"Be honest and gain trust": a population health study to understand the factors associated with building trust in local government related to COVID-19 and vaccination in three historically disinvested neighborhoods in New York City.

Background: Distrust in government among people of color is a response to generations of systemic racism that have produced preventable health inequities. Higher levels of trust in government are associated with better adherence to government guidelines and policies during emergencies, but factors associated with trust and potential actions to increase trust in local government are not well understood. Methods: The COVID-19 Community Recovery study sampled participants from the New York City (NYC) Department of Health and Mental Hygiene's NYC Health Panel, a probability-based survey panel who complete health surveys periodically. Participants who lived in one of three historically disinvested communities in NYC where the NYC Department of Health and Mental Hygiene has dedicated resources to reduce health inequities were included. The cross-sectional survey was fielded from September 30 to November 4, 2021 and could be self-administered online or conducted via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese (Mandarin and Cantonese by phone). Demographic data were summarized by descriptive statistics. Crude and adjusted logistic regression analyses were used to assess factors predictive of trust in local government as a source of information about COVID-19 vaccines. Open-ended responses about strengthening residents' trust in local government were coded using an iteratively generated codebook. Results: In total, 46% of respondents indicated NYC local government was a trusted source of information about COVID-19 vaccines, relatively high compared to other sources. In bivariate analyses, race/ethnicity, age group, educational attainment, length of time living in NYC, and household income were significantly associated with identifying NYC government as a trusted source of information about COVID-19 vaccines. In multivariable logistic regression, no variables remained significant predictors of selecting local government as a trusted source of information. Key recommendations for local government agencies to build residents' trust include communicating clearly and honestly, addressing socioeconomic challenges, and enhancing public COVID-19 protection measures. Conclusion: Study findings demonstrate that nearly half of residents in three historically divested NYC communities consider local government to be a trusted source of information about COVID-19 vaccines. Strategies to increase trust in local government can help reduce community transmission of COVID-19 and protect public health.

Disruption of Healthcare in New York City During the COVID-19 Pandemic: Findings From Residents Living in North and Central Brooklyn, the South Bronx, and East and Central Harlem.

INTRODUCTION: The COVID-19 pandemic has disproportionately affected some New York City (NYC) neighborhoods that primarily consist of Black, Indigenous, and Latinx residents. In comparison to the rest of NYC, these neighborhoods experienced high hospitalization and COVID-related death rates, which has been attributed to a longstanding history of structural racism and disinvestment. While stay-at-home orders were implemented to reduce the spread of COVID-19, this may have also affected access and utilization of non-COVID related healthcare services. This study aims to assess the prevalence of and reasons for the disruption of non-COVID related healthcare services during the first 18 months of the pandemic. METHODS: From September 30, 2021 to November 4, 2021, the NYC Health Department administered the COVID-19 Community Recovery Survey to a subset of residents who were part of the NYC Health Panel a probability-based survey panel. This cross-sectional survey, which included closed and open-ended questions, was either self-administered online or completed via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese. Descriptive statistics were used to summarize responses and unweighted, weighted, age-adjusted percentages, and 95% Confidence Intervals (CIs) were calculated. RESULTS: With a response rate of 30.3% (N = 1358), more than half of participants (54%) reported disruption to either routine physical healthcare or mental health services. Concern about getting COVID-19 (61%), stay-at-home policies (40%), belief that care could safely be postponed (35%), and appointment challenges (34%) were among reasons for delaying routine healthcare. Concern about getting COVID-19 (38%) and reduced hours of service (36%) were primary reasons for delaying mental healthcare. Reported reasons for the sustained delay of care past 18 months involved COVID concerns, appointment, and insurance challenges. CONCLUSIONS: Due to the pandemic, some disruption to healthcare was expected. However, most study participants either avoided or experienced a delay in healthcare. The delay of non-COVID related healthcare throughout the pandemic may result in the further widening of the health inequity gap among NYC residents dealing with a higher chronic disease burden before the start of the COVID-19 pandemic in March 2020. Findings from this study can support equitable COVID-19 recovery, and guide efforts with health promotion.

