Childhood obesity is among the highest in the Mexican immigrant/Mexican-American population, the fastest growing segment of the U.S. Latino population. Substantial evidence supports the importance of a healthy food environment for childhood obesity prevention and control. The latest intervention research to improve the restaurant food environment for children has focused on menu labeling, however no study has tested methods for improving the restaurant food environment by changing what is offered to children and altering the social environment through an innovative children's menu marketing campaign and restaurant employee training, strategies recommended by the Institute of Medicine and the White House Task Force on Childhood Obesity. The proposed study, Introducing Child Menus in Restaurants to Improve Access to Healthier Foods builds on our formative research and an exploratory intervention study. During Phase I we will develop a method for observing menu ordering and consumption behaviors among children in 12 restaurants similar to those targeted during the intervention phase though located in a different community. Phase II will involve assessing the feasibility, fidelity and short-term efficacy of a restaurant-based intervention. Five pair-matched independently-owned restaurants will be randomized to an intervention or a delayed treatment control condition. The intervention will involve (a) creating healthy child menus that meet dietary guidelines for reducing calories, fat, and sugar and increasing fruits and vegetables, and (b) promoting this menu through an innovative children's menu marketing campaign and prompting by restaurant employees. Our focus on independent restaurants is driven by the lack of child menus as determined by our formative research;in addition, this work compliments and does not overlap with what the restaurant industry is doing with chain restaurants. The primary aim of this study is to evaluate the efficacy of the intervention on sales of new healthy child menu items using restaurant sales data. An exploratory aim will examine whether the addition of new healthy child menus is effective at altering ordering and consumption behaviors, assessed observationally, to decrease the calories, fat, and sugar, and increase the fruits and vegetables that children consume. Process evaluation aims include assessing the: (a) feasibility and intervention fidelity based on the extent to which healthy menus are created and promoted, and (b) customer reactions including satisfaction with the healthy child menus. The proposed study will provide the necessary data on feasibility, short-term efficacy, and potential sustainability and generalizability of a restaurant-based intervention for a future larger scale randomized controlled trial assessing changes in dietary intake. It also has the potential to contribute to NIH's request for research targeting ethnic minorities and studies that seek to prevent and control childhood obesity.

Public Health Relevance

National health surveys demonstrate that obesity is the most prevalent chronic disorder among youth, with 31% of children classified as obese;rates are higher among Mexican-origin children living in the U.S. Nutrition research indicates that more frequent consumption of away-from-home foods is associated with higher intakes of calories, fat, and sugar. This study proposes to change the restaurant food environment by modifying what is offered to children and promoting these changes through a marketing campaign and employees.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Community-Level Health Promotion Study Section (CLHP)
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Esposito, Layla E
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San Diego State University
Public Health & Prev Medicine
Other Domestic Higher Education
San Diego
United States
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Ayala, Guadalupe X; Castro, Iana A; Pickrel, Julie L et al. (2017) A Cluster Randomized Trial to Promote Healthy Menu Items for Children: The Kids' Choice Restaurant Program. Int J Environ Res Public Health 14:
Castro, Iana A; Williams, Christine B; Madanat, Hala et al. (2016) Food ordering for children in restaurants: multiple sources of influence on decision making. Public Health Nutr 19:2404-9
Ayala, Guadalupe X; Castro, Iana A; Pickrel, Julie L et al. (2016) A restaurant-based intervention to promote sales of healthy children's menu items: the Kids' Choice Restaurant Program cluster randomized trial. BMC Public Health 16:250