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Background: Dietary trans fat increases risk for coronary heart disease. In 2006, New York City (NYC) passed the first regulation in the United States restricting trans fat use in restaurants. Objective: To assess the effect of the NYC regulation on the trans and saturated fat content of fast-food purchases. Design: Cross-sectional study that included purchase receipts matched to available nutritional information and brief surveys of adult lunchtime restaurant customers conducted in 2007 and 2009, before and after implementation of the regulation. Setting: 168 randomly selected NYC restaurant locations of 11 fast-food chains. Participants: Adult restaurant customers interviewed in 2007 and 2009. Measurements: Change in mean grams of trans fat, saturated fat, trans plus saturated fat, and trans fat per 1000 kcal per purchase, overall and by chain type. Results: The final sample included 6969 purchases in 2007 and 7885 purchases in 2009. Overall, mean trans fat per purchase decreased by 2.4 g (95% CI, <2.8 to -2.0 g; P <0.001), whereas saturated fat showed a slight increase of 0.55 g (CI, 0.1 to 1.0 g; P 0.011). Mean trans plus saturated fat content decreased by 1.9 g overall (CI, -2.5 to -1.2 g; P < 0.001). Mean trans fat per 1000 kcal decreased by 2.7 g per 1000 kcal (CI, 3.1 to 2.3 g per 1000 kcal; P < 0.001). Purchases with zero grams of trans fat increased from 32% to 59%. In a multivariate analysis, the poverty rate of the neighborhood in which the restaurant was located was not associated with changes. Limitation: Fast-food restaurants that were included may not be representative of all NYC restaurants. Conclusion: The introduction of a local restaurant regulation was associated with a substantial and statistically significant decrease in the trans fat content of purchases at fast-food chains, without a commensurate increase in saturated fat. Restaurant patrons from high- and low-poverty neighborhoods benefited equally. However, federal regulation will be necessary to fully eliminate population exposure to industrial trans fat sources. Primary Funding Source: City of New York and the Robert Wood Johnson Foundation Healthy Eating Research program. [ABSTRACT FROM AUTHOR]

The article summarizes a report from the New York City Department of Health and Mental Hygiene which analyzed body mass index (BMI) data from public school children in kindergarten through eighth grade (K-8) from the 2006-07 to 2010-2011 school years. Findings show that the overall prevalence of obesity in grades K-8 decreased by 5.5 percent during the periods. The need for continuous public health interventions to further reduce obesity is suggested.

OBJECTIVES:In 2003, in response to low colonoscopy screening rates and significant sociodemographic disparities in colonoscopy screening in New York City (NYC), the NYC Department of Health and Mental Hygiene, together with the Citywide Colon Cancer Control Coalition, launched a multifaceted campaign to increase screening. We evaluated colonoscopy trends among adult New Yorkers aged 50 years and older between 2003 and 2007, the first five years of this campaign.METHODS:Data were analyzed from the NYC Community Health Survey, an annual, population-based surveillance of New Yorkers. Annual prevalence estimates of adults who reported a timely colonoscopy, one within the past 10 years, were calculated. Multivariate models were used to analyze changes over time in associations between colonoscopy screening and sociodemographic characteristics.RESULTS:Overall, from 2003 to 2007 the proportion of New Yorkers aged 50 years and older who reported timely colonoscopy screening increased from 41.7% to 61.7%. Racial/ethnic and sex disparities observed in 2003 were eliminated by 2007: prevalence of timely colonoscopy was similar among non-Hispanic whites, non-Hispanic blacks, Hispanics, men, and women. However, Asians, the uninsured, and those with lower education and income continued to lag in receipt of timely colonoscopies.CONCLUSIONS:The increased screening colonoscopy rate and reduction of racial/ethnic disparities observed in NYC suggest that multifaceted, coordinated urban campaigns can improve low utilization of clinical preventive health services and reduce public-health disparities. [ABSTRACT FROM AUTHOR]

Objectives. We assessed consumer awareness of menu calorie information at fast-food chains after the introduction of New York City's health code regulation requiring these chains to display food-item calories on menus and menu boards. Methods. At 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. Results. We 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). Conclusions. Posting calorie information on menu boards increases the number of people who see and use this information. Since enforcement of New York's calorie labeling regulation began, approximately 1 million New York adults have seen calorie information each day. [ABSTRACT FROM AUTHOR]

