Density of outdoor advertising of consumable products in NYC by neighborhood poverty level.

BACKGROUND: To determine if outdoor advertising density for non-alcoholic drinks, food, tobacco products, and alcohol, is associated with neighborhood poverty or other Census-level characteristics in New York City (NYC). METHODS: From June - July of 2015, photographs were taken of all street-level, stationary outdoor advertising (posters, stickers, decals, etc.) for consumable products in a sample of 953 NYC retail-dense street segments. Density of product images was analyzed by neighborhood poverty level and other characteristics using multivariate negative-binomial regression. RESULTS: A total of 16,305 discrete advertisements displaying 50,673 product images were photographed. Total product image prevalence relative to retail density was not significantly higher in high- vs. low-poverty neighborhoods, as hypothesized (OR: 1.31; 95% CI: 0.98, 1.77). However, total product image prevalence was higher in neighborhoods with a higher percentage of Black residents (OR: 1.08; 95% CI: 1.04, 1.12), and for sugary drinks in areas with a higher percentage of adults with

Sugary Drink Consumption Among NYC Children, Youth, and Adults: Disparities Persist Over Time, 2007-2015.

Sugary drink consumption is associated with many adverse health outcomes, including weight gain, diabetes, and other chronic conditions. These beverages are widely marketed and ubiquitously available. This analysis explores sugary drink consumption across all age groups among New York City (NYC) residents using representative survey data. Three population-based representative surveys of NYC residents of different age groups were analyzed. Adult participants, youth participants, and caregivers of child participants self-reported the number of sugary drinks they consumed per day. Mean sugary drink intake per day was estimated overall and by demographic characteristics, for the 2015 cycle of each survey and the 2007-2015 cycles of the adult survey. T tests were used to determine whether means differed by demographics. Long-term trends in mean sugary drink consumption among adult participants were conducted to examine changes over time overall and by demographic characteristics. In 2015, the mean daily number of sugary drinks consumed was 0.53 (95% CI 0.45, 0.61) among children 0-5 years old, 1.05 (95% CI 0.90, 1.21) among children 6-12 years old, and 1.16 (95% CI 1.09, 1.29) among NYC high school students. Among all NYC adults, sugary drink intake decreased 36% from 1.03 (95% CI 0.99, 1.08) in 2007 to 0.66 (95% CI 0.62, 0.70) drinks per day in 2015, p < 0.01. However, at each age level, there were persistent disparities in sugary drink consumption by sex, race/ethnicity, educational attainment, and poverty level. Decreasing overall rates of sugary drink consumption are promising; however, disparities by socio-demographics are a concern. Reducing sugary drink consumption across all ages is recommended as is minimizing the introduction at an early age. Reduction of sugary drink consumption will require a collaborative, multi-sectoral approach.

Comparing sugary drinks in the food retail environment in six NYC neighborhoods.

Obesity is a national public health concern linked to numerous chronic health conditions among Americans of all age groups. Evidence suggests that discretionary calories from sugary drink consumption have been a significant contributor to excess caloric intake among both children and adults. Research has established strong links between retail food environments and purchasing habits of consumers, but little information exists on the sugary drink retail environment in urban neighborhoods. The objective of this assessment was to compare various aspects of the sugary drink retail environment across New York City (NYC) neighborhoods with disparate self-reported sugary drink consumption patterns. In-store retail audits were conducted at 883 corner stores, chain pharmacies, and grocery stores in 12 zip codes throughout NYC. Results showed that among all beverage types assessed, sugary drinks had the most prominent presence in the retail environment overall, which was even more pronounced in higher-consumption neighborhoods. In higher- versus lower-consumption neighborhoods, the mean number of sugary drink varieties available at stores was higher (11.4 vs. 10.4 varieties), stores were more likely to feature sugary drink advertising (97 vs. 89 %) and advertising at multiple places throughout the store (78 vs. 57 %), and several sugary drinks, including 20-oz Coke® or Pepsi®, were less expensive ($1.38 vs. $1.60). These results, all statistically significant, indicate that neighborhoods characterized by higher levels of sugary drink consumption expose shoppers to sugary drinks to a greater extent than lower-consumption neighborhoods. This builds upon evidence documenting the association between the environment and individual behavior.

