Hand hygiene product use by food employees in casual dining and quick-service restaurants.

Hand hygiene product usage characteristics by food employees when hand sanitizers are made available are not well understood. To investigate hand hygiene product usage in casual dining and quick-service restaurants, we placed automated monitoring soap and sanitizer dispensers side-by-side at handwash sinks used by food employees in seven restaurants. Dispenses were monitored, and multiple dispenses that occurred within 60 s of each other were considered a single hand hygiene event. This resulted in 186,998 events during the study (149,779 soap only, 21 985 sanitizer only, and 15,234 regimen [defined as soap followed by sanitizer at the same sink within 60 s]) over 15,447 days of use. Soap was the most frequently used hand hygiene method by food employees in both restaurant types. Regimen use, despite being the preferred hand hygiene method by both restaurant chains, was the least used hand hygiene method. When pooled over restaurant types, the median daily usage for soap was statistically significantly highest of all methods at 23.5 dispenses per sink per day (p < 0.0001), the sanitizer median daily usage was 4.27 dispenses per sink per day, and regimen use was statistically significantly lowest of all methods at 4.02 dispenses per sink per day (p < 0.0001). When hand hygiene event types were pooled, casual dining restaurants had similar median hand hygiene event rates (11.4 dispenses per sink per day) compared to quick-service restaurants (11.9 dispenses per sink per day; p = 0.890). The number of events by sink location varied, with sinks located at a warewash station having the highest number of events (19.3 dispenses per sink per day; p < 0.0001), while sinks located by a ready-to-eat food preparation area had the lowest number of events (6.8 dispenses per sink per day; p < 0.0001). These data provide robust baseline benchmarks for future hand hygiene intervention studies in these settings.

Nutritional Content of Popular Menu Items from Online Food Delivery Applications in Bangkok, Thailand: Are They Healthy?

The rise in online food delivery (OFD) applications has increased access to a myriad of ready-to-eat options, which may lead to unhealthier food choices. Our objective was to assess the nutritional profile of popular menu items available through OFD applications in Bangkok, Thailand. We selected the top 40 popular menu items from three of the most commonly used OFD applications in 2021. Each menu item was collected from the top 15 restaurants in Bangkok for a total of 600 items. Nutritional contents were analysed by a professional food laboratory in Bangkok. Descriptive statistics were employed to describe the nutritional content of each menu item, including energy, fat, sodium, and sugar content. We also compared nutritional content to the World Health Organization's recommended daily intake values. The majority of menu items were considered unhealthy, with 23 of the 25 ready-to-eat menu items containing more than the recommended sodium intake for adults. Eighty percent of all sweets contained approximately 1.5 times more sugar than the daily recommendation. Displaying nutrition facts in the OFD applications for menu items and providing consumers with filters for healthier options are required to reduce overconsumption and improve consumer food choice.

Adopting an Extended Theory of Planned Behaviour to Examine Buying Intention and Behaviour of Nutrition-Labelled Menu for Healthy Food Choices in Quick Service Restaurants: Does the Culture of Consumers Really Matter?

This research aims to examine an extended model of the Theory of Planned Behaviour (TPB) to understand the determinants of consumers' intentions to buy and recommend nutrition-labelled menu (NLM) items for making healthy food choices. The research examines the influence of attitude towards behaviour (ATT), subjective norms (SNs), perceived behavioural control (PBC) and health consciousness on consumers' intentions to buy and recommend NLM. The research also examines the role of culture in shaping buying and recommendation intentions of NLM by undertaking a comparative study of the extended model among consumers in two different countries that have enough variation based on Hofstede's cultural dimensions, i.e., the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). The results of questionnaire surveys analysed with SmartPLS version 4 showed that ATT, SNs and health consciousness significantly predict intentions to buy NLM items among KSA consumers in quick service restaurants (QSRs). However, PBC did not have a significant influence on KSA consumers' intentions to buy NLM items. On the other hand, ATT, PBC and health consciousness significantly predict intentions to buy NLM items among UK consumers in QSRs. Nonetheless, SNs did not have a significant influence on UK consumers' intentions to buy NLM items. The intention to buy NLM significantly predicts the intentions to recommend NLM among consumers in both countries (KSA and UK). The results of a multi-group analysis showed significant differences between the KSA and the UK regarding the influence of both SNs and PBC on consumers' intentions to buy NLMs as well as on their indirect influence on intentions to recommend NLM items. The results value the role of culture in shaping consumers' intentions to buy and to recommend NLM items for healthy food choices, which has numerous implications for international QSRs, policy makers, and academics.

