Comparing life cycle environmental impacts of food access and consumption pre- and during COVID 19 in New York State's Capital Region.

The COVID-19 pandemic has significantly influenced household food shopping, food consumption, and food waste generation. However, the dietary environmental impacts for different income groups during COVID-19 remain unknown. To analyze dietary environmental impacts for various income groups, a process-based life cycle assessment (LCA) was conducted based on two electronic food access surveys implemented in the New York State's Capital Region during the COVID-19 pandemic and public and proprietary databases. We found that life cycle global warming potential, cumulative energy demand, acidification potential, and water resource depletion of per capital food consumption in the studied area tended to be lower during COVID-19 than pre-COVID-19. In contrast, life cycle eutrophication during COVID-19 was slightly higher than pre-COVID-19. The environmental impacts occurring at the food production stage were higher than those at the local transportation and waste disposal stages. The lowest income group had the lowest dietary environmental impacts due to their lowest food consumption of all the food categories. The second-highest income group had the highest dietary environmental impacts, since they consumed the most red meat which has a high impact intensity. This is the first study to our knowledge to investigate the differences in dietary environmental impacts among income groups during COVID-19.

Fruit and Vegetable Consumption, Food Acquisition Behavior, and Food Insecurity Before and After the COVID-19 Vaccine Rollout.

OBJECTIVES: To assess changes in food acquisition behavior, food insecurity, and dietary behavior and identify factors associated with fruit and vegetable (FV) consumption during the transitional period (before and after the initial vaccine rollout for all adults) of the COVID-19 pandemic. DESIGN: Successive independent samples design. Online surveys were conducted from October 2020 to February 2021 (time 1, before the vaccine rollout) and from October 2021 to December 2021 (time 2, after the vaccine rollout). Descriptive analysis examined changes in food sources, food security, and daily FV consumption in cup equivalents (CEs) from time 1 to time 2. A multivariable logistic regression analysis examined factors associated with FV consumption. SETTING: The Capital Region of New York State. PARTICIPANTS: 1553 adults 18 years of age and older. MAIN OUTCOME MEASURE: Meeting the 2020-2025 MyPlate daily FV consumption recommendations. RESULTS: There were statistically significant (P < .05) increases in the use of supermarkets, eat-in restaurants, farmers' markets, and convenience stores from time 1 to time 2. Food insecurity (40.1% vs 39.4%) and FV consumption (2.6 CE vs 2.4 CE) slightly declined but not significantly. Home food procurement such as gardening and foraging (OR, 1.61; 95% CI, 1.08-2.37) and shopping at food co-op/health food stores (OR, 1.64; 95% CI, 1.07-2.49) were significantly associated with the FV outcome, and these relationships were not modified by food security status. CONCLUSIONS: The present study highlights the importance of food sources in understanding adult dietary behavior during the transitional period of the pandemic. Continuing efforts to monitor access to food sources, food insecurity, and dietary behavior are warranted as various COVID-related emergency food assistance measures have expired.

Ambient heat and diabetes hospitalizations: Does the timing of heat exposure matter?