Marketing Sustainability Analysis of Stores Participating in a Healthier Retail Food Program.

OBJECTIVES: To examine how food retailers completing Shop Healthy NYC, a healthy food retail program, (1) changed availability, placement, and promotion of healthier food immediately after participation and (2) sustained changes 1-year postintervention. METHODS: From 2014 to 2017, stores in 2 high-poverty New York City neighborhoods participated in a low-intensity intervention focused on in-store advertising or a high-intensity intervention to meet 7 criteria related to availability, placement, and promotion of healthy items. Stores were assessed preintervention (Pre), 1-month postintervention (Post 1), and 12-16 months postintervention (Post 2). Analyses were restricted to stores that completed the intervention and were assessed at all time points (n = 64). Changes were compared across time points. RESULTS: Across stores participating in the low-intensity intervention, the ratio of unhealthy-to-healthy ads decreased from Pre to Post 1, and by Post 2 remained improved over baseline. Among stores participating in the high-intensity intervention, the median number of healthy criteria met increased from 3.5 to 6 from Pre to Post 1 and decreased to 5 at Post 2. CONCLUSIONS: Improvements in the marketing and availability, placement, and promotion of healthy products are feasible but may require reinforcement and additional support over time.

Implementation Facilitators and Challenges of a Place-Based Intervention to Reduce Health Disparities in Harlem Through Community Activation and Mobilization.

Background: To address significant health inequities experienced by residents of public housing in East and Central Harlem compared to other New Yorkers, NYC Department of Health and Mental Health (DOHMH) collaborated with community and academic organizations and the New York City Housing Authority to develop a place-based initiative to address chronic diseases in five housing developments, including a community activation and mobilization component led by community health organizers (CHOs). Purpose: Guided by the Consolidated Framework for Implementation Research (CFIR), we evaluated the initial implementation of the community activation and mobilization component to systematically investigate factors that could influence the successful implementation of the intervention. Methods: Nineteen in-depth qualitative interviews were conducted with a purposive sample of CHOs, community members and leaders, collaborating agencies and DOHMH staff. Interviews were transcribed verbatim, and themes and codes were developed to identify theoretically important concepts of the CFIR and emergent analytic patterns. Results: Findings identified important facilitators to implementation: positive community perception of the program, CHO engagement and responsiveness to community needs, CHO norms and values and adaptability of DOHMH and CHOs to community needs. Challenges included the instability of the program in the first year, limited ability to address housing related issues, concerns about long term funding, competing community priorities, low expectations by the community for the program, time and labor intensity to build trust within the community, and the dual roles of CHOs as community advocates and DOHMH employees. Conclusions: Findings will guide future community activation and mobilization activities. The study demonstrates the value of integrating implementation science and health equity frameworks.

The Community Assessment to Inform Rapid Response (CAIRR): A Novel Qualitative Data Collection and Analytic Process to Facilitate Hyperlocal COVID-19 Emergency Response Operations in New York City.

All disasters are local but implementing a hyperlocal response in the midst of a public health emergency is challenging. The availability of neighborhood-level qualitative data that are both timely and relevant to evolving objectives and operations is a limiting factor. In 2020, the New York City Department of Health and Mental Hygiene (NYC DOHMH) responded to the COVID-19 emergency using a novel, hyperlocal approach. Key to the implementation of this approach was the creation of the Community Assessment to Inform Rapid Response (CAIRR), a process for rapid collection and analysis of neighborhood-specific, objective-focused, qualitative data to inform tailored response operations. This paper describes the process of developing the CAIRR and its contribution to the NYC DOHMH's hyperlocal response in order to guide other jurisdictions seeking to employ a hyperlocal approach in future disaster responses.

Resident Experiences With a Place-Based Collaboration to Address Health and Social Inequities: A Survey of Visitors to the East Harlem Neighborhood Health Action Center.

