JMIR Publications

ABSTRACT

Background:

U.S. children’s diets are high in calories and of poor nutritional quality. One likely contributing factor is consumption of food from restaurants, where meals tend to be higher in calories and lower in nutritional quality than those prepared at home. While children readily accept sweet and salty foods that tend to be lower in nutritional quality, research shows that their taste preferences are malleable, and regular exposure to healthier foods can promote their acceptance.

Objective:

We describe a cluster-randomized controlled trial testing effects of behavioral intervention strategies (choice architecture, repeated exposure) on ordering and dietary intake among children in restaurants and present baseline demographic data for the study cohort.

Methods:

Six locations of a regional quick-service restaurant chain were randomized to either the intervention or control group in pairs based on income in surrounding census tracts. Families with 4-to-8-year-old children were recruited and asked to complete 8 visits to the study restaurant, including 6 visits during a designated 2-month exposure period. 235 families (78.3% female parents, 56.6% female children, child age M=6.5+1.3 years) completed baseline procedures and are considered the study cohort. Intervention content provided to intervention group families after baseline assessments includes placemats promoting two healthier kids’ meals and the opportunity to redeem their kids’ meal “cone token” for a toy instead of a dessert (choice architecture strategies). Additionally, participating families receive frequent diner cards which can be used to earn a free kids’ meal after purchasing a promoted kids’ meal 6 times (repeated exposure strategy). Families in control restaurants receive generic versions of these materials (e.g., frequent diner cards that can be redeemed for a free kids’ meal after purchasing any 6 kids’ meals).

Results:

The primary outcome is the meal ordered for the child at a post-test restaurant visit following the exposure period (i.e., whether or not a promoted meal was ordered). Additional order data will include calories, saturated fat, sodium, and sugar content of children’s orders at post-test. Other outcomes include children’s in-restaurant and daily consumption of calories, saturated fat, sodium and sugar.

Conclusions:

Given that restaurants are normative eating contexts for many children, this intervention has the potential to impact children’s dietary intake and health. Clinical Trial: Registered at clinicaltrials.gov prior to participant recruitment (NCT04334525).