BACKGROUND: Although ambient heat exposure is linked with diabetes mortality, the impacts of heat exposure on diabetes-related hospitalizations remain controversial. Previous research did not examine the timing of heat-diabetes associations and relation with comorbidities/risk factors. OBJECTIVE: We examined the association between heat exposure and diabetes-related hospitalizations in the transitional and summer months and identified populations vulnerable to heat. METHODS: We conducted a time-stratified case-crossover study. Data on diabetes hospital admissions (primary diagnosis of type 1 and type 2 diabetes, 2013-2020) were collected by the New York State (NYS) Department of Health under the state legislative mandate. We treated temperature and air pollutants as continuous variables and defined the heat exposure as per interquartile range (IQR, a measure between the 25th and 75th percentiles) increase of daily mean temperature. Conditional logistic regressions were performed to quantify the heat-diabetes associations after controlling for air pollutants and time variant variables. Multiplicative-scale interactions between heat and demographics/comorbidities/risk factors on diabetes hospitalizations were investigated. RESULTS: Each IQR increase in temperature was associated with significantly increased risks for diabetes admissions that occurred immediately and lasted for an entire week during multi-day lags in the transitional month of May (ranges of excess risk: 3.1 %-4.8 %) but not in the summer (June-August) (ranges of excess risk: -0.3 %-1.3 %). The significant increases in the excess risk of diabetes were also found among diabetes patients with complications of neuronopathy (excess risk: 27.7 %) and hypoglycemia (excess risk: 19.1 %). Furthermore, the modification effects on the heat-diabetes association were significantly stronger in females, Medicaid enrollees, non-compliant patients, and individuals with comorbidities of atherosclerotic heart disease and old myocardial infarction. CONCLUSIONS: Ambient heat exposure significantly increased the burden of hospital admissions for diabetes in transitional rather than summer months indicating the importance of exposure timing. Vulnerability to heat varied by demographics and heart comorbidity.

Factors associated with fruit and vegetable consumption among Burmese refugees.

OBJECTIVE: The Burmese population is one of the fast-growing refugee populations in the USA. This study investigated behavioural and environmental factors associated with fruit and vegetable (FV) consumption among Burmese refugees. DESIGN: We conducted a cross-sectional interview survey in 2018-2019. The 24-h recall was used to assess dietary behaviour. Multivariable logistic regression models were constructed with meeting the daily FV consumption recommendation (two or more servings of fruits and three or more servings of vegetables) as the outcome variable. We selected socio-economics, nutritional knowledge, food shopping frequency, ethnicity of preferred food store owners, perceived neighbourhood food environment and network distance to preferred food stores as potential explanatory variables. SETTING: Two Upstate New York counties. PARTICIPANTS: Burmese refugees (n 173) aged ≥18 years. RESULTS: Forty-five percentage of respondents met the daily FV consumption recommendation, and nearly all respondents identified ethnic (Burmese, Chinese/pan-Asian, or South Asian/halal) stores as their preferred stores to purchase FV. In the best-fit model, age (OR 1·08, 95 % CI (1·04, 1·12)) and shopping frequency (OR 1·51, 95 % CI (1·01, 2·26)) were positively associated, and network distance to preferred stores in kilometres (OR 0·81, 95 % CI (0·73, 0·90)) was negatively associated with meeting the daily FV consumption recommendation. No significant effect modifications by car ownership, poverty, length of stay in the USA and Supplemental Nutrition Assistance Program participation were detected. CONCLUSIONS: The findings suggested that having Asian ethnic food stores within a short, walkable distance from home and shopping at these stores often can promote healthy dietary behaviour among Burmese refugees.

Association Between Tobacco Retailer Density and Smoking Among Adults With Diabetes and Serious Mental Illness in New York State.

INTRODUCTION: Smoking prevalence is high among adults with comorbid diabetes and serious mental illness. This population is at elevated risk of smoking-related health consequences and premature death. We focused on the community environment and investigated the association between tobacco retailer density and smoking in this population. METHODS: We obtained individual-level data from the 2017 Patient Characteristics Survey, a medical record-based survey of patients served by the public mental health system in New York State. We computed the density of state-authorized tobacco retailers at the 3-digit zip code level. RESULTS: The data included 19,492 adults (aged ≥18) with comorbid diabetes and serious mental illness. Of these, 55.6% resided in New York City, 53.1% were female, 38.1% were non-Hispanic White, 30.7% were non-Hispanic Black, 25.2% were Hispanic, and 38.1% were smokers, including electronic cigarette users. The density of tobacco retailers (range, 6.1-16.4 per 10,000 population) was positively associated with smoking (odds ratio = 1.05; 95% CI, 1.03-1.07) after adjusting for sex, race or ethnicity, education, employment, health insurance coverage, obesity, and region (New York City vs outside New York City). We observed no interaction between region and tobacco retailer density. CONCLUSION: Findings of this study suggest that allocating more smoking cessation resources to zip code areas with a high density of tobacco retailers, especially in rural areas, along with supporting policy change to reduce tobacco retailor density, may mitigate the negative health consequences of smoking among people with comorbid diabetes and serious mental illness.

