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Dietitians are key in addressing existing diet-related health inequities, yet, research is lacking concerning how dietitians’ experiences working within culturally diverse communities. Addressing this gap, we interviewed fifteen dietitians working with Hispanic Caribbean (HC) communities in New York City, an understudied community with high incidence of diet-related conditions, to assess the best practices and experienced barriers when working with these communities. The best practices identified included building rapport, incorporating cultural values, and addressing food access. However, the interviews revealed important barriers that prevented successful implementation of these best practices. These included personal factors (language, food culture knowledge, food preferences), lack of culturally-relevant resources, cultural challenges that prevented engaging clients in participatory decision making, and institution-related constraints (time scarcity and funding). The findings underscore the need for improved training for dietitians to be better equipped to work with communities with different cultural and economic backgrounds from their own, for more culturally-relevant resources and funding to address underlying causes of diet-related health disparities in minority populations, and for increased diversity in the profession. Furthermore, our focus on Hispanic Caribbean communities expands existing research promoting cultural competence in the profession, presenting experiences working in with this large segment of the Hispanic community in the United States.

Hispanics in the USA, particularly those of Caribbean descent, experience high levels of diet-related diseases and dietary risk factors. Restaurants are an increasingly important yet understudied source of food and may present opportunities to positively influence urban food environments. We sought to explore food environments further, by examining the association between neighborhood characteristics and restaurant consumer nutrition environments within New York City's Hispanic Caribbean (HC) restaurant environments. We applied an adapted version of the Nutrition Environment Measurements Survey for Restaurants (NEMS-R) to evaluate a random sample of HC restaurants (n=89). NEMS-HCR scores (continuous and categorized as low, medium, and high based on data distribution) were examined against area sociodemographic characteristics using bivariate and logistic regression analysis. HC restaurants located in Hispanic geographic enclaves had a higher proportion of fried menu items (p6), compared with their medium (aOR: 6.6, 95% CI: 1.8-24.6) and large counterparts (aOR: 5.6, 95% CI: 1.5-21.4). This research is the first to examine the association between restaurant location and consumer nutrition environments, providing information to contribute to future interventions and policies seeking to improve urban food environments in communities disproportionately affected by diet-related conditions, as in the case of HC communities in New York City.

Intuitive Eating (IE) and Health at Every Size (HAES) are health promotion paradigms used by dietitians in private practice more commonly than in community-based practice where more diverse and vulnerable populations are served. The primary objective of this study was to examine the perceived barriers and facilitators that dietitians encounter when using IE and HAES in community nutrition practice settings. This phenomenological, qualitative study applied a grounded theory analysis to identify emergent themes from transcripts of semi-structured interviews with 27 dietitians working in community settings in the United States. Dietitians reported the following perceived barriers to the use of IE/HAES: diet culture which was often expressed as inconsistent messages patients receive from the media and other professionals that conflict with nutrition providers’ messages; legislative restrictions and weight-centric administrative policies; and personal beliefs of clients and colleagues concerning weight and health. Dietitians reported occupational autonomy as a salient factor facilitating the use of IE/HAES in community practice and identified the need for shifts in attitudes about weight and its relation to health achieved through research and dissemination of information on weight-inclusive practices. Collectively, respondents experienced more systemic barriers than individual barriers and identified several macro-level facilitators that remain elusive. The unique experiences of RDNs in community practice provide a roadmap for ongoing research to establish the evidence base for best practices, inform education and training, and achieve cultural shifts that move towards weight-inclusive practice in this setting. More research is needed to explore the generalizability of these experiences.

