Evaluating A Healthy Restaurant Kids Meals Policy

项目摘要 十几个城市已经通过了健康餐厅儿童餐政策。这些政策旨在 减少儿童对含糖饮料（SSB）的消费，要求餐馆只提供 健康饮料（水、牛奶或100%果汁）代替SSB作为儿童餐的默认选择， 餐厅.这些政策有可能有意义地减少儿童SSB消费; 10%的儿童卡路里 来自餐馆的食物。自愿将办学团体从儿童餐厅移走的食肆 菜单（但仍然允许SSBs的要求）已经发现显着减少SSBs和总热量， 儿童餐的订单。然而，在我们对健康儿童的影响的认识方面存在重大差距。 关于儿童健康的膳食政策;迄今为止，尚未对这些政策的短期影响进行评估 对儿童的膳食顺序或总膳食摄入量，或其对儿童肥胖的长期影响。本研究 通过与餐厅经理和市政府官员进行自然实验， 访谈和成本效益模型，以评估健康的实施和健康影响， 华盛顿特区的儿童餐政策，是迄今为止实施这一政策的最大城市。我们的研究 采用混合方法，结合准实验差异分析; 定性访谈餐厅经理和城市官员;和成本效益建模。我们将 收集并调查了2,000名2-10岁的成年人和儿童在快餐店用餐的收据， 一个干预城市与健康的儿童膳食政策（华盛顿DC）和一个比较城市没有 政策（宾夕法尼亚州费城），以评估之前和之后12个月购买的SSB和卡路里的变化 实施健康儿童膳食政策（目标1）。我们还将进行次日电话饮食召回 评估儿童SSB消耗量、饮食质量和总热量摄入量在治疗当天的变化， 餐厅用餐（目标2）。我们将在餐馆进行实施调查，收集当地食品安全信息， 检查数据从DC公共卫生部，并进行采访的餐厅经理 和市政府官员估计成本，合规性，并在华盛顿特区的政策范围，并模拟10- 年健康影响、人口覆盖范围、实施成本、医疗保健成本节约和成本效益， 该政策在全国范围内实施（目标3）。年，华盛顿特区提出了一项健康儿童膳食法案。 2018年9月，预计将于本月（2019年3月）重新推出。倡导者相信， 法案将在本届立法会通过，实施期限通常是通过后90天。因此，在本发明中， 对时间敏感的供资对于确保基线数据收集有足够的时间至关重要。该提案的 重要性在于我们能够提供第一个经验证据，证明健康的儿童膳食在多大程度上 政策影响儿童的饮食摄入。研究结果将提供所需的证据，以告知州和地方 决策者关于儿童肥胖预防措施的决定。

PROJECT SUMMARY More than a dozen municipalities have passed healthy restaurant kids’ meals policies. These policies seek to reduce child consumption of sugar-sweetened beverages (SSBs) by requiring that restaurants serve only healthy beverages (water, milk, or 100% juice) instead of SSBs as the default choice with children’s meals in restaurants. These policies have potential to meaningfully reduce child SSB consumption; 10% of child calories from SSBs come from restaurant sources. Restaurants that have voluntarily removed SSBs from children’s menus (but still allow SSBs by request) have found significant reductions in SSBs and total calories in children’s meal orders. However, there are significant gaps in our knowledge of the effects of healthy kids’ meals policies on children’s health; to date, these policies have not been evaluated for their short-term effects on children’s meal orders or total dietary intake, or for their long-term effects on childhood obesity. This study makes a significant contribution by combining a natural experiment with restaurant manager and City official interviews and cost-effectiveness modeling to evaluate the implementation and health effects of a healthy restaurant kids’ meals policy in Washington DC, the largest City to implement this policy to date. Our study uses a mixed-methods approach incorporating quasi-experimental difference-in-differences analyses; qualitative interviews with restaurant managers and City officials; and cost-effectiveness modeling. We will collect receipts from and survey 2,000 adults and children aged 2-10 years dining at fast-food restaurants in one intervention City with a healthy kids’ meals policy (Washington DC) and one comparison City without a policy (Philadelphia, PA) to assess changes in SSBs and calories purchased before and 12 months following implementation of a healthy kids’ meals policy (Aim 1). We will also conduct next-day telephone dietary recalls to assess changes in children’s SSB consumption, diet quality, and total caloric intake on the day of the restaurant meal (Aim 2). We will conduct implementation surveys in restaurants, collect local food safety inspection data from the DC Department of Public Health, and conduct interviews with restaurant managers and City officials to estimate costs, compliance, and reach of the policy in Washington DC and to model the 10- year health impact, population reach, implementation cost, healthcare cost savings, and cost-effectiveness if the policy were implemented nationwide (Aim 3). A healthy kids’ meals bill was introduced in Washington DC in September 2018 and is expected to be reintroduced this month (March 2019). Advocates are confident that the bill will pass this legislative session, and implementation deadlines are typically 90 days from passage. Thus, time-sensitive funding is critical for ensuring adequate time for baseline data collection. The proposal’s significance lies in our ability to provide the first empirical evidence on the degree to which healthy kids’ meals policies influence child dietary intake. Study results will provide needed evidence to inform state and local policymakers’ decisions about child obesity prevention measures.