When Students Patronize Fast-Food Restaurants near School: The Effects of Identification with the Student Community, Social Activity Spaces and Social Liability Interventions.

US schools have fast-food restaurants nearby, encouraging student patronage, unhealthy consumption, and weight gain. Geographers have developed an activity space framework which suggests this nearby location effect will be moderated by whether people perceive the location as their activity space. Therefore, we study whether students perceive a fast-food restaurant near school as their activity space, and whether social marketing messages can change that perception. We conducted six studies: a secondary data analysis with 5986 students, a field experiment with 188 students, and four lab experiments with 188, 251, 178, and 379 students. We find that students who strongly identify with their student community patronize a fast-food restaurant near school (vs. farther away) because they view it as their activity space, while students who weakly identify do not. For example, in our field experiment, 44% vs. 7% of students who strongly identified with the student community patronized the near versus farther restaurant, while only 28% versus 19% of students who weakly identified patronized the near and farther restaurants comparably. We also find that to deter the strong identifiers, messages should convey that patronage is a social liability, e.g., portray student activism against fast food. We show that standard health messages do not change perceptions of restaurants as social activity spaces. Thus, to combat the problem of fast-food restaurants near schools causing unhealthy consumption, policy and educational interventions should focus on students who strongly identify with their student community and find ways to weaken their perceptions that fast-food restaurants near schools are their activity spaces.

Development of an Empirically Derived Measure of Food Safety Culture in Restaurants.

A poor food safety culture has been described as an emerging risk factor for foodborne illness outbreaks, yet there has been little research on this topic in the retail food industry. The purpose of this study was to identify and validate conceptual domains around food safety culture and develop an assessment tool that can be used to assess food workers' perceptions of their restaurant's food safety culture. The study, conducted from March 2018 through March 2019, surveyed restaurant food workers for their level of agreement with 28 statements. We received 579 responses from 331 restaurants spread across eight different health department jurisdictions. Factor analysis and structural equation modeling supported a model composed of four primary constructs. The highest rated construct was Resource Availability (x¯=4.69, sd=0.57), which assessed the availability of resources to maintain good hand hygiene. The second highest rated construct was Employee Commitment (x¯=4.49, sd=0.62), which assessed workers' perceptions of their coworkers' commitment to food safety. The last two constructs were related to management. Leadership (x¯=4.28, sd=0.69) assessed the existence of food safety policies, training, and information sharing. Management Commitment (x¯=3.94, sd=1.05) assessed whether food safety was a priority in practice. Finally, the model revealed one higher-order construct, Worker Beliefs about Food Safety Culture (x¯=4.35, sd=0.53). The findings from this study can support efforts by the restaurant industry, food safety researchers, and health departments to examine the influence and effects of food safety culture within restaurants.

Consistent and changing consumption of fast-food and full-service meals and 3-year weight change in a large population cohort study.

BACKGROUND: An average American consumes 3 meals weekly from fast-food or full-service restaurants, which contain more calories, fat, sodium, and cholesterol than meals prepared at home. OBJECTIVES: This study examined whether consistent and changing fast-food or full-service consumption was associated with weight change over a 3-y period. METHODS: Among 98,589 US adults from the American Cancer Society's Cancer Prevention Study-3, self-reported weight and fast-food and full-service consumption from 2015 and 2018 were examined using a multivariable-adjusted linear regression analysis to assess the association of consistent and changing consumption on 3-y weight change. RESULTS: Individuals who made no changes to their fast-food or full-service intake over the study period gained weight regardless of consumption frequency, although low consumers gained less weight than high consumers (low fast-food: ß = -1.08; 95% CI: -1.22, -0.93; low full-service: ß = -0.35; 95% CI: -0.50, -0.21; P < 0.001). Decreased fast-food intake during the study period (e.g., from high [>1 meal/wk] to low [≤0.5 meal/wk], high to medium [>0.5 to ≤1 meal/wk], or medium to low) and decreased full-service intake from high (≥1 meal/wk) to low (<1 meal/mo) were significantly associated with weight loss (high-low: ß = -2.77; 95% CI: -3.23, -2.31; high-medium: ß = -1.53; 95% CI: -1.72, -1.33; medium-low: ß = -0.85; 95% CI: -1.06, -0.63; high-low full-service: ß = -0.92; 95% CI: -1.36, -0.49; P < 0.001). Decreased consumption of both fast-food and full-service restaurant meals was associated with greater weight loss than decreasing fast-food alone (both: ß = -1.65; 95% CI: -1.82, -1.37; fast-food only: ß = -0.95; 95% CI: -1.12, -0.79; P < 0.001). CONCLUSIONS: Decreased consumption of fast-food and full-service meals over 3 y, particularly among high consumers at baseline, was associated with weight loss and may be an effective approach to weight loss. Moreover, decreasing both fast-food and full-service meal consumption was associated with a greater weight loss than decreasing only fast-food meal consumption.