Introduction: Latin American restaurants (LARs) are an increasingly important food source with the potential to positively influence diets to promote cardiovascular health. Yet, modifiable factors influencing food choices in LARs remain unclear. Determinants frameworks, such as the Capabilities, Opportunities, and Motivation for Behavior (COM-B Model) can help identify key drivers of dietary behaviors for informing intervention design. Objectives: (1) Apply the COM-B model to understand healthy eating behavior at LARs; (2) Examine differences in COM-B factors by ethnicity (Latin/Hispanic background), age, income, gender, and education. Methods: We developed a Likert scale to quantitatively assess the capabilities (physical and psychological), opportunities (social and physical), and motivation (reflective and automatic) factors associated with healthy eating in LARs. The scale was applied as part of an online survey with adults in the United States that reported eating food from LARs at least once a month (n=509). Bivariate analyses were used to examine the association between COM-B scores and demographic characteristics. Results: Within a possible range of 0-12, the mean COM-B total score was 7.35±1.97. Higher overall scores were significantly associated with being from a Latin background (p=0.04) and having a higher income (p=0.02). Within a possible range of 0-2 for COM-B area scores, the lowest score was found for Psychological Capability (0.95±0.97), where higher mean scores were found among men (p=0.03), older age (p=0.04), and those with higher education (p Conclusions: This work addresses a research gap to inform future interventions to improve community food environments through work with LARs. The application of the COM-B revealed areas for intervention, particularly the need to improve knowledge (Psychological Capability) and social opportunity, the areas with the lowest scores, to promote healthier eating behaviors at LARs. Future research can be used to promote innovative ways to change perceptions of Latin foods in LARs and awareness of existing healthy offerings, which at the same time may help motivate LARs owners in increasing healthy offerings.

This introductory chapter presents the book’s motivation and theoretical underpinnings. It opens with the author’s personal trajectory as a Puerto Rican moving to the United States as an adult, and the resulting dietary changes. This personal story grounds the book’s argument, highlighting the need for examining the structural factors (i.e., race, class, and gender) that shape our food practices and the outcomes of such actions, through facilitating or hindering access to care, food, and overall living conditions. The chapter also introduction also includes the theoretical and methodological underpinnings of the book, reviewing scholarship addressing cuisine, diets, and Hispanic Caribbean communities in New York City.

Based on interviews with Dominicans, Cubans and Puerto Ricans and the author’s experiences, this chapter examines food practices as drivers for dietary change and maintenance in the Hispanic Caribbean community. The analysis demonstrates the influence of structural factors (particularly gender, social class, and migratory status) in food practices, underscoring that migrants’ eating patterns are the result of much more than ethnic identity and changes upon migration.

This chapter outlines the histories of Cubans, Puerto Ricans, and Dominicans, and their foodways (including food markets and restaurants), in New York City, covering the early arrivals in the mid-1800s, the large migratory waves of the mid-twentieth century, and the contemporary communities using archival sources (city guides, magazines, newspapers), and existing scholarship from historians and migration scholars. The history is used to show how global and structural factors influenced the movement of these communities to the city, and how these same factors resulted in different racialization processes, which in turn have affected the communities’ wellbeing and health outcomes.

This chapter weaves public health nutrition scholarship with interviews with registered dietitians working with the Hispanic Caribbean community in New York City to examine how nutrition experts describe the diet-related problems in the community, its causes and solutions. The main problems discussed are diabetes and obesity, which are explained using an over-emphasis on culture, where tradition is seen as the cause and solution to health disparities in the community, following a linear view of dietary acculturation. The chapter also shows that the emphasis on culture diminishes the important role of structural and environmental factors, such as poverty and racism.

This final chapter brings the book full circle from the opening in the introduction by examining how cuisines have changed in the Hispanic Caribbean (Puerto Rico, Cuba, Dominican Republic) and the current economic and political situations shaping the communities in the region and in the United States. The chapter discusses the communities outside of New York City, including other points of encounter in the United States and changes in migratory trajectories. It then outlines key lessons learned from the comparative analysis presented in the book and proposes new ways forward for public health interventions to address existing health inequities using structure-inclusive approaches, including emerging food justice movements in the community and food environment interventions.