In 2016 and 2017, the New York City Department of Health and Mental Hygiene established Neighborhood Health Action Centers (Action Centers) in disinvested communities of color as part of a place-based model to advance health equity. This model includes co-located partners, a referral and linkage system, and community space and programming. In 2018, we surveyed visitors to the East Harlem Action Center to provide a more comprehensive understanding of visitors' experiences. The survey was administered in English, Spanish, and Mandarin. Respondents were racially diverse and predominantly residents of East Harlem. The majority had been to the East Harlem Action Center previously. Most agreed that the main service provider for their visit made them feel comfortable, treated them with respect, spoke in a way that was easy to understand, and that they received the highest quality of service. A little more than half of returning visitors reported engaging with more than one Action Center program in the last 6 months. Twenty-one percent of respondents reported receiving at least one referral at the Action Center. Two thirds were aware that the Action Center offered a number of programs and services and half were aware that referrals were available. Additional visits to the Action Center were associated with increased likelihood of engaging with more than one program and awareness of the availability of programs and referral services. Findings suggest that most visitors surveyed had positive experiences, and more can be done to promote the Action Center and the variety of services it offers.

"Come with us for a week, for a month, and see how much food lasts for you:" A Qualitative Exploration of Food Insecurity in East Harlem, New York City.

BACKGROUND: Food insecurity refers to uncertain access to food on a consistent basis and the stress experienced by families who worry about having sufficient resources to provide balanced meals in their households. Food insecurity has a disproportionate influence on people of color. A robust body of evidence links food insecurity to poor health outcomes. OBJECTIVE: To document experiences of food insecurity among linguistically and ethnically diverse residents of the East Harlem neighborhood of New York City by exploring the ways in which food availability and cost intersect with household budgets, personal preferences, and shopping strategies. DESIGN: In-depth qualitative interviews were conducted with adult residents of New York City's East Harlem neighborhood to provide insights about the links between food insecurity, well-being, and quality of life. PARTICIPANTS/SETTING: Thirty-seven adult residents of East Harlem were recruited through purposive sampling. Eligibility requirements included living in an East Harlem zip code (10029 or 10035); being aged 18 years or older; being the main food shopper and food decision-maker in the household; and speaking English, Spanish, or Mandarin Chinese. The study was conducted from February to May 2018. STATISTICAL ANALYSES PERFORMED: Interviews were analyzed using a grounded theory approach. Codes were organized into broad thematic topics and cross-case analyses were conducted. RESULTS: Participants discussed overall perceptions of food insecurity and seven themes related to the challenges of and strategies for coping with food insecurity: intermittent vs chronic food insecurity, shopping and budgeting strategies, pantries as a vital community resource, social support systems, food insecurity and health, frustration with an unjust system, and pride in "making it work." CONCLUSIONS: To manage food insecurity, many study participants carefully managed food spending, dedicated substantial time to visiting stores and accessing food pantries, and relied on a public benefits cycle that left many without sufficient financial resources at the end of each month.

Building a Culture of Health at the Neighborhood Level Through Governance Councils.

To explore facilitators and barriers to developing and sustaining collaboration among New York City Department of Health and Mental Hygiene's Neighborhood Health Action Centers and co-located partners, who share information and decision-making through a Governance Council structure of representative members. Semi-structured interviews were conducted in 2018 with 43 Governance Council members across the three Action Centers of East Harlem (13), Tremont (15), and Brownsville (15), New York City. Governance Council members identified collaboration through information- and resource-sharing, consistent meetings and continuous communication as valuable for fostering a culture of health in their communities. Immediate benefits included building relationships, increased access to resources, and increased reach and access to community members. Challenges included difficulty building community trust, insufficient advertisement of services, and navigation of government bureaucracy. The Governance Councils forged collaborative relationships among local government, community-based organizations and clinical providers to improve health and well-being in their neighborhoods. Sharing space, resources and information is feasible with a movement towards shared leadership and decision-making. This may result in community-driven and tailored solutions to historical inequities. In shared leadership models, some internal reform by Government partners may be required.

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.

The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center.

