Jonathan Cantor

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes.

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 childrens 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 childrens 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.

Who reports noticing and using calorie information posted on fast food restaurant menus

OBJECTIVE Identify consumer characteristics that predict seeing and using calorie information on fast food menu boards. METHODS Two separate data collection methods were used in Philadelphia during June 2010, several weeks after calorie labeling legislation went into effect: (1) point-of-purchase survey and receipt collection conducted outside fast food restaurants (N = 669) and (2) a random digit dial telephone survey (N = 702). Logistic regressions were used to predict the odds of reporting seeing, and of reporting seeing and being influenced by posted calorie information. RESULTS Approximately 35.1% of point-of-purchase and 65.7% of telephone survey respondents reported seeing posted calorie information, 11.8% and 41.7%, respectively, reported that the labels influenced their purchasing decisions, and 8.4% and 17% reported they were influenced in a healthful direction. BMI, education, income, gender, consumer preferences, restaurant chain, and frequency of visiting fast food restaurants were associated with heterogeneity in the likelihood of reporting seeing and reporting seeing and using calorie labels. CONCLUSION Demographic characteristics and consumer preferences are important determinants in the use of posted calorie information. Future work should consider the types of consumers this information is intended for, and how to effectively reach them.

Potential Effect of the New York City Policy Regarding Sugared Beverages

The authors estimate how much caloric intake could be reduced by limiting portion sizes of sugar-sweetened beverages to 16 oz.

The Introduction of a Supermarket via Tax-Credits in a Low-Income Area: The Influence on Purchasing and Consumption.

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.

When diet and exercise are not enough: an examination of lifestyle change inefficacy claims in direct-to-consumer advertising.

Previous research suggests that direct-to-consumer (DTC) advertisements for pharmaceutical drugs have the potential to influence consumers’ perceptions of whether symptoms should be treated medically and/or through behavior change. However, the relative frequency of messages emphasizing these approaches in pharmaceutical advertising remains largely unknown. A content analysis of print and television advertisements for cholesterol management medication between 1994 and 2005 (for print) and between 1999 and 2007 (for television) was conducted. First, the extent to which established theoretical constructs drawn from health communication scholarship are depicted in the content of DTC cholesterol advertisements is quantified. Second, specific claims about behavior change inefficacy when a pharmaceutical alternative is available are identified. Findings indicate that DTC ads offer many mixed messages about the efficacy of diet and exercise in reducing cholesterol and risk of heart disease. Theoretical and practical implications of this work are discussed.

New York City "Healthy Happy Meals" Bill: Potential Impact on Fast Food Purchases.

Introduction The New York City (NYC) Council recently proposed a policy (“Healthy Happy Meals” bill) to improve the nutritional quality of children’s combination meals at fast food restaurants by requiring meals with toys or promotional items meet certain nutritional criteria (Figure 1). This is similar to legislation in two California localities. One experimental study distributed toys with modified McDonald’s Happy Meals designed to comply with the California law. Children were more likely to choose healthier modified meals with the toy than unchanged meals without the toy. The present study focuses on the NYC “Healthy Happy Meals” bill and how it might impact the nutritional quality of purchases for children if the proposed targets were met.

Raising Red Flags: The Change in Deceptive Advertising of Weight Loss Products After the Federal Trade Commission's 2003 Red Flag Initiative

This study investigates whether the Federal Trade Commissions Red Flag initiative (2003), which asked the media to voluntarily cease running ads for over-the-counter weight loss products that contained facially false statements, reduced deception in such ads. Strengths of the study include a large sample of ads in both magazines and on television; an extended postguideline period; and examination of a wide variety of statements, including those that are clearly false, those that are potentially deceptive, and warnings. The results indicate that (1) the Federal Trade Commissions Red Flag initiative is associated with a significant reduction in almost all false and potentially misleading statements, (2) the reduction in deception was greater for ads on television than those in magazines, and (3) a significant number of ads in the postguideline period continued to include false and potentially misleading statements. There is suggestive evidence of offsetting behavior; specifically, at the time that false statements were becoming less common, potentially misleading statements became more common. The author conclude by exploring implications for regulatory policy.

