Voluntary healthier kids' meals policies: Are caregivers choosing kids' meals and healthier items for their child?

BACKGROUND: Children's fast-food consumption increases risks for obesity and other diet-related diseases. To address concerns, from 2010 to 2016 U.S. fast-food restaurants implemented voluntary policies to offer healthier drinks and/or sides with kids' meals. OBJECTIVES: Examine the effectiveness of voluntary kids' meal policies. METHODS: Online repeated cross-sectional survey (2010, 2013, 2016) of U.S. caregivers (N = 2093) who purchased fast-food for their child (2-11 years) in the past week. Logistic regression examined associations between healthier kids' meal policy implementation and caregivers' purchases of kids' meals and selection of healthier sides and drinks. Separate models investigated caregivers' attitudes about McDonald's kids' meal items. RESULTS: Overall, 55% of caregivers reported choosing a kids' meal for their child, and approximately one-half of those caregivers selected a healthier drink and/or side. Healthier kids' meal policy implementation was associated with increased selection of healthier sides, but not healthier drinks or choice of kids' meals over higher-calorie menu items. Child's age, caregiver gender and visit frequency were significant in most models. Caregivers' perceptions that their child(ren) like healthier drinks and sides were positively associated with selection of those items. CONCLUSIONS: Existing healthier kids' meal policies may not improve children's fast-food consumption. Public health initiatives should examine more effective alternatives.

Association of a Community Campaign for Better Beverage Choices With Beverage Purchases From Supermarkets.

Importance: Data are needed to evaluate community interventions to reduce consumption of sugary drinks. Supermarket sales data can be used for this purpose. Objective: To compare beverage sales in Howard County, Maryland (HC), with sales in comparison stores in a contiguous state before and during a 3-year campaign to reduce consumption of sugary beverages. Design, Setting, and Partipicants: This observational experiment with a control group included 15 HC supermarkets and 17 comparison supermarkets. Weekly beverage sales data at baseline (January 1 to December 31, 2012) and from campaign years 1 to 3 (January 1, 2013, through December 31, 2015) were analyzed. A difference-in-differences (DID) regression compared the volume sales per product per week in the HC and comparison stores, controlling for mean product price, competitor's product price, product size, weekly local temperature, and manufacturer. Exposures: The campaign message was to reduce consumption of all sugary drinks. Television advertising, digital marketing, direct mail, outdoor advertising, social media, and earned media during the 3-year period created 17 million impressions. Community partners successfully advocated for public policies to encourage healthy beverage consumption in schools, child care, health care, and government settings. Main Outcomes and Measures: Sales were tracked of sugary drinks highlighted in the campaign, including regular soda, sports drinks, and fruit drinks. Sales of diet soda and 100% juice were also tracked. Sales data are expressed as mean fluid ounces sold per product, per store, per week. Results: Regular soda sales in the 15 HC supermarkets decreased (-19.7%) from 2012 through 2015, whereas sales remained stable (0.8%) in the 17 comparison supermarkets (DID adjusted mean, -369 fl oz; 95% CI, -469 to -269 fl oz; P < .01). Fruit drink sales decreased (-15.3%) in HC stores and remained stable (-0.6%) in comparison stores (DID adjusted mean, -342 fl oz; 95% CI, -466 to -220 fl oz; P < .001). Sales of 100% juice decreased more in HC (-15.0%) than comparison (-2.1%) stores (DID mean, -576 fl oz; 95% CI, -776 to -375 fl oz; P < .001). Sales of sports drinks (-86.3 fl oz; 95% CI, -343.6 to 170.9 fl oz) and diet soda (-17.8 in HC stores vs -11.3 in comparison stores; DID adjusted mean, -78.9 fl oz; 95% CI, -182.1 to 24.4 fl oz) decreased in both communities, but the decreases were not significantly different between groups. Conclusions and Relevance: A locally designed, multicomponent campaign to reduce consumption of sugary drinks was associated with an accelerated decrease in sales of regular soda, fruit drinks, and 100% juice. This policy-focused campaign provides a road map for other communities to reduce consumption of sugary drinks.

