US children?s diets are unhealthy, a critical issue to address in the context of the obesity epidemic. Restaurants are one setting in which environmental shifts could promote healthier eating among children. One-third of children eat food from quick-service (fast food) restaurants on a given day, and consumption of restaurant food has been linked with increased energy intake and poorer diet quality. Taste is a key factor influencing food choices for children in restaurants, so approaches that increase children?s liking of healthier options offer promise to improve their eating behavior in these settings and more broadly. The goal of the proposed research is to make healthier options more appealing and easier to choose via an in-restaurant intervention that combines choice architecture and repeated exposure strategies. The choice architecture element will be a placemat designed to make it easier to choose healthier kids? meal items and omit dessert. The repeated exposure element will be frequent diner cards, designed to increase exposure to and enjoyment of target foods. Extensive basic research supports repeated exposure as a powerful strategy to improve children?s taste preferences. Further, in a pilot study of 58 families in a quick-service restaurant, we showed the promise of our planned intervention: Children provided with placemats promoting healthier kids? meals ordered a greater number of healthier foods than controls, and children who ordered promoted main dishes consumed less saturated fat than those who did not. Our long-term goal is to establish the effectiveness of an in-restaurant healthy eating intervention that can be implemented and disseminated across restaurants. The objective of this grant is to expand on our preliminary research by rigorously testing effects of an intervention that combines choice architecture and repeated exposure strategies on children?s food selection and intake in quick-service restaurants and throughout the day. We will randomize restaurant locations to groups, and children who visit restaurants regularly (n=930; 310 per cohort) will be exposed to placemats and frequent diner cards promoting healthier meals or generic (control) versions of these materials. The frequent diner cards will incentivize selection of a healthier featured meal over 6 occasions in the intervention group. The central hypothesis is that after these exposures, intervention group children will be more likely to select a healthier meal. Children?s meal selection and dietary intake in the restaurant and throughout the day will be assessed at initial and post-test time points to test hypotheses that this intervention promotes healthier meal selection (Specific Aim 1) and dietary intake (Specific Aim 2). Families? behaviors at interim time points and potential impacts on restaurants will also be monitored. Given how frequently children eat food from restaurants, the typical consumption patterns while there, and the promise of repeated exposure to impact eating behaviors broadly, this intervention has the potential for meaningful public health impact. The present approach is novel in its application of behavioral strategies and offers the potential for lasting impacts on children?s diets and health.
More than one-third of children eat food from restaurants on a given day, and consumption of restaurant food has been linked with increased energy intake and poorer diet quality. The goal of this application is to test an in-restaurant intervention that aims to use behavioral strategies, specifically choice architecture and repeated exposure, to promote healthier meal selection and dietary intake among children. This study will be the first to apply these evidence-based behavioral strategies in a randomized study within restaurants and offers the potential for a meaningful impact on children's diets and health.
