Healthy Menu Options Research Articles

A Quantitative Assessment of Changes in the Consumer Nutrition Environments of New York City Hispanic Caribbean Restaurants During the COVID-19 Pandemic

Objectives(1) Examine changes in healthy food availability among Hispanic Caribbean restaurants (HCR) in response to COVID-19. (2) Assess the association between changes and restaurant type.MethodsA random sample of HCRs (n = 89) offering Cuban, Dominican, Puerto Rican cuisine, were examined in Summer 2019 (T1) using the NEMS-HCR, an adapted version of the Nutrition Environment Measures Survey for Restaurants (NEMS-R) and reassessed after the onset of COVID-19 in January 2021 (T2, n = 76) using online menus. We examined menu changes between T1 and T2 data sets in the NEMS-HCR overall healthy food availability (HFA) score, and specific variables: the number of healthy main dish salads (HMDS) and the menu proportion of nonfried foods (NFF) on the menu. We then examined changes by restaurant type (sit-down vs. counter-style) using repeated measures ANOVA.ResultsBetween T1 and T2, 7 HRCs permanently closed, 1 closed for the season, and 5 were excluded due to lack of online menus. Mean proportion of NFF significantly decreased from 71.7% ± 17.5 (T1) to 66.1% ± 17.8 (T2) (P = 0.002). Changes in HFA scores (4.5 ± 2.0 to 4.1 ± 2.2) and HMDS (1.7 ± 2.8 to 1.8 ± 3.0) were not statistically significant (P = 0.06 and P = 0.65, respectively). Repeated measures ANOVA indicated no correlation between the decrease in availability of NFF between T1 and T2 and restaurant type (P = 0.29).ConclusionsRestaurants can play a significant role in the mitigation of diet-related diseases such as cardiovascular disease and diabetes by providing customers with healthy menu offerings. Our study showed a decrease in healthier menu options, particularly non-fried entrees, contributing to our understanding of how restaurants may need to adapt for their own survival in times of crisis such as a pandemic or disaster. Because unfavorable menu options can contribute to the rising incidence of diet-related chronic diseases within the community, more research is needed to understand how restaurants respond to crises in order to better support the preservation of HFA within their menu selections, and the effects of these changes in customers’ diets.Funding SourcesCUNY PSC Award and NIH National Heart, Lung, and Blood Institute

Eat Well El Paso!: Lessons Learned From a Community-Level Restaurant Initiative to Increase Availability of Healthy Options While Celebrating Local Cuisine.

Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative. Descriptive case study. EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border. Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively). EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options. Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability. Thematic and descriptive analyses. 57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding. Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants' healthy menu options.

Understanding the healthfulness of outlets providing lunch and dinner meals: a census of a rural food retail environment in Victoria, Australia

ObjectiveTo undertake a census of the healthfulness of food venues providing lunch or dinner meals in a rural Australian setting and compare healthfulness by remoteness, using two measurement tools. MethodsA census of the rural local government area food venues was undertaken using two validated tools: the Healthfulness Rating Classification System (HRCS) and the Nutrition Environment Measures Survey (NEMS‐R). Data were collected covering an area of 3,438 square kilometres in Victoria, Australia, with a population of >21,000. Healthfulness by remoteness was described and variability between tools was explored. ResultsData were collected from all 95 eligible food venues. Both tools classified the food venues as relatively unhealthy. The mean HRCS score was ‐2.9 (unhealthy) and the mean NEMS‐R score was 10.8 (SD 7.0; possible range ‐27 to 64). There were no significant differences in healthiness of venues by remoteness (as measured by the Modified Monash Model), although the outer‐rural region had lower scores. ConclusionsThis census of a rural food retail environment showed low access to healthy menu options along with minimal provision of nutrition information and promotion of healthy food in food venues. This environment has the potential to affect the dietary intake of more than 21,000 rural‐dwelling Australians and action to improve rural food environments is desperately needed. Implications for public healthIf unhealthful rural food environments are not addressed, inequalities in the diet‐related disease burden for rural Australians will continue to persist. This study shows that interventions are needed for independent venues that could be targeted by researchers, local health promotion officers, community nutritionists or community education programs.

