Publications by authors named "Sonia Y Angell"

38 Publications

Mapping stages, barriers and facilitators to the implementation of HEARTS in the Americas initiative in 12 countries: A qualitative study.

J Clin Hypertens (Greenwich) 2021 04 18;23(4):755-765. Epub 2021 Mar 18.

Department of Non-Communicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA.

The World Health Organization (WHO) Global Hearts Initiative offers technical packages to reduce the burden of cardiovascular diseases through population-wide and targeted health services interventions. The Pan American Health Organization (PAHO) has led implementation of the HEARTS in the Americas Initiative since 2016. The authors mapped the developmental stages, barriers, and facilitators to implementation among the 371 primary health care centers in the participating 12 countries. The authors used the qualitative method of document review to examine cumulative country reports, technical meeting notes, and reports to regional stakeholders. Common implementation barriers include segmentation of health systems, overcoming health care professionals' scope of practice legal restrictions, and lack of health information systems limiting operational evaluation and quality improvement mechanisms. Main implementation facilitators include political support from ministries of health and leading scientific societies, PAHO's role as a regional catalyst to implementation, stakeholder endorsement demonstrated by incorporating HEARTS into official documents, and having a health system oriented to primary health care. Key lessons include the need for political commitment and cultivating on-the-ground leadership to initiate a shift in hypertension care delivery, accompanied by specific progress in the development of standardized treatment protocols and a set of high-quality medicines. By systematizing an implementation strategy to ease integration of interventions into delivery processes, the program strengthened technical leadership and ensured sustainability. These study findings will aid the regional approach by providing a staged planning model that incorporates lessons learned. A systematic approach to implementation will enhance equity, efficiency, scale-up, and sustainability, and ultimately improve population hypertension control.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jch.14157DOI Listing
April 2021

Sodium, calorie, and sugary drink purchasing patterns in chain restaurants: Findings from NYC.

Prev Med Rep 2020 Mar 7;17:101040. Epub 2020 Jan 7.

New York City Department of Health and Mental Hygiene, Division of Prevention and Primary Care, 42-09 28 Street, Long Island City, NY 11101, United States.

To understand how consumer purchases in chain restaurants relate to nutrients of public health concern, sodium, calories and sugary drinks purchased for personal consumption were assessed through a customer intercept receipt study at a sample of New York City quick- and full-service chain restaurants (QSR and FSR) in 2015. The percentages of respondents purchasing ≥2,300 mg sodium, ≥2,000 calories, and a sugary drink, respectively, were 14%, 3% and 32% at QSR, and 56%, 23%, and 22% at FSR. Sodium content of purchases averaged 1,260 mg at QSR and 2,897 mg at FSR and calories averaged 770 at QSR and 1,456 at FSR. 71% of QSR sugary drink purchases contained at least 200 calories. Purchasing patterns that are exceptionally high in sodium and calories, and that include sugary drinks, are common in chain restaurants. Because restaurant-sourced foods are a cornerstone of the American diet, fostering conditions that support healthful purchases is essential to reduce preventable disease and advance health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pmedr.2019.101040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005460PMC
March 2020

The American Heart Association 2030 Impact Goal: A Presidential Advisory From the American Heart Association.

Circulation 2020 03 29;141(9):e120-e138. Epub 2020 Jan 29.

Each decade, the American Heart Association (AHA) develops an Impact Goal to guide its overall strategic direction and investments in its research, quality improvement, advocacy, and public health programs. Guided by the AHA's new Mission Statement, to be a relentless force for a world of longer, healthier lives, the 2030 Impact Goal is anchored in an understanding that to achieve cardiovascular health for all, the AHA must include a broader vision of health and well-being and emphasize health equity. In the next decade, by 2030, the AHA will strive to equitably increase healthy life expectancy beyond current projections, with global and local collaborators, from 66 years of age to at least 68 years of age across the United States and from 64 years of age to at least 67 years of age worldwide. The AHA commits to developing additional targets for equity and well-being to accompany this overarching Impact Goal. To attain the 2030 Impact Goal, we recommend a thoughtful evaluation of interventions available to the public, patients, providers, healthcare delivery systems, communities, policy makers, and legislators. This presidential advisory summarizes the task force's main considerations in determining the 2030 Impact Goal and the metrics to monitor progress. It describes the aspiration that these goals will be achieved by working with a diverse community of volunteers, patients, scientists, healthcare professionals, and partner organizations needed to ensure success.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIR.0000000000000758DOI Listing
March 2020