Association between extreme ambient heat exposure and diabetes-related hospital admissions and emergency department visits: A systematic review.

Background and objectives: Diabetes is an increasing public health concern worldwide. The impact of extreme heat exposure on diabetes healthcare utilization such as diabetes-related hospital admissions and emergency department (ED) visits was understudied although extreme temperature exposure was linked with diabetes mortality. In addition, very few systematic reviews have been conducted in this field. This review aims to systematically evaluate the currently available evidence on the association between extreme ambient heat exposure and hospital admissions/ED visits for diabetes and the vulnerable population to heat extremes. Methods: A systematic literature review was conducted by using the keywords/terms "ambient temperature or heatwave or heat wave or extreme temperature or high temperature effect " and "diabetes morbidity or diabetes hospital admissions or diabetes emergency room visits " for available publications until August 2022. The heat exposure was categorized into four groups using difference definitions. The outcomes were diabetes-related hospital admissions/ED visits. A meta-analysis was performed to estimate the pooled effects of relative risk (RR)/odds ratio (OR) and 95% confidence intervals (CI) for each of the associations of interest. Results: Eighteen articles were selected from forty full-text, English written papers based on the inclusion and exclusion criteria. The overall pooled effect of excessive heat on diabetes, across all groups, was 1.045 (95% CI 1.024-1.066). The pooled effects for each exposure group were significant/borderline significant. Additionally, the pooled effect of the RR/OR was 1.100 (95% CI: 1.067-1.135) among adults aged 65 years or older. The most controlled confounders were air pollutants. The commonly listed limitation in those studies was misclassification of exposure. Conclusions: The body of evidence supports that ambient extreme heat exposure is associated with diabetes-related hospital admissions/ED visits. Additionally, adults 65 years of age or older with diabetes are vulnerable to heat extremes. Future studies should consider controlling for various biases and confounders.

A Multi-Site Analysis of the Prevalence of Food Insecurity in the United States, before and during the COVID-19 Pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support and identify long-term impacts and needs. OBJECTIVE: The National Food Access and COVID research Team (NFACT) was formed to assess food security over different US study sites throughout the pandemic, using common instruments and measurements. This study presents results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. METHODS: A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA 6-item module. Food security prevalence was analyzed using ANOVA by sampling method to assess statistically significant differences. RESULTS: Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, compared with before the pandemic. In nearly all study sites, there is a higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but a statistically higher prevalence of food insecurity among high-risk compared with convenience surveys. CONCLUSIONS: This comprehensive study demonstrates a higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to the survey implementation method.

Association between preexisting mental illnesses and mortality among medicaid-insured women diagnosed with breast cancer.

BACKGROUND: We investigated the impact of preexisting mental illnesses on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. METHODS: Data from the New York State Cancer Registry for 10,444 women diagnosed with breast cancer from 2004 to 2016 and aged <65 years at diagnosis were linked with Medicaid claims. Women were categorized as having depression or a severe mental illness (SMI) if they had at least three relevant diagnosis claims with at least one claim within three years prior to breast cancer diagnosis. SMI included schizophrenia, bipolar disorder, and other psychotic disorders. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated with Cox proportional hazards regression, adjusting for potential confounders. RESULTS: Preexisting SMI was associated with greater all-cause (HR = 1.36; 95%CI 1.18, 1.57) and cancer-specific (HR = 1.21; 95%CI 1.03, 1.44) mortality compared to those with no mental illnesses. No association was observed between preexisting depression and mortality. Among racial/ethnic subgroups, the association between SMI and all-cause mortality was observed among non-Hispanic white (HR = 1.47; 95%CI 1.19, 1.83) and non-Hispanic Asian/Pacific Islander (HR = 2.59; 95% 1.15, 5.87) women. Additionally, mortality hazards were greatest among women with preexisting SMI that were postmenopausal (HR = 1.49; 95%CI 1.25, 1.78), obese (HR = 1.58; 95%CI 1.26, 1.98), and had documented tobacco use (HR = 1.42; 95%CI 1.13, 1.78). CONCLUSION: Women with preexisting SMI prior to breast cancer diagnosis have an elevated mortality hazard and should be monitored and treated by a coordinated cross-functional clinical team.

