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

Abstract

Objective: In 2019, California and Wilmington, Delaware implemented policies requiring healthier default beverages with restaurant kids’ meals. This 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 unflavored milk and water (78.8%, 52.0%); in Wilmington, juice, milk, and sugar-sweetened beverages were most common (81.8%, 66.7%, 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.

Limited implementation of California’s Healthy Default Beverage law for children’s meals sold online

“…Prior work examining California QSR beverage offerings with children's meals before and after implementation of SB1192 demonstrated that the number of in-restaurant and drive-through QSR menus including only law-consistent beverages significantly increased nearly sixfold, from 10 % to 66 % (34) . However, 1-year post SB1192 implementation, one-third of sampled QSR were still not consistent with the law in regard to the menu board and only 1 % were offering beverages during in-person ordering in a manner consistent with the legislation.…”

“…Interestingly, the same study found offerings on menus/menu boards did not change after similar legislation was passed in Wilmington, Delaware. This could be because no restaurant managers in Wilmington reported knowing about the law, compared with nearly one-third of California managers; or, it could be because a smaller proportion of Wilmington restaurants were chains and chains might be expected to have increased awareness and more systematic implementation of applicable legislation (34) . Online ordering platforms, however, were not examined and to our knowledge there is no published literature on the implementation of SB1192 or similar legislation on online ordering platforms.…”

“…A study examining adherence to California's Healthy-By-Default Children's Meal Beverage law when ordering in-person at QSR (either inside the restaurant or via drive through) demonstrated the proportion of menu boards listing only healthy default beverages with children's meals increased from 9•7 % to 66•1 % after SB1192 was enacted; however, few staff verbally offered beverages consistent with the legislation, with a significant decrease from 5 % to 1 % (18,34) . The incomplete implementation of the law could result in an attenuation of the intended impact to reduce SSB consumption among young children.…”

Exploring restaurant and customer needs, barriers, interests, and food choices induced by the COVID-19 pandemic in Tarragona Province (Catalonia, Spain): A cross-sectional study

“…These results are in line with other studies that tried to help restaurateurs better adapt their menus to the Mediterranean diet or healthier diets by giving personalized directions to restaurateurs regarding the dishes listed on their menus. Such instructions included introducing more side vegetables, offering fruit for dessert, and using extra virgin olive oil for different types of cooking (20,(28)(29)(30). Additionally, the pandemic resulted in some changes to customer preferences, and restaurateurs could be interested in acting on those changes, such as by offering more vegetarian/vegan or allergen-free dish choices.…”

Evaluation of Short-Term Changes in Fast-Food Restaurant Online Kids’ Meal Beverage Offerings Following a State-Level Healthy Beverage Default Policy

“…A pre-post study of healthy default beverage policies enacted in CA and Wilmington, DE, found that more fast-food restaurants in low-income communities in CA offered healthy beverages as the default option with kids’ meals on the menu board after a state law came into effect (the percentage of restaurants offering healthier beverages complying with the state law increased from 9.7% at baseline to 66.1% after the policy came into effect). There was no change, however, in the proportion of restaurants offering healthy beverage options with kids’ meals in Wilmington (30.8% of restaurants offered healthy beverages with kids’ meals on the menu board at both the time points) [ 23 ]. Further, in CA, fewer sales associates offered healthy beverages to customers verbally when a kids’ meal was ordered (the verbal offers decreased from 5.0% at baseline to 1.0% after policy enactment) [ 23 ].…”