Health Behaviors and Outcomes Associated With Personal and Family History of Criminal Justice System Involvement, New York City, 2017.

Am J Public Health 2020 03 16;110(3):378-384. Epub 2020 Jan 16.

At the time of this study, María Baquero, Kimberly Zweig, and Sharon B. Meropol were with the Health Access Equity Unit, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. All authors were with the Division of Prevention and Primary Care, NYC DOHMH.

To quantify the association between personal and family history of criminal justice system (CJS) involvement (PHJI and FHJI, respectively), health outcomes, and health-related behaviors. We examined 2017 New York City Community Health Survey data (n = 10 005) with multivariable logistic regression. We defined PHJI as ever incarcerated or under probation or parole. FHJI was CJS involvement of spouse or partner, child, sibling, or parent. We found that 8.9% reported only FHJI, 5.4% only PHJI, and 2.9% both FHJI and PHJI (mean age = 45.4 years). Compared with no CJS involvement, individuals with only FHJI were more likely to report fair or poor health, hypertension, diabetes, obesity, depression, heavy drinking, and binge drinking. Respondents with only PHJI reported more fair or poor health, asthma, depression, heavy drinking, and binge drinking. Those with both FHJI and PHJI were more likely to report asthma, depression, heavy drinking, and binge drinking. New York City adults with personal or family CJS involvement, or both, were more likely to report adverse health outcomes and behaviors. Measuring CJS involvement in public health monitoring systems can help to identify important health needs, guiding the provision of health care and resource allocation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2019.305415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002931PMC
March 2020

Lower 24-h urinary sodium excretion is associated with hypertension control: the 2010 Heart Follow-Up Study.

J Hum Hypertens 2020 09 11;34(9):624-632. Epub 2019 Nov 11.

New York City Department of Health and Mental Hygiene, Long Island City, NY, USA.

Among individuals with hypertension, controlling high blood pressure (BP) reduces the risk for cardiovascular events and death. Reducing dietary sodium can help achieve BP control. The study aim was to use a population-based sample utilizing the gold standard for urinary sodium to quantify the degree with which sodium was independently associated with BP control among individuals with hypertension. Participants included 1568 adults from the Heart Follow-Up Study, a New York City population-based representative study conducted in 2010. Participants collected urine for 24 h and had BP and other anthropometrics measured. Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or being on BP lowering medication. Sodium intake (mg/day) was measured from a single 24-h urine collection. Hypertension prevalence was 30.8%. Among those with hypertension, 64.6% were aware, 56.3% were treated, and 40.3% were controlled. Among those treated for hypertension, 73.0% were controlled. Mean sodium intake among those with hypertension was 3564 mg/day. From multivariable adjusted logistic regression models, each 500 mg decrease in 24-h urinary sodium excretion was associated with a 18% higher odds of hypertension control among those with hypertension (1.18, 95% CI: 1.07, 1.30). In New York City, approximately one in three people has hypertension with a majority uncontrolled. Sodium intake among those with hypertension was 55% greater than recommended upper limit of 2300 mg per day. Among individuals with hypertension, lower sodium intake was associated with hypertension control.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41371-019-0285-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211546PMC
September 2020

New York City's Sodium Warning Regulation: From Conception to Enforcement.