The chapter uses field interviews with Dominicans, Cubans, and Puerto Ricans in New York City to examine the global and structural factors that influence community formation is reflected in discourse concerning traditional diets. The interviews demonstrate internalized notions of traditional diets (“comidas”) being largely unhealthy, described using nutrient-dense language (“nutri-speak”). The notions of traditional diets as unhealthy are linked to the associations of the cuisine as born out of poverty and a history of slavery and motivate a detachment from the cuisine expressed by some caribeños (particularly Cubans). Hence, contrary to the emphasis on culture often placed by nutrition experts, the interviews demonstrate that the maintenance of traditional food practices is influenced by migration histories and the relationship individuals hold with their heritage country.

Melissa Fuster thinks expansively about the multiple meanings of comida, food, from something as simple as a meal to something as complex as one’s identity. She listens intently to the voices of New York City residents with Cuban, Dominican, or Puerto Rican backgrounds, as well as to those of the nutritionists and health professionals who serve them. She argues with sensitivity that the migrants’ health depends not only on food culture but also on important structural factors that underlie their access to food, employment, and high-quality healthcare. People in Hispanic Caribbean communities in the United States present high rates of obesity, diabetes, and other diet-related diseases, conditions painfully highlighted during the COVID-19 pandemic. Both eaters and dietitians may blame these diseases on the shedding of traditional diets in favor of highly processed foods. Or, conversely, they may blame these on the traditional diets of fatty meat, starchy root vegetables, and rice. Applying a much needed intersectional approach, Fuster shows that nutritionists and eaters often misrepresent, and even racialize or pathologize, a cuisine’s healthfulness or unhealthfulness if they overlook the kinds of economic and racial inequities that exist within the global migration experience.

Americans spend the majority of their food dollars at restaurants and other prepared food sources, including quick-service and fast-food restaurants (PFS); independent small restaurants make up 66% of all PFS in the US. In this feasibility study, 5 independent and Latino-owned PFS in the Washington DC metro area worked with academic partners to start offering healthy combo meals with bottled water and promote these using on-site, community, and social media advertising. The number of healthy combos sold was collected weekly, showing that the new combos sold, and customers in all 5 sites were surveyed as they exited the PFS (n=50): >85% had noticed the combo meals; 100% thought it was a good idea to offer it, 68% had ordered the combo (of these, >94% of customers responded that they liked it). Results suggest that it is feasible to work with independent Latino-owned restaurants to promote healthy combos and collect data.

Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youthn13, Age (Mean ±sd) 20 y ± 5⋅4, Parents (n6) and Grandparents (n6) age 58⋅7 ± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US.

This study used interviews with New York City Hispanic Caribbean (HC) restaurant owners, managers, and cooks/chefs (n=19) to examine perceptions concerning the healthfulness of the HC diet and diet-related disparities in the HC community, and document factors potentially influencing their engagement in community nutrition interventions. The interviews revealed high awareness of diet-related issues. Respondents had mixed notions concerning their role in improving community food environments, noting important barriers for collaboration to consider in future interventions. The study underscores the important role of ethnic restaurants, providing information to facilitate engagement with this largely untapped sector in immigrant/ethnic communities in the US.

We utilized key informant interviews to examine traditional diet (TD) perceptions among members of the Hispanic Caribbean (HC) community in New York City (Dominicans, Cubans and Puerto Ricans, n = ...

