Using fundraising incentives and point-of-purchase nutrition promotion to improve food choices among school families in restaurants: a pilot and feasibility study.

OBJECTIVE: To assess the feasibility and efficacy of in-restaurant interventions aiming to promote healthy choices via fundraising incentives benefiting school wellness programmes and point-of-purchase nutrition promotion. DESIGN: Twelve schools were randomly assigned to one of the two intervention periods: Fundraising Incentive (FI) donated funds for visiting the study restaurant and Fundraising-Healthy Eating Incentive (F-HEI) included FI with additional funds given when selecting a healthier item. Both conditions included point-of-purchase nutrition promotions. Families were recruited to attend their designated intervention and complete a survey. Feasibility was assessed based on recruitment and participation, implementation fidelity and intervention acceptability. Efficacy was assessed by comparing participant receipts between intervention periods and by comparing overall restaurant sales during intervention v. two no-intervention time frames. SETTING: Fast-casual restaurant in Southern California. PARTICIPANTS: Parents with children attending participating schools. RESULTS: Eighty-one families visited the restaurant during the intervention, with sixty-six completing surveys. All study activities were implemented successfully, but school family participation in the intervention was low (0·95 %). Among participants completing surveys, all indicated satisfaction with the programme. The percentage of healthier items ordered was significantly greater during both FI (χ2 = 5·97, P = 0·01) and F-HEI (χ2 = 8·84, P = 0·003) v. Comparison 2. Results were similar but did not reach statistical significance when comparing the interventions to Comparison 1. CONCLUSIONS: Results support potential efficacy of this programme, but more research is needed to inform feasibility. Fidelity and acceptability data supported feasibility, but participation rates were low in this initial study. Methods evaluating this intervention with a greater proportion of parents should be considered.

Promoting healthier children's meals at quick-service and full-service restaurants: Results from a pilot and feasibility study.

High-calorie restaurant foods contribute to childhood overweight. Increased consumer demand for healthier kids' meals may motivate the restaurant industry to provide additional healthy options. This study pilot-tested a combination of four strategies (toy incentive, placemats, server prompts, signage) designed to increase demand for healthier kids' meals, which were defined as those eligible for the National Restaurant Association's Kids LiveWell program. Relative sales of healthier kids' meals were examined before (n = 3473 total kids' meal orders) and during Month 1 (n = 3546 total kids' meal orders) and Month 2 of implementation (n = 3645 total kids' meal orders) of an 8-week intervention in two locations each of a quick-service (QSR) and full-service (FSR) restaurant chain. Convenience samples of children (n = 27) and their parents (n = 28) were surveyed regarding parent and child perceptions of intervention components. Findings regarding the effectiveness and feasibility of the intervention were mixed. At the FSRs, the relative percentage of monthly sales from healthier kids' meals increased from 5.0% of kids' meal orders at baseline to 8.3% during Month 1, ending at 6.4% during Month 2. At the QSRs, the relative percentage of monthly sales from healthier kids' entrees decreased from 27.5% at baseline to 25.2% during Month 1, ending at 25.9% during Month 2. Implementation quality tracking showed that consistent implementation of intervention components was a challenge; parent- and child-reported awareness of intervention components supported this finding. Future directions are discussed, aiming to build upon these findings and maximize the feasibility, effectiveness, and sustainability of efforts to promote healthier eating in restaurants.

Healthier Children's Meals in Restaurants: An Exploratory Study to Inform Approaches That Are Acceptable Across Stakeholders.

OBJECTIVE: Assess parents', children's, and restaurant executives' perspectives on children's meals in restaurants. DESIGN: Cross-sectional. SETTING: Parents and children completed predominantly quantitative surveys at 4 quick- and full-service restaurant locations. Telephone interviews were conducted with executives representing additional restaurants. PARTICIPANTS: Parents (n = 59) and their first- through fourth-grade children (n = 58); executives (n = 4). VARIABLES MEASURED: Parent/child perspectives on child meal selection and toy incentives in restaurants; executives' views on kids' meals and barriers to supplying healthier kids' meals. ANALYSIS: Frequencies, thematic analysis. RESULTS: A total of 63% of children ordered from children's menus, 8% of whom ordered healthier kids' meals. Half of parents reported that children determined their own orders. Taste was the most common reason for children's meal choices. Most (76%) children reported visiting the restaurant previously; 64% of them placed their usual order. Parents' views on toy incentives were mixed. Themes from executive interviews highlighted factors driving children's menu offerings, including children's habits and preferences and the need to use preexisting pantry items. Executives described menu changes as driven by profitability, consumer demand, regulation, and corporate social responsibility. CONCLUSIONS AND IMPLICATIONS: Findings can inform the development of restaurant interventions that are effective in promoting healthier eating and are acceptable to parents, children, and restaurant personnel.

Mixed Messages: Ambiguous Penalty Information in Modified Restaurant Menu Items.

Restaurant menu items from six national or regional brands were modified to reduce fat, saturated fat, sodium and total calories. Twenty-four items were tested with a current recipe, and two modifications (small and moderate reductions) for 72 total products. Approximately 100 consumers tested each product for acceptability as well as for desired levels of tastes/flavor, amounts of key ingredients and texture/consistency using just-about-right (JAR) scales. Penalty analysis was conducted to assess the effects of non-JAR ratings on acceptability scores. Situations arose where JAR ratings and penalty analyses could yield different recommendations, including large groups with low penalties and small groups with high penalties. Opposing groups with moderate to high penalties on opposite sides of the same JAR scale were also seen. Strategies for dealing with these observances are discussed.

Reducing calories, fat, saturated fat, and sodium in restaurant menu items: Effects on consumer acceptance.

OBJECTIVE: To assess consumer acceptance of reductions of calories, fat, saturated fat, and sodium to current restaurant recipes. METHODS: Twenty-four menu items, from six restaurant chains, were slightly modified and moderately modified by reducing targeted ingredients. Restaurant customers (n = 1,838) were recruited for a taste test and were blinded to the recipe version as well as the purpose of the study. Overall consumer acceptance was measured using a 9-point hedonic (like/dislike) scale, likelihood to purchase scale, Just-About-Right (JAR) 5-point scale, penalty analysis, and alienation analysis. RESULTS: Overall, modified recipes of 19 menu items were scored similar to (or better than) their respective current versions. Eleven menu items were found to be acceptable in the slightly modified recipe version, and eight menu items were found to be acceptable in the moderately modified recipe version. Acceptable ingredient modifications resulted in a reduction of up to 26% in calories and a reduction of up to 31% in sodium per serving. CONCLUSIONS: The majority of restaurant menu items with small reductions of calories, fat, saturated fat, and sodium were acceptable. Given the frequency of eating foods away from home, these reductions could be effective in creating dietary improvements for restaurant diners.