Ethnic Restaurant Nutrition Environments and Cardiovascular Health: Examining Hispanic Caribbean Restaurants in New York City

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