OBJECTIVES: Examine the acceptability and potential barriers for the implementation of healthy eating promoting (HEP) strategies in independently-owned Latin American restaurants (LAR), including the influence of the COVID-19 pandemic. METHODS: LAR owners and staff were recruited via social media and community networks across the US. Potential participants completed an online survey (n = 20) on demographic and restaurant characteristics and current HEP strategies. Subsequently, we conducted semi-structured, online interviews with LAR owners and staff (n = 13) to examine attitudes of and barriers to the implementation of HEP strategies. Each verbatim transcript was analyzed by two coders using Dedoose, following an iterative process. Excerpts were rated according to how open respondents were to implement potential strategies (1 = opposed, 2 = neutral, 3 = open). RESULTS: The survey revealed that the most common HEP strategies already in place were offering vegetarian options (80%) and seafood (75%). The interviews asked about additional, potential HEP strategies, showing that the highest rated was the provision of nutrition information, with all excerpts rated as “open” (rate = 3). This was followed by increasing healthy options, notably vegetarian dishes (Mean excerpt rate = 2.9 ± 0.3); menu highlights (2.6 ± 0.9); and promotion of healthier options (2.5 ± 0.7). Portion size changes were rated the lowest (1.1 ± 0.3). The results included barriers identified for each strategy, the influence of COVID-19, and alternative strategies identified. CONCLUSIONS: Latin communities present higher dietary risk factors for chronic disease, compared to non-Hispanic Whites. LARs are a significant source of dietary intake and have the potential to positively influence eating behaviors but are seldom engaged by public health. This research aimed to bridge this gap, finding common grounds for potential collaborations benefiting both community health and the wellbeing of these important community institutions. FUNDING SOURCES: National Institutes of Health/NHLBI and the Centers for Disease Control and Prevention.

OBJECTIVES: (1) Examine changes in healthy food availability among Hispanic Caribbean restaurants (HCR) in response to COVID-19. (2) Assess the association between changes and restaurant type. METHODS: A random sample of HCRs (n = 89) offering Cuban, Dominican, Puerto Rican cuisine, were examined in Summer 2019 (T1) using the NEMS-HCR, an adapted version of the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and reassessed after the onset of COVID-19 in January 2021 (T2, n = 76) using online menus. We examined menu changes between T1 and T2 data sets in the NEMS-HCR overall healthy food availability (HFA) score, and specific variables: the number of healthy main dish salads (HMDS) and the menu proportion of nonfried foods (NFF) on the menu. We then examined changes by restaurant type (sit-down vs. counter-style) using repeated measures ANOVA. RESULTS: Between T1 and T2, 7 HRCs permanently closed, 1 closed for the season, and 5 were excluded due to lack of online menus. Mean proportion of NFF significantly decreased from 71.7% ± 17.5 (T1) to 66.1% ± 17.8 (T2) (P = 0.002). Changes in HFA scores (4.5 ± 2.0 to 4.1 ± 2.2) and HMDS (1.7 ± 2.8 to 1.8 ± 3.0) were not statistically significant (P = 0.06 and P = 0.65, respectively). Repeated measures ANOVA indicated no correlation between the decrease in availability of NFF between T1 and T2 and restaurant type (P = 0.29). CONCLUSIONS: Restaurants can play a significant role in the mitigation of diet-related diseases such as cardiovascular disease and diabetes by providing customers with healthy menu offerings. Our study showed a decrease in healthier menu options, particularly non-fried entrees, contributing to our understanding of how restaurants may need to adapt for their own survival in times of crisis such as a pandemic or disaster. Because unfavorable menu options can contribute to the rising incidence of diet-related chronic diseases within the community, more research is needed to understand how restaurants respond to crises in order to better support the preservation of HFA within their menu selections, and the effects of these changes in customers’ diets. FUNDING SOURCES: CUNY PSC Award and NIH National Heart, Lung, and Blood Institute

Restaurants are understudied yet increasingly important food environment institutions for tackling diet-related diseases. This scoping review analyzes research and gray literature (n = 171 records) to assess which healthy eating promotion strategies have been implemented in restaurants and the associated motivations, barriers, and outcomes, compared by restaurant type (corporate/chain vs. independently owned restaurants) and initiator (restaurant-initiated vs. investigator-initiated). We found that the most commonly reported strategy was the increase of generally healthy offerings and the promotion of such offerings. Changes in food availability were more common among corporate restaurants and initiated by restaurants, while environmental facilitators were more commonly initiated by investigators and associated with independently owned restaurants. Aside from those associated with revenue, motivations and barriers for healthy eating promoting strategies varied by restaurant type. While corporate restaurants were also motivated by public health criticism, independently owned restaurants were motivated by interests to improve community health. Revenue concerns were followed by food sourcing issues in corporate restaurants and lack of interest among independently owned restaurants. Among reporting sources, most outcomes were revenue positive. This study shows the need for practice-based evidence and accounting for restaurant business models to tailor interventions and policies for sustained positive changes in these establishments.

