Understanding the Density and Distribution of Restaurants in Los Angeles County to Inform Local Public Health Practice.

INTRODUCTION: To describe the potential reach of restaurant-based strategies that seek to improve the healthfulness of menu options, it is important to understand the local restaurant environment, including the extent to which restaurants subject to policy mandates are located in communities disproportionately affected by diet-related diseases. METHODS: This cross-sectional study examined the restaurant environment in Los Angeles County, a large jurisdiction with diverse geographic and socioeconomic characteristics, specifically 1) the number and characteristics of restaurants; 2) the association between neighborhood sociodemographics and restaurant density; and 3) the association between neighborhood sociodemographics and restaurant characteristics, including chain status (large chain, small chain, independent restaurant). Data sources were 1) industry data on restaurant location and characteristics (N = 24,292 restaurants) and 2) US Census data on neighborhood sociodemographics (N = 247 neighborhoods). We conducted descriptive and bivariate analyses at the restaurant and neighborhood level. RESULTS: Countywide, only 26.5% of all restaurants were part of a large chain (a chain with ≥20 locations). We found positive associations between restaurant density and neighborhood proportions of non-Hispanic white residents and residents with more than a high school education. We found limited support to suggest a greater density of large chains in neighborhoods with lower socioeconomic status. CONCLUSION: Results highlight the potentially limited reach of strategies targeting chain restaurants and point to the importance of including small chain restaurants and independent restaurants in public health efforts to improve the healthfulness of restaurants. Understanding where restaurants are in relation to priority populations is a critical step to planning strategies that address diet-related disparities.

Dietary Behaviors among Public Health Center Clients with Electronic Benefit Transfer Access at Farmers' Markets.

BACKGROUND: Although increasing access to electronic benefit transfer (EBT) at farmers' markets has become a popular strategy for encouraging healthy eating, its relationships to a number of dietary behaviors in low-income populations are not well understood. OBJECTIVE: To describe the frequency of and relationships between EBT access, fruit and vegetable intake, and sugar-sweetened beverage (SSB) consumption among public health center (PHC) clients with access to EBT at farmers' markets during 2011-2012. DESIGN: Cross-sectional. PARTICIPANTS/SETTING: Low-income participants recruited from the waiting rooms of five multipurpose PHCs operated by the Los Angeles County Department of Public Health. MAIN OUTCOME MEASURES: Fruit and vegetable and SSB consumption (number per week). STATISTICAL ANALYSIS: Data from the 2012 Los Angeles County Health and Nutrition Examination Survey were analyzed using multivariable regressions, with EBT access at farmers' markets as the primary independent variable. Covariates included EBT use, transportation behaviors, neighborhood attributes, and sociodemographic characteristics. RESULTS: A total of 1,503 adults participated in the survey (response rate=69%). Of these, 529 reported receiving EBT benefits. Among these benefits recipients, 64% were women, 54% were aged 25 to 44 years, 62% were black, and 75% were unemployed or part-time employed. In multivariable regression analyses, EBT access at farmers' markets was positively associated with higher fruit and vegetable consumption; however, an association to SSB consumption was not demonstrated. CONCLUSIONS: EBT access at farmers' markets is related to higher fruit and vegetable consumption among PHC clients in Los Angeles County. However, the finding of no association to SSB consumption raises important questions about the need for strategies to discourage EBT recipients' purchase of foods of minimal nutritional value in other venues that accept nutrition assistance program benefits.

Media Outlet and Consumer Reactions to Promotional Activities of the Choose Health LA Restaurants Program in Los Angeles County.

OBJECTIVE: This study sought to assess promotional activities undertaken to raise public awareness of the Choose Health LA Restaurants program in Los Angeles County, an environmental change strategy that recognizes restaurants for offering reduced-size and healthier menu options. DESIGN: We used multiple methods to assess public awareness of and reactions to the promotional activities, including an assessment of the reach of core promotional activities, a content analysis of earned media, and an Internet panel survey. SETTING: The study was conducted in Los Angeles County, home to more than 10 million residents. PARTICIPANTS: An online survey firm recruited participants for an Internet panel survey; to facilitate generalization of results to the county's population, statistical weights were applied to analyses of the survey data. INTERVENTION: Promotional activities to raise awareness of the program included community engagement, in-store promotion, and a media campaign. MAIN OUTCOME MEASURES: Outcomes included media impressions, the number of people who reported seeing the Choose Health LA Restaurants logo, and a description of the themes present in earned media. RESULTS: Collectively, paid media outlets reported 335 587 229 total impressions. The Internet panel survey showed that 12% of people reported seeing the program logo. Common themes in earned media included the Choose Health LA Restaurants program aims to provide restaurant patrons with more choices, represents a new opportunity for restaurants and public health to work together, will benefit participating restaurants, and will positively impact health. CONCLUSIONS: Promotional activities for the Choose Health LA Restaurants program achieved modest reach and positive reactions from media outlets and consumers. The program strategy and lessons learned can help inform present and future efforts to combine environmental and individually focused strategies that target key influences of consumer food selection.

What menu changes do restaurants make after joining a voluntary restaurant recognition program?

Programs that recognize restaurants for offering healthful options have emerged as a popular strategy to address the obesity epidemic; however, program fidelity and business responses to such programs are rarely assessed. This study sought to examine how retail restaurants in Los Angeles County chose to comply with participation criteria required by the Choose Health LA Restaurants initiative in the region; the program recognizes restaurants for offering reduced-size portions and healthy children's meals. Menus of all restaurants that joined within 1 year of program launch (n = 17 restaurant brands) were assessed for changes. Nine of the 17 brands made changes to their menus to meet participation criteria for reduced-size portions while 8 of the 10 restaurant brands that offered children's menus made changes to improve the healthfulness of children's meals. Results of this comparative assessment lend support to restaurant compliance with program criteria and menu improvements, even though they are voluntary, representing an important step toward implementing this strategy in the retail environment.