Advertisement

State and Local Healthy Kids’ Meal Laws in the United States: A Review and Content Analysis

Published:December 08, 2021DOI:https://doi.org/10.1016/j.jand.2021.12.003

      Abstract

      Background

      To address unhealthy restaurant food intake among children, localities and states are passing healthy restaurant kids’ meal laws. However, there is limited knowledge of what these policies require and how they compare with expert and industry nutrition standards.

      Objectives

      The aim of this study was to develop a research instrument to evaluate healthy kids’ meal laws and assess their alignment with expert and industry nutrition standards.

      Design

      The study team conducted a content analysis of healthy kids’ meal laws passed between January 2010 and August 2020 in the United States. Using a structured codebook, two researchers abstracted policy elements and implementation language from laws, regulations, fiscal notes, and policy notes. Nutritional criteria for kids’ beverages and meals were compared with existing expert and industry nutrition standards for meals and beverages.

      Main outcome measures

      Measures included law characteristics, implementation characteristics, enforcement characteristics, definitions of key terms, and nutritional requirements for meals and default beverage options and alignment with expert and industry nutrition standards.

      Statistical analyses performed

      Interrater reliability of the coding tool was estimated using the Cohen kappa statistic, and researchers calculated descriptive statistics of policy elements.

      Results

      Twenty laws were identified. Eighteen were healthy default beverage policies, two were toy restriction policies, and one was a nutrition standards policy. The nutrition standards, default beverage offerings, and implementation characteristics varied by location. No law met the expert nutrition standards for kids’ meals or beverages.

      Conclusions

      The variations in policy specifications may influence how restaurants implement the policies, and, consequently, the policies’ influences on children’s consumption. Future policies could use expert nutrition standards to inform the standards set for kids’ meals and specify supports for implementation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Powell L.M.
        • Nguyen B.T.
        Fast-food and full-service restaurant consumption among children and adolescents: effect on energy, beverage, and nutrient intake.
        JAMA Pediatr. 2013; 167: 14-20
        • Poti J.M.
        • Popkin B.M.
        Trends in energy intake among US children by eating location and food source, 1977-2006.
        J Am Diet Assoc. 2011; 111: 1156-1164
        • Guthrie J.F.
        • Lin B.-H.
        • Frazao E.
        Role of food prepared away from home in the American diet, 1977-78 versus 1994-96: changes and consequences.
        J Nutr Educ Behav. 2002; 34: 140-150
        • Fryar C.D.
        • Carroll M.D.
        • Ahluwalia N.
        • Ogden C.L.
        Fast Food Intake Among Children and Adolescents in the United States, 2015-2018.
        National Center for Health Statistics, 2020
        • Emond J.A.
        • Longacre M.R.
        • Titus L.J.
        • et al.
        Fast food intake and excess weight gain over a 1-year period among preschool-age children.
        Pediatr Obes. 2020; 15e12602
        • DeBoer M.D.
        • Scharf R.J.
        • Demmer R.T.
        Sugar-sweetened beverages and weight gain in 2-to 5-year-old children.
        Pediatrics. 2013; 132: 413-420
        • Bowman S.A.
        • Gortmaker S.L.
        • Ebbeling C.B.
        • Pereira M.A.
        • Ludwig D.S.
        Effects of fast-food consumption on energy intake and diet quality among children in a national household survey.
        Pediatrics. 2004; 113: 112-118
        • Batada A.
        • Wootan M.
        Kids’ Meals II: Obesity and Poor Nutrition on the Menu.
        Center for Science in the Public Interest, 2013
        • National School Boards Association
        Model Local School Wellness Policies on Physical Activity and Nutrition.
        National Alliance for Nutrition and Activity, 2005
        • Ribakove S.
        • Wootan M.
        Soda Still on the Menu: Progress, but More to Do to Get Soda off Restaurant Children’s Menus.
        Center for Science in the Public Interest, 2019
        • National Restaurant Association
        Welcome to Kids LiveWell.
        (Published 2019)
      1. Wendy’s removes soda from kids’ meals.
        (Published 2015)
      2. Jack in the Box removes toys from kids’ meals.
        (Published 2011)
        • Moran A.J.
        • Block J.P.
        • Goshev S.G.
        • Bleich S.N.
        • Roberto C.A.
        Trends in nutrient content of children’s menu items in US chain restaurants.
        Am J Prev Med. 2017; 52: 284-291
        • Dunn C.G.
        • Vercammen K.A.
        • Frelier J.M.
        • Moran A.J.
        • Bleich S.N.
        Nutrition composition of children’s meals in twenty-six large US chain restaurants.
        Public Health Nutr. 2020; 23: 2245-2252
      3. Center for Science in the Public Interest. State and Local Restaurant Kids’ Meal Policies.
      4. Westlaw Next Campus Research.
        Thomson Reuters, Minnesota City, MN2020
      5. Legiscan Legislation Tracker.
        https://legiscan.com/CA/legislation
        Date accessed: September 1, 2020
      6. 50-State Searchable Bill Tracking Database. National Conference of State Legislatures.
      7. Healthy Food Policy Project Policy Database. Healthy Food Policy Project.
        https://healthyfoodpolicyproject.org/policy-database
        Date: 2022
        Date accessed: September 1, 2022
      8. NOURISHING policy database. World Cancer Research Fund International.
      9. Growing Food Connections Database. Growing Food Connections.
      10. Rudd Center for Food Policy Legislation Database. Rudd Center for Food Policy Legislation.
        https://uconnruddcenter.org/legislation/#
        Date: 2020
        Date accessed: September 1, 2020
      11. Center for Public Health Law Research Law Atlas at Temple University.
        http://lawatlas.org/topics
        Date accessed: September 1, 2020
        • McHugh M.L.
        Interrater reliability: the kappa statistic.
        Biochemia Medica. 2012; 22: 276-282
      12. Qualtrics; 2020 https://www.qualtrics.com/