Objective: To adapt and apply the Nutri­tion Environment Measures Survey for Res­taurants (NEMS-R) to Hispanic Caribbean (HC) restaurants and examine associations between restaurant characteristics and nutrition environment measures.Methods: We adapted the NEMS-R for HC cuisines (Cuban, Puerto Rican, Dominican) and cardiovascular health-promoting fac­tors, and applied the instrument (NEMS-HCR) to a random sample of HC restau­rants in New York City (NYC) (N=89). Multivariable linear regression was used to assess independent associations between NEMS-HCR score and restaurant charac­teristics (cuisine, size, type [counter-style vs sit-down] and price).Results: None of the menus in the res­taurants studied listed any main dishes as “healthy” or “light.” More than half (52%) offered mostly (>75%) nonfried main dishes, and 76% offered at least one vegetarian option. The most common facilitator to healthy eating was offering reduced portion sizes (21%) and the most common barrier was having salt shak­ers on tables (40%). NEMS-HCR scores (100-point scale) ranged from 24.1-55.2 (mean=39.7). In multivariable analyses, scores were significantly related to cuisine (with Puerto Rican cuisine scoring lower than Cuban and Dominican cuisines), and size (with small [

OBJECTIVES: Examine the nutrition environment in Hispanic Caribbean (HC) restaurants, and identify restaurant-level factors associated with healthier nutrition restaurant environments. METHODS: We adapted the Nutrition Environment Measure Survey for Restaurants (NEMS-R) to HC cuisines and applied the instrument (NEMS-HCR) to a random sample of Cuban, Puerto Rican, and Dominican restaurants in New York City (n = 89). Descriptive and regression analysis examined the associations between the NEMS-HCR score and restaurant characteristics (HC cuisine, restaurant type, and midpoint price). RESULTS: No restaurant offered dishes labeled as healthy and almost none (2%) offered whole grains or fruit. Half of the restaurants (52%) had menus with a large proportion (>75%) of nonfried (NF) main dishes and three-quarters (76%) offered at least one vegetarian option. The most common environmental facilitator to healthy eating was offering reduced portion sizes (21%) and the most common barrier was having salt shakers on tables (40%). NEMS-HCR scores (100-point scale) ranged from 24.1–55.2 (mean = 39.7). Scores varied by cuisine and size category, but not by restaurant type (sit-down vs fast casual). Puerto Rican restaurants had the lowest mean score, compared with Dominican and Cuban restaurants (33.7 ± 6.8, 39.6 ± 6.4, 43.3 ± 6.9, respectively, P

This article examines the policy change process that resulted in the current sugar-sweetened beverages taxes in Mexico and Chile, using the Kaleidoscope Model for Policy Change, a framework developed for nutrition and food policy change analysis. We used a qualitative study design, including 24 key informant (KI) interviews (16 researchers, 5 civil society representatives and 3 food/beverage industry representatives), encompassing global and in-country perspectives. The analysis shows concurrence with the Kaleidoscope Model, highlighting commonalities in the policy change process. These included the importance of focusing events and coalitions for agenda-setting. Both top-down executive leadership and bottom-up pressure from civil society coalitions were important for the policy adoption as were flexible framing of the tax, and taking advantage of windows of opportunity. In both countries, the tax resulted from national, revenue-seeking fiscal reforms and in sub-optimal tax rates, as a result of the industry influence. KIs also discussed emerging evaluation results, highlighting differences in interpretation concerning the magnitude of change from the tax, and shared potential modifications to the current policies. This analysis contributes to a greater understanding of the policy change process focused on obesity prevention, using an innovative theoretical framework developed specifically for food and nutrition policy.

