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OBJECTIVE: To assess the accuracy of government inspection records, relative to ground observation, for identifying businesses offering foods/drinks. DESIGN: Agreement between city and state inspection records v. ground observations at two levels: businesses and street segments. Agreement could be 'strict' (by business name, e.g. 'Rizzo's') or 'lenient' (by business type, e.g. 'pizzeria'); using sensitivity and positive predictive value (PPV) for businesses and using sensitivity, PPV, specificity and negative predictive value (NPV) for street segments. SETTING: The Bronx and the Upper East Side (UES), New York City, USA. PARTICIPANTS: All food/drink-offering businesses on sampled street segments (n 154 in the Bronx, n 51 in the UES). RESULTS: By 'strict' criteria, sensitivity and PPV of government records for food/drink-offering businesses were 0·37 and 0·57 in the Bronx; 0·58 and 0·60 in the UES. 'Lenient' values were 0·40 and 0·62 in the Bronx; 0·60 and 0·62 in the UES. Sensitivity, PPV, specificity and NPV of government records for street segments having food/drink-offering businesses were 0·66, 0·73, 0·84 and 0·79 in the Bronx; 0·79, 0·92, 0·67, and 0·40 in the UES. In both areas, agreement varied by business category: restaurants; 'food stores'; and government-recognized other storefront businesses ('gov. OSB', i.e. dollar stores, gas stations, pharmacies). Additional business categories - 'other OSB' (barbers, laundromats, newsstands, etc.) and street vendors - were absent from government records; together, they represented 28·4 % of all food/drink-offering businesses in the Bronx, 22·2 % in the UES ('other OSB' and street vendors were sources of both healthful and less-healthful foods/drinks in both areas). CONCLUSIONS: Government records frequently miss or misrepresent businesses offering foods/drinks, suggesting caveats for food-environment assessments using such records.
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Comércio/estatística & dados numéricos , Serviços de Alimentação/estatística & dados numéricos , Governo , Registros , Coleta de Dados , Meio Ambiente , Alimentos/normas , Inspeção de Alimentos , Serviços de Alimentação/normas , Abastecimento de Alimentos/normas , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , Cidade de Nova Iorque , Observação , Características de Residência , Restaurantes/normas , Restaurantes/estatística & dados numéricosRESUMO
BACKGROUND: The decisions that individuals make about the food and beverage products they purchase and consume directly influence their energy intake and dietary quality and may lead to excess weight gain and obesity. However, gathering and interpreting data on food and beverage purchase patterns can be difficult. Leveraging novel sources of data on food and beverage purchase behavior can provide us with a more objective understanding of food consumption behaviors. OBJECTIVE: Food and beverage purchase receipts often include time-stamped location information, which, when associated with product purchase details, can provide a useful behavioral measurement tool. The purpose of this study was to assess the feasibility, reliability, and validity of processing data from fast-food restaurant receipts using crowdsourcing via Amazon Mechanical Turk (MTurk). METHODS: Between 2013 and 2014, receipts (N=12,165) from consumer purchases were collected at 60 different locations of five fast-food restaurant chains in New Jersey and New York City, USA (ie, Burger King, KFC, McDonald's, Subway, and Wendy's). Data containing the restaurant name, location, receipt ID, food items purchased, price, and other information were manually entered into an MS Access database and checked for accuracy by a second reviewer; this was considered the gold standard. To assess the feasibility of coding receipt data via MTurk, a prototype set of receipts (N=196) was selected. For each receipt, 5 turkers were asked to (1) identify the receipt identifier and the name of the restaurant and (2) indicate whether a beverage was listed in the receipt; if yes, they were to categorize the beverage as cold (eg, soda or energy drink) or hot (eg, coffee or tea). Interturker agreement for specific questions (eg, restaurant name and beverage inclusion) and agreement between turker consensus responses and the gold standard values in the manually entered dataset were calculated. RESULTS: Among the 196 receipts completed by turkers, the interturker agreement was 100% (196/196) for restaurant names (eg, Burger King, McDonald's, and Subway), 98.5% (193/196) for beverage inclusion (ie, hot, cold, or none), 92.3% (181/196) for types of hot beverage (eg, hot coffee or hot tea), and 87.2% (171/196) for types of cold beverage (eg, Coke or bottled water). When compared with the gold standard data, the agreement level was 100% (196/196) for restaurant name, 99.5% (195/196) for beverage inclusion, and 99.5% (195/196) for beverage types. CONCLUSIONS: Our findings indicated high interrater agreement for questions across difficulty levels (eg, single- vs binary- vs multiple-choice items). Compared with traditional methods for coding receipt data, MTurk can produce excellent-quality data in a lower-cost, more time-efficient manner.