The Impact of the COVID-19 Pandemic on Public Interest in the Energy Labelling on Restaurant Menus.

No study has investigated the effect of the COVID-19 pandemic on the public's interest in using energy labelling on restaurant menus. This study explores the effects of the COVID-19 pandemic on the public interest in using energy labelling on restaurant menus and meal delivery applications and the impact of energy-labelling availability on food choices during the COVID-19 pandemic in Saudi Arabia. An online questionnaire was completed by 1657 participants aged ≥ 18 years. Before the COVID-19 pandemic, 32% of customers visited a restaurant 2-4 times/week. However, during the pandemic, 35% of customers visited a restaurant only once per week. There was no difference in interest in reading energy labelling or using meal delivery applications before and during the pandemic. During the COVID-19 pandemic, about 55% of restaurant customers reported that they had noticed energy labelling, with 42% of them being influenced by the energy-labelling information. Regarding energy information on food delivery applications, 40% of customers noticed energy labelling when using the applications, with 33% of them being affected by the energy labelling. Customer interest in reading about energy on restaurant menus during the pandemic did not change significantly from the level of interest before the pandemic. The interest expressed by the public in using the energy labelling was low both before and during the COVID-19 pandemic.

Environmental assessment of casual dining restaurants in urban and suburban areas of peninsular Malaysia during the COVID-19 pandemic.

Food waste has been considered a global problem due to its adverse impacts on food security, the environment, and the economy; hence needs urgent attention and action. Its generation is expected to increase as the world population grows rapidly, leading to more global waste. This study sought the impacts of the COVID-19 outbreak on the 1-week operation of selected casual dining restaurants in urban (Ampang, Kuala Lumpur) and suburban areas (Kota Bharu, Kelantan and Jasin, Melaka) of Peninsular Malaysia, as the local community adjusted to life with COVID-19. The food waste in this study was classified into three categories: preparation loss, serving loss, and customer's plate waste. Our material flow analysis revealed that the highest food loss at these locations came from preparation loss (51.37%), followed by serving loss (30.95%), and preparation loss (17.8%). Meanwhile, the total average electricity consumption and its carbon footprint for Ampang were 127 kWh and 13.87 kgCO2e, Kota Bharu 269.8 kWh and 29.47 kgCO2e, and Jasin 142.2 kWh and 15.54 kgCO2e, respectively. As for water, Ampang exhibited 22.93 m3 total average consumption and 7.91 kgCO2e greenhouse emissions from this source, Jasin consuming 17.11 m3 of water and releasing 5.88 kgCO2e of carbon footprint, while Kota Bharu emitted 20.21 kgCO2e of greenhouse gases from its 58.71 m3 water consumption. Our findings indicate a major 'food leak' at the preparation stage, from which the waste could be utilised as livestock feed, and that electricity consumption is a greater carbon emitter than water consumption, suggesting a need for improvement to the kitchen practices and equipment.

Differences in food parenting at home versus restaurants among parents of 3-to-8-year-old children.

Indulgent parent feeding styles have been linked to less healthful eating behaviors and higher BMI among children. Restaurants are becoming a frequent eating environment for children. Frequent intake of food from restaurants has been associated with increased weight status, making restaurants a target for childhood obesity prevention efforts. Currently, little research has considered parent feeding styles in restaurants and how they might differ from the home setting. Given the increased frequency of children's restaurant consumption, examining parent feeding styles in restaurants may contribute to future research in this area. Therefore, the objective of this study was to examine parent feeding styles at home and in restaurants. Parents whose 3-to-8-year-old children dined out regularly completed a one-time, online survey in February/March 2022. The Caregiver's Feeding Style Questionnaire assessed parent feeding styles at home and in restaurants. Differences in feeding styles were examined across settings. Indulgent feeding styles were most common overall. Parents (n = 117; 92% mothers; 85% white; 61% reported household income > $75,000/year) reported higher demandingness at home (M = 2.6 ± 0.5) compared to restaurants (M = 2.4 ± 0.5; t(116) = 6.7, P < 0.001). Parents were more likely to use indulgent feeding styles (X2 = 11.6, P < 0.001) and less likely to use authoritarian feeding styles (X2 = 4.6, P < 0.05) in restaurants compared to the home, suggesting parent feeding styles are less structured in restaurants. Results may have implications for future healthy eating interventions in away-from-home contexts.

