Breastfeeding Awareness Every Month – Not Just August

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By Ellie DeGarmo, B.A., Junior Policy Associate

August is National Breastfeeding Month, and New York State (NYS) is dedicated to promoting breastfeeding as a part of the NYS Prevention Agenda (NYSPA). Specifically, the NYSPA identifies the goal of “increas[ing] the proportion of NYS babies who are breastfed” as one of the ways to accomplish the Promoting Healthy Women, Infants and Children Action Plan.

Breastfeeding is important because there are many proven benefits to both mothers who breastfeed and to their babies. For example, breastfed babies are more likely to have stronger immune systems and are less likely to develop childhood obesity, while mothers who nurse are also likely to have positive effects on their immune systems and will have a reduced risk of developing breast cancer.

When in the hospital, after giving birth and before discharging, mothers typically make the crucial decision of whether to breastfeed or to use formula. This is why the position that hospitals take plays a crucial role in informing this decision.

The NYSPA recognizes this influence. To this end, as a part of its suggested interventions, the NYSPA emphasizes the expansion of Baby Friendly Hospitals, calling on various stakeholders to support this effort. To acquire the designation of being a Baby Friendly Hospital, birthing facilities must implement the Ten Steps to Successful Breastfeeding and abide by the International Code of Marketing Breast-milk Substitutes.

In addition to breastfeeding being a part of the NYSPA, there is relevant information that, if equipped with, New Yorkers can become aware about breastfeeding in NYS. Two examples of this are by understanding (1) the relevant legal framework in NYS; and (2) the resources available to breastfeeding mothers.

The most important piece of NYS legislation to know is the “right to breast feed,” found in Section 79-E within the 1994 New York Civil Rights Law. This law provides the most explicit and comprehensive protection to nursing women, allowing mothers to nurse wherever they want, regardless of whether they are in a public or private space. The New York Civil Liberties Union expands upon this by highlighting the fact that and the ways in which the right to breast feed protects women in specific settings like at hospitals and in the workplace.

Despite these protections, prevailing stigma towards breastfeeding in public can deter women from exercising their right to do so. To address this, baby cafés, which are places that “offer support on all aspects of breastfeeding,” have sprung up across the country. There are currently 17 baby cafés operating in NYS alone, six of which recently opened.

Nursing mothers in New York City (NYC) also have the option of using public “lactation pods” to pump milk or breastfeed their babies. These 4 foot by 8 foot pods are enclosed spaces that can be locked and are equipped with an electrical outlet for breast pumps. There are dozens of these units located throughout NYC, five of which were unveiled at the beginning of this month.

Although the official National Breastfeeding Month is coming to a close, our dedication to this issue is far from over. It’s important to ensure that awareness and advocacy extends beyond August, and continues throughout the year.

Accomplishing this requires sustained attention to both the institutional level and the individual level. Specifically, relevant professionals and hospitals must adopt the guidelines delineated in the NYSPA to become baby friendly, while mothers must be provided with necessary information about the protections and services that are available to them. For more material and resources to help guide this process, please refer to the breastfeeding factsheet that was assembled by the Academy’s Designing a Strong and Healthy New York (DASH-NY) project team.

Children’s Menus Offer Fewer Sugary Drink Options but There is Still Room for Improvement: New Report

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By Ellie DeGarmo, B.A., Junior Policy Associate

Research reveals that children’s chain restaurant meals have gotten healthier. More specifically, children’s menu items are less likely to offer sugary drinks and more likely to offer low-fat milk now than they did four years ago. The Center for Science in the Public Interest (CSPI) recently released a report examining 38 of the country’s largest restaurant chains like McDonald’s, Chipotle Mexican Grill, and Panda Express. The image accompanying this post is a figure from this report and can be found on page two.

Researchers explored beverage options found on the children’s menus at these restaurants and grouped each drink into five categories: sugary drinks, high-fat milk, low-fat milk, juice, and bottled water/seltzer. Findings related to two of these groups were significant. First, sugary drinks, like soda and sports drinks, were offered by 74 percent of restaurant’s children’s menus, a drop from 83 percent in 2012. Second, low-fat milk, characterized by being fat free or 1 percent, was offered by 69 percent, a sharp increase from 40 percent in 2012.

Information about drink options in restaurants is increasingly important as Americans are eating out more now than ever before. According to CSPI, over half (50.1 percent) of the money used for food is spent at venues away from the home, like restaurants and cafeterias. This is nearly double the 1970 rate of 26 percent.

As sugary drinks continue to be a part of children’s meals at restaurants, kids remain at a greater risk for developing health issues like obesity, type 2 diabetes, and dental disease. Although trending in the right direction, additional restaurants need to trade unhealthy drinks for healthier ones in order to minimize rates of childhood obesity and prevent the onset of associated chronic health conditions.

The 26 percent of restaurants that do not offer sugary drinks comprise nine restaurants that decided to remove these kinds of beverages from their children’s menus. While complete elimination of sugary drinks is ideal, CSPI offers alternative measures that can be taken. The report’s three recommendations involve making healthy beverage options the default, ensuring that nutrition guidelines are met, and restricting advertising to feature children’s meals that are healthy.