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Comportamento do Consumidor/economia , Crowdsourcing/métodos , Coleta de Dados , Fast Foods , Estudos de Viabilidade , Feminino , Humanos , Reprodutibilidade dos TestesRESUMO
INTRODUCTION: Residents of some low-income neighborhoods have limited access to fresh fruits and vegetables. In 2008, New York City issued new mobile fruit and vegetable cart licenses for neighborhoods with inadequate availability of fresh produce. Some of these carts were equipped with electronic benefit transfer (EBT) machines, allowing them to accept Supplemental Nutrition Assistance Program (SNAP) benefits. This article examines the association between type and quantities of fruits and vegetables purchased from mobile fruit and vegetable vendors and consumer characteristics, including payment method. METHODS: Customers at 4 produce carts in the Bronx, New York, were surveyed during 3 periods in 2013 and 2014. Survey data, including purchased fruit and vegetable quantities, were analyzed using multivariable negative binomial regressions, with payment method (cash only vs EBT or EBT and cash) as the primary independent variable. Covariates included availability of EBT, vendor, and customer sociodemographic characteristics. RESULTS: A total of 779 adults participated in this study. Shoppers who used SNAP benefits purchased an average of 5.4 more cup equivalents of fruits and vegetables than did shoppers who paid with cash. Approximately 80% of this difference was due to higher quantities of purchased fruits. CONCLUSION: Expanding access to EBT machines at mobile produce carts may increase purchases of fruits and vegetables from these vendors.
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Comportamento do Consumidor , Assistência Alimentar , Frutas/economia , Verduras/economia , Comércio , Estudos Transversais , Coleta de Dados , Abastecimento de Alimentos , Humanos , Cidade de Nova Iorque , PobrezaRESUMO
OBJECTIVES: We determined the influence of "water jets" on observed water and milk taking and self-reported fluid consumption in New York City public schools. METHODS: From 2010 to 2011, before and 3 months after water jet installation in 9 schools, we observed water and milk taking in cafeterias (mean 1000 students per school) and surveyed students in grades 5, 8, and 11 (n=2899) in the 9 schools that received water jets and 10 schools that did not. We performed an observation 1 year after implementation (2011-2012) with a subset of schools. We also interviewed cafeteria workers regarding the intervention. RESULTS: Three months after implementation we observed a 3-fold increase in water taking (increase of 21.63 events per 100 students; P<.001) and a much smaller decline in milk taking (-6.73 events per 100 students; P=.012), relative to comparison schools. At 1 year, relative to baseline, there was a similar increase in water taking and no decrease in milk taking. Cafeteria workers reported that the water jets were simple to clean and operate. CONCLUSIONS: An environmental intervention in New York City public schools increased water taking and was simple to implement.
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Dieta/estatística & dados numéricos , Ingestão de Líquidos , Leite , Instituições Acadêmicas/estatística & dados numéricos , Abastecimento de Água , Adolescente , Animais , Criança , Arquitetura de Instituições de Saúde , Feminino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Instituições Acadêmicas/normas , Estudantes/psicologia , Estudantes/estatística & dados numéricosRESUMO
OBJECTIVE: To assess the impact of a new government-subsidized supermarket in a high-need area on household food availability and dietary habits in children. DESIGN: A difference-in-difference study design was utilized. SETTING: Two neighbourhoods in the Bronx, New York City. Outcomes were collected in Morrisania, the target community where the new supermarket was opened, and Highbridge, the comparison community. SUBJECTS: Parents/caregivers of a child aged 3-10 years residing in Morrisania or Highbridge. Participants were recruited via street intercept at baseline (pre-supermarket opening) and at two follow-up periods (five weeks and one year post-supermarket opening). RESULTS: Analysis is based on 2172 street-intercept surveys and 363 dietary recalls from a sample of predominantly low-income minorities. While there were small, inconsistent changes over the time periods, there were no appreciable differences in availability of healthful or unhealthful foods at home, or in children's dietary intake as a result of the supermarket. CONCLUSIONS: The introduction of a government-subsidized supermarket into an underserved neighbourhood in the Bronx did not result in significant changes in household food availability or children's dietary intake. Given the lack of healthful food options in underserved neighbourhoods and need for programmes that promote access, further research is needed to determine whether healthy food retail expansion, alone or with other strategies, can improve food choices of children and their families.
