 3.21 increased likelihood of stair use. Naturally lit stairwells and stairwell visibility were also positively associated. Higher floor residency and BMI were negatively related, as were gender, stairwell distance from lobby entrances, the total number of floors in each building, and building averages for BMI and gender. Residual heterogeneity measured by adjusted median odds ratios indicates that buildings can have a moderate effect on the likelihood of stair use beyond those of individual characteristics. CONCLUSIONS: Specific building features and stair prompts may potentially be leveraged to positively influence rates of incidental physical activity and contribute to improvements in population health.

BACKGROUND: Cities across the U.S. and internationally are adopting Bus Rapid Transit to improve transit services for residents. Features of Bus Rapid Transit include fewer stops, dedicated bus lanes, and expedited systems for boarding busses, compared to regular bus service. This study examines whether Bus Rapid Transit (BRT) ridership is associated with increased rates of walking, because of the greater distance between BRT stops compared to regular bus service. METHODS: Surveys were conducted with riders of local and BRT buses for New York City's M15 Select Bus Service line. Surveys examined bus ridership, health status and physical activity, walking rates, and demographic information. RESULTS: BRT riders reported walking approximately half a block more than did local bus riders. The average number of blocks walked decreased for BRT riders who previously used the subway prior to the implementation of the BRT. CONCLUSIONS: BRT may be a useful tool to support walking for some groups. Depending on where it is implemented, BRT may also be associated with reduced walking among users who switch to BRT from other active transportation modes. Future research should examine associations between walking and BRT ridership with a larger sample and more sites.

OBJECTIVE: To explore the temporal relationship between 9/11-related posttraumatic stress disorder (PTSD) and new-onset diabetes in World Trade Center (WTC) survivors up to 11years after the attack in 2001. METHODS: Three waves of surveys (conducted from 2003 to 2012) from the WTC Health Registry cohort collected data on physical and mental health status, sociodemographic characteristics, and 9/11-related exposures. Diabetes was defined as self-reported, physician-diagnosed diabetes reported after enrollment. After excluding prevalent cases, there were 36,899 eligible adult enrollees. Logistic regression and generalized multilevel growth models were used to assess the association between PTSD measured at enrollment and subsequent diabetes. RESULTS: We identified 2,143 cases of diabetes. After adjustment, we observed a significant association between PTSD and diabetes in the logistic model [adjusted odds ratio (AOR) 1.28, 95% confidence interval (CI) 1.14-1.44]. Results from the growth model were similar (AOR 1.37, 95% CI 1.23-1.52). CONCLUSION: This exploratory study found that PTSD, a common 9/11-related health outcome, was a risk factor for self-reported diabetes. Clinicians treating survivors of both the WTC attacks and other disasters should be aware that diabetes may be a long-term consequence.