Am J Public Health 2019 09;109(9):1191-1192

Amaka V. Anekwe, Shannon M. Farley, and Kimberly Kessler are with the Bureau of Chronic Disease Prevention and Tobacco Control, Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene, Queens, NY. Maura O. Kennelly is with the Office of External Affairs, New York City Department of Health and Mental Hygiene. At the time of the study, Megan Lent was with the Bureau of Chronic Disease Prevention and Tobacco Control, Division of Prevention and Primary Care, and Sonia Y. Angell was with the Division of Prevention and Primary Care, New York City Department of Health and Mental Hygiene.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2019.305228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687254PMC
September 2019

Impact of a Municipal Policy Restricting Trans Fatty Acid Use in New York City Restaurants on Serum Trans Fatty Acid Levels in Adults.

Am J Public Health 2019 04 21;109(4):634-636. Epub 2019 Feb 21.

At the time of the writing, Melecia Wright, Wendy McKelvey, Christine Johnson Curtis, and Sonia Y. Angell were with the New York City Department of Health and Mental Hygiene, Queens, NY. Lorna E. Thorpe is with the New York University School of Medicine, Department of Population Health, New York, NY. Hubert W. Vesper and Heather C. Kuiper are with Centers for Disease Control and Prevention, National Center for Environmental Health, Atlanta, GA.

Objectives: To estimate the impact of the 2006 policy restricting use of trans fatty acids (TFAs) in New York City restaurants on change in serum TFA concentrations in New York City adults.

Methods: Two cross-sectional population-based New York City Health and Nutrition Examination Surveys conducted in 2004 (n = 212) and 2013-2014 (n = 247) provided estimates of serum TFA exposure and average frequency of weekly restaurant meals. We estimated the geometric mean of the sum of serum TFAs by year and restaurant meal frequency by using linear regression.

Results: Among those who ate less than 1 restaurant meal per week, geometric mean of the sum of serum TFAs declined 51.1% (95% confidence interval [CI] = 42.7, 58.3)-from 44.6 (95% CI = 39.7, 50.1) to 21.8 (95% CI = 19.3, 24.5) micromoles per liter. The decline in the geometric mean was greater (P for interaction = .04) among those who ate 4 or more restaurant meals per week: 61.6% (95% CI = 55.8, 66.7) or from 54.6 (95% CI = 49.3, 60.5) to 21.0 (95% CI = 18.9, 23.3) micromoles per liter.

Conclusions: New York City adult serum TFA concentrations declined between 2004 and 2014. The indication of greater decline in serum TFAs among those eating restaurant meals more frequently suggests that the municipal restriction on TFA use was effective in reducing TFA exposure. Public Health Implications. Local policies focused on restaurants can promote nutritional improvements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2018.304930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417598PMC
April 2019

Monitoring and evaluation framework for hypertension programs. A collaboration between the Pan American Health Organization and World Hypertension League.

J Clin Hypertens (Greenwich) 2018 06 22;20(6):984-990. Epub 2018 May 22.

Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

The Pan American Health Organization (PAHO)-World Hypertension League (WHL) Hypertension Monitoring and Evaluation Framework is summarized. Standardized indicators are provided for monitoring and evaluating national or subnational hypertension control programs. Five core indicators from the World Health Organization hearts initiative and a single PAHO-WHL core indicator are recommended to be used in all hypertension control programs. In addition, hypertension control programs are encouraged to select from 14 optional qualitative and 33 quantitative indicators to facilitate progress towards enhanced hypertension control. The intention is for hypertension programs to select quantitative indicators based on the current surveillance mechanisms that are available and what is feasible and to use the framework process indicators as a guide to program management. Programs may wish to increase or refine the number of indicators they use over time. With adaption the indicators can also be implemented at a community or clinic level. The standardized indicators are being pilot tested in Cuba, Colombia, Chile, and Barbados.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jch.13307DOI Listing
June 2018

Bridging the gap between clinical practice and public health: Using EHR data to assess trends in the seasonality of blood-pressure control.

Prev Med Rep 2017 Jun 26;6:369-375. Epub 2017 Apr 26.

Primary Care Information Project (PCIP) Division of Prevention and Primary Care New York City Department of Health and Mental Hygiene (NYCDOHMH), United States.