Health Literacy and Emergency Department Utilization Among Community Adults With Mental and Chronic Health Conditions.

Reducing unnecessary emergency department (ED) utilization is a national health care priority. Low health literacy is a little explored but suggested cause of excess ED utilization. This study investigated the association between health literacy and ED utilization among a community sample of adults with common mental and chronic health conditions. Cross-sectional health interview survey data from Schenectady, New York, were used. Adults (aged ≥18 years) who were diagnosed with anxiety/emotional disorders, depression, asthma, or diabetes were included in the study. Health literacy was assessed using the three-question screener developed and validated by L. D. Chew et al. (2004). ED visits in the previous 12 months specific to these health conditions were analyzed. Multivariable regression models were fitted for each condition with incremental covariate adjustments of demographics, health care access, and number of comorbidities. Odds ratio (OR) and 95% confidence intervals (CI) were reported. Sample sizes were 404, 509, 409, and 237 for anxiety/emotional disorders, depression, asthma, and diabetes, respectively. Inadequate health literacy was significantly higher among individuals who had depression and visited an ED compared with individuals with depression without an ED visit (28.1% vs. 16.9%, p = 0.029). Significant and independent associations between inadequate health literacy and ED utilization was found among adults with anxiety/emotional disorder (fully-adjusted OR 2.22 [CI: 1.03, 4.76]) and among adults with depression (fully-adjusted OR 2.29 [CI: 1.18, 4.44]). No significant association was found among adults with asthma or diabetes. This study presented evidence that inadequate health literacy is common and independently associated with ED utilization among adults with mental health conditions. It supports an initiative to prioritize individuals with mental health conditions, and systematically screen, identify, and provide assistance to those with inadequate health literacy to reduce excess ED utilization. Several existing health literacy screening tools suitable for an emergency care setting are suggested.

The relationship between parental involvement in childhood and depression in early adulthood.

BACKGROUND: Positive early life experiences may help prevent depression later in life. We examined the accumulated benefit, timing, and trajectories of positive parental involvement in childhood in association with incident depression in early adulthood. METHODS: Prospectively assessed Avon Longitudinal Study of Parents and Children (ALSPAC) data (n = 7120) were analyzed. Overall and developmental stage-specific parental involvement scores were estimated from multiple measures from birth to age 7 years. Trajectory groups of parental involvement were derived via latent class growth analysis. At 18 years, depression cases were identified with diagnostic instruments. Multiple imputation was used to handle missingness. We constructed logistic regression models with potential confounders adjusted. RESULTS: Participants from trajectory groups with higher average parenting scores over time had 30% to 40% lower odds of developing depression in early adulthood than participants from the group with the lowest average parenting score over time. However, the relationship became non-significant when all covariates were adjusted. A one-unit increase in the overall parenting score corresponded to 12% lower odds of developing depression (adjusted OR=0.88 [0.79-0.98]). Protective effects on incident depression in early adulthood from parental involvement in school age (5-7 years), and not at other ages, were observed (OR=0.87 [0.77-0.99] for a one-unit increase in the parenting score at school age). However, the relationship became non-significant when all covariates were adjusted (OR=0.91 [0.80-1.03]). LIMITATIONS: Measurements of parental involvement were only based on maternal report. The study has limited generalizability to other racial/ethnic groups. CONCLUSION: Higher level of parental involvement during childhood lowers the risk of developing depression in early adulthood. These results suggest positive early life experiences may promote mental health across the life course.

Impact of preexisting type 2 diabetes mellitus and antidiabetic drugs on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer.

