Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting

TitleEnvironmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting
Publication TypeJournal Article
Year of Publication2015
AuthorsLee-Kwan, SH, Bleich, SN, Kim, H, Colantuoni, E, Gittelsohn, J
JournalAm J Health Promot
Date PublishedJul-Aug
ISBN Number0890-1171 (Print)0890-1171
Accession Number24968184
KeywordsEnvironmental Approaches to Obesity, Health focus: nutrition, Intervention, Low-income, Manuscript format: research, MARYLAND, Menu Labeling, Outcome measure: behavioral, financial, Point of Purchase, Prepared Food Sources, Prevention Research, Research purpose: intervention testing/evaluation, Restaurants, Setting: community, Strategy: multiphased environmental intervention, Study design: quasi-experimental, Target population age: adults, Target population circumstances: low-income African-Americans in Baltimore, Urban

PURPOSE: To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants. DESIGN: Quasi-experimental. SETTING: Low-income neighborhoods of Baltimore, Maryland. SUBJECTS: Seven carryouts (three intervention, four comparison). INTERVENTION: Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals. MEASURES: Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entree, sides and beverages, and combined). ANALYSIS: Logistic and Poisson regression models with generalized estimating equations. RESULTS: In the intervention group, odds for healthy entree units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entree revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05). CONCLUSION: Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.