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Comércio , Dieta , Características da Família , Comportamento Alimentar , Assistência Alimentar , Pobreza , Características de Residência , Adulto , Criança , Pré-Escolar , Inquéritos sobre Dietas , Ingestão de Energia , Feminino , Abastecimento de Alimentos , Humanos , Renda , Masculino , Rememoração Mental , Grupos Minoritários , Cidade de Nova IorqueRESUMO
We assessed purchases made, motivations for shopping, and frequency of shopping at four New York City corner stores (bodegas). Surveys and purchase inventories (n = 779) were collected from consumers at four bodegas in Bronx, NY. We use Chi square tests to compare types of consumers, items purchased and characteristics of purchases based on how frequently the consumer shops at the specific store and the time of day the purchase was made. Most consumers shopped at the bodega because it was close to their home (52 %). The majority (68 %) reported shopping at the bodega at least once per day. The five most commonly purchased items were sugary beverages, (29.27 %), sugary snacks (22.34 %), coffee, (13.99 %), sandwiches, (13.09 %) and non-baked potato chips (12.2 %). Nearly 60 % of bodega customers reported their purchase to be healthy. Most of the participants shopped at the bodega frequently, valued its convenient location, and purchased unhealthy items. Work is needed to discover ways to encourage healthier choices at these stores.
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Comportamento Alimentar , Pobreza , População Urbana , Adolescente , Adulto , Bebidas , Comportamento de Escolha , Feminino , Geografia , Humanos , Almoço , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Características de Residência , Lanches , Fatores Socioeconômicos , Adulto JovemRESUMO
This study examines purchases at fruit and vegetable carts and evaluates the potential benefits of expanding the availability of electronic benefit transfer machines at Green Carts. Customers at 4 Green Carts in the Bronx, New York, were surveyed in 3 waves from June 2013 through July 2014. Customers who used Supplemental Nutrition Assistance Program benefits spent on average $3.86 more than customers who paid with cash. This finding suggests that there may be benefits to increasing the availability of electronic benefit transfer machines at Green Carts.
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Comércio/estatística & dados numéricos , Assistência Alimentar/estatística & dados numéricos , Abastecimento de Alimentos/métodos , Frutas/economia , Verduras/economia , Adolescente , Adulto , Idoso , Comportamento de Escolha , Processamento Eletrônico de Dados , Planejamento Ambiental , Honorários e Preços , Feminino , Abastecimento de Alimentos/economia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Características de Residência/estatística & dados numéricos , Classe Social , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
Obesity is a challenging public health problem that affects millions of Americans. Increasingly policy makers are seeking environmental and policy-based solutions to combat and prevent its serious health effects. Calorie labeling mandates, including the provision in the 2010 Patient Protection and Affordable Care Act that is set to begin in 2014, have been one of the most popular and most studied approaches. This review examines 31 studies published from January 1, 2007 through July 19, 2013. It builds on Harnack and French's 2008 review and assesses the evidence on the effectiveness of calorie labeling at the point of purchase. We find that, while there are some positive results reported from studies examining the effects of calorie labeling, overall the best designed studies (real world studies, with a comparison group) show that calorie labels do not have the desired effect in reducing total calories ordered at the population level. Moving forward, researchers should consider novel, more effective ways of presenting nutrition information, while keeping a focus on particular subgroups that may be differentially affected by nutrition policies.