Is the effect of menu energy labelling on consumer behaviour equitable? A pooled analysis of twelve randomized control experiments.

Menu energy labelling has been implemented as a public health policy to promote healthier dietary choices and reduce obesity. However, it is unclear whether the influence energy labelling has on consumer behaviour differs based on individuals' demographics or characteristics and may therefore produce inequalities in diet. Data were analysed from 12 randomized control trials (N = 8508) evaluating the effect of food and drink energy labelling (vs. labelling absent) on total energy content of food and drink selections (predominantly hypothetical) in European and US adults. Analyses examined the moderating effects of participant age, sex, ethnicity/race, education, household income, body mass index, dieting status, food choice motives and current hunger on total energy content of selections. Energy labelling was associated with a small reduction (f2 = 0.004, -50 kcal, p < 0.001) in total energy selected compared to the absence of energy labelling. Participants who were female, younger, white, university educated, of a higher income status, dieting, motivated by health and weight control when making food choices, and less hungry, tended to select menu items of lower energy content. However, there was no evidence that the effect of energy labelling on the amount of energy selected was moderated by any of the participants' demographics or characteristics. Energy labelling was associated with a small reduction in energy content of food selections and this effect was similar across a range of participants' demographics and characteristics. These preliminary findings suggest that energy labelling policies may not widen existing inequalities in diet.

Selective Daily Mobility Bias in the Community Food Environment: Case Study of Greater Hartford, Connecticut.

The community food environment has potential influences on community members' dietary health outcomes, such as obesity and Type II diabetes. However, most existing studies evaluating such health effects neglect human mobility. In food patrons' daily travels, certain locations may be preferred and patronized more frequently than others. This behavioral uncertainty, known as the selective daily mobility bias (SDMB), is less explored in community-food-environment research. In this paper, we aim to confirm the existence of the SDMB by systematically exploring the large-scale GPS-based restaurant-visit patterns in the Greater Harford region, Connecticut. Next, we explore the restaurant and neighborhood characteristics that are associated with the restaurant-visit patterns. Our primary results demonstrate that (1) most restaurant customers originate from areas outside of the census tract where the restaurant is located, and (2) restaurants located in socially vulnerable areas attract more customers in total, more customers from local areas, and more customers from other socially vulnerable areas. These results confirm the relevance of the SDMB to the community food environment, and suggest ways that the SDMB can be moderated by an uneven socio-economic landscape. The findings demonstrate the necessity of incorporating human-mobility data into the study of the community food environment.

The Impact of the COVID-19 Pandemic on Public Interest in the Energy Labelling on Restaurant Menus.

No study has investigated the effect of the COVID-19 pandemic on the public's interest in using energy labelling on restaurant menus. This study explores the effects of the COVID-19 pandemic on the public interest in using energy labelling on restaurant menus and meal delivery applications and the impact of energy-labelling availability on food choices during the COVID-19 pandemic in Saudi Arabia. An online questionnaire was completed by 1657 participants aged ≥ 18 years. Before the COVID-19 pandemic, 32% of customers visited a restaurant 2-4 times/week. However, during the pandemic, 35% of customers visited a restaurant only once per week. There was no difference in interest in reading energy labelling or using meal delivery applications before and during the pandemic. During the COVID-19 pandemic, about 55% of restaurant customers reported that they had noticed energy labelling, with 42% of them being influenced by the energy-labelling information. Regarding energy information on food delivery applications, 40% of customers noticed energy labelling when using the applications, with 33% of them being affected by the energy labelling. Customer interest in reading about energy on restaurant menus during the pandemic did not change significantly from the level of interest before the pandemic. The interest expressed by the public in using the energy labelling was low both before and during the COVID-19 pandemic.

Associations between the food environment and food and drink purchasing using large-scale commercial purchasing data: a cross-sectional study.