BACKGROUND: We investigated the influence preexisting type 2 diabetes mellitus (T2DM) and antidiabetic drugs have on all-cause and cause-specific mortality among Medicaid-insured women diagnosed with breast cancer. METHODS: 9221 women aged <64 years diagnosed with breast cancer and reported to the New York State (NYS) Cancer Registry from 2004 to 2016 were linked with Medicaid claims. Preexisting T2DM was determined by three diagnosis claims for T2DM with at least one claim prior to breast cancer diagnosis and a prescription claim for an antidiabetic drug within three months following breast cancer diagnosis. Estimated menopausal status was determined by age (premenopausal age <50; postmenopausal age ≥50). Hazard ratios (HR) and 95 % confidence intervals (95 %CI) were calculated with Cox proportional hazards regression, adjusting for confounders. RESULTS: Women with preexisting T2DM had greater all-cause (HR = 1.40; 95 %CI 1.21, 1.63), cancer-specific (HR = 1.24; 95 %CI 1.04, 1.47), and cardiovascular-specific (HR = 2.46; 95 %CI 1.54, 3.90) mortality hazard compared to nondiabetic women. In subgroup analyses, the association between T2DM and all-cause mortality was found among non-Hispanic White (HR 1.78 95 %CI 1.38, 2.30) and postmenopausal (HR = 1.47; 95 %CI 1.23, 1.77) women, but not among other race/ethnicity groups or premenopausal women. Additionally, compared to women prescribed metformin, all-cause mortality hazard was elevated among women prescribed sulfonylurea (HR = 1.44; 95 %CI 1.06, 1.94) or insulin (HR = 1.54; 95 %CI 1.12, 2.11). CONCLUSION: Among Medicaid-insured women with breast cancer, those with preexisting T2DM have an increased mortality hazard, especially when prescribed sulfonylurea or insulin. Further research is warranted to determine the role antidiabetic drugs have on survival among women with breast cancer.

The relationship between inflammatory dietary pattern in childhood and depression in early adulthood.

BACKGROUND: Inflammation may be a hidden process in the relationship between dietary intake and depression, but no study has evaluated the role of diet and inflammation jointly in explaining depression risk in early life. The current study aims to investigate the relationship between inflammatory dietary pattern (IDP) in childhood and depression in early adulthood. METHODS: This study used data prospectively collected over 10 years from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort (n â€‹= â€‹6939) free from depression at baseline (age 8.5 years). An IDP score was empirically derived via reduced rank regression and stepwise linear regression based on dietary intake data from the food frequency questionnaire at 8.5 years and levels of inflammatory biomarkers, C-reactive protein and interleukin-6, at 9.5 years. At age 18 years, depression cases were identified via the International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnosis and the Clinical Interview Schedule-Revised (CIS-R) depression score. Logistic regression models were constructed to examine the relationship between the IDP score and risk of depression adjusted for potential confounders. Analyses stratified by weight status were also conducted. Multiple imputations were utilized to minimize bias due to loss-to-follow-up. RESULTS: Participants in the highest tertile of IDP score had 1.34 times odds to develop depression compared to those in the lowest tertile (95% CI, 1.08-1.66; P-trend<0.01), after dietary misreporting status and energy intake were adjusted. After all covariates were adjusted, the relationship between IDP tertiles and depression was attenuated (highest tertile vs. lowest tertile: OR â€‹= â€‹1.21; 95% CI, 0.96-1.51); in addition, the relationship was marginally significant among participants who were not overweight or obese (p â€‹< â€‹0.10) but not significant among participants who were overweight or obese. CONCLUSIONS: Higher IDP in childhood seems to be associated with higher depression risk in early adulthood. The study provides preliminary evidence that chronic inflammation may underlie the relationship between diet and depression even for children, especially those who are not overweight or obese.

Effect of Change in the Supplemental Nutrition Assistance Program Guidelines on Vendor Participation and Availability of Fresh Produce.