To understand the process by which immigrants adopt dietary practices, this study offers a binational comparison of factors that predispose, enable, and reinforce healthful eating in the sending and receiving countries. Data are from two qualitative studies that examined barriers and facilitators to healthful eating in El Salvador (four focus groups, n = 28 adults) and in the US (30 in-depth interviews n = 15 mothers recently migrated from Central America). There was a strong emphasis on hygiene and vitamin-content of foods among participants in El Salvador. In both settings, participants perceived that their respective community food environments (schools, food stores) exposed their families to highly processed, unhealthful foods. In both settings, they described similar struggles to encourage their families to eat foods healthfully (traditional, home-made foods). These results underscore the importance of acknowledging the changing food environment in sending countries where people may already be exposed to processed foods.

Twenty years ago, sociologist Alan Warde published Eating Out: Social Differentiation, Consumption and Pleasure, an extensive research of food consumption away from home in Britain (Warde and Marte...

This study examined the perceived connections between culture and food practices among Latino pre-adolescents (n = 17) and their parents (n = 15) through semi-structured interviews. Results show that pre-adolescents have formed perceptions concerning the association between their eating behaviors and cultural background that coincide with their parent's notions. Participants associated culture to both healthy and unhealthy food practices. Latin American food environments were described as healthier than in the US. The interviews revealed conflict between traditional foods preferences and perceptions of health, underscoring the need for better approaches to help Latino families navigate US food environments, while also preserving healthful traditional food practices.

OBJECTIVES: Assess how Latin American restaurants (LAR) have been adapting in response to COVID-19, and the potential implications of those changes for community food environments. METHODS: Qualitative study design using semi-structured interviews with LAR owners and staff (n = 12). Interviews were conducted via Zoom, lasting between 30 and 90 minutes. Verbatim transcripts were analyzed by two independent coders using Dedoose following an iterative approach for organizing results using emergent themes. RESULTS: COVID-19 led to initial closures, decrease in clientele and interrupted food supply. LAR adjusted by switching to outdoor dining and/or delivery/takeout, reducing hours and staff, increasing social media presence, and making changes to the menus. Menus were reduced, decreasing items not well-suited for takeout/delivery, (notably salads), while keeping customer favorites, such as high-energy “comfort foods.” Menu changes were more prevalent in full-service restaurants, compared with fast casual LAR. The results also include experiences with delivery companies and government assistance during COVID-19. CONCLUSIONS: The pandemic has forced drastic changes in LARs, with potential implications for future health promoting interventions. The results from this study contribute to informing how restaurants are adapting in response to COVID-19 and the potential implications on community health and nutrition, as well as what restaurants can do to prepare for future crises. This will need to be considered for the survival of the industry and the communities that they serve. Future research is needed to examine long-term effect of changes in community food environments and customers’ diets. FUNDING SOURCES: NIH - National Heart, Lung, and Blood Institute

The study was conducted to understand fried-food (FF) consumption among Hispanic Caribbean (HC) communities in New York City. Data were collected through qualitative interviews with 23 adults self-identified as Cuban, Dominican, or Puerto Rican. Most informants considered FFs an important part of their traditional diet. Potential explanations included taste, cost, convenience, and the emotive values attached to FF. FF consumption was contextualized in local foodscapes. Results include strategies to diminish FF consumption and differences across HC groups and migratory generations. The relevance for future nutrition interventions addressing health disparities in this community is discussed.

The weight of obesity is a thoughtful and well researched anthropological examination of the growing concerns over obesity and the ‘diseases of modernity’ in Xela, Guatemala. The city, like many ot...