Decades after key modifiable risk factors were identified, cardiovascular disease remains the leading cause of preventable death, and only one quarter of persons with high cholesterol levels have attained recommended levels of control. Cholesterol control efforts have focused on consumer education and medical treatment. A powerful, complementary approach is to change the makeup of food, a route the New York City Department of Health and Mental Hygiene took when it restricted artificial trans fat—a contributor to coronary heart disease—in restaurants. The Department first undertook a voluntary campaign, but this effort did not decrease the proportion of restaurants that used artificial trans fat. In December 2006, the Board of Health required that artificial trans fat be phased out of restaurant food. To support implementation, the Department provided technical assistance to restaurants. By November 2008, the restriction was in full effect in all New York City restaurants and estimated restaurant use of artificial trans fat for frying, baking, or cooking or in spreads had decreased from 50% to less than 2%. Preliminary analyses suggest that replacement of artificial trans fat has resulted in products with more healthful fatty acid profiles. For example, in major restaurant chains, total saturated fat plus trans fat in French fries decreased by more than 50%. At 2 years, dozens of national chains had removed artificial trans fat, and 13 jurisdictions, including California, had adopted similar laws. Public health efforts that change food content to make default choices healthier enable consumers to more successfully meet dietary recommendations and reduce their cardiovascular risk. [ABSTRACT FROM AUTHOR]

To promote use of essential clinical preventive services, the New York City Department of Health and Mental Hygiene developed the Public Health Detailing Program, a primary care provider outreach initiative modeled on pharmaceutical detailing. Department representatives conducted topical campaigns, making unscheduled visits to health care practices and meeting with providers and office staff members. Representatives distributed "action kits" containing practice tools, provider information, and patient education materials; nicotine replacement therapy was distributed during the smoking cessation campaign. More than 2,500 interactions with practice staff members were completed by six health department representatives at approximately 200 sites. Physician visits lasted 10 minutes or longer, and by provider self-report, use of office systems for prevention and adherence to recommended practices increased. Public health detailing is an effective method of reaching providers to deliver key prevention messages, feasible for public health agencies and acceptable to practices. The effectiveness of this intervention in improving clinical prevention services requires further evaluation. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of obesity in children in kindergarten through eighth grade (K-8) in New York City from 2006-2007 to 2010-2011 academic years based on an analysis conducted by the New York City Department of Health and Mental Hygiene. The analysis found a 5.5% reduction in child obesity in 2006-2007 and 20.7% in 2010-2011. Body mass index (BMI) data for public schoolchildren in K-8 was used in the analysis. White and Asian/Pacific Islander children aged 5-6 years showed greater decrease in obesity prevalence compared with Hispanic and African American children. Some factors that possibly contributed to the overall decrease in prevalence include regulations that require improved nutrition and increased physical activity among children. INSET: What is already known on this topic?.

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. (Am J Public Health. 2008;98:1457-1459. doi: 10.2105/AJPH.2008.135020) [ABSTRACT FROM AUTHOR]

Poor diet is a leading cause of disability, death, and rising health care costs. Government agencies can have a large impact on population nutrition by adopting healthy food purchasing policies. In 2007, New York City (NYC) began developing a nutrition policy for all foods purchased, served, or contracted for by City agencies. A Food Procurement Workgroup was created with representatives from all City agencies that engaged in food purchasing or service, and the NYC Health Department served as technical advisor. The NYC Standards for Meals/Snacks Purchased and Served (Standards) became a citywide policy in 2008. The first of its kind, the Standards apply to more than 3,000 programs run by 12 City agencies. This paper describes the development process and initial implementation of the Standards. With more than 260 million meals and snacks per year covered, the Standards increase demand for healthier products, model healthy eating, and may also affect clients’ food choices beyond the institutional environment. Our experience suggests that implementation of nutrition standards across a wide range of diverse agencies is feasible, especially when high-level support is established and technical assistance is available. Healthy procurement policies can ensure that food purchased by a jurisdiction supports its public health efforts. [Copyright &y& Elsevier]

