A Local Perspective –New York City’s Strategies to

Reduce Sugary Drink ConsumptionKim Kessler, JD

Assistant Commissioner, Bureau of Chronic Disease Prevention and

Tobacco Control June 21, 2017

Health Inequities Are Unfair

PovertyRace by

NeighborhoodPremature Mortality

Source: NYC DOHMH population estimates, matched from US Census Bureau intercensal population estimates, 2010-2013, updated June 2014. U.S. Census Bureau; American Community Survey, 2013 3-year Estimates, Table S1701; generated using American Fact Finder (http://factfinder2.census.gov/). Bureau of Vital Statistics, based on events occurring in 2014. Population (based on zip code) defined as percent of non-Hispanic black and Hispanic residents, per 2010 Census. : Neighborhood poverty (based on Community Districts) defined as percent of residents with incomes below 100% of the Federal Poverty Level, per American Community Survey 2011- 2013. Population (based on zip code) defined as percent of non-Hispanic black and Hispanic residents, per 2010 Census. Self-Reported health – NYC DOHMH Community Health Survey, 2011-2013

Patterns of Sugary Drink Consumption

Sources: NYC DOHMH Community Health Survey, 2011-2013

SUGARY DRINK CONSUMPTION

The Challenge of Sugary Drinks: Health Risks + A Saturated Environment

• Sugary drinks are associated with long-term weight gain, and increased risk of heart disease and diabetes1-6

• Retail environment is saturated with sugary drinks

• Marketing is ubiquitous

Sources:1. Fung TT, et al. Sweetened beverage consumption and risk of coronary heart disease in women. AJCN 2009;89(4):1037-42. 2. Welsh JA, Sharma A, Cunningham SA, Vos MB. Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents. Circulation 2011;123(3):249-57. 3. Schulze MB, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004;292(8):927-34. 4. Malik VS, Popkin BM, Bray GA, Despres J-P, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010;121(11):1356-64. 5. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: A systematic review. AJCN 2006;84(2):274-88. 6. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. NEJM 2011;364:2392-404.

Make the Healthy Choice the Easier Choice

Environment & Systems • Physical Access/Availability• Pricing/Economic• Communication/Media• Point of Decision • Education/Promotion

• Culture• Attitudes/Beliefs• Skills • Knowledge• Time• Affordability

Individual

Healthy Behaviors

Environment

Adapted from presentation by Dr. Heidi Blanch, CDC, NCCHPDP, DNPAO

What NYC is Doing

• Increasing access to and awareness of healthy foods

• Decreasing availability and overconsumption of unhealthy foods

Promoting Healthy Children’s Spaces

• Health Code Amendments� Child Care Centers

9 Sugary drinks: not permitted9 Juice: only 100%, only for ages 2+, maximum

serving of 4 oz./day9 Milk: 1% or less for ages 2+, unsweetened9 Water: must be available, easily accessible

� Day Camps 9 Sugary drinks: not permitted9 Juice: only 100%, maximum serving of 6 oz./day9 Milk: 1% or less for ages 2+, unsweetened9 Water: available, easily accessible

• Eat Well, Play Hard

• NYC Food Standards� Meals/Snacks Purchased &

Served� Food and Beverage Vending

Machines

• Schools and Communities� Healthy beverage initiatives

and water promotion� NYC Food & Beverage

Guidelines

Transforming City and Community Environments

Changing Broader Policies (Attempts)

• NYS Sugary Drink Excise Tax-2010� Penny-per-ounce excise tax on

sugary drinks in NYS� Withdrawn under pressure from

lobbyists

• SNAP Waiver Request-2010

• Portion Cap Proposal-2012� Maximum size of sugary drinks� Overturned by courts

Educating Individuals: Nutrition Education and NYC Sugary Drink Campaigns

Youth-focused Campaigns

35.9%32.6%

31.6% 30.3% 29.9%28.2%

23.3%22.5% 23.7%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Perc

ent o

f New

Yor

k Ci

ty a

dults

co

nsum

ing

1 or

mor

e su

gary

drin

ks p

er

day

Community outreach;State tax attempt Portion cap rule (attempt);

Sugary drinks restricted in day camps

Sugary drinks restricted in child care centers

Food standards for city agencies;Calorie labeling

Food standards for city agency vending machines

Hard hitting media campaignsNutrition education

Surveillance

34% Decline in Sugary Drink Consumption Among NYC Adults

Source: New York City Department of Health and Mental Hygiene, Community Health Survey 2015. Sugar sweetened beverage includes soda and other sweetened drinks like iced tea, sports drinks, fruit punch/other fruit –flavored drinks. NYC Community Health Survey included adults with landline phones since 2002 and, starting in 2009, also has included adults who can be reached only by cell-phone. 2007 is baseline for Take Care New York 2012.

0

10

20

30

40

50

60

2007 2008 2009 2010 2011 2012 2013 2014 2015

Perc

ent o

f NYC

adu

lts

Adult Daily SSB Consumption (1+) by Race/Ethnicity, NYC CHS

White Black Latino Asian/PI

Trends in Sugary Drink Consumption Among NYC Adults

Source: New York City Department of Health and Mental Hygiene, Community Health Survey 2007-2015. Sugar sweetened beverage includes soda and other sweetened drinks like iced tea, sports drinks, fruit punch/other fruit –flavored drinks. NYC Community Health Survey included adults with landline phones since 2002 and, starting in 2009, also has included adults who can be reached only by cell-phone.

Source: Child Health Survey, 2009* Estimate should be interpreted with caution. Estimate’s Relative Standard Error (a measure of estimate precision) is greater than 30% or the sample size is less than 50, or the 95% Confidence Interval half width is greater than ten, making the estimate potentially unreliable

Sugary Drink Consumption Among Youth (6-12)

33

5449

33*

0

10

20

30

40

50

60

White Black Latino Asian/PI

Perc

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f NYC

chi

ldre

n 6-

12w

ho co

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e 1+

suga

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rinks

/day

NYC Children’s Sugary Drink Consumption (1+/Day), 2009

Takeaways• Cross cutting efforts are needed

� Layering of strategies, cumulative efforts � Role of localities� State and national context

• Progress doesn’t always take expected form

• Surveillance efforts are critical

• Onward!

With thanks to many NYC DOHMH colleagues

Kim Kessler, JDAssistant Commissioner,

Bureau of Chronic Disease Prevention and Tobacco Control June 21, 2017

CONFIDENTIAL AND PROPRIETARYAny use of this material without specific permission of DOHMH is strictly prohibited