Place-based approaches have been promoted as one way to reduce health inequities by addressing community-level factors that shape health, such as housing quality, healthcare systems, the built environment, and social capital. In 2016-2017, the NYC Health Department's Center for Health Equity launched three Neighborhood Health Action Centers (Action Centers), which use a place-based approach to improve health in neighborhoods with disproportionate burdens of premature mortality. We describe this approach and the genesis of the Action Centers. We then describe the East Harlem Action Center, which was the first to open, and share findings from qualitative interviews with the East Harlem Action Center's Governance Council, a group comprised of Action Center staff and co-located partners and programs which supports Action Center coordination. Interviewees felt that collaboration, being responsive to community needs, and being community based were essential elements of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members' expectations and hopes for the East Harlem Action Center were consistent with the overall vision and model for the Action Centers, which may facilitate implementation.

Health in Action: Evaluation of a Participatory Grant-Making Project in East Harlem.

Decision-making processes that include resident input have been shown to be effective in addressing community needs. However, few examples discuss the role of a local health department in leading a participatory decision-making process. In 2016, the New York City Department of Health and Mental Hygiene implemented a participatory grant-making process to allocate grant funds to community organizations in East Harlem. Findings from the evaluation suggest that a participatory grant-making process can be an effective way to include community member as decision makers. It can also build capacity among organizations and foster meaningful community engagement with a local health department.

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

A Cohort Review Approach Evaluating Community Health Worker Programs in New York City, 2015-2017.

The objective of this study was to describe how a cohort review approach was applied as an evaluation framework for a community health worker intervention among adult residents in 5 public housing developments in New York City in 2015-2017. The cohort review approach involved systematically monitoring participants engaged in the Harlem Health Advocacy Partners program during a given time period ("cohort") to assess individual outcomes and program performance. We monitored participation status (completed, still active, disengaged, on leave, or died) and health outcomes. In this example of a cohort review, levels of enrollment and program disengagement were higher in cohort 1 than in cohort 2. For 6-month health outcomes, the percentage of participants with hypertension who had controlled blood pressure was static in cohort 1 and improved significantly in cohort 2. The percentage of participants with diabetes who self-reported controlled hemoglobin A1c increased significantly in cohort 1 at 6-month follow-up. The cohort approach highlighted important outcome successes and identified workload challenges affecting recruitment and retention.

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.

A Place-Based Community Health Worker Program: Feasibility and Early Outcomes, New York City, 2015.

INTRODUCTION: This study examined feasibility of a place-based community health worker (CHW) and health advocate (HA) initiative in five public housing developments selected for high chronic disease burden and described early outcomes. METHODS: This intervention was informed by a mixed-method needs assessment performed December 2014-January 2015 (representative telephone survey, n=1,663; six focus groups, n=55). Evaluation design was a non-randomized, controlled quasi-experiment. Intake and 3-month follow-up data were collected February-December 2015 (follow-up response rate, 93%) on 224 intervention and 176 comparison participants, and analyzed in 2016. All participants self-reported diagnoses of hypertension, diabetes, or asthma. The intervention consisted of chronic disease self-management and goal setting through six individual CHW-led health coaching sessions, instrumental support, and facilitated access to insurance/clinical care navigation from community-based HAs. Feasibility measures included CHW service satisfaction and successful goal setting. Preliminary outcomes included clinical measures (blood pressure, BMI); disease management behaviors and self-efficacy; and preventive behaviors (physical activity). RESULTS: At the 3-month follow-up, nearly all intervention participants reported high satisfaction with their CHW (90%) and HA (76%). Intervention participants showed significant improvements in self-reported physical activity (p=0.005) and, among hypertensive participants, self-reported routine blood pressure self-monitoring (p=0.013) compared with comparison participants. No improvements were observed in self-efficacy or clinical measures at the 3-month follow-up. CONCLUSIONS: Housing-based initiatives involving CHW and HA teams are acceptable to public housing residents and can be effectively implemented to achieve rapid improvements in physical activity and chronic disease self-management. At 3-month assessment, additional time and efforts are required to improve clinical outcomes.

Evaluation of the Farmers' Markets for Kids programme.

