Restaurant kids' meal beverage offerings before and after implementation of healthy default beverage policy statewide in California compared with citywide in Wilmington, Delaware

Lorrene D Ritchie; Laura Lessard; Phoebe Harpainter; Marisa M Tsai; Gail Woodward-Lopez; Tara Tracy; Wendi Gosliner; Kathleen McCallops; Isabel Thompson; Allison Karpyn

doi:10.1017/S1368980021001245

Restaurant kids' meal beverage offerings before and after implementation of healthy default beverage policy statewide in California compared with citywide in Wilmington, Delaware

Public Health Nutr. 2022 Mar;25(3):794-804. doi: 10.1017/S1368980021001245. Epub 2021 Apr 12.

Affiliations

¹ Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin Street, Oakland, CA 94607, USA.
² Department of Behavioral Health & Nutrition, University of Delaware, Newark, DE, USA.
³ Center for Research in Education and Social Policy, University of Delaware, Newark, DE, USA.
⁴ School of Public Health, University of California, Berkeley, Berkeley, CA, USA.

Abstract

Objective: In 2019, California and Wilmington, Delaware' implemented policies requiring healthier default beverages with restaurant kids' meals. The current study assessed restaurant beverage offerings and manager perceptions.

Design: Pre-post menu observations were conducted in California and Wilmington. Observations of cashiers/servers during orders were conducted pre-post implementation in California and post-implementation in Wilmington. Changes in California were compared using multilevel logistic regression and paired t tests. Post-implementation, managers were interviewed.

Setting: Inside and drive-through ordering venues in a sample of quick-service restaurants in low-income California communities and all restaurants in Wilmington subject to the policy, the month before and 7-12 months after policy implementation.

Participants: Restaurant observations (California n 110; Wilmington n 14); managers (California n 75; Wilmington n 15).

Results: Pre-implementation, the most common kids' meal beverages on California menus were unflavoured milk and water (78·8 %, 52·0 %); in Wilmington, juice, milk and sugar-sweetened beverages were most common (81·8 %, 66·7 % and 46·2 %). Post-implementation, menus including only policy-consistent beverages significantly increased in California (9·7 % to 66·1 %, P < 0·0001), but remained constant in Wilmington (30·8 %). During orders, cashiers/servers offering only policy-consistent beverages significantly decreased post-implementation in California (5·0 % to 1·0 %, P = 0·002). Few managers (California 29·3 %; Wilmington 0 %) reported policy knowledge, although most expressed support. Most managers wanted additional information for customers and staff.

Conclusions: While the proportion of menus offering only policy-consistent kids' meal default beverages increased in California, offerings did not change in Wilmington. In both jurisdictions, managers lacked policy knowledge, and few cashiers/servers offered only policy-consistent beverages. Additional efforts are needed to strengthen implementation of kids' meal beverage policies.

Keywords: Beverage; Children; Fast food; Meal; Policy; Restaurant.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Beverages
Delaware
Health Policy
Humans
Meals*
Restaurants*