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Ingestão de Alimentos , Ingestão de Energia , Rotulagem de Alimentos , Fast Foods , Humanos , ObesidadeRESUMO
Vaccination is an indispensable tool to reduce negative outcomes due to COVID-19. Although COVID-19 disproportionately affected lower income and Black and Hispanic communities, these groups have had lower population-level uptake of vaccines. Using detailed cross-sectional data, we examined racial and ethnic group differences in New York City schoolchildren becoming fully vaccinated (two doses) within 6 months of vaccine eligibility. We matched school enrollment data to vaccination data in the Citywide Immunization Registry, a census of all vaccinations delivered in New York City. We used ordinary least squares regression models to predict fully vaccinated status, with key predictors of race and ethnicity using a variety of different control variables, including residential neighborhood or school fixed effects. We also stratified by borough and by age. The sample included all New York City public school students enrolled during the 2021-2022 school year. Asian students were most likely to be vaccinated and Black and White students least likely. Controlling for student characteristics, particularly residential neighborhood or school attended, diminished some of the race and ethnicity differences. Key differences were also present by borough, both overall and by racial and ethnic groups. In sum, racial and ethnic disparities in children's COVID-19 vaccination were present. Vaccination rates varied by the geographic unit of borough; controlling for neighborhood characteristics diminished some disparities by race and ethnicity. Neighborhood demographics and resources, and the attributes, culture and preferences of those who live there may affect vaccination decisions and could be targets of future efforts to increase vaccination rates.
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BACKGROUND: Because of the strong link between childhood obesity and adulthood obesity comorbidities, and the difficulty in decreasing body mass index (BMI) later in life, effective strategies are needed to address this condition in early childhood. The ability to predict obesity before age five could be a useful tool, allowing prevention strategies to focus on high risk children. The few existing prediction models for obesity in childhood have primarily employed data from longitudinal cohort studies, relying on difficult to collect data that are not readily available to all practitioners. Instead, we utilized real-world unaugmented electronic health record (EHR) data from the first two years of life to predict obesity status at age five, an approach not yet taken in pediatric obesity research. METHODS AND FINDINGS: We trained a variety of machine learning algorithms to perform both binary classification and regression. Following previous studies demonstrating different obesity determinants for boys and girls, we similarly developed separate models for both groups. In each of the separate models for boys and girls we found that weight for length z-score, BMI between 19 and 24 months, and the last BMI measure recorded before age two were the most important features for prediction. The best performing models were able to predict obesity with an Area Under the Receiver Operator Characteristic Curve (AUC) of 81.7% for girls and 76.1% for boys. CONCLUSIONS: We were able to predict obesity at age five using EHR data with an AUC comparable to cohort-based studies, reducing the need for investment in additional data collection. Our results suggest that machine learning approaches for predicting future childhood obesity using EHR data could improve the ability of clinicians and researchers to drive future policy, intervention design, and the decision-making process in a clinical setting.
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Índice de Massa Corporal , Aprendizado de Máquina , Obesidade Infantil/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Obesidade Infantil/diagnóstico , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de RiscoRESUMO
[This corrects the article DOI: 10.1371/journal.pone.0215571.].
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The new paradigm of recovery has highlighted the importance of positive social relationships, but little is known about their role in recovery among homeless individuals with serious mental illness and comorbid substance abuse. This study used within- and across-case analyses of longitudinal data from qualitative interviews with 41 dually diagnosed individuals entering residential programs to exit homelessness and receive needed services. Thematic findings include (a) "loner talk" and the need for privacy; (b) family ties as "good news, bad news"; (c) when it comes to a partner, other things come first; and (d) in search of positive people. Analyses of change in individual trajectories revealed that stronger social relationships did not coincide exactly with positive outcomes. Although positive life changes were gradual, negative changes could be precipitous. Social relationships were threatened by concentrated disadvantage, that is, a lack of social and economic currency. Findings are discussed with implications for improving services for the most vulnerable individuals who stand to benefit from the era of recovery.
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Pessoas Mal Alojadas/psicologia , Relações Interpessoais , Transtornos Mentais/reabilitação , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Serviços Comunitários de Saúde Mental , Diagnóstico Duplo (Psiquiatria) , Usuários de Drogas , Feminino , Humanos , Acontecimentos que Mudam a Vida , Masculino , Transtornos Mentais/complicações , Índice de Gravidade de Doença , Meio Social , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Resultado do TratamentoRESUMO
This qualitative study analyzed 72 interviews with 39 formerly homeless psychiatric consumers to develop a grounded theory model of engagement and retention in mental health and substance abuse services. Person-centered themes included severity of mental illness and substance abuse (the latter also conflicting with programmatic abstinence requirements). System-related themes inhibiting service use included program rules and restrictions and a lack of one-on-one therapy. Those promoting service use were acts of kindness by staff, pleasant surroundings, and the promise (or attainment) of independent housing. Implications of these findings are discussed in terms of integrating consumers' opinions about services to enhance treatment engagement and retention.