BACKGROUND: Evidence for an association between the local food environment, diet and diet-related disease is mixed, particularly in the UK. One reason may be the use of more distal outcomes such as weight status and cardiovascular disease, rather than more proximal outcomes such as food purchasing. This study explores associations between food environment exposures and food and drink purchasing for at-home and out-of-home (OOH) consumption. METHODS: We used item-level food and drink purchase data for London and the North of England, UK, drawn from the 2019 Kantar Fast Moving Consumer Goods panel to assess associations between food environment exposures and household-level take-home grocery (n=2,118) and individual-level out-of-home (n=447) food and drink purchasing. Density, proximity and relative composition measures were created for both supermarkets and OOH outlets (restaurants and takeaways) using a 1 km network buffer around the population-weighted centroid of households' home postcode districts. Associations between food environment exposure measures and frequency of take-home food and drink purchasing, total take-home calories, calories from fruits and vegetables, high fat, salt and sugar products, and ultra-processed foods (UPF), volume of take-home alcoholic beverages, and frequency of OOH purchasing were modelled using negative binomial regression adjusted for area deprivation, population density, and individual and household socio-economic characteristics. RESULTS: There was some evidence for an inverse association between distance to OOH food outlets and calories purchased from ultra-processed foods (UPF), with a 500 m increase in distance to the nearest OOH outlet associated with a 1.1% reduction in calories from UPF (IR=0.989, 95%CI 0.982-0.997, p=0.040). There was some evidence for region-specific effects relating to purchased volumes of alcohol. However, there was no evidence for an overall association between food environment exposures and take-home and OOH food and drink purchasing. CONCLUSIONS: Despite some evidence for exposure to OOH outlets and UPF purchases, this study finds limited evidence for the impact of the food environment on household food and drink purchasing. Nonetheless, region-specific effects regarding alcohol purchasing indicate the importance of geographical context for research and policy.

Food Safety Behaviours among Food Handlers in Different Food Service Establishments in Montenegro.

Foodborne diseases in food facilities are a major public health problem, due mostly to the limited surveillance and educational level of food-handling workers. This study was conducted in 220 food service locations in Montenegro. Participants' behaviour was assessed by a survey using the specifically designed structured questionnaire, administered before and after the training. To determine the effect of the training on the performance of food handlers, a microbiological analysis of food contact surfaces and food handlers' hands was also performed. The behaviour of food handlers, viewed as a whole, is unacceptable. There was a statistically significant difference (<0.05) among participants who completed catering school compared with those who did not, regarding hand washing. The type of facility in which participants worked (restaurant, bakery, or pastry shop) revealed statistically significant differences (<0.05) in relation to hand washing, that is, restaurant employees had better habits than those from bakeries and pastry shops. Before the training, participants showed acceptable behaviour regarding hand hygiene, but it was much better after the training. Results of microbiological analyses of food contact surfaces and food handlers' hands indicated better results after the education, especially with regard to hand swabs. The results of this study indicate the importance of education to improve food handling practices among food handlers, which might also decrease the possibilities for contamination of food.

Survey-derived activity space-based exposures to fast food outlets and their cross-sectional associations with use of fast food outlets, diet quality and BMI.

There is a need for conceptual and methodological innovation in food environment-health research. We compared different operationalizations of survey-derived activity space exposures to fast food outlets (FFOs) in associations with use of FFO, diet quality and body mass index (BMI). FFO exposure was determined for home, work and a maximum of sixteen other locations reported by 1728 Dutch adults. Considerable differences in count of FFO between locations were found. Adjusted linear regression analyses resulted in small, unexpected associations with use of FFO, diet quality and BMI, whereby the strength of associations differed between exposure measures. Using home and work areas may be a cost-efficient compromise to capture large parts of the exposure to FFOs.

Association of fast-food restaurants with overweight and obesity in school-aged children and adolescents: A systematic review and meta-analysis.

We aimed to explore associations between the accessibility of fast-food restaurants (FFRs) and weight-related outcomes in children and adolescents through a systematic review and meta-analysis of studies. We searched three databases for studies published before October 21, 2022. Study quality was assessed using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Meta-analysis was performed, and the leave-one-out method was used for sensitivity analysis. A total of 60 studies were included. According to our analysis, FFRs within a smaller buffer radius from residences or that provide unhealthy foods may have a more significant influence on children's and adolescents' weight. Children of younger ages and girls may have a higher possibility of being overweight due to FFRs. Though we could hardly avoid bias, the estimates in low-and middle-income countries (only six studies) are