Setting healthy options as the default in children’s menus is an action that is overwhelmingly supported by New York City residents. A recent poll by the American Heart Association found that “87% of New Yorkers agree: restaurants should make healthy drinks the default option on kids’ menus.”

This sentiment is also reflected in the goals of the New York State (NYS) Prevention Agenda (NYSPA), which calls upon state and local actors to “create community environments that promote and support healthy food and beverage choice and physical activity.”

As a part of the Academy’s commitment to the NYSPA, our Advancing Prevention Project and Designing a Strong and Healthy New York project teams support the NYS recommendations and strongly encourage restaurants to either remove sugary drinks from their children’s menus or implement CSPI’s suggestions.

Beyond this, there is opportunity for action in the legislative arena as well. The Academy recommends amending and passing Introduction 442 to promote children’s health by ensuring that healthy drinks are the default option in kids’ meals in every New York City restaurant. Permissible beverages to be sold with a children’s meal include (1) water, sparkling water, or flavored water, with no added natural or artificial sweeteners; (2) milk or non-dairy milk alternatives; and (3) 100% juice. This bill was introduced to by Council Member Ben Kallos (D-Manhattan) to The New York City Council in 2014, yet it remains undecided.

Most recently, the bill, which has 16 co-sponsors, was discussed in a committee hearing in January of 2016. Introduction 442 was laid over in committee at this hearing, and has not been revisited since. The Academy urges New York City Council Members to use the momentum generated from CSPI’s recent, promising findings to move forward with this legislation. We must hold our local lawmakers accountable to ensure that they take this crucial step towards making children’s meals healthier, ultimately reducing both the rate of childhood obesity as well as the risk of developing chronic conditions like type 2 diabetes and heart disease.

 

New Yorkers Need to Get Serious about Getting Active: New Report

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FROM THE URBAN HEALTH MATTERS BLOG BY ELLIE DEGARMO

New Yorkers are exercising less than they did five years ago and at a rate below that of the average American. That’s what a newly released Behavioral Risk Factor Surveillance System (BRFSS) report tells us. BRFSS, an annual nationwide survey, assessed physical activity among American adults by measuring Leisure-Time Physical Activity (LTPA)—a fancy term used to encompass a broad range of activities like gardening, swimming, and golf.

The survey findings are particularly important tools for evaluating the progress made towards the New York State (NYS) Prevention Agenda (NYSPA). The NYSPA identifies increasing physical activity, as a way to prevent chronic disease, as one of five core goals. Unfortunately, this goal has not been met. The NYSPA calls for increasing exercise rates by 5 percent, from 73.7 percent in 2011, to 77.4 percent by the end of 2018.

So far, New Yorkers have failed to hit this target and are now farther from it than in 2011. By 2015, the percentage had actually dropped 3 percent, to 70.7, the lowest it had been for five years, slipping below the national average of 73.8 percent.

As New Yorkers spend more time sitting and less time walking, running, riding bikes or otherwise on the move, their chances of developing chronic diseases, like type 2 diabetes, increase. To improve this situation, the NYSPA offers several suggestions, such as investing in community-based organizations dedicated to increasing physical activity, as well as creating safe public spaces for exercise.

Communities across the state are also working toward the goal. For example, David Sandman, PhD, president and CEO of the New York State Health Foundation, discusses the revamping and renaming of the Corning Riverfront Park in Albany as a successful way of attracting more visitors to the site.

The survey also revealed that some NYS residents were more likely to get a healthy amount of physical activity than others. People living with disabilities or struggling with obesity spent less time engaged in physical activity. Rates were also lower in some ethnic groups, such as Hispanic adults, and among people with less than a high school education.

In an ongoing effort to address disparities, the NYSPA‘s mission includes a commitment to improving these discrepancies: “reduce health disparities for racial, ethnic, disability, and low socioeconomic groups, as well as other populations who experience them.”

Specifically tailoring interventions to certain groups has also proven to increase physical activity among individuals in communities facing greater health disparities. Another article by Sandman demonstrates this by explaining the success of the Citi Bike program in the Brooklyn neighborhood of Bedford-Stuyvesant. Making Citi Bikes available in Bedford Stuyvesant adds to local resources like the YMCA and may help residents address high rates of obesity and diabetes.

As part of the Academy’s dedication to improving health in New York City and State, our Advancing Prevention Project and Designing a Strong and Healthy NY project teams energetically support the BRFSS report’s call to increase opportunities for physical activity for all New Yorkers.  Continuing to turn NYSPA objectives into action is one of the best ways to help all New York communities get moving.

Paving the Road for Expansive Policies, the Complete Streets List is In

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People everywhere are demanding safer, innovative streets for their towns. One of the ways to go about this is to come up with new transportation policies that will accommodate every citizen, regardless of race, ethnicity, socioeconomic status, and ability. The top 15 best policies to enhance localities’ roads for 2016 were named earlier this month.