Electronic health records (EHRs) provide timely access to millions of patient data records while limiting errors associated with manual data extraction. To demonstrate these advantages of EHRs to public health practice, we examine the ability of a EHR calculated blood-pressure (BP) measure to replicate seasonal variation as reported by prior studies that used manual data extraction. Our sample included 609 primary-care practices in New York City. BP control among hypertensives was defined as systolic blood pressure of 140 or less and diastolic blood pressure of 90 or less (BP < 140/90 mm Hg). An innovative query-distribution system was used to extract monthly BP control values from the EHRs of adult patients diagnosed with hypertension over a 25-month period. Generalized estimating equations were used to compare the association between seasonal temperature variations and BP control rates at the practice level, while adjusting for known demographic factors (age, gender), comorbid diseases (diabetes) associated with blood pressure, and months since EHR implementation. BP control rates increased gradually from the spring months to peak summer months before declining in the fall months. In addition to seasonal variation, the adjusted model showed that a 1% increase in patients with a diabetic comorbidity is associated with an increase of 3% (OR 1.03; CI 1.028-1.032) on the BP measure. Our findings identified cyclic trends in BP control and highlighted greater association with increased proportion of diabetic patients, therefore confirming the ability of the EHR as a tool for measuring population health outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pmedr.2017.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443962PMC
June 2017

US Food Industry Progress During the National Salt Reduction Initiative: 2009-2014.

Am J Public Health 2016 10 23;106(10):1815-9. Epub 2016 Aug 23.

At the time of the study, Christine J. Curtis, Jenifer Clapp, Sarah A. Niederman, and Sonia Y. Angell were with the New York City Department of Health and Mental Hygiene, New York, NY. Shu Wen Ng is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill.

Objectives: To assess the US packaged food industry's progress from 2009 to 2014, when the National Salt Reduction Initiative had voluntary, category-specific sodium targets with the goal of reducing sodium in packaged and restaurant foods by 25% over 5 years.

Methods: Using the National Salt Reduction Initiative Packaged Food Database, we assessed target achievement and change in sales-weighted mean sodium density in top-selling products in 61 food categories in 2009 (n = 6336), 2012 (n = 6898), and 2014 (n = 7396).

Results: In 2009, when the targets were established, no categories met National Salt Reduction Initiative 2012 or 2014 targets. By 2014, 26% of categories met 2012 targets and 3% met 2014 targets. From 2009 to 2014, the sales-weighted mean sodium density declined significantly in almost half of all food categories (43%; 26/61 categories). Overall, sales-weighted mean sodium density declined significantly (by 6.8%; P < .001).

Conclusions: National target setting with monitoring through a partnership of local, state, and national health organizations proved feasible, but industry progress was modest.

Public Health Implications: The US Food and Drug Administration's proposed voluntary targets will be an important step in achieving more substantial sodium reductions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2016.303397DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024394PMC
October 2016

How the Nurses' Health Study Helped Americans Take the Trans Fat Out.

Am J Public Health 2016 Sep;106(9):1537-9

Christine J. Curtis is a consultant to the NYC Department of Health and Mental Hygiene, Queens, NY. Jenifer Clapp, Gail Goldstein, and Sonia Y. Angell are with the NYC Department of Health and Mental Hygiene.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2016.303353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981820PMC
September 2016

Transforming Global Health by Improving the Science of Scale-Up.

PLoS Biol 2016 Mar 2;14(3):e1002360. Epub 2016 Mar 2.

Global Health Delivery and Diplomacy, Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America.

