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9780826173034_WEB.pdf -- Cover -- Half Title: Health Care Delivery in the United States -- Author Bio -- Book Title: Health Care Delivery in the United States -- Copyright -- Contents -- List of Features -- Contributors -- Instructor Resources -- Foreword -- Acknowledgments -- Organization of This Book -- Part 1: Health Policy -- Chapter 1: The Challenge of Health Care Delivery and Health Policy -- INTRODUCTION -- THE IMPORTANCE OF GOOD HEALTH TO AMERICAN LIFE -- DEFINING CHARACTERISTICS OF THE U.S. HEALTH SYSTEM -- MAJOR ISSUES AND CONCERNS -- KEY STAKEHOLDERS INFLUENCING THE HEALTH SYSTEM -- ORGANIZATION OF THIS BOOK -- CONCLUSION -- REFERENCE -- Chapte 2: Organization of Care -- INTRODUCTION -- DESCRIPTION OF THE CURRENT CARE DELIVERY SYSTEM -- HEALTH SYSTEM PERFORMANCE -- INNOVATIVE APPROACHES TO IMPROVING CARE DELIVERY -- CONCLUSION -- REFERENCES -- Chapter 3:Policy and the Politics of Health Care: Policy Choices in a Divided Political Environment -- INTRODUCTION -- HEALTH CARE INFRASTRUCTURE AND SPENDING: MANY DOLLARS, TO WHAT EFFECT? -- WHO PAYS? THE POLITICS OF MEDICARE, MEDICAID, AND MUCH MORE -- THE POLITICS OF PROVIDING EQUITABLE HEALTH SERVICES -- HOW PERSONAL HEALTH DECISIONS BECOME PUBLIC: THE CASE OF OBESITY -- CONCLUSION: BETTER NATIONAL HEALTH AHEAD? -- REFERENCES -- Part 2: Keeping Americans Healthy -- Chapter 4: Population Health -- INTRODUCTION -- THE POPULATION HEALTH MODEL -- THE MEDICAL MODEL -- COMPARING THE MEDICAL AND POPULATION HEALTH MODELS -- THE INFLUENCE OF SOCIAL DETERMINANTS ON HEALTH EQUITY -- LEADING DETERMINANTS OF HEALTH: WEIGHTING THE DIFFERENT DOMAINS -- HEALTH POLICY AND RETURNS ON INVESTMENT -- CONCLUSION -- REFERENCES -- Chapter 5: Public Health Systems and Their Role in Society -- OVERVIEW OF A COMPLEX INFRASTRUCTURE -- PUBLIC HEALTH REQUIRES A COLLECTIVE RESPONSE FROM SOCIETY.

AbstractParticipation in the federally subsidized school breakfast program often falls well below its lunchtime counterpart. To increase take‐up, many districts have implemented Breakfast in the Classroom (BIC), offering breakfast directly to students at the start of the school day. Beyond increasing participation, advocates claim BIC improves academic performance, attendance, and engagement. Others caution BIC has deleterious effects on child weight. We use the implementation of BIC in New York City (NYC) to estimate its impact on meals program participation, body mass index (BMI), achievement, and attendance. While we find large effects on participation, our findings provide no evidence of hoped‐for gains in academic performance, or of feared increases in obesity. The policy case for BIC will depend upon reductions in hunger and food insecurity for disadvantaged children, or its longer‐term effects.

Purpose. Interest and funding continue to grow for bringing supermarkets to underserved areas, yet little is known about their impact. Design. A quasi-experimental study was used to determine the impact of a new supermarket opening as a result of tax and zoning incentives. Setting. The study took place in the South Bronx, New York City, New York. Subjects: Studied were residents of two South Bronx neighborhoods deemed high need. Measures. Food purchasing and consumption were examined via surveys and 24-hour dietary recalls before and at two points after the supermarket opened (1–5, 13–17 months). Analysis. Data were analyzed using difference-in-difference models controlling for gender, race and ethnicity, age, education, marital status, and self-reported income. Ordinary least squares and logistic regression models were estimated for continuous and binary outcomes, respectively. Results. At baseline, 94% to 97% of consumers shopped at a supermarket. There was a 2% increase in this behavior in the intervention community ( p < .05) not seen in the comparison community. One year later there was a 7% net increase in eating at home ( p < .1) and a 20% decrease in drinking sugary beverages ( p < .05), but no appreciable change in fruit/vegetable consumption or overall dietary quality. Conclusion. The new supermarket did not result in substantial or broad changes in purchasing patterns or nutritional quality of food consumed, though smaller, positive changes were observed over a 1-year period. Future work should examine different contexts and a broader set of outcomes, including economic development.

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

OBJECTIVE: To assess the accuracy of government inspections records, relative to ground observation, for identifying businesses offering food/drink. DESIGN: Agreement between city and state inspections records versus ground observations at two levels—businesses, street segments. Agreement could be 'strict' (by business names, e.g., "Rizzo's") or 'lenient' (by business types, e.g., "pizzeria"), using sensitivity and positive predictive value (PPV) for businesses; using sensitivity, PPV, specificity, and negative predictive value (NPV) for street segments. SETTING: New York City—the Bronx and the Upper East Side (UES) PARTICIPANTS: All food/drink-offering businesses on sampled street segments (154 segments in the Bronx, 51 in the UES) RESULTS: By 'strict' criteria, sensitivities and PPVs of government records for food/drink-offering businesses were 0.37 and 0.57 in the Bronx; 0.58 and 0.60 in UES. 'Lenient' values were 0.40 and 0.62 in the Bronx; 0.60 and 0.62 in the UES. Sensitivities, PPVs, specificities, and NPVs of government records for street segments having food/drink-offering businesses were 0.66, 0.73, 0.84, and 0.79 in the Bronx; 0.79, 0.92, 0.67, and 0.40 in UES. In both areas, agreement varied by business category: restaurants; "food stores;" and government-recognized other storefront businesses ("gov. OSBs", i.e. dollar stores, gas stations, pharmacies). Additional business categories—"Other OSBs" (barbers, laundromats, newsstands, etc.) and street vendors—were absent from government records; together, they represented 28.4% of all food/drink-offering businesses in the Bronx, 22.2% in the UES (they were sources of both healthful and less-healthful food/drink in both areas). CONCLUSIONS: Government records frequently miss or misrepresent businesses offering food/drink, suggesting caveats for food-environment assessments using such records.