In 2004, the community planning and advocacy organization Smart Growth America launched the National Complete Streets Coalition. The coalition was a call for localities across the country to draft policies for that Smart Growth calls Complete Streets, which are “for everyone,” meaning that they should be accessible to pedestrians, bikers, and people of all ages and abilities. A Complete Street includes sidewalks, special lanes for public transit, more median islands in crosswalks, and curb extensions. 2016 saw more than a thousand towns in the United States draft policies towards safer and more accessible streets. 2016 saw the most policies than any other year of the coalition existing, with a whopping 222 new policies drafted. They were also the strongest ever, many of them achieving scores of 90 or higher. Among them was our own Binghamton, NY, whose policy included adding more walkways for access to public transit, bike racks on buses to allow for more travel destinations for bikers, and add greenways in parks. These simple additions will improve air quality, increase physical activity, and will overall enhance quality of life for Binghamton’s residents.

On a national scale, the promises of safe streets are an immensely positive step, as these localities are leading the way in equitable and safe roads. The United States is steadily improving to avoid accidents and harm coming to pedestrians. A Smart Growth report called Dangerous by Design 2016 highlighted alarming statistics of disparate pedestrian accidents and deaths. It reported that the aging, low-income, and communities of color were the most susceptible to pedestrian deaths because of roads being more catered to cars. For example, Non-White populations make up 34.9 percent of the national population, but make up 46.1 percent of pedestrian deaths. At the same time, individuals that are 65 years or older are 50 percent more likely to be hit and killed by a car while walking. It also stated that many individuals in those communities do not have access to a car and must walk, putting them at risk of injury or death.

Not only is the sheer number of new policies monumental, it also shows a shift in the nation’s thinking. More and more, localities and states are implementing projects and policies to make their landscape more equitable and safe, taking the first steps to lessen the disparities between communities, building crosswalks instead of road blocks. We hope the results of Complete Streets will start a trend for even more localities to make their spaces more accessible and safe for everyone. The Advancing Prevention Project (APP) and DASH-NY are proud to support Complete Streets initiatives, which is part of our ongoing support to Local Health Departments’ Prevention Agenda plans and our advocacy for Active Communities around New York State.

Congratulations to all the ranking towns on their policies, keep paving the road for equity and justice.

Does a One-Size-Fits-All Approach Work When It Comes to Reducing Sodium Intake?

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FROM THE URBAN HEALTH MATTERS BLOG BY AMANDA LI

Cardiovascular disease (CVD) currently ranks as the number one killer in the United States. In fact, one out of every four deaths can be attributed to CVD. In New York City, more than one in three adults lives with cardiovascular disease. Many factors contribute to CVD, but most research suggests that one of the major risks can be attributed to something we eat every day: salt.

Our bodies need sodium to function as it helps regulate fluid balance, transmit nerve impulses, and control muscle function. Yet, when consumed in excess, sodium can cause severe damage to our heart and blood vessels. With 75 percent of the population eating nearly two times the amount of daily recommended sodium, and almost 1.65 million CVD-related deaths in the world associated with high sodium consumption, there’s a critical need to find an effective way to lower the amount of salt in our national and international diet.

Multiple government and community-based initiatives have attempted to help people reduce excessive sodium intake. This includes the American Heart Association’s #BreakUpWithSalt Campaign, New York City’s sodium warning label requirement for chain restaurants, and recommendations encouraging health professionals to advise patients on reducing their sodium intake. New research suggests, however, that a one-size-fits-all approach may not be effective.

A 2017 study conducted at The New York Academy of Medicine by Yan Li, PhD, José Pagán, PhD, and Julia Berenson, MS, along with Andrew Moran, MD, from Columbia University Medical Center, investigates this question. The research team identified key characteristics (i.e., age, geographic location, income, ethnicity, race, body mass index, and self-reported hypertension status) that they used to categorize people into subgroups based on how likely they might be to heed professional recommendations to reduce sodium consumption. The study was based on survey data on 125,764 respondents to the 2013 Behavioral Risk Factor Surveillance System.

Li and colleagues found that age was the most significant predictor for whether a person would follow recommendations from their health professional on sodium intake. The study results also revealed that within each age group, predictors of sodium intake were quite different. For instance, for people ages 18 through 64, the predictors of sodium intake behavior were linked to geographic location, income, and self-reported hypertension status. For the younger group, under age 45, BMI was also a factor. Yet, for people 65 and older, diabetes, hypertension, race, ethnicity, and geographic location shaped their sodium-intake choices.

Findings like these suggest that a one-size-fits-all approach to reducing sodium intake at the population level, such as simply informing people about the sodium content of popular foods, may not be enough to get people to act. When it comes to reducing sodium consumption, a more productive approach may be to segment populations into different groups based on demographic, clinical, and geographic characteristics, and tailor interventions to the needs and interests of each subgroup.

Earlier work by Pagán and Li found that among New York City residents, cutting salt intake could actually add years to life. With this new research, the Center for Health Innovation team may be a few steps closer to figuring out the best ways to convince people to shake off the salt for better health.