In its report Global Health 2035, the Commission on Investing in Health proposed that health investments can reduce mortality in nearly all low- and middle-income countries to very low levels, thereby averting 10 million deaths per year from 2035 onward. Many of these gains could be achieved through scale-up of existing technologies and health services. A key instrument to close this gap is policy and implementation research (PIR) that aims to produce generalizable evidence on what works to implement successful interventions at scale. Rigorously designed PIR promotes global learning and local accountability. Much greater national and global investments in PIR capacity will be required to enable the scaling of effective approaches and to prevent the recycling of failed ideas. Sample questions for the PIR research agenda include how to close the gap in the delivery of essential services to the poor, which population interventions for non-communicable diseases are most applicable in different contexts, and how to engage non-state actors in equitable provision of health services in the context of universal health coverage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pbio.1002360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775018PMC
March 2016

Relationships Between Blood Pressure and 24-Hour Urinary Excretion of Sodium and Potassium by Body Mass Index Status in Chinese Adults.

J Clin Hypertens (Greenwich) 2015 Dec 29;17(12):916-25. Epub 2015 Aug 29.

Department of Cardiovascular Disease Control and Prevention, National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China.

This study examined the impact of overweight/obesity on sodium, potassium, and blood pressure associations using the Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project baseline survey data. Twenty-four-hour urine samples were collected in 1948 Chinese adults aged 18 to 69 years. The observed associations of sodium, potassium, sodium-potassium ratio, and systolic blood pressure (SBP) were stronger in the overweight/obese population than among those of normal weight. Among overweight/obese respondents, each additional standard deviation (SD) higher of urinary sodium excretion (SD=85 mmol) and potassium excretion (SD=19 mmol) was associated with a 1.31 mm Hg (95% confidence interval, 0.37-2.26) and -1.43 mm Hg (95% confidence interval, -2.23 to -0.63) difference in SBP, and each higher unit in sodium-potassium ratio was associated with a 0.54 mm Hg (95% confidence interval, 0.34-0.75) increase in SBP. The association between sodium, potassium, sodium-potassium ratio, and prevalence of hypertension among overweight/obese patients was similar to that of SBP. Our study indicated that the relationships between BP and both urinary sodium and potassium might be modified by BMI status in Chinese adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jch.12658DOI Listing
December 2015

A public health approach to global management of hypertension.

Lancet 2015 Feb;385(9970):825-7

Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0140-6736(14)62256-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830267PMC
February 2015

Self-blood pressure monitoring in an urban, ethnically diverse population: a randomized clinical trial utilizing the electronic health record.

Circ Cardiovasc Qual Outcomes 2015 Mar 3;8(2):138-45. Epub 2015 Mar 3.

From the Bureau of Chronic Disease Prevention and Tobacco Control (S.S.Y., S.C.), Primary Care Information Project (B.P.T., A.R., M.D.B., S.C.), and Division of Prevention and Primary Care (S.Y.A.), New York City Department of Health and Mental Hygiene, Queens; Lutheran Family Health Centers, Clinical Affairs Brooklyn; Riverdale Family Practice PC, Bronx; (F.J.M.); and Heritage HealthCare Center (A.S.); New York, NY.

Background: Hypertension is a leading risk factor for cardiovascular disease. Although control rates have improved over time, racial/ethnic disparities in hypertension control persist. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with limited resources.

Methods And Results: The New York City Health Department in partnership with community clinic networks implemented a randomized clinical trial (n=900, 450 per arm) to investigate the effectiveness of self-blood pressure monitoring in medically underserved and largely black and Hispanic participants. Intervention participants received a home blood pressure monitor and training on use, whereas control participants received usual care. After 9 months, systolic blood pressure decreased (intervention, 14.7 mm Hg; control, 14.1 mm Hg; P=0.70). Similar results were observed when incorporating longitudinal data and calculating a mean slope over time. Control was achieved in 38.9% of intervention and 39.1% of control participants at the end of follow-up; the time-to-event experience of achieving blood pressure control in the intervention versus control groups were not different from each other (logrank P value =0.91).

Conclusions: Self-blood pressure monitoring was not shown to improve control over usual care in this largely minority, urban population. The patient population in this study, which included a high proportion of Hispanics and uninsured persons, is understudied. Results indicate these groups may have additional meaningful barriers to achieving blood pressure control beyond access to the monitor itself.