Correlates of Sugar-Sweetened Beverages Purchased for Children at Fast-Food Restaurants

OBJECTIVES To determine consumer and fast-food purchase characteristics associated with the purchase of a sugar-sweetened beverage, as well as calories and grams of sugar, for children at a fast-food restaurant. METHODS We completed cross-sectional analyses of fast-food restaurant receipts and point-of-purchase surveys (n = 483) collected during 2013 and 2014 in New York City and Newark and Jersey City, New Jersey. RESULTS Caregivers purchased beverages for half of all children in our sample. Approximately 60% of these beverages were sugar-sweetened beverages. Fast-food meals with sugar-sweetened beverages had, on average, 179 more calories than meals with non-sugar-sweetened beverages. Being an adolescent or male, having a caregiver with a high school degree or less, having a caregiver who saw the posted calorie information, ordering a combination meal, and eating the meal in the restaurant were associated with ordering a sugar-sweetened beverage. Purchases that included a combination meal or were consumed in the restaurant included more beverage grams of sugar and calories. CONCLUSIONS Characteristics of fast-food purchases appear to have the largest and most important association to beverage calories for children at fast-food restaurants. Targeting fast-food restaurants, particularly combination meals, may improve childhood obesity rates.

Food environment does not predict self-reported SSB consumption in New York City: A cross sectional study

The purpose of this research was to examine whether the local food environment, specifically the distance to the nearest sugar sweetened beverage (SSB) vendor, a measure of SSB availability and accessibility, was correlated with the likelihood of self-reported SSB consumption among a sample of fast food consumers. As part of a broader SSB behavior study in 2013–2014, respondents were surveyed outside of major chain fast food restaurants in New York City (NYC). Respondents were asked for the intersection closest to their home and how frequently they consume SSBs. Comprehensive, administrative food outlet databases were used to geo-locate the SSB vendor closest to the respondents’ home intersections. We then used a logistic regression model to estimate the association between the distance to the nearest SSB vendor (overall and by type) and the likelihood of daily SSB consumption. Our results show that proximity to the nearest SSB vendor was not statistically significantly associated with the likelihood of daily SSB consumption, regardless of type of vendor. Our results are robust to alternative model specifications, including replacing the linear minimum distance measure with count of the total number of SSB vendors or presence of a SSB vendor within a buffer around respondents’ home intersections. We conclude that there is not a strong relationship between proximity to nearest SSB vendor, or proximity to a specific type of SSB vendor, and frequency of self-reported SSB consumption among fast food consumers in NYC. This suggests that policymakers focus on alternative strategies to curtail SSB consumption, such as improving the within-store food environment or taxing SSBs.

The response of substance use disorder treatment providers to changes in macroeconomic conditions

OBJECTIVE To study how substance use disorder (SUD) treatment providers respond to changes in economic conditions. DATA SOURCES 2000-2012 National Survey of Substance Abuse Treatment Services (N-SSATS) which contains detailed information on specialty SUD facilities in the United States. STUDY DESIGN We use fixed-effects regression to study how changes in economic conditions, proxied by state unemployment rates, impact treatment setting, accepted payment forms, charity care, offered services, special programs, and use of pharmacotherapies by specialty SUD treatment providers. DATA COLLECTION Secondary data analysis in the N-SSATS. PRINCIPAL FINDINGS Our findings suggest a one percentage point increase in the state unemployment rate is associated with a 2.5% reduction in outpatient clients by non-profit providers and a 1.8% increase in the acceptance of private insurance as a form of payment overall. We find no evidence that inpatient treatment, the provision of charity care, offered services, or special programs are impacted by changes in the state unemployment rate. However, a one percentage point increase in the state unemployment rate leads to a 2.5% increase in the probability that a provider uses pharmacotherapies to treat addiction. CONCLUSIONS Deteriorating economic conditions may increase financial pressures on treatment providers, prompting them to seek new sources of revenue or to change their care delivery models.