INTRODUCTION: In January 2018, new vendor eligibility standards for the Supplemental Nutrition Assistance Program (SNAP) were fully implemented to increase availability of healthy staple and perishable foods. We examined changes in SNAP vendor participation and availability of fresh fruits and vegetables (FFV) both short-term (2015 vs 2018) and long term (2003 vs 2018) in an urban, low-income community. METHODS: We conducted food store assessments from late June through early September of 2003, 2009, 2012, 2015, and 2018 in Albany, New York. SNAP status was assessed by using the US Department of Agriculture's list of SNAP-authorized stores and in-store verification. RESULTS: Numbers of SNAP vendors were 77 in 2003, 92 in 2009, 103 in 2012, 115 in 2015, and 109 in 2018. We observed a marginally significant (P = .049) short-term (2015, 85.9% vs 2018, 73.9%) decline in SNAP participation among convenience stores but no significant short-term changes in FFV availability among either SNAP or non-SNAP vendors. In long-term (2003 through 2018) trends, we found significant (P < .01) increases in SNAP participation among farmers markets and nonprofit organizations. The proportion of SNAP vendors stocking only 1 type of FFV also significantly increased, which was likely related to a consumer trend of favoring bananas as a grab-and-go snack. CONCLUSION: Despite the decline of SNAP participation among convenience stores, which primarily came from increased program withdrawals, the new SNAP rule did not substantially alter FFV availability after 6 to 8 months of its full implementation. Long term, policy efforts increased SNAP participation among farmers markets.

Metabolic Syndrome Among Asian Indians in the United States.

INTRODUCTION: Metabolic syndrome (MetS), a clustering of cardiometabolic risk factors of type 2 diabetes and cardiovascular disease, disproportionately affects Asian Indians (AIs). We examined prevalence of MetS using 3 ethnicity-specific MetS criteria among immigrant AIs in the United States. We also examined associations between MetS and health promotion behaviors. OBJECTIVE: To present MetS prevalence estimates by the 3 ethnicity-specific criteria and investigate differences in health promotion behaviors among AIs with and without MetS to highlight the critical need for lifestyle modification strategies for this population. DESIGN: We analyzed data from a national cross-sectional study of 1037 AIs in the United States (2004-2006). We used the consensus criteria, International Diabetes Federation criteria, and modified criteria to estimate MetS prevalence. The Health Promotion Lifestyle Profile II scale measured health promotion behaviors. Bioclinical data (fasting blood glucose, triglyceride levels) were collected. Directed acyclic graphs and Likelihood Ratio Test assisted with model selection. Multiple imputation inference incorporated uncertainty due to missing data and made use of all available data. Adjusted multivariable logistic regression analysis tested for associations. RESULTS: Out of all participants, 40.3% met the consensus criteria, 34.8% met the International Diabetes Federation criteria, and 52.5% met the modified criteria. We found no statistically significant associations between engagement in health promotion measures and the prevalence of MetS and its criteria. CONCLUSION: Our study confirmed the high prevalence of MetS in the immigrant AI population in the United States. Our results showed that AIs with MetS did not exhibit an increased level of engagement in health promotion behaviors. We recommend continued refining of criteria for diagnosis and culturally suitable, age-appropriate strategies to increase engagement in healthier lifestyles among this high-risk population.

Retrospective Evaluation of the Short-Term Sustainability of the Locally Grown Produce Initiative of the Hunger Prevention and Nutrition Assistance Program in New York State.

