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
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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.
Article info
Publication history
Published online: December 08, 2021
Accepted:
December 6,
2021
Received:
May 26,
2021
Footnotes
Supplementary materials: Figures 1 and 2 and Tables 1, 2, 3, and 6 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This research was supported by the Johns Hopkins 21st Century Cities Initiative.
AUTHOR CONTRIBUTIONS C. L. Perez was involved in conceptualizing the study, defining the methodology, collecting the data, analyzing findings, and drafting and editing the manuscript to prepare for submission. A. Moran and K. M. P. Porter were involved in conceptualizing the study, defining the methodology, and reviewing and editing the manuscript for important intellectual content. G. Headrick was involved in collecting the data and reviewing and editing the manuscript. J. McCarthy and A. L. Cradock were involved in conceptualizing the study and reviewing and editing the manuscript for important intellectual content. All authors have read and agreed to the published version of the manuscript.
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© 2022 by the Academy of Nutrition and Dietetics.
