Recent biomedical advances inspire hope that an end to the epidemic of HIV is in sight. Adopting new approaches and paradigms for treatment and prevention in terms of both messaging and programming is a priority to accelerate progress. Defining the key sequential steps that comprise engagement in HIV care has provided a useful framework for clinical programs and motivated quality improvement initiatives. Recently, the same approach has been applied to use of pre-exposure prophylaxis for HIV prevention. Building on the various prevention and care continua previously proposed, we present a novel schematic that incorporates both people living with HIV and people at risk, making it effectively “status-neutral” in that it proposes the same approach for engagement, regardless of one’s HIV status. This multidirectional continuum begins with an HIV test and offers 2 divergent paths depending on the results; these paths end at a common final state. To illustrate how this continuum can be utilized for program planning as well as for monitoring, we provide an example using data for New York City men who have sex with men, a population with high HIV incidence and prevalence.
BackgroundFood retail studies have focused on the availability of food stores, and on disparities in food access by neighborhood race and income level. Previous research does not address possible changes in local food environments over time, because little is known about the extent to which food environments fluctuate.MethodsRecords of stores licensed to sell food with the New York State Department of Agriculture and Markets from 2007–2011 were compared to detect differences in the total number of food stores and supermarkets annually, as well as the total change for the five-year period. Food stores and supermarkets per 10,000 persons were also calculated. Food retail stability – how many individual food stores opened and closed – was also calculated for total stores and supermarkets. All results were stratified by income level and racial characteristics of 2000 Census Bureau census tracts.ResultsThere was an overall increase in all food stores, as well as in supermarkets specifically. However, stability – the proportion of stores that remained open for five years – was greater in higher-wealth and predominantly white areas. Supermarkets remained open in greater proportion than total stores in all racial/ethnic and income areas, but areas with the highest wealth had the greatest supermarket stability. Those areas also had slightly more supermarkets per 10,000 persons, and had no permanent closures of supermarkets. The proportion of new store locations was similar between areas, but lowest-income areas had the greatest proportion of new supermarket locations.ConclusionsThese data suggest that food retail environments change over short periods of time. Stability of food retail environments varies between neighborhoods by race and income. Fluctuations may need to be studied further to understand their impact on food behaviors and health of residents. Finally, the dynamic nature of food retail environments suggests opportunities for policymakers and community organizations to create programs that promote the availability of healthier foods at the neighborhood level.
There are few studies that evaluate dietary intakes and predictors of diet quality in older adults. The objectives of this study were to describe nutrient intakes and examine associations between demographic, economic, behavioral, social environment, and health status factors and diet quality. Cross-sectional data was from Black, White, and Hispanic adults ages 60-99 years, living independently in New York City and participating in the Cardiovascular Health of Seniors and the Built Environment Study, 2009-2011 (n=1306). Multivariable log-linear regression estimated associations between selected factors and good diet quality, defined as a Healthy Eating Index score based on the 2005 Dietary Guidelines for Americans (HEI-2005)>80. Dietary intakes were similar for men and women; intakes of energy, fiber, and the majority of micronutrients were below recommendations, while intakes of fats, added sugar, and sodium were within the upper range or exceeded recommendations. Hispanic ethnicity (Relative Risk, RR=1.37; 95% Confidence Interval, CI, 1.07-1.75), caloric intake <~1500 calories/day (RR=1.93; 95%CI, 1.37-2.71), adherence to a special diet (RR=1.23; 95%CI: 1.02-1.50), purchasing food at supermarkets at least once/week (RR=1.34; 95%CI, 1.04-1.74), and being married/living with a partner (RR=1.37; 95%CI, 1.10-1.71) were positively associated with HEI-2005>80. Consuming at least restaurant one meal/day was negatively associated with HEI-2005>80 (RR=0.69; 95%CI, 0.50-0.94). These findings identify specific groups of older adults, such as Blacks or those who live alone, who may benefit from dietary interventions, as well as specific modifiable behaviors among older adults, such as eating restaurant meals or shopping at supermarkets, which may be targeted through interventions.
The scale-up of preexposure prophylaxis (PrEP) represents a paradigm shift in HIV prevention that poses unique challenges for public health programs. Monitoring of PrEP implementation at the population level is a national priority, with particular significance in New York City (NYC) given the substantial HIV burden and the prominence of PrEP in state and local Ending the Epidemic program plans. We highlight the importance of local monitoring and evaluation of PrEP implementation outcomes and describe the experience at the NYC Health Department, which includes engaging communities, triangulating a variety of data sources regarding PrEP implementation, and leveraging those data to help guide programming. In NYC, we used data from national surveillance systems and incorporated PrEP-related indicators into existing local data collection systems to help illustrate gaps in PrEP awareness and use. Ultimately, ensuring that PrEP achieves the desired impact at the population level depends on identifying disparities through appropriate and accurate measurement, and addressing them through evidence-based programs.
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