CONTEXT: The Hunger Prevention and Nutrition Assistance Program (HPNAP) is a New York State Department of Health program. The HPNAP improves nutritional quality of food available at food banks, food pantries, soup kitchens, and emergency shelters through contractual relationships to fund the purchase, delivery, storage, and service of nutritious food. OBJECTIVE: To determine whether a one-time fiscal stimulus of the Locally Grown Produce Initiative to HPNAP contractors in 2012-2013 would result in a short-term sustainable increase in the proportion of dollars spent on New York State Grown (NYSG) produce. DESIGN: Quasi-experimental, nonequivalent control group design. We analyzed New York State Department of Health administrative data regarding expenditures on all produce and NYSG produce by HPNAP contractors. SETTING: New York State. OUTCOME MEASURES: The proportion of dollars spent on NYSG produce during 2011-2012 (preintervention) and 2013-2014 (postintervention) was compared between HPNAP food bank contractors (recipients of stimulus money, n = 8) and non-food bank contractors (nonrecipients, n = 34) using nonparametric methods. RESULTS: The HPNAP Locally Grown Produce Initiative was associated with an increased proportion of NYSG produce spending by food bank contractors that received a fiscal stimulus 1 year later. Upstate food banks had the largest increase (median 31.6%) among all HPNAP contractors. CONCLUSION: The results of this study revealed that the Locally Grown Produce Initiative fiscal stimulus had a positive, year-long and statewide effect on the proportion of expenditure on NYSG produce by food banks. We hope that the initial success seen in New York State may encourage other states to adopt similar initiatives in future.

Everyday Discrimination Experience and Depressive Symptoms in Urban Black, Guyanese, Hispanic, and White Adults.

BACKGROUND: Discrimination experience is a stressor that may disproportionately affect the mental health of minority populations. AIMS: We examined the association between discrimination experience and depressive symptoms among four urban racial/ethnic groups. METHOD: Cross-sectional community-based health survey data for Black (n = 434), Guyanese (n = 180), Hispanic (n = 173), and White (n = 809) adults aged ⩾18 years were collected in Schenectady, New York, in 2013. Discrimination experience was measured with the Everyday Discrimination Scale (EDS), and depressive symptoms were measured with the Center for Epidemiologic Studies-Depression (CES-D) scale. Logistic regression models for the association between EDS and major depressive symptoms (CES-D ⩾ 16) were fitted for each racial/ethnic group. The final model adjusted for age, sex, education, income, smoking, alcohol binge drinking, emotional/social support, and perceived stress. RESULTS: The mean EDS scores varied significantly across groups (p < .001), with 2.6 in Hispanics, 2.2 in Whites, 2.0 in Blacks, and 1.1 in the Guyanese. There was a consistent and significant independent association between EDS and major depressive symptoms in the crude model and at each step of covariate adjustment in each group. Fully adjusted odds ratios were 1.28 (95% confidence interval [CI; 1.16, 1.41]) in Blacks, 1.83 in the Guyanese [1.36, 2.47], 1.23 in Hispanics [1.07, 1.41], and 1.24 [1.16, 1.33] in Whites. The presence of covariates did not significantly modify the main effect in each group. CONCLUSIONS: This study suggests that discrimination experience can be one of the fundamental social causes of depression. It may be feasible to assess discrimination experience as a risk factor of depression in individuals of all racial/ethnic backgrounds.

A Comprehensive Health Profile of Guyanese Immigrants Aged 18-64 in Schenectady, New York.

Guyanese immigrants are the 5th largest foreign-born group in NY State, but sparse literature is available on their health status and health needs. A community-based health interview survey of Schenectady NY residents aged 18-64 (N = 1861) was analyzed. Bivariate comparisons between Guyanese respondents and White, Black, and Hispanic respondents were made for each variable to identify disparities. As predominantly low SES immigrants, Guyanese adults were less likely to be covered by health insurance, have a usual place for care, and receive cancer screenings. They were more likely to engage in alcohol binge drinking, but generally in good overall physical and mental health and less likely to smoke or report disability. Stable family structure and supportive interpersonal relationships are major assets of this group. Improved access to affordable health insurance, linkages to primary care, targeted cancer screening programs, and culturally-sensitive behavioral health services are recommended for Guyanese immigrants.

Rationale and Descriptive Analysis of Specific Health Guidance: the Nationwide Lifestyle Intervention Program Targeting Metabolic Syndrome in Japan.