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Pessoas Mal Alojadas/psicologia , Pessoas Mal Alojadas/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Comorbidade , Feminino , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , New York/epidemiologia , Satisfação do Paciente , Relações Profissional-Paciente , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitaçãoRESUMO
OBJECTIVE: To examine Supplemental Nutrition Assistance Program (SNAP) recipients' use of the first online supermarket accepting Electronic Benefit Transfer (EBT) payment. METHODS: In this mixed-methods study, the authors collected EBT purchase data from an online grocer and attempted a randomized controlled trial in the South Bronx, New York City, followed by focus groups with SNAP beneficiaries aged ≥18 years. Participants were randomized to shop at their usual grocery store or an online supermarket for 3 months. Focus groups explored barriers and motivators to online EBT redemption. RESULTS: Few participants made online purchases, even when incentivized in the randomized controlled trial. Qualitative findings highlighted a lack of perceived control over the online food selection process as a key barrier to purchasing food online. Motivators included fast, free shipping and discounts. CONCLUSIONS AND IMPLICATIONS: Electronic Benefit Transfer for online grocery purchases has the potential to increase food access among SNAP beneficiaries, but challenges exist to this new food buying option. Understanding online food shopping barriers and motivators is critical to the success of policies targeting the online expansion of SNAP benefits.
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Comércio/métodos , Assistência Alimentar , Abastecimento de Alimentos/métodos , Promoção da Saúde/métodos , Internet , Adulto , Comércio/economia , Grupos Focais , Abastecimento de Alimentos/economia , Humanos , Internet/estatística & dados numéricos , Pessoa de Meia-Idade , Motivação , Cidade de Nova Iorque , Projetos Piloto , Pobreza , Adulto JovemRESUMO
BACKGROUND: Local food environments include food stores (eg, supermarkets, grocery stores, bakeries) and restaurants. However, the extent to which other storefront businesses offer food/drink is not well described, nor is the extent to which food/drink availability through a full range of storefront businesses might change over time. OBJECTIVES: This study aimed to assess food/drink availability from a full range of storefront businesses and the change over time and to consider implications for food-environment research. DESIGN: Investigators compared direct observations from 2010 and 2015. PARTICIPANTS/SETTING: Included were all storefront businesses offering foods/drinks on 153 street segments in the Bronx, NY. MAIN OUTCOME MEASURES: The main outcome was change between 2010 and 2015 as determined by matches between businesses. Matches could be strict (businesses with the same name on the same street segment in both years) or lenient (similar businesses on the same street segment in both years). Investigators categorized businesses as general grocers, specialty food stores, restaurants, or other storefront businesses (eg, barber shops/beauty salons, clothing outlets, hardware stores, laundromats, and newsstands). STATISTICAL ANALYSES PERFORMED: Investigators quantified change, specifically calculating how often businesses in 2015 were present in 2010 and vice versa. RESULTS: Strict matches for businesses in 2015 present in 2010 ranged from 29% to 52%, depending on business category; lenient matches ranged from 43% to 72%. Strict matches for businesses in 2010 present in 2015 ranged from 34% to 63%; lenient matches ranged from 72% to 83%. In 2015 compared with 2010, on 22% more of the sampled street segments, 30% more businesses were offering food/drink: 66 vs 46 general grocers, 22 vs 19 specialty food stores, 99 vs 99 restaurants, 98 vs 56 other storefront businesses. CONCLUSIONS: Over 5 years, an urban food environment changed substantially, even by lenient standards, particularly among "other storefront businesses" and in the direction of markedly greater food availability (more businesses offering food on more streets). Failure to consider a full range of food/drink sources and change in food/drink sources could result in erroneous food-environment conclusions.