Calorie intake, sugar-sweetened beverage consumption, and obesity among New York City adults: findings from a 2013 population study using dietary recalls.

Obesity and overweight-obesity have contributed to increases in early mortality and noncommunicable disease incidence. The consumption of sugar-sweetened beverages (SSBs) is linked to obesity, weight gain, and metabolic syndrome. To further explore this relationship in a large urban environment, we assessed disparities in calorie intake between SSB and non-SSB consumers and determine the association between varying SSB consumption, obesity, and overweight-obesity using data from a 2013 representative dietary survey conducted in New York City. Results show that adult SSB drinkers consume 193 kcal/day from SSBs, approximately 10% of daily caloric needs. Compared to non-SSB drinkers, those who consume SSBs have a 572 kcal greater daily intake. Total calorie differences are due to greater SSB calorie and food calorie consumption. Among SSB consumers, each 10-oz increase in SSB consumption is associated with a greater likelihood of obesity (OR 1.62, 95% CI 1.05, 2.05) and overweight-obesity (OR 2.23, 95% CI 1.31, 3.80). Additionally, each 10-kcal SSB increase is related to obesity (OR 1.04, 95% CI 1.01, 1.08) and overweight-obesity (OR 1.07, 95% CI 1.02, 1.11).

Evaluation of the New York City breakfast in the classroom program.

OBJECTIVES: We determined the impact of Breakfast in the Classroom (BIC) on the percentage of children going without morning food, number of locations where food was consumed, and estimated calories consumed per child. METHODS: We used a cross-sectional survey of morning food consumed among elementary school students offered BIC and not offered BIC in geographically matched high-poverty-neighborhood elementary schools. RESULTS: Students offered BIC (n = 1044) were less likely to report not eating in the morning (8.7%) than were students not offered BIC (n = 1245; 15.0%) and were more likely to report eating in 2 or more locations during the morning (51.1% vs 30%). Overall, students offered BIC reported consuming an estimated 95 more calories per morning than did students not offered BIC. CONCLUSIONS: For every student for whom BIC resolved the problem of starting school with nothing to eat, more than 3 students ate in more than 1 location. Offering BIC reduced the percentage of students not eating in the morning but may contribute to excess calorie intake. More evaluation of BIC's impact on overweight and obesity is needed before more widespread implementation.

Disparities in Sugary Drink Advertising on New York City Streets.

INTRODUCTION: Studies show that outdoor advertisements for unhealthy, consumable products are associated with increased intake and often target youth, low-income neighborhoods, and neighborhoods of color. Despite evidence that overconsumption of sugary drinks contributes to obesity and other chronic conditions, little is known specifically regarding the patterns of outdoor sugary drink advertising. METHODS: The number of outdoor, street-level advertisements featuring sugary drinks was assessed in a random sample of retail-dense street segments (N=953) in low, medium, and high-poverty neighborhoods in each of New York City's 5 boroughs in 2015. Negative binomial regression was used to determine associations between sugary drink ad density, poverty level, and other census tract-level demographics (2009-2013 estimates) in each borough and New York City overall. Data were analyzed in 2017-2019. RESULTS: In New York City and in 3 of 5 boroughs, sugary drink ad density was positively associated with increased percentages of black, non-Latino residents (New York City: incidence rate ratio=1.20, p<0.001; Bronx: incidence rate ratio=1.30, p=0.005; Brooklyn: incidence rate ratio=1.18, p<0.001; Manhattan: incidence rate ratio=1.20, p<0.05). Positive associations were also observed with poverty level in Brooklyn (low versus medium poverty: incidence rate ratio=2.16, p=0.09; low versus high poverty: incidence rate ratio=2.17, p=0.02) and Staten Island (low versus medium poverty: incidence rate ratio=3.27, p=0.03). CONCLUSIONS: This study found a consistent positive association between the density of outdoor sugary drink advertisements and the presence of non-Latino black residents in New York City and, in some boroughs, evidence of a positive association with neighborhood poverty. These findings highlight the inequities where sugary drinks are advertised in New York City.

Healthy Checkout Lines: A Study in Urban Supermarkets.

