sábado, 9 de agosto de 2014

Preventing Chronic Disease | Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012 - CDC

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Preventing Chronic Disease | Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012 - CDC

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Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012

Jennifer J. Otten, PhD, RD; Brian E. Saelens, PhD; Kristopher I. Kapphahn, MS; Eric B. Hekler, PhD; Matthew P. Buman, PhD; Benjamin A. Goldstein, PhD; Rebecca A. Krukowski, PhD; Laura S. O’Donohue, BS; Christopher D. Gardner, PhD; Abby C. King, PhD

Suggested citation for this article: Otten JJ, Saelens BE, Kapphahn KI, Hekler EB, Buman MP, Goldstein BA, et al. Impact of San Francisco’s Toy Ordinance on Restaurants and Children’s Food Purchases, 2011–2012. Prev Chronic Dis 2014;11:140026. DOI:http://dx.doi.org/10.5888/pcd11.140026External Web Site Icon.


In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children’s meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children’s menus), and the energy and nutrient content of all orders and children’s-meal–only orders purchased for children aged 0 through 12 years.
Restaurant responses were examined from January 2010 through March 2012. Parent–caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.
Both restaurant chains responded to the ordinance by selling toys separately from children’s meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children’s meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children’s side dishes and beverages at Chain A.
Although the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes.

Figure. Total calories per order (n = 335) before and after enactment of the San Francisco Healthy Food Incentives ordinance, for children ordering a children’s meal at 2 national restaurant chains in San Francisco, 2011–2012. Mann–Whitney U tests were used to test for comparisons between time points. The horizontal line in the middle of each box indicates the median, and the top and bottom borders of the box mark the 75th and 25th percentiles, respectively. The upper whisker extends to the largest data point within 1.5 IQR of the upper quartile while the lower quartile extends to the smallest data point within 1.5 IQR of the lower quartile. Points beyond the whiskers are shown as dots. Abbreviations: Pre 1, pre-ordinance time point 1; Pre 2, pre-ordinance time point 2; Post, post-ordinance time point. Abbreviation: IQR, interquartile range. [A tabular version of this figure is also available.]


This project was supported by The Obesity Society Early-Career Research Grant awarded to Dr Otten and by Robert Wood Johnson Foundation grant no. 68301 awarded to Dr King.

Author Information

Corresponding Author: Jennifer J. Otten, PhD, RD, Assistant Professor, University of Washington School of Public Health, Nutritional Sciences Program, Box 353410, Seattle, WA 98115. Telephone: 206-221-8233. E-mail: jotten@uw.edu.
Author Affiliations: Brian E. Saelens, University of Washington and Seattle Children’s Research Institute, Seattle, Washington; Kristopher I. Kapphahn, Benjamin A. Goldstein, Laura S. O’Donohue, Christopher D. Gardner, Abby C. King, Stanford University School of Medicine, Stanford, California; Eric B. Hekler, Matthew P. Buman, School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona; Rebecca A. Krukowski, University of Tennessee Health Science Center, Memphis, Tennessee.


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