Tamara Dumanovsky

Purchasing behavior and calorie information at fast-food chains in New York City, 2007.

We surveyed 7318 customers from 275 randomly selected restaurants of 11 fast food chains. Participants purchased a mean of 827 calories, with 34% purchasing 1000 calories or more. Unlike other chains, Subway posted calorie information at point of purchase and its patrons more often reported seeing calorie information than patrons of other chains (32% vs 4%; P<.001); Subway patrons who saw calorie information purchased 52 fewer calories than did other Subway patrons (P<.01). Fast-food chains should display calorie information prominently at point of purchase, where it can be seen and used to inform purchases.

Changes in energy content of lunchtime purchases from fast food restaurants after introduction of calorie labelling: cross sectional customer surveys

Objective To assess the impact of fast food restaurants adding calorie labelling to menu items on the energy content of individual purchases. Design Cross sectional surveys in spring 2007 and spring 2009 (one year before and nine months after full implementation of regulation requiring chain restaurants’ menus to contain details of the energy content of all menu items). Setting 168 randomly selected locations of the top 11 fast food chains in New York City during lunchtime hours. Participants 7309 adult customers interviewed in 2007 and 8489 in 2009. Main outcome measures Energy content of individual purchases, based on customers’ register receipts and on calorie information provided for all items in menus. Results For the full sample, mean calories purchased did not change from before to after regulation (828 v 846 kcal, P=0.22), though a modest decrease was shown in a regression model adjusted for restaurant chain, poverty level for the store location, sex of customers, type of purchase, and inflation adjusted cost (847 v 827 kcal, P=0.01). Three major chains, which accounted for 42% of customers surveyed, showed significant reductions in mean energy per purchase (McDonald’s 829 v 785 kcal, P=0.02; Au Bon Pain 555 v 475 kcal, P<0.001; KFC 927 v 868 kcal, P<0.01), while mean energy content increased for one chain (Subway 749 v 882 kcal, P<0.001). In the 2009 survey, 15% (1288/8489) of customers reported using the calorie information, and these customers purchased 106 fewer kilocalories than customers who did not see or use the calorie information (757 v 863 kcal, P<0.001). Conclusion Although no overall decline in calories purchased was observed for the full sample, several major chains saw significant reductions. After regulation, one in six lunchtime customers used the calorie information provided, and these customers made lower calorie choices.

Consumer Awareness of Fast-Food Calorie Information in New York City After Implementation of a Menu Labeling Regulation

OBJECTIVESnWe assessed consumer awareness of menu calorie information at fast-food chains after the introduction of New York Citys health code regulation requiring these chains to display food-item calories on menus and menu boards.nnnMETHODSnAt 45 restaurants representing the 15 largest fast-food chains in the city, we conducted cross-sectional surveys 3 months before and 3 months after enforcement began. At both time points, customers were asked if they had seen calorie information and, if so, whether it had affected their purchase. Data were weighted to the number of city locations for each chain.nnnRESULTSnWe collected 1188 surveys pre-enforcement and 1229 surveys postenforcement. Before enforcement, 25% of customers reported seeing calorie information; postenforcement, this figure rose to 64% (P < .001; 38% and 72%, weighted). Among customers who saw calorie information postenforcement, 27% said they used the information, which represents a 2-fold increase in the percentage of customers making calorie-informed choices (10% vs 20%, weighted; P < .001).nnnCONCLUSIONSnPosting calorie information on menu boards increases the number of people who see and use this information. Since enforcement of New Yorks calorie labeling regulation began, approximately 1 million New York adults have seen calorie information each day.

Racial/ethnic and socioeconomic disparities in mortality among women diagnosed with cervical cancer in New York City, 1995-2006

BackgroundThough cervical cancer rates have declined due to Pap screening, racial and socioeconomic disparities in cervical cancer incidence and mortality persist. This study assesses the relative impact of race/ethnicity and neighborhood poverty on cervical cancer incidence and mortality in New York City (NYC).MethodsInvasive cervical cancer cases in NYC from 1995 to 2006 were identified along with demographic and socioeconomic measures. Odds ratios (OR) of late stage diagnosis were estimated using logistic regression. Hazard ratios (HR) of death were calculated using Cox proportional hazards regression.ResultsFrom 1995 to 2006 cervical cancer incidence and mortality rates decreased in NYC, though black and Hispanic women had higher incidence and mortality rates than white women. Puerto Ricans (ORxa0=xa01.55, 95% CIxa0=xa01.20–2.01) and blacks (ORxa0=xa01.34, 95% CIxa0=xa01.15–1.57) were more likely to be diagnosed with late stage disease than whites. In multivariate analysis, blacks had similar mortality risk (HR 1.07, 95% CIxa0=xa00.95–1.20) to whites while Puerto Ricans had increased risk (HRxa0=xa01.31, 95% CIxa0=xa01.10–1.55), and non-Puerto Rican Hispanics (HRxa0=xa00.54, 95% CIxa0=xa00.45–0.63) and Asian/PIs (HRxa0=xa00.64, 95% CIxa0=xa00.52–0.78) had reduced risk. Women living in high poverty neighborhoods had higher mortality than women in higher income neighborhoods (HRxa0=xa01.32, 95% CIxa0=xa01.16–1.52).ConclusionsBlack and Puerto Rican women in NYC are at greatest risk of dying from cervical cancer. Race/ethnicity is predictive of late stage diagnosis, while both race/ethnicity and neighborhood poverty are important predictors of cervical cancer mortality.

