Evaluating A Healthy Restaurant Kids Meals Policy

项目总结 十多个市政当局已经通过了健康餐厅儿童餐政策。这些政策旨在 通过要求餐馆只提供含糖饮料来减少儿童的含糖饮料(SSB)消费 健康饮料(水、牛奶或100%果汁)取代SSB作为儿童膳食的默认选择 餐厅。这些政策有可能有效地减少儿童SSB的摄入量；儿童卡路里的10% 来自SSB的来自餐厅的来源。自愿从儿童餐厅中移除SSB的餐厅 菜单(但仍允许按要求提供SSB)发现SSB和总卡路里显著减少 儿童套餐。然而，我们对健康儿童的影响的认识存在着显著的差距。 关于儿童健康的膳食政策；到目前为止，这些政策尚未就其短期效果进行评估 关于儿童膳食订单或总膳食摄入量，或它们对儿童肥胖症的长期影响。本研究 通过将餐厅经理和市政府官员的自然实验结合在一起，做出了重大贡献 访谈和成本-效果模型以评估健康计划的实施和健康效果 华盛顿特区的餐厅儿童餐政策，这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； 对餐厅经理和市政府官员的定性访谈；以及成本效益模型。我们会 向2,000名2-10岁在快餐店就餐的成年人和儿童收取收据并进行调查 一个有健康儿童膳食政策的干预城市(华盛顿特区)和一个没有健康儿童膳食政策的对照城市 政策(宾夕法尼亚州费城)评估在之前和12个月后购买的SSB和卡路里的变化 实施健康儿童膳食政策(目标1)。我们还将进行第二天的电话饮食召回 评估儿童SSB摄入量、饮食质量和总卡路里摄入量的变化 餐厅用餐(目标2)。我们会在食肆进行执行情况调查，收集本地食物安全资料 来自华盛顿公共卫生部的检查数据，并与餐厅经理进行访谈 和市政府官员评估华盛顿特区该政策的成本、合规性和影响范围，并对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，如果 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， 法案将在本立法会期通过，实施截止日期通常为通过后90天。因此， 对时间敏感的资金对于确保有足够的时间收集基线数据至关重要。该提案的 重要的是我们有能力提供第一个关于健康儿童膳食程度的经验证据 政策会影响儿童的饮食摄入量。研究结果将提供必要的证据，以告知州和地方 政策制定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.