Introduction: Scalable self-management interventions are necessary to address suboptimal diabetes control, especially among minority populations. The study tested the effectiveness of a telephone behavioral intervention in improving glycemic control among adults with diabetes in the New York City A1c Registry.Design: RCT comparing a telephone intervention to print-only intervention in the context of the A1c Registry program.Setting/participants: Nine hundred forty-one adults with diabetes and hemoglobin A1c (A1c) >7% from a low-income, predominantly Latino population in the South Bronx were recruited from the A1c Registry.Intervention: All study participants were mailed print diabetes self-management materials at baseline and modest lifestyle incentives quarterly. Only the telephone participants received four calls from health educators evenly spaced over 1 year if baseline A1c was >7%-9%, or eight calls if baseline A1c was >9%. Medication adherence was the main behavioral focus and, secondarily, nutrition and exercise.Main Outcome Measures: Primary outcome was difference between two study arms in change in A1c from baseline to 1 year. Secondary outcomes included diabetes self-care activities, including self-reported medication adherence. Data were collected in 2008-2012 and analyzed in 2012-2014.Results: Participants were predominantly Latino (67.7%) or non-Latino black (28%), with 69.7% foreign-born and 55.1% Spanish-speaking. Among 694 (74%) participants with follow-up A1c, mean A1c decreased by 0.9 (SD=0.1) among the telephone group compared with 0.5 (SD=0.1) among the print-only group, a difference of 0.4 (95% CI=0.09, 0.74, p=0.01). The intervention had significant effect when baseline A1c was >9%. Both groups experienced similar improvements in self-care activities, medication adherence, and intensification.Conclusions: A telephone intervention delivered by health educators can be a clinically effective tool to improve diabetes control in diverse populations, specifically for those with worse metabolic control identified using a registry. This public health approach could be adopted by health systems supported by electronic record capabilities. CLINICALTRIALS.Gov Registration: NCT00797888. [ABSTRACT FROM AUTHOR]

Background: Although studies have demonstrated that stair prompts are associated with increased physical activity, many were conducted in low-rise buildings over a period of weeks and did not differentiate between stair climbing and descent. Purpose: This study evaluated the impact of a prompt across different building types, and on stair climbing versus descent over several months. Methods: In 2008–2009, stair and elevator trips were observed and analyzed at three buildings in New York City before and after the posting of a prompt stating “Burn Calories, Not Electricity” (total observations=18,462). Sites included a three-story health clinic (observations=4987); an eight-story academic building (observations=5151); and a ten-story affordable housing site (observations=8324). Stair and elevator trips up and down were recorded separately at the health clinic to isolate the impact on climbing and descent. Follow-up was conducted at the health clinic and affordable housing site to assess long-term impact. Results: Increased stair use was seen at all sites immediately after posting of the prompt (range=9.2%–34.7% relative increase, p<0.001). Relative increases in stair climbing (20.2% increase, p<0.001) and descent (4.4% increase, p<0.05) were seen at the health clinic. At both sites with long-term follow-up, relative increases were maintained at 9 months after posting compared to baseline: 42.7% (p<0.001) increase in stair use at the affordable housing site and 20.3% (p<0.001) increase in stair climbing at the health clinic. Conclusions: Findings suggest that the prompt was effective in increasing physical activity in diverse settings, and increases were maintained at 9 months. [Copyright &y& Elsevier]

In 2006, New York City's Health Department amended the city Health Code to require the posting of calorie counts by chain restaurants on menus, menu boards, and item tags. This was one element of the city's response to rising obesity rates. Drafting the rule involved many decisions that affected its impact and its legal viability. The restaurant industry argued against the rule and twice sued to prevent its implementation. An initial version of the rule was found to be preempted by federal law, but a revised version was implemented in January 2008. The experience shows that state and local health departments can use their existing authority over restaurants to combat obesity and, indirectly, chronic diseases. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the impact of the Wellness at Work program of the New York City Department of Health and Mental Hygiene on health risk of employees from ten organizations at 26 worksites in New York City. The method used in the study was done by matching and assigning the employer sites to receive either moderate or high intensity health promotion interventions. It was concluded that private-public partnerships which may promote employee health in the workplace have the capacity to decrease health risks which are precursor to chronic disease.

Background: Given evidence of widespread underuse of recommended clinical preventive services and chronic disease management, New York City developed the Public Health Detailing Program, a primary care provider outreach initiative to increase uptake of best practices on public health priorities. Purpose: The goal of the study was to evaluate the effectiveness of the Public Health Detailing Program in helping primary care providers and their staff to improve patient care on public health challenges. Methods: An analysis was conducted of reported changes in clinical practice or behavior by examining providers'' retention and implementation of recommendations for campaigns. Results: During each campaign, 170 to 443 providers and 136 to 221 sites were reached. Among providers who responded to questions on changes in their practice behavior, the following significant increases occurred from baseline to follow-up. Screening for clinical preventive services increased, including routinely screening for intimate partner violence (14%–42%). Clinical management increased, such as prescribing longer-lasting supplies of medicine (29%–42%). Lifestyle modification and behavior change, such as recommending increased physical activity to patients with high cholesterol levels, rose from 52% to 73%. Self-management goal-setting with patients increased, such as using a clinical checkbook to track hemoglobin HbA1c goals (28% to 43%). Conclusions: Data suggest that public health detailing can be effective for linking public health agencies and their recommendations to providers and influencing changes in clinical practice behavior. [Copyright &y& Elsevier]