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Comércio/estatística & dados numéricos , Meio Ambiente , Indústria Alimentícia/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Alimentos/estatística & dados numéricos , População Urbana , Bebidas/estatística & dados numéricos , Dieta , Ingestão de Alimentos , Fast Foods , Humanos , Cidade de Nova Iorque , Características de Residência , Restaurantes/estatística & dados numéricosRESUMO
Studies of the social lives of men and women living with co-occurring disorders (substance abuse and serious mental illness) suggest that social networks critically influence recovery. In this paper, we examine some of the reasons that the social networks of individuals with co-occurring disorders are small, and the impact of small networks for this population. Using a social capital framework with cross-case analysis, we analyze 72 in-depth qualitative interviews with 39 formerly homeless mentally ill men and women who were substance abusers. All were participants in the New York Services Study (NYSS), a federally funded study of mentally ill adults in New York City. The patterns suggest that networks shrunk because (1) social network members died prematurely, (2) study participants withdrew or pushed others away, and (3) friends and family members faced so many obstacles of their own that they could not provide resources for the study participants. We suggest that as networks diminished, some participants responded by attempting to rebuild their networks, even if the networks provided negative social capital, and others isolated themselves socially to escape the pressures and disappointments of interaction.
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Pessoas Mal Alojadas , Transtornos Mentais , Apoio Social , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Cidade de Nova IorqueRESUMO
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.
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Abastecimento de Alimentos , Pobreza , Adulto , Feminino , Humanos , Masculino , Motivação , Impostos/legislação & jurisprudênciaRESUMO
In-depth interviews were conducted with 13 formerly homeless mentally ill women to capture their individual life trajectories of mental illness, substance abuse, and trauma in their own words. Cross-case analyses produced 5 themes: (a) betrayals of trust, (b) graphic or gratuitous nature of traumatic events, (c) anxiety about leaving their immediate surroundings (including attending group treatment programs), (d) desire for one's own space, and (e) gender-related status loss and stigmatization. Findings suggest formerly homeless mentally ill women need (and want) autonomy, protection from further victimization, and assistance in restoring status and devalued identity. Avenues for intervention include enhanced provider training, addressing experiences of betrayal and trauma, and more focused attention to current symptoms rather than previous diagnoses.
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Alcoolismo/psicologia , Pessoas Mal Alojadas/psicologia , Transtornos Psicóticos/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adaptação Psicológica , Adulto , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/psicologia , Criança , Abuso Sexual na Infância/psicologia , Abuso Sexual na Infância/estatística & dados numéricos , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Diagnóstico Duplo (Psiquiatria) , Feminino , Pessoas Mal Alojadas/estatística & dados numéricos , Humanos , Entrevista Psicológica , Acontecimentos que Mudam a Vida , Pessoa de Meia-Idade , Cidade de Nova Iorque , Carência Psicossocial , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Fatores Socioeconômicos , Estatística como Assunto , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
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≤0.026) than non-Hispanic white respondents. Odds of ordering a large SSB were higher for respondents who ate in the restaurant (AOR=1.66, p<0.001) or stated that they chose beverage based on price (AOR=2.02, p<0.001). CONCLUSIONS: Young adults and customers of restaurants with a larger cup size were more likely to purchase SSBs, and their beverage calories increased with meal size. Increased understanding of these factors is an important step toward limiting unhealthy SSB consumption.
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Bebidas/estatística & dados numéricos , Fast Foods/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
To follow up on a previous study that examined how the mandated displaying of calorie information on menu boards in fast-food restaurants in New York City influenced consumers' behavior, we analyzed itemized cash register receipts and survey responses from 7,699 consumers at four fast-food chains. Using a difference-in-differences study design, we found that consumers exposed to menu labeling immediately after the mandate took effect in 2008 and at three points in 2013-14 reported seeing and using the information more often than their counterparts at fast-food restaurants without menu labeling. In each successive period of data collection, the percentage of respondents noticing and using the information declined, while remaining above the prelabeling baseline. There were no statistically significant changes over time in levels of calories or other nutrients purchased or in the frequency of visits to fast-food restaurants. Menu labeling at fast-food chain restaurants, which the Affordable Care Act requires to be implemented nationwide in 2016, remains an unproven strategy for improving the nutritional quality of consumer food choices at the population level. Additional policy efforts that go beyond labeling and possibly alter labeling to increase its impact must be considered.