        • Lott M.
        • Callahan E.
        • Duffy E.W.
        • Story M.
        • Daniels S.
        Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations.
        Healthy Eating Research, 2019
        • Healthy Food America
        Kids meals policies.
        (Published 2021)
        • National Restaurant Asssociation
        About Kids Live Well.
      13. Nutrition Standards in the National School Lunch and School Breakfast Programs. Vol 77. US Department of Agriculture, Food and Nutrition Service; 2012.

      14. Stata Statistical Software. StataCorp LP, 2017
        www.stata.com
        Version: Release 15
      15. An Emergency Ordinance to Supplement the Codified Ordinances of Cleveland, Ohio, 1976, by Enacting New Section 241.43 Relating to Sale of Beverages Offered with Children’s Meals by Food Service Operations. July 29, 2020.
        https://bit.ly/3yxhWq5
        Date accessed: August 1, 2020
      16. Amending Title 6 of the Philadelphia Code, Entitled “Health Code,” by Adding A New Chapter 6-311, Entitled “Children’s Meals at Food Service Establishments”. October 2, 2019.
        (Available at)
        https://bit.ly/2WGqZIk
        Date accessed: August 1, 2020
      17. An Act to Amend Title 16 of the Delaware Code Regarding Default Beverages in Children’s Meals in Restaurants. July 17, 2019.
        https://legis.delaware.gov/BillDetail/47551
        Date accessed: August 1, 2020
      18. A Bill for an Act Relating to Healthy Beverages for Children. June 28, 2019.
        https://bit.ly/3jx837z
        Date accessed: August 1, 2020
      19. A Local Law to Amend the Administrative Code of the City of New York, in Relation to Selections for Beverages Included in Children’s Meals. April 28, 2019.
        https://on.nyc.gov/3zMvOyh
        Date accessed: August 1, 2020
      20. An Ordinance to Amend Chapter 5 of the City Code Regarding Beverages Offered in Children’s Meals. October 8, 2018.
        https://bit.ly/3BsmIXJ
        Date accessed: August 1, 2020
      21. An Act to Add Chapter 12.8 (Commencing with Section 114379) to Part 7 of Division 104 of the Health and Safety Code, Relating to Children’s Health. September 20, 2018.
        https://bit.ly/3jvOSLa
        Date accessed: August 1, 2020
      22. An Ordinance Amending Chapter 118 of the Louisville Metro Code of Ordinances Regarding Establishing the Nutrition Requirements and Default Beverages Offered with Children’s Meals (as Amended). June 7, 2018.
        https://bit.ly/2WHZQ7J
        Date accessed: August 1, 2020
      23. An Ordinance Concerning Food Service Facilities - Healthy Beverages for Children’s Meals. April 19, 2018.
        (Available at)
        https://bit.ly/3DsgN6K
        Date accessed: August 1, 2020
      24. An Ordinance of the City Council of the City of Daly City Adding Chapter 8.72 to Title 8 of the Daly City Municipal Code Re: Establishing Healthy Default Beverages Offered with Children’s Meals. January 8, 2018.
        https://bit.ly/3BtihMb
        Date accessed: August 1, 2020
      25. An Ordinance of the City Council of the City of Long Beach Amending the Long Beach Municipal Code by Adding Chapter 8.17 Relating to Default Beverages Offered with Children’s Meals. November 16, 2017.
        https://bit.ly/38rpUXh
        Date accessed: August 1, 2020
      26. An Ordinance of the City Council of the City of Cathedral City California Adding Cathedral City Municipal Code Chapter 5.92 Requiring Healthy Beverages to be the Default Beverage Offering by Restaurants for Children’s Meals. November 8, 2017.
        https://bit.ly/3jvPHne
        Date accessed: August 1, 2020
      27. An Ordinance of the City Council of the City of Lafayette, Colorado, Enacting a New Article IX of Chapter 55 Establishing the Default Beverages Offered with Children’s Meals within the City of Lafayette, Colorado. October 17, 2017.
        https://bit.ly/3BsR8sP
        Date accessed: August 1, 2020
