A Quantitative Assessment of Changes in the Consumer Nutrition Environments of New York City Hispanic Caribbean Restaurants During the COVID-19 Pandemic

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

Suicide Mortality in the Americas. Regional Report 2010–2014

Suicide is a serious public health problem surrounded by stigma, myths, and taboos. With an annual average of 81,746 suicide deaths in the period 2010–2014 and an age-adjusted suicide rate of 9.3 per 100,000 population (age-unadjusted rate of 9.6), suicide continues to be a public health problem of great relevance in the Region of the Americas. Contrary to common belief, suicides are preventable with timely, evidence-based, and often low-cost interventions. It is estimated that for each suicide that occurs, there are more than 20 attempts. Suicide can occur at any age and it is the third highest cause of death among young people between the ages of 20 and 24 in the Region of the Americas. This report corresponds to the five-year period between 2010 and 2014. It provides a general description of suicide mortality in the Americas, by subregions and countries. It analyzes the distribution of suicide according to age, sex, and methods used, along with the changes in suicide from 2010 to 2014. This report is limited to the study of mortality as, in most countries, no record of self-harm exists, due to lack of appropriate surveillance systems. In the period 2010–2014, 55.8% of suicide deaths in the Region occurred in North America. The age-adjusted suicide rate was also highest in North America (12.8 per 100,000 population), which along with the non-Hispanic Caribbean (9.8) was higher than the regional rate, while the other two subregions had rates lower than the regional rate (6.7 in Central America, the Hispanic Caribbean, and Mexico; 6.9 in South America). In Latin America and the Caribbean, it is essential that national suicide prevention programs be developed, especially in those countries with higher suicide rates. This report identifies 12 countries in the Region of the Americas with high suicide rates compared with the regional average and where two-thirds of the suicide deaths are concentrated. Strengthening information systems and surveillance of suicidal behavior is required. Improving mortality registries alone is not enough. It is also necessary to develop registries of suicidal behavior and implement follow-up mechanisms in high-risk cases. This report identifies the most frequent suicide methods. The availability of firearms is an important risk factor, particularly in North America. Access to pesticides in rural areas is another risk factor, especially in the non-Hispanic

Caribbean Immigrant Youths’ Ethnic Identity and Academic Achievement: The Role of Academic Beliefs

Ethnic identity (EI) can facilitate racially and ethnically marginalized youths’ academic achievement but the mediating process by which it exerts its influence is unclear. This study examines how EI is associated with academic achievement through academic beliefs in a sample of Caribbean first and second generation immigrant adolescents whose identities are connected to cultural groups outside of the U.S. Youth ( N = 128; 12–18 years old, M = 16.32, SD = 1.81; 69.3% second generation; 58.6% Black) reported on their EI affirmation and belonging and EI achievement, academic self-efficacy, academic aspirations, and grades. Results of our serial mediation model showed that stronger EI achievement was associated with higher academic self-efficacy and in turn higher academic aspirations, and higher grades. These findings offer potential targets (i.e., academic self-beliefs) for supporting the academic success of Black and Hispanic Caribbean immigrant students and have implications for their boosting educational outcomes.

Ethnic Restaurant Nutrition Environments and Cardiovascular Health: Examining Hispanic Caribbean Restaurants in New York City

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 [<22 seats] restaurants scoring lower than larger restaurants). We found a significant quadratic association with midpoint price, suggesting that scores increased with increasing price in the low­est price range, did not vary in the middle range, and decreased with increasing price in the highest range.Conclusions: Our application of the NEMS-R to HC restaurants in NYC revealed areas for potential future interventions to improve food offerings and environmental cues to encourage healthful choices. Ethn Dis. 2020;30(4):583-592; doi:10.18865/ed.30.4.592

Examining Community Restaurant Nutrition Environments for Cardiovascular Health: An Assessment of Hispanic Caribbean Restaurants in New York City

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 (&gt;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 &lt; 0.001). Small restaurants (&lt;22 seats) had significantly lowest scores, compared with large and medium sized (36.7 ± 7.1, 41.3 ± 7.2, 41.6 ± 6.1, respectively, P &lt; 0.05). Multivariate regression indicated that HC cuisine, restaurant size, and price were significantly associated with the score (P &lt; 0.05). Price was found to have a significant quadratic association, where lower scores were found among lower and higher priced restaurants. Conclusions HC communities present more dietary risk factors than other Hispanic groups. Our study is the first to adapt and apply the NEMS-R to HC restaurants. Restaurants are increasingly important daily sources of food. As interventions targeting individual behavior change have shown limited impact, restaurants represent an important environmental target for health promotion. The assessment showed areas for potential improvements in food offerings and environmental cues to encourage healthful choices in HC restaurants. Funding Sources CUNY PSC Award and NIH/NHLBI Career Development Award (K01).