AIM: All health insurers in Japan are mandated to provide Specific Health Checkups and Specific Health Guidance (SHG) focusing on metabolic syndrome (MetS) in middle-aged adults, beginning in 2008; intensive HG for individuals who have abdominal obesity and two or more additional MetS risk factors, and motivational HG for individuals with one risk factor. The aim of this study is to describe medium-term changes in health indexes for intensive and motivational HG groups using the National Database. METHODS: We compared changes of risk factors and initiation of pharmacological therapy over 3 yr between participants (n=31,790) and nonparticipants (n=189,726) who were eligible for SHG in 2008. RESULTS: Body weight reduction in intensive HG was 1.98 kg (participants) vs 0.42 kg (nonparticipants) in men (p＜0.01) and 2.25 vs 0.68 kg in women (p＜0.01) after 1 yr. In motivational HG, the respective reduction was 1.40 vs 0.30 kg in men (p＜0.01) and 1.53 vs 0.42 kg in women (p＜0.01). Waist circumference reduction was also greatest among participants in intensive HG (2.34 cm in men and 2.98 cm in women). These reductions were fairly unchanged over 3 yr and accompanied greater improvements in MetS risk factors in participants. We also detected significantly smaller percentages of SHG participants who initiated pharmacological therapy compared with nonparticipants. CONCLUSION: Participants in SHG showed greater improvements in MetS profiles with proportionally smaller pharmacological treatment initiations than did nonparticipants for 3 yr. Although selection bias may be present, this study suggests SHG would be a feasible strategy to prevent MetS and its sequelae.

Association Between Food Distress and Smoking Among Racially and Ethnically Diverse Adults, Schenectady, New York, 2013-2014.

INTRODUCTION: Smoking and poor nutrition are 2 leading preventable causes of death. This study investigated associations between smoking and indicators of individual- and neighborhood-level food distress among racially and ethnically diverse urban adults. METHODS: We analyzed data from a health interview survey and a food environment assessment collected in 2013 and 2014 in Schenectady, New York. We constructed logistic regression models for current smoking with 6 indicators of food distress as exposure variables and sociodemographic characteristics, depression, anxiety, perceived stress, alcohol binge drinking, and disability as covariates. RESULTS: The analytic sample consisted of 1,917 adults; 59.4% were female, more than half were racial/ethnic minorities (26.2% non-Hispanic black, 10.3% Hispanic, 10.9% Guyanese, 4.0% multiracial and other), and 37.1% were current smokers. All indicators of food distress remained in the parsimonious final model: consuming 0 or 1 serving of fruits and vegetables daily more than doubled the odds of smoking, compared with consuming 5 or more servings (odds ratio [OR], 2.05). Food insecurity (OR, 1.77), receiving Supplemental Nutrition Assistance Program benefits (OR, 1.79), using a food pantry (OR, 1.41), living in a neighborhood with low access to healthy food (OR, 1.40), and shopping for food often at a store with limited healthy food choices (OR, 1.38) were also associated with significantly higher odds of smoking. CONCLUSION: Recognizing that smoking and food distress are independently associated would lead to innovative public health intervention strategies. We suggest stronger collaboration between tobacco and nutrition public health professionals to synergistically reduce tobacco use and improve nutrition behavior and food environments in communities.

The association between antidepressant use and hemoglobin A1C in older adults.

Depression is known to increase diabetes risk and worsen glycemic control in older adults, who already experience high rates of diabetes. The independent impact of antidepressants on glucose control is less clear. Data was drawn from the Health and Retirement Study, a large nationally-representative longitudinal study of retired individuals. Crude and adjusted linear models stratified by diabetes status were used to examine the cross-sectional associations between antidepressant use categorized by subclass and continuous hemoglobin A1C. The sample included 1,153 individuals, most over the age of 70. Antidepressant use was not associated with hemoglobin A1C in any model whether stratified or in the total combined sample. Antidepressants as a class were also not associated with hemoglobin A1C. These findings add to the literature suggesting that antidepressants are not associated with diabetes risk or glycemic control. Prospective studies with larger sample sizes are needed to confirm this finding.