OBJECTIVE: To assess the impact of Farmers' Markets for Kids, a farmers' market-based, child-oriented nutrition education programme, on attitudes and behaviours related to preparing and consuming produce among child participants and their caregivers in New York City (NYC). DESIGN: Retrospective pre-test/post-test cross-sectional survey with caregivers of children participating in Farmers' Markets for Kids classes. SETTING: Four NYC farmers' markets where Farmers' Markets for Kids classes are implemented; these markets serve low-income communities. SUBJECTS: Two hundred and twelve adult caregivers of children who participated in Farmers' Markets for Kids classes. RESULTS: Caregivers reported that children's consumption of fruits and vegetables had increased since participating in Farmers' Markets for Kids and that their children more frequently assisted with food preparation; both of these improvements were statistically significant. Caregivers also reported significant improvements in attitudes: since participating in Farmers' Markets for Kids, their children were more willing to try new fruits and vegetables and caregivers found it easier to prepare fruits and vegetables for their children. Almost all respondents (99 %) reported purchasing more fruits and vegetables since participating in Farmers' Markets for Kids and 95 % had prepared the programme's recipes at home. CONCLUSIONS: Findings suggest that Farmers' Markets for Kids may be an effective approach for increasing produce consumption among participating children and improving related attitudes among children and caregivers. This evaluation provides support for future efforts to undertake more rigorous evaluations of such programmes.

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.

A Mixed-Methods Evaluation of a SNAP-Ed Farmers' Market-Based Nutrition Education Program.

OBJECTIVE: Evaluate the effectiveness of the Stellar Farmers' Market program. DESIGN: Mixed methods including focus groups and a quasi-experiment comparing a control group of market shoppers who had never attended a class, participants attending 1 class, and participants attending ≥ 2 classes. SETTING: Eighteen farmers' markets in New York City. PARTICIPANTS: A total of 2,063 survey respondents; 47 focus group participants. INTERVENTION: Farmers' market-based nutrition education and cooking classes paired with vouchers for fresh produce. MAIN OUTCOME MEASURES: Attitudes, self-efficacy, and behaviors regarding fruit and vegetable (FV) preparation and consumption. ANALYSIS: Bivariate and regression analysis examined differences in outcomes as a function of number of classes attended. Qualitative analysis based on a grounded theory approach. RESULTS: Attending ≥ 1 classes was associated with more positive attitudes toward consuming FV; attending ≥ 2 classes was associated with greater FV consumption and higher self-efficacy to prepare and consume produce. Respondents attending ≥ 2 classes consumed almost one-half cup more FV daily than others. These associations remained after controlling for age, race/ethnicity, education, and gender. CONCLUSIONS AND IMPLICATIONS: Offering nutrition education and cooking classes at farmers' markets may contribute to improving attitudes, self-efficacy, and behaviors regarding produce preparation and consumption in low-income populations.

Evaluation of the New York City Green Carts program.

Access to fresh fruits and vegetables is a concern, particularly among low-income populations. Mobile vending is one strategy to expand produce availability and access to increase consumption. In 2008, New York City launched a mobile vending initiative, Green Carts. We report on the evaluation. Three waves of cross-sectional observational surveys of produce availability, variety, and quality were conducted during the summers of 2008, 2009, and 2011 in a stratified random sample of stores and carts comparing establishments in Green Cart neighborhoods (n = 13) with comparison neighborhoods (n = 3). Bivariate analyses for availability, variety, and quality comparing Green Cart and comparison neighborhoods were presented across years, and logistic and negative binomial regressions were used to test whether fruit and vegetable availability, variety, and quality increased in Green Cart compared with comparison neighborhoods, adjusting for clustering and neighborhood demographics. Establishments selling fruits and vegetables in Green Cart neighborhoods increased between 2008 and 2011 (50% to 69%, p <0.0001); there was no comparable increase in comparison neighborhoods. Establishments selling more than 10 fruits and vegetables types increased from 31% to 38% (p = 0.0414) in Green Cart neighborhoods; there was no change in comparison neighborhoods. Produce quality was high among comparison establishments, with 95% and 94% meeting the quality threshold in 2008 and 2011, while declining in Green Cart neighborhood establishments from 96% to 88% (p < 0.0001). Sustained produce availability was found in Green Cart neighborhoods between 2008-2011. Green Carts are one strategy contributing to improving produce access among New Yorkers.

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.