Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting

Abstract

Purpose: To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants.

Design: Quasi-experimental.

Setting: Low-income neighborhoods of Baltimore, Maryland.

Subjects: Seven carryouts (three intervention, four comparison).

Intervention: Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals.

Measures: Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined).

Analysis: Logistic and Poisson regression models with generalized estimating equations.

Results: In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05).

Conclusion: Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.

Keywords: Environmental Approaches to Obesity; Health focus: nutrition; Intervention; Low-Income; Manuscript format: research; Maryland; Menu Labeling; Outcome measure: behavioral, financial; Point of Purchase; Prepared Food Sources; Prevention Research; Research purpose: intervention testing/evaluation; Restaurants; Setting: community; Strategy: multiphased environmental intervention; Study design: quasi-experimental; Target population age: adults; Target population circumstances: low-income African-Americans in Baltimore; Urban.