Restaurant Industry Practices to Promote Healthy Sustainable Eating: A Content Analysis of Restaurant Websites Using the Value Chain Approach

The purpose of this study is to help researchers and restaurant owners gain an understanding of healthy sustainable initiatives within restaurant businesses. This study applied a content analysis of 93 restaurant chains’ websites with a systematic coding procedure. The study identified fifteen healthy sustainable initiatives under a value chain framework, four of which follow value chain dimensions: sourcing, production, marketing, and service. The most frequently mentioned healthy sustainable practice was presenting nutrition-related information, followed by providing healthy menu options and using organic/natural produce. Sit-down restaurants were more likely to engage in healthy sustainable eating initiatives than were fast-food restaurants (e.g., increasing the availability of healthy options, smaller/reduced portion sizes, using fresh and local food, and using healthy cooking methods). This study contributes to the restaurant/foodservice management and food marketing literature by showing a comprehensive picture of what U.S. restaurant chains are doing to promote healthy sustainable eating. The findings can be used as a benchmark tool for practitioners to evaluate and develop healthy sustainable restaurant initiatives and as the foundation of measurement items for scholars.

Addressing workplace violence with the Pathway to Excellence® framework.

Addressing workplace violence with the Pathway to Excellence® framework.

Description and Evaluation of Changes to the Rural Nutrition Environment After Implementation of Community-led Policy, System, and Environment Change Strategies (P04-163-19)

ObjectivesTo assess the nutrition environment in three rural Louisiana parishes (counties) with high rates of poverty (range 25%-41.7%), obesity (>40%), and chronic diseases and to better understand the local nutrition environment in rural, low-income, food insecure areas and to evaluate policy, systems, and environmental (PSE) change strategies aimed at improving the rural food environment. MethodsHealthy Access, Behaviors, Communities was a community-participatory, multi-level approach to obesity prevention in Louisiana. This evaluation used a descriptive, mixed methods design that focused on 1st and 3rd year project data. Nutrition environments were assessed using the reduced Nutrition Environment Measurement Survey (NEMS) for food stores and restaurants. Pre and post NEMS scores were compared to determine if PSE interventions were effective in improving the nutrition environment. ResultsOverall, 48 food stores and 39 restaurants were assessed at baseline, while 45 food stores and 36 restaurants were assessed at follow-up. Different numbers between baseline and follow-up assessments are due to store closures/openings. Except for the grocery store and fast food environments in Madison parish, the food environments were poor across the targeted parishes, with NEMS scores indicating a lack of healthy grocery items (stores) or a lack of healthy menu options (restaurants). With few exceptions, average NEMS scores generally increased slightly over the assessments, which is a positive trend; however, these positive changes did not result in the food retail environment moving from unhealthy to healthy. Five stores were targeted by the coalition to implement PSE changes. Of the partner stores, the average number of healthy foods available increased in all categories, except skim or low-fat milk, from baseline to post-intervention. ConclusionsFindings from baseline indicate that the nutrition environment in these poor, rural parishes can present challenges to individuals attempting to meet preventative health recommendations. PSE interventions can improve the nutrition environment in these locations. Funding SourcesCenters for Disease Control High Obesity 1416 Cooperative agreement.

Parenting practices toward food and children's behavior: Eating away from home versus at home

Parenting style influences a child's overall diet quality and establishes food preferences. Parenting style and “food rules” for children differ by eating at home or away from home. Eating meals away from home is increasing despite associations with consumption of unhealthy foods and higher weight status. The objective of the current study was to compare parenting practices and decision-making at restaurants versus at home. A mixed methods approach was utilized: facilitated, individual interviews to explore decision-making and parenting practices; written questionnaires for socio-demographic information; and body mass index. Summaries and emergent themes were generated based on examination of tapes and transcripts. Descriptive statistics were computed for questionnaire data. Twenty-five mothers of children of five to eight years who ate at restaurants at least two times per week participated. Mothers reported more permissive food rules at restaurants yet maintained higher behavioral expectations. Mothers were also more likely to make decisions about whether they eat out, where to eat, and children's meal selections than their children. The findings suggest that parenting practices toward overall behavior and food choices may differ at restaurants than at home, highlighting the importance of healthy menu options, further research, and educational strategies.