      28. An Ordinance of the Board of Supervisors of the County of Santa Clara Renaming Chapter XXII and Amending and Adding Sections to Chapter XXII of Division A18 of the Santa Clara County Ordinance Code Relating to Beverages in Restaurant Meals for Children. May 9, 2017.
        https://bit.ly/3kGb9p3
        Date accessed: August 1, 2020
      29. Healthy Default Beverages Offered with Children’s Meals; Adding Berkeley Municipal Code Chapter 12.72. June 27, 2017.
        https://bit.ly/3DxCpyL
        Date accessed: August 1, 2020
      30. An Ordinance of the City Council of the City of Perris, County of Riverside, State of California, Adding Chapter 7.46 to Title 7 of the Perris Municipal Code Establishing Default Beverages Offered in Children’s Meals. March 14, 2017.
        https://bit.ly/3zALi8a
        Date accessed: August 1, 2020
      31. An Ordinance Amending Stockton Municipal Code Title 5 by Adding Chapter 5.70 Regarding Establishing the Default Beverages Offered with Children’s Meals. June 7, 2016.
        https://bit.ly/3kYzg2D
        Date accessed: August 1, 2020
      32. Ordinance of the City Council of the City of Davis Adding Article 17.02 To Chapter 17 of the Davis Municipal Code Establishing Default Beverages Offered with Children’s Meals. June 2, 2015.
        https://bit.ly/3kKsEo3
        Date accessed: August 1, 2020
      33. Ordinance Amending Article 8 of the San Francisco Health Code by Adding Sections 471.1 through 471.9, to Set Nutritional Standards for Restaurant Food Sold Accompanied by Toys or Other Youth Focused Incentive Items. November 23, 2010.
        https://bit.ly/3BvInhH
        Date accessed: August 1, 2020
      34. An Ordinance of the Board of Supervisors of the County of Santa Clara Adding Chapter XXII of Division A18 to the County of Santa Clara Ordinance Code Relating to Toys and Other Incentives with Restaurant Food. May 11, 2010.
        https://bit.ly/3BA5lEx
        Date accessed: August 1, 2020
        • Otten J.J.
        • Hekler E.B.
        • Krukowski R.A.
        • et al.
        Food marketing to children through toys: response of restaurants to the first US toy ordinance.
        Am J Prev Med. 2012; 42: 56-60
        • Otten J.J.
        • Saelens B.E.
        • Kapphahn K.I.
        • et al.
        Peer reviewed: Impact of San Francisco’s toy ordinance on restaurants and children’s food purchases, 2011–2012.
        Prev Chronic Dis. 2014; : 11
        • Southy F.
        Online food delivery ‘one of the only winners’ in coronavirus outbreak. 2020.
        • Ritchie L.D.
        • Lessard L.
        • Harpainter P.
        • et al.
        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. 2021; : 1-11
        • Ross A.
        • Krishnan N.
        • Ruggiero C.
        • Kerrigan D.
        • Gittelsohn J.
        A mixed methods assessment of the barriers and readiness for meeting the SNAP depth of stock requirements in Baltimore’s small food stores.
        Ecol Food Nutr. 2018; 57: 94-108
        • Schwartz M.B.
        • Henderson K.E.
        • Read M.
        • Cornelius T.
        Student acceptance of plain milk increases significantly 2 years after flavored milk is removed from school cafeterias: an observational study.
        J Acad Nutr Diet. 2018; 118: 857-864
      35. Cleveland City Council Health and Human Services 7-27-2020. In. Health and Human Services 2020. https://youtu.be/4Hph8Z_1XXU. Accessed January 24, 2022.

      Biography

      C. L. Perez is a doctoral degree candidate, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      A. Moran is an assistant professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      K. M. P. Porter is a professor, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      G. Headrick is a doctoral degree student, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

      Biography

      J. McCarthy is a senior program officer, New York State Health Foundation, New York City.

      Biography

      A. L. Cradock is deputy director, Harvard Prevention Research Center, Harvard T.H. Chan School of Public Health, Boston, MA.