What people buy from fast-food restaurants: caloric content and menu item selection, New York City 2007.

Fast‐food restaurants provide a growing share of daily food intake, but little information is available in the public health literature about customer purchases. In order to establish baseline data on mean calorie intake, this study was completed in the Spring of 2007, before calorie labeling regulations went into effect in New York City. Receipts were collected from lunchtime customers, at randomly selected New York City fast‐food chains. A supplementary survey was also administered to clarify receipt items. Calorie information was obtained through company websites and ascribed to purchases. Lunchtime purchases for 7,750 customers averaged 827 calories and were lowest for sandwich chains (734 calories); and highest for chicken chains (931 calories). Overall, one‐third of purchases were over 1,000 calories, predominantly from hamburger chains (39%) and chicken chains (48%); sandwich chains were the lowest, with only 20% of purchases over 1,000 calories. “Combination meals” at hamburger chains accounted for 31% of all purchases and averaged over 1,200 calories; side orders accounted for almost one‐third of these calories. Lunch meals at these fast‐food chains are high in calorie content. Although calorie posting may help to raise awareness of the high calories in fast‐food offerings, reducing portion sizes and changing popular combination meals to include lower calorie options could significantly reduce the average calorie content of purchases.

Sodium Content of Lunchtime Fast Food Purchases at Major US Chains

C ardiovascular disease is the leading cause of death in the United States, and high blood pressure is a leading risk factor. An extensive body of research describes a direct association between sodium intake and blood pressure. Current US recommendations advise adults to limit sodium intake to less than 2300 mg/d, and several demographic groups (blacks, middle-aged and older adults, and people with hypertension), which together compose 69% of US adults, to limit daily intake to 1500 mg. Despite these suggestions, adults consume an average of approximately 3500 mg of sodium per day. Individual efforts to reduce sodium intake have limited effect, likely because more than 75% of dietary sodium comes from packaged and restaurant foods. The American Medical Association has called on industry to reduce the sodium content of processed and restaurant foods by 50%. A reduction by this amount would save tens of thousands of lives each year, and this reduction could save almost

Closing Schools in Response to the 2009 Pandemic Influenza A H1N1 Virus in New York City: Economic Impact on Households

20 billion in health care costs annually. There are limited published data on the relationship between restaurant food and sodium intake. Using data from a large cross-sectional survey of patrons exiting fast food chain restaurants in New York City (NYC), we assessed the amount of sodium in meal purchases by fast food chain and by chain category.

Health improvement from a worksite health promotion private-public partnership.

Understanding the effectiveness of a school closure in limiting social interaction and the economic impact of school closure on households is critical when developing guidelines to prevent spread of pandemic influenza. A New York City survey conducted in June 2009 in 554 households affected by the 2009 pandemic influenza H1N1-related school closures showed that, during closure, 30% of students visited at least 1 locale outside their homes. If all the adults in the home were employed, an ill child was less likely to leave home. In 17% of the households, at least 1 adult missed some work because of the closure. If all adults in the home were employed, someone was more likely to take time off work. If other children were in the household, it was less likely that an adult took time off work. The findings of our study will be important when developing future pandemic school-closure guidance.

Variation in Adult Asthma Prevalence in Hispanic Subpopulations in New York City

Objective: To examine the impact of the New York City Department of Health and Mental Hygiene’s Wellness at Work program on health risks of employees from 10 New York City organizations at 26 worksites. Methods: Employer sites were matched and assigned to receive either moderate or high intensity health promotion interventions. Changes from time 1 to time 3 in employees’ risk status on 12 health risks were examined using &khgr;2 and t tests for a cohort group (N = 930). Comparisons between moderate and high intensity groups used multivariate methods, controlling for confounders. Results: From time 1 to time 3, both moderate and high intensity sites demonstrated significant risk reductions. Nevertheless, comparisons by intervention intensity did not reveal significant differences between treatment conditions. Conclusions: Private-public partnerships to promote employee health in the workplace have the potential to reduce health risks that are precursors to chronic disease.

The Primary Care Nutrition Training Program: An Approach to Communication on Behavior Change

Background. We compared asthma prevalence among New York City Hispanics–Puerto Rican, Dominican, and other Hispanics–in relation to nativity, socioeconomic status, and asthma risk factors. Methods. Weighted logistic regression analyses on telephone survey data for New York City (NYC) adults in 2003/2004. Results. Asthma prevalence was highest among Puerto Ricans (11.8%) compared with Dominicans and other Hispanics. Non–US-born Dominicans and other Hispanics were significantly less likely to report current asthma than were Puerto Ricans (OR = 0.27, 95% CI 0.18-0.41 and OR = 0.17, 95% CI 0.11-0.26, respectively). In multivariate analyses, US-born Dominicans and other Hispanics had rates comparable to Puerto Ricans. Conclusions. Puerto Ricans, both mainland- and native-born, report the highest rates of adult asthma. Non–US-born Hispanics report lower rates. Acculturation and patterns of residential settlement may account for this variation.