Increasing Healthy Menu Options through the Nutrition Integrity Assessment Project: A Statewide Initiative

Increasing Healthy Menu Options through the Nutrition Integrity Assessment Project: A Statewide Initiative

Media Outlet and Consumer Reactions to Promotional Activities of the Choose Health LA Restaurants Program in Los Angeles County.

This study sought to assess promotional activities undertaken to raise public awareness of the Choose Health LA Restaurants program in Los Angeles County, an environmental change strategy that recognizes restaurants for offering reduced-size and healthier menu options. We used multiple methods to assess public awareness of and reactions to the promotional activities, including an assessment of the reach of core promotional activities, a content analysis of earned media, and an Internet panel survey. The study was conducted in Los Angeles County, home to more than 10 million residents. An online survey firm recruited participants for an Internet panel survey; to facilitate generalization of results to the county's population, statistical weights were applied to analyses of the survey data. Promotional activities to raise awareness of the program included community engagement, in-store promotion, and a media campaign. Outcomes included media impressions, the number of people who reported seeing the Choose Health LA Restaurants logo, and a description of the themes present in earned media. Collectively, paid media outlets reported 335 587 229 total impressions. The Internet panel survey showed that 12% of people reported seeing the program logo. Common themes in earned media included the Choose Health LA Restaurants program aims to provide restaurant patrons with more choices, represents a new opportunity for restaurants and public health to work together, will benefit participating restaurants, and will positively impact health. Promotional activities for the Choose Health LA Restaurants program achieved modest reach and positive reactions from media outlets and consumers. The program strategy and lessons learned can help inform present and future efforts to combine environmental and individually focused strategies that target key influences of consumer food selection.

'McDonalds and KFC, it's never going to happen': the challenges of working with food outlets to tackle the obesogenic environment

Food outlets may make an important contribution to an obesogenic environment. This study investigated barriers and facilitators to public health work with food outlets in disadvantaged areas. In-depth qualitative interviews with 36 directors, managers and public health service delivery staff in a coterminous primary care trust and local authority in northwest England. Data were analysed using the constant comparative method. Three interventions were available to engage with businesses; awards for premises that welcomed breastfeeding mothers or offered healthy menu options and local authority planning powers. Sensitivity to the potential conflict between activities that generate profit and those that promote health, led to compromises, such as awards for cafés that offer only one healthy option on an otherwise unhealthy menu. An absence of existing relationships with businesses and limited time were powerful disincentives to action, leading to greater engagement with public rather than private sector organizations. Hiring staff with commercial experience and incentives for businesses were identified as useful strategies, but seldom used. Encouraging food outlets to contribute to tackling the obesogenic environment is a major challenge for local public health teams that requires supportive national policies. Commitment to engage with the local public health service should be part of any national voluntary agreements with industry.

Pilot environmental intervention trial in carry‐outs in low‐income neighborhoods of Baltimore City

Among low‐income African Americans in Baltimore City, a significant proportion of daily caloric intake is derived from prepared foods served at carry‐outs. However, little is known about the city's carry‐out food environment and strategies to improve accessibility and consumption of healthy foods in these settings. We conducted a two‐month pilot intervention trial in 3 carry‐outs in low income areas of the city. We assessed acceptability of environmental interventions including: replacing the menu board to promote existing healthy menu options with photos, promotional posters, and the substitution of low‐fat for regular mayonnaise on sandwiches. All 3 carry‐out owners were Korean Americans who owned their restaurants for 15–29 years. Each carry‐out conducted business from behind Plexiglas, with little direct customer contact. Acceptability and fidelity of the new menu board and poster interventions were high (3 out of 3) and use of low‐fat mayo was moderate (2 out of 3). Perceived sustainability of the modified menu board and poster interventions were high (3 out of 3), but low‐fat mayo was low (0 out of 3). Low fat mayo purchasing was the primary barrier, given the lack of bulk availability and price at wholesalers. Our findings will be used to test the feasibility and impact of these carryout interventions using a larger sample size.Grant Funding Source: Diabetes Research and Traning Center

Availability of healthier options in traditional and nontraditional rural fast-food outlets.