OBJECTIVE: To understand the impact of healthy checkouts in Bronx, New York City supermarkets. DESIGN: Consumer purchasing behavior was observed for 2 weeks in 2015. SETTING: Three supermarkets in the South Bronx. PARTICIPANTS: A total of 2,131 adult shoppers (aged ≥18 years) who paid for their groceries at 1 of the selected study checkout lines. INTERVENTION: Two checkout lines were selected per store; 1 was converted to a healthy checkout and the other remained as it was (standard checkout). Data collectors observed consumer behavior at each line and recorded items purchased from checkout areas. MAIN OUTCOME MEASURES: Percentage of customers who purchase items from the checkout area; quantity and price of healthy and unhealthy items purchased from the healthy and standard checkout lines. ANALYSIS: Measures were analyzed by study condition using chi-square and t tests; significance was determined at α = .05. RESULTS: Only 4.0% of customers bought anything from the checkout area. A higher proportion of customers using the healthy vs standard checkout line bought healthy items (56.5% vs 20.5%; P < .001). CONCLUSIONS AND IMPLICATIONS: When healthier products were available, the proportion of healthy purchases increased. Findings contribute to limited research on effectiveness of healthy checkouts in supermarkets. Similar interventions should expect an increase in healthy purchases from the checkout area, but limited overall impact.

Small Convenience Stores and the Local Food Environment: An Analysis of Resident Shopping Behavior Using Multilevel Modeling.

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.

Food shopping behaviors of residents in two Bronx neighborhoods.

BACKGROUND: Numerous researchers have documented associations between neighborhood food environments and residents' diets. However, few quantitative studies have examined the food shopping behaviors of residents in low-income neighborhoods, including the types of stores patronized and frequency of visits. This study presents findings on the food shopping behaviors of residents in the Bronx neighborhoods of West Farms and Fordham. METHODS: Street-intercept surveys were conducted in spring 2012 with residents of West Farms and Fordham as part of a broader program evaluation. The survey included questions on general food shopping behaviors including visits to neighborhood bodegas (corner stores) and supermarkets, mode of transportation to the supermarket most commonly frequented, and the primary source for purchases of fruits and vegetables. RESULTS: The survey was conducted with 505 respondents. The sample was 59% Hispanic and 34% black, with a median age of 45 years. Thirty-four percent of respondents had less than a high school education, 30% were high school graduates or had their GED, and 36% had attended some college. Almost all respondents (97%) shopped at supermarkets in their neighborhood; 84% usually shopped at a supermarket within their neighborhood, and 16% usually shopped at a supermarket outside of their neighborhood. Most respondents (95%) shopped at bodegas in their neighborhood, and 65% did so once per day or more. CONCLUSIONS: Residents of these neighborhoods have high exposure to local food stores, with the vast majority of respondents shopping at neighborhood supermarkets and bodegas and almost 2 in 3 respondents going to bodegas every day. These findings demonstrate the important role of supermarkets and bodegas in local residents' shopping patterns and support the inclusion of these stores in efforts to create food environments that support and promote healthy eating.

Validation of self-rated overall diet quality by Healthy Eating Index-2010 score among New York City adults, 2013.

OBJECTIVE: Chronic conditions such as cardiovascular disease and cancer can result from a number of diet-related environmental and behavioral factors. Screening for poor diet is helpful in developing interventions to prevent chronic disease, but measuring dietary behavior can be costly and time-consuming. The purpose of this study was to test the ability of a self-rated, single-item measure for evaluating diet quality among individuals and populations. METHODS: A 24-h dietary recall and single-item self-rated diet quality measure were collected for 485 adults. From dietary recalls, Healthy Eating Index-2010 (HEI) scores were computed and compared with self-rated diet quality. Data were collected in 2013 among adult (18 years and older) New York City residents. RESULTS: The study sample was 57% female, 47% white, 56% college educated, and 45% in the highest income tertile. The mean HEI score was 56.5 out of a possible 100. Women averaged higher HEI scores compared to men (58.1 vs 54.3, p = .01). There was a modest yet significant correlation between HEI scores and self-rated diet quality (ρ = 0.29, p < .01). Overall, mean HEI score increased as self-rated diet quality improved (from 48.2 for "poor" to 63.0 for "excellent"). CONCLUSIONS: The single-item measure of self-rated diet quality may provide a simple method of identifying those with the worst diet quality. Further investigation of this measure's validity is needed with alternative measures of dietary intake and with health outcomes.