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.