BackgroundFood prepared away from home has become increasingly popular to U.S. families, and may contribute to obesity. Sales have been dominated by fast food outlets, where meals are purchased for dining away from home or in the home. Although national chain affiliated fast-food outlets are considered the main source for fast food, fast foods are increasingly available in convenience stores and supermarkets/grocery stores. In rural areas, these nontraditional fast-food outlets may provide most of the opportunities for procurement of fast foods.MethodsUsing all traditional and nontraditio nal fast-food outlets identified in six counties in rural Texas, the type and number of regular and healthiermenu options were surveyed using on-site observation in all food venues that were primarily fast food, supermarket/grocery store, and convenience store and compared with 2005 Dietary Guidelines.ResultsTraditional fast-food outlets represented 84 (41%) of the 205 opportunities for procurement of fast food; 109 (53.2%) were convenience stores and 12 (5.8%) supermarkets/grocery stores. Although a s imilar variety of regular breakfast and lunch/dinner entrées were available in traditional fast-food outlets and convenience stores, the variety of healthier breakfast and lunch/dinner entrées was significantly greater in fast food outlets. Compared with convenience stores, supermarkets/grocery stores provided a greater variety of regular and healthier entrées and lunch/dinner side dishes.ConclusionConvenience stores and supermarkets/grocery stores more than double the potential access to fast foods in this rural area than traditional fast-food outlets alone; however, traditional fast food outlets offer greater opportunity for healthier fast food options than convenience stores. A complete picture of fast food environment and the availability of healthier fast food options are essential to understand environmental influences on diet and health outcomes, and identify potential targets for intervention.

The Availability of Healthy Food Options in Fast Food Outlets in Six Rural Counties

Background: The environment in which an individual lives can play a role in food choice as food selection may be limited to those readily available. Rural environments, in particular, may have less availability to healthy foods due to unique characteristics of these areas. Fast foods may be present in rural areas but the number of healthy options at restaurants and other food outlets may be limited. Methods: Using food outlets identified in the Brazos Valley Food Environment Project, marketing of fast food items and data on the type and number of healthy menu options were surveyed and compared with the 2005 Dietary Guidelines. Results: 222 fast food outlets were identified within 6 rural counties; 98 were primarily fast foods, 112 were convenience stores with fast food, and 12 were grocery stores with fast food. Healthy options for breakfast meals were available in 22.4% of fast food stores, 8.9% of convenience stores, and 50% of grocery stores. Healthy options for lunch entrees were available at 67.3% of fast food stores, 35.7% of convenience stores, and 75% of grocery stores. The types of healthy options varied among stores. When compared to other fast food outlets, national chain fast food stores were more likely to offer healthy options. Conclusions: Analyzing healthy options from fast food stores only may exclude outlets that are the predominant sources of fast food in rural areas. Additionally, healthy options are more likely to be found in national chain restaurants but the majority of fast food outlets are not national chains.

Healthier Choices and Increased Participation in a Middle School Lunch Program: Effects of Nutrition Policy Changes in San Francisco

In order to address overall nutritional health, including increases in numbers of overweight children and adolescents, the San Francisco Unified School District implemented a progressive nutrition policy beginning in August 2003. We review this policy and focus on its impact on school and district revenues and students' participation in the federally subsidized school lunch program. We examined changes in menu items and the consequent effects of these changes on student eating patterns and school revenues at Aptos Middle School in San Francisco. This case study and additional district data show that provision of healthy menu options led to increased student participation in the federal school lunch program.

Healthy Menu Intervention in Restaurants in Low-Income Neighbourhoods: A Field Experience

The objective of this study was to evaluate the feasibility of an intervention aimed at offering healthy menu options in a fast-food restaurant and a family-style restaurant, both located in a low-income, inner-city neighbourhood. Data on frequency of ordering healthy menu options, as well as customer reaction to the intervention, were collected in self-administered questionnaires in on-site surveys of restaurant clientele (n = 940).The results suggest that there is a demand for healthy menu options in such restaurants. Males in the family-style restaurant and regular customers (at least one visit per week) in the fast-food restaurant were more likely than others to order these options, which suggests that environmental interventions of this kind might be an effective way to reach subgroups that are difficult to reach with more traditional educational strategies.