In 2007, Tacoma-Pierce County Health Department launched a restaurant menu labeling project called SmartMenu. The objective was to recruit locally owned restaurants to voluntarily post basic nutrition information on their menus or menu boards. Participating restaurants submitted recipes to an independent contractor for nutritional analysis and agreed to post calorie, fat, carbohydrate, and sodium values on new menus within 90 days of receiving results. Vigorous recruitment efforts by the Health Department between June 2007 and September 2008 included free advertising, consultation with a Registered Dietitian, and free nutritional analysis. By the end of 2008, a total of 24 restaurants participated in the program. Significant barriers to participation included infrequent use of standardized recipes, perceived business risk of labeling, and low perceived customer demand for nutrition information. Key program elements, recruitment strategies, and costs are discussed. Results have important implications for future efforts to increase the adoption of menu labeling by locally owned and operated restaurants.
"As a result, the sample likely suffered from selection bias in that those who chose to respond may have stronger feelings in favor of or against menu labeling than most restaurant owners and employees. In addition, although the survey questions/domains were derived from prior literature  and pilot-tested, its validity and reliability were not formally assessed. Future studies may need to do so to establish the survey's validity and reliability. "
[Show abstract][Hide abstract] ABSTRACT: Objective: Exploring opinions and intentions regarding the soon-to-be implemented menu labeling legislation of restaurant owners and management nationwide. Methods: An email message with a link to an online survey was sent to those who were part of the Nation's Restaurant News and Restaurant Hospitality opt-in email lists. Data were collected in January-February 2012. Participants: 178 participants completed the survey. Variables Measured: The survey included: restaurant operation characteristics, restaurant owners' perception about the health impact of the law, restaurant owners' plan to change the menu and anticipated costs, and restaurants owners' attitudes about the new law. Analysis: Fisher's exact tests were performed, with a critical value of 05. 0 = α to determine significance. Results: In general, respondents with knowledge of and experience with menu labeling laws were more likely to respond that they would make menu changes as a result of the law. The majority of respondents, however, either disagreed or were neutral in response to questions about whether the law has the potential to improve health. Conclusions and Implications: Understanding what motivates restaurant owners to comply with the menu labeling law may contribute to efforts to ensure the success of its implementation.
"Energy, fat, chol, sugar Laboratory analysis Bruemmer et al., 2012 20 mg Energy, saturated fat Point of purchase, Web site Britt et al., 2011 21 mg Energy, fat, CHO Menu analysis a Boutelle et al., 2011 22 mg Energy, fat, chol, fiber Menu analysis Johnson et al., 2010 23 mg, mg/1000 calories, sodium categories/meal b None Restaurant's Web site O'Donnell et al., 2008 24 < 800 mg/meal Energy, fat, CHO, sugar, protein, vitamins A and C, Ca, Fe Menu analysis c Sarathy et al., 2008 25 < 900 mg/entrée < 300 mg/side dish K, P Restaurant's Web site "
[Show abstract][Hide abstract] ABSTRACT: We reviewed methods of studies assessing restaurant foods' sodium content and nutrition databases. We systematically searched the 1964-2012 literature and manually examined references in selected articles and studies. Twenty-six (5.2%) of the 499 articles we found met the inclusion criteria and were abstracted. Five were conducted nationally. Sodium content determination methods included laboratory analysis (n = 15), point-of-purchase nutrition information or restaurants' Web sites (n = 8), and menu analysis with a nutrient database (n = 3). There is no comprehensive data system that provides all information needed to monitor changes in sodium or other nutrients among restaurant foods. Combining information from different sources and methods may help inform a comprehensive system to monitor sodium content reduction efforts in the US food supply and to develop future strategies. (Am J Public Health. Published online ahead of print July 18, 2013: e1-e10. doi:10.2105/AJPH.2013.301442).
American Journal of Public Health 07/2013; 103(9). DOI:10.2105/AJPH.2013.301442 · 4.55 Impact Factor
"Placing little obligation on carry-out owners was crucial to initiate a successful intervention in these settings. The importance of establishing strong rapport has been shown in other interventions in prepared food source settings [17,31,34]. Maintaining communication with owners and incorporating their ideas for intervention strategy development enhanced commitment and proved to be key to the success of the intervention. "
[Show abstract][Hide abstract] ABSTRACT: Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation.
To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment.
On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entree availability and revised menu and poster presence all demonstrated high fidelity and feasibility.
The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets.
BMC Public Health 07/2013; 13(1):638. DOI:10.1186/1471-2458-13-638 · 2.26 Impact Factor
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