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A Natural Experiment to Evaluate Changes in Kids’ Meal Beverages in Fast-Food Restaurants Following a Healthy Default Policy, 2019-2022 - 06/05/25

Doi : 10.1016/j.jand.2025.03.010 
Angie L. Cradock, ScD, MPE a, ⁎ , Jessica L. Barrett, MPH a, Jason P. Block, MD, MPH b, Amy A. Bolton, BA a, Carolyn Bresnahan, MPH c, Lisa Harnack, DrPH, RD d, Stephanie McCulloch, MS, MPH a, Christina A. Roberto, PhD e, Kristine Wiant f, Alyssa Moran, ScD, MPH, RD g
a Harvard Prevention Research Center, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 
b Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts 
c Westat, Rockville, Maryland 
d Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 
e Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 
f RTI International, Research Triangle Park, North Carolina 
g Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 

∗Address correspondence to: Angie L. Cradock, ScD, MPE, Harvard Prevention Research Center, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, 7th Floor, Boston, MA 02115.Harvard Prevention Research CenterHarvard TH Chan School of Public Health677 Huntington Ave7th FloorBostonMA02115
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 06 May 2025
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Abstract

Background

Jurisdictions have implemented “healthy beverage policies” requiring restaurants to make lower-sugar beverages the default option listed on kids’ menus to improve the nutrition of restaurant offerings for children.

Objective

The aim of this study was to compare changes in beverage offerings in kids’ meals written on menu boards within chain restaurants before and after policy implementation in intervention and comparison communities.

Design

This was a quasi-experimental study with comparison using photograph and audit observations at restaurants from October 2019 to June 2022.

Participants/setting

Forty-three restaurants in 3 fast-food chains serving kids’ meals with a beverage that did not make lower-sugar beverages the default option at baseline in 2 intervention communities (New York, New York, and Philadelphia, Pennsylvania) and 1 comparison community (Newark, New Jersey) were included.

Intervention

Policies that require only healthier beverages as default options are written on kids’ meal menus.

Main outcome measures

Beverage options listed in the kids’ meal on the menu board were allowable under healthy beverage policies.

Statistical analyses performed

Descriptive and repeated measures analyses were performed for difference in primary outcome from baseline to follow-up overall and by policy status.

Results

At follow-up, 39 locations (91%), including 8 (89%) in the comparison area with no healthy default policy, listed only beverages allowable as defaults under healthy beverage policies (P < .001 vs baseline, all locations). From baseline to follow-up, 2 chains changed the beverages listed with the kids’ meal to align with the healthy default policies in all but 1 location, and 1 chain made no menu changes (P < .001). No statistically significant differences in menu changes were observed between intervention and comparison areas.

Conclusions

After healthy beverage policies were enacted in 2 of 3 communities, most locations in 2 restaurant chains listed only allowable beverages regardless of location outside of cities where the policies were in place. Regional implementation in response to new local healthy default policies may result in broader accessibility of healthier children’s beverage options.

Le texte complet de cet article est disponible en PDF.

Keywords : Sugar-sweetened beverage, Menu, Chain restaurant, Children, Drinks


Plan


 STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
 FUNDING/SUPPORT This work was supported by a grant from the National Institutes of Health (5R01HD100983-04) and in part by a grant from the Centers for Disease Control and Prevention (U48DP006376) and a grant from the Bloomberg American Health Initiative. The findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.
 AUTHOR CONTRIBUTIONS A. L. Cradock: conceptualization, methodology, formal analysis, resources, writing-original draft, visualization, supervision, funding acquisition. J. L. Barrett: methodology, formal analysis, data curation, writing – review and editing. J. Block: conceptualization, methodology, writing – review and editing. A. A. Bolton: methodology, validation, formal analysis, writing - reviewing and editing. C. Bresnahan: methodology, investigation, writing – review and editing, project administration. L. Harnack: conceptualization, methodology, writing – review and editing. S. McCulloch: methodology, formal analysis, data curation, writing – review and editing. C. Roberto: conceptualization, methodology, writing – review and editing. K. Wiant: methodology, supervision, writing – review and editing. A. Moran: conceptualization, methodology, investigation, resources, writing – review and editing, supervision, funding acquisition.


© 2025  Academy of Nutrition and Dietetics. Publié par Elsevier Masson SAS. Tous droits réservés.
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