Hispanic Youth Visits to Food and Beverage Company Websites.

Purpose: To measure disparities in exposure to food/beverage websites by Hispanic youth. Methods: Observational study using market research panel data compared frequency and time spent visiting food/beverage websites and the Internet overall for Hispanic and non-Hispanic children (6-11 years) and youth (6-17 years). Results: Hispanic children and youth, particularly Spanish-speaking youth, were less likely to visit the Internet overall, but more likely to visit food/beverages websites, compared with their non-Hispanic peers. Conclusions: Food and beverage company websites disproportionately appeal to Hispanic youth. Public health advocates and companies should take action to reduce Hispanic youth exposure to unhealthy food marketing online.

Effects of Offering Look-Alike Products as Smart Snacks in Schools.

BACKGROUND: In 2014, USDA established nutrition standards for snack foods sold in schools. Many manufacturers reformulated products to meet these Smart Snacks standards, but continue to advertise unhealthy versions of the same brands. Furthermore, Smart Snack packaging often looks similar to less nutritious versions sold outside of schools (look-alike products). This practice may confuse consumers about the nutritional quality of Smart Snacks and raise concerns about schools selling them. METHODS: An online experiment with 659 students (13-17 years) and 859 parents (children ages 10-13) was performed. Participants randomly viewed information about snacks sold at a hypothetical school, including (1) look-alike Smart Snacks; (2) existing store versions of the same brands; (3) repackaged Smart Snacks (highlighting differences versus unhealthy versions); or (4) consistent brands (i.e., Smart Snack versions also sold in stores). They then rated the individual snacks offered and the school selling them. RESULTS: As hypothesized, students and parents rated look-alike and store versions similarly in taste, healthfulness, and purchase intent, while considering repackaged Smart Snacks as healthier, but less tasty. Most participants also inaccurately believed they had seen look-alike products for sale in stores. Furthermore, they rated schools offering look-alike Smart Snacks and store versions as less concerned about students' health and well-being than schools in the other two conditions. CONCLUSIONS: The nutritional quality of snacks sold in schools has improved, but many Smart Snacks are virtually indistinguishable from less nutritious versions widely sold outside of schools. This practice likely benefits the brands, but may not improve children's overall diet and undermines schools' ability to teach good nutrition.

Comparing Current Practice to Recommendations for the Child and Adult Care Food Program.

BACKGROUND: The federal Child and Adult Care Food Program (CACFP) assists child care centers serving low-income preschoolers and regulates the quality and quantity of food served. The aim of this study was to assess the nutritional quality of lunches served at 38 child care centers and examine how current practices compare to proposed meal pattern recommendations. METHODS: Preschool-aged children (n = 204) were observed eating lunch in 38 CACFP-participating preschools. All foods served and consumed were measured and compared to the 2011 Institute of Medicine (IOM) recommendations to improve CACFP and the 2015 Proposed Rule issued by the USDA. RESULTS: All centers provided access to all required lunch components, but not all components were served (i.e., placed on the child's plate). Vegetables were significantly less likely to be served than meat or grains. Compared with CACFP recommended portion sizes, servings of meat and grain were high, whereas milk was low. Compared with IOM recommendations, average calorie consumption was appropriate, but saturated fat, protein, and sodium intake were high and dietary fiber was low. Meals that offered children both a fruit and a vegetable led to significantly higher produce consumption than meals that offered only one fruit or one vegetable. CONCLUSIONS: Child care centers generally comply with current CACFP regulations, but do not provide lunches consistent with the 2011 IOM recommendations for saturated fat, protein, fiber, and sodium. Decreased use of beef and cheese and increased provision of whole grains, fruits, and vegetables are recommended.