Clinical Trial Registration: http://clinicaltrials.gov. Unique Identifier: NCT01123577.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCOUTCOMES.114.000950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366280PMC
March 2015

Deaths ascribed to non-communicable diseases among rural Kenyan adults are proportionately increasing: evidence from a health and demographic surveillance system, 2003-2010.

PLoS One 2014 26;9(11):e114010. Epub 2014 Nov 26.

Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.

Background: Non-communicable diseases (NCDs) result in more deaths globally than other causes. Monitoring systems require strengthening to attribute the NCD burden and deaths in low and middle-income countries (LMICs). Data from health and demographic surveillance systems (HDSS) can contribute towards this goal.

Methods And Findings: Between 2003 and 2010, 15,228 deaths in adults aged 15 years (y) and older were identified retrospectively using the HDSS census and verbal autopsy in rural western Kenya, attributed into broad categories using InterVA-4 computer algorithms; 37% were ascribed to NCDs, 60% to communicable diseases (CDs), 3% to injuries, and <1% maternal causes. Median age at death for NCDs was 66y and 71y for females and males, respectively, with 43% (39% male, 48% female) of NCD deaths occurring prematurely among adults aged below 65y. NCD deaths were mainly attributed to cancers (35%) and cardio-vascular diseases (CVDs; 29%). The proportionate mortality from NCDs rose from 35% in 2003 to 45% in 2010 (χ2 linear trend 93.4; p<0.001). While overall annual mortality rates (MRs) for NCDs fell, cancer-specific MRs rose from 200 to 262 per 100,000 population, mainly due to increasing deaths in adults aged 65y and older, and to respiratory neoplasms in all age groups. The substantial fall in CD MRs resulted in similar MRs for CDs and NCDs among all adult females by 2010. NCD MRs for adults aged 15y to <65y fell from 409 to 183 per 100,000 among females and from 517 to 283 per 100,000 population among males. NCD MRs were higher among males than females aged both below, and at or above, 65y.

Conclusions: NCDs constitute a significant proportion of deaths in rural western Kenya. Evidence of the increasing contribution of NCDs to overall mortality supports international recommendations to introduce or enhance prevention, screening, diagnosis and treatment programmes in LMICs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0114010PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245262PMC
December 2015

The World Health Organization recognizes noncommunicable diseases and raised blood pressure as global health priority for 2025.

J Clin Hypertens (Greenwich) 2014 Sep 4;16(9):624. Epub 2014 Aug 4.

Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jch.12384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5723123PMC
September 2014

Highlighting the ratio of sodium to potassium in population-level dietary assessments: cross-sectional data from New York City, USA.

Public Health Nutr 2014 Nov 20;17(11):2484-8. Epub 2014 Jun 20.

1New York City Department of Health and Mental Hygiene,Bureau of Chronic Disease Prevention and Tobacco Control,2 Gotham Center,42-09 28th Street,9th Floor,CN-46,Long Island City,NY 11101,USA.

Objective: To contrast mean values of Na:K with Na and K mean intakes by demographic factors, and to calculate the prevalence of New York City (NYC) adults meeting the WHO guideline for optimal Na:K (<1 mmol/mmol, i.e. <0·59 mg/mg) using 24 h urinary values.

Design: Data were from the 2010 Community Health Survey Heart Follow-Up Study, a population-based, representative study including data from 24 h urine collections.

Setting: Participants were interviewed using a dual-frame sample design consisting of random-digit dial telephone exchanges that cover NYC. Data were weighted to be representative of NYC adults as a whole.

Subjects: The final sample of 1656 adults provided 24 h urine collections and self-reported health data.

Results: Mean Na:K in NYC adults was 1·7 mg/mg. Elevated Na:K was observed in young, minority, low-education and high-poverty adults. Only 5·2 % of NYC adults had Na:K in the optimal range.

Conclusions: Na intake is high and K intake is low in NYC adults, leading to high Na:K. Na:K is a useful marker and its inclusion for nutrition surveillance in populations, in addition to Na and K intakes, is indicated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1368980014001293DOI Listing
November 2014

Toward a healthier city: nutrition standards for New York City government.

Am J Prev Med 2014 Apr;46(4):423-8

New York City Department of Health and Mental Hygiene, Long Island City, New York.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2013.11.011DOI Listing
April 2014

Sodium intake in a cross-sectional, representative sample of New York City adults.

Am J Public Health 2014 Dec 16;104(12):2409-16. Epub 2014 Jan 16.

At the time of the study, Sonia Y. Angell, Stella Yi, Christine J. Curtis, and Lynn D. Silver were with the Bureau of Chronic Disease Prevention; Donna Eisenhower, Bonnie D. Kerker, and Katherine Bartley were with the Bureau of Epidemiology Services; and Thomas A. Farley was with the New York City Department of Health and Mental Hygiene, New York, NY.

Objectives: We estimated sodium intake, which is associated with elevated blood pressure, a major risk factor for cardiovascular disease, and assessed its association with related variables among New York City adults.

Methods: In 2010 we conducted a cross-sectional, population-based survey of 1656 adults, the Heart Follow-Up Study, that collected self-reported health information, measured blood pressure, and obtained sodium, potassium, and creatinine values from 24-hour urine collections.

Results: Mean daily sodium intake was 3239 milligrams per day; 81% of participants exceeded their recommended limit. Sodium intake was higher in non-Hispanic Blacks (3477 mg/d) and Hispanics (3395 mg/d) than in non-Hispanic Whites (3066 mg/d; both P < .05). Higher sodium intake was associated with higher blood pressure in adjusted models, and this association varied by race/ethnicity.

Conclusions: Higher sodium intake among non-Hispanic Blacks and Hispanics than among Whites was not previously documented in population surveys relying on self-report. These results demonstrate the feasibility of 24-hour urine collection for the purposes of research, surveillance, and program evaluation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2013.301542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232161PMC
December 2014

Sodium reduction is a public health priority: reflections on the Institute of Medicine's report, sodium intake in populations: assessment of evidence.

Am J Hypertens 2013 Oct;26(10):1178-80

National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajh/hpt143DOI Listing
October 2013

Progress toward sodium reduction in the United States.

Rev Panam Salud Publica 2012 Oct;32(4):301-6

Centers for Disease Control and Prevention, Atlanta, GA, USA.

The average adult in the United States of America consumes well above the recommended daily limit of sodium. Average sodium intake is about 3 463 mg/day, as compared to the 2010 dietary guidelines for Americans recommendation of < 2 300 mg/day. A further reduction to 1 500 mg/day is advised for people 51 years or older; African Americans; and people with high blood pressure, diabetes, or chronic kidney disease. In the United States of America, the problem of excess sodium intake is related to the food supply. Most sodium consumed comes from packaged, processed, and restaurant foods and therefore is in the product at the time of purchase. This paper describes sodium reduction policies and programs in the United States at the federal, state, and local levels; efforts to monitor the health impact of sodium reduction; ways to assess consumer knowledge, attitudes, and behavior; and how these activities depend on and inform global efforts to reduce sodium intake. Reducing excess sodium intake is a public health opportunity that can save lives and health care dollars in the United States and globally. Future efforts, including sharing successes achieved and barriers identified in the United States and globally, may quicken and enhance progress.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/s1020-49892012001000009DOI Listing
October 2012

Angell and Farley respond to Lucan.

Am J Public Health 2013 Feb 13;103(2):e3-4. Epub 2012 Dec 13.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2012.301155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558783PMC
February 2013

Can we finally make progress on sodium intake?

Am J Public Health 2012 Sep 19;102(9):1625-7. Epub 2012 Jul 19.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2105/AJPH.2012.300722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482039PMC
September 2012

Change in trans fatty acid content of fast-food purchases associated with New York City's restaurant regulation: a pre-post study.

Ann Intern Med 2012 Jul;157(2):81-6

Centers for Disease Control and Prevention, 1600 Clifton Road, MS D-69, Atlanta, GA 30333, USA.

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7326/0003-4819-157-2-201207170-00004DOI Listing
July 2012

Adherence to chronic disease medications among New York City Medicaid participants.

J Urban Health 2013 Apr;90(2):323-8

Department of Population Health, New York University School of Medicine, New York, NY, USA.

Medication adherence is critical for cardiovascular disease prevention and control. Local health departments are well positioned to address adherence issues, however relevant baseline data and a mechanism for monitoring impact of interventions are lacking. We performed a retrospective analysis using New York State Medicaid claims from 2008 to 2009 to describe rates and predictors of adherence among New York City Medicaid participants with dyslipidemia, diabetes, or hypertension. Adherence was measured using the medication possession ratio, and multivariable logistic regression was used to assess factors related to adherence. Medication regimen adherence was 63%. Greater adherence was observed in those who were older, male, and taking medications from ≥3 drug classes. Compared with whites, blacks and Hispanics were less likely to be adherent (adjusted odds ratio [OR]=0.67, 95% confidence interval [CI]: 0.65-0.70 and adjusted OR=0.76, 95% CI: 0.73-0.78, respectively), while Asians were as likely. Medication adherence was inadequate and racial disparities were identified in NYC Medicaid participants on stable medication regimens for chronic disease. This study demonstrates a claims-based model that may be used by local health departments to monitor and evaluate efforts to improve adherence and reduce disparities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11524-012-9724-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675715PMC
April 2013

Population-wide sodium reduction: the bumpy road from evidence to policy.

Ann Epidemiol 2012 Jun;22(6):417-25

Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21287, USA.

Elevated blood pressure is a highly prevalent condition that is etiologically related to coronary heart disease and stroke, two of the leading causes of morbidity and mortality throughout the world. Excess salt (sodium chloride) intake is a major determinant of elevated blood pressure. In this article, we discuss the scientific rationale for population-wide salt reduction, the types and strength of available evidence, policy-making on dietary salt intake in the United States and other countries, and the role and impact of key stakeholders. We highlight a number of lessons learned, many of which are germane to policy development in other domains.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.annepidem.2012.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847711PMC
June 2012

Metabolic syndrome among adults in New York City, 2004 New York City Health and Nutrition Examination Survey.

Prev Chronic Dis 2012 15;9:E04. Epub 2011 Dec 15.

New York City Department of Health and Mental Hygiene, 42-09 28th St, 7th Floor, Long Island City, NY 11101, USA.

Introduction: The objective of this study was to describe the prevalence of and factors associated with metabolic syndrome among adult New York City residents.

Methods: The 2004 New York City Health and Nutrition Examination Survey was a population-based, cross-sectional study of noninstitutionalized New York City residents aged 20 years or older. We examined the prevalence of metabolic syndrome and its components as defined by the National Cholesterol Education Program's Adult Treatment Panel III revised guidelines, according to demographic subgroups and comorbid diagnoses in a probability sample of 1,263 participants. We conducted bivariable and multivariable analyses to identify factors associated with metabolic syndrome.

Results: The age-adjusted prevalence of metabolic syndrome was 26.7% (95% confidence interval, 23.7%-29.8%). Prevalence was highest among Hispanics (33.9%) and lowest among whites (21.8%). Prevalence increased with age and body mass index and was higher among women (30.1%) than among men (22.9%). More than half (55.4%) of women and 33.0% of men with metabolic syndrome had only 3 metabolic abnormalities, 1 of which was abdominal obesity. The most common combination of metabolic abnormalities was abdominal obesity, elevated fasting blood glucose, and elevated blood pressure. Adjusting for other factors, higher body mass index, Asian race, and current smoking were positively associated with metabolic syndrome; alcohol use was inversely associated with metabolic syndrome among women but increased the likelihood of metabolic syndrome among men.

Conclusion: Metabolic syndrome is pervasive among New York City adults, particularly women, and is associated with modifiable factors. These results identify population subgroups that could be targeted for prevention and provide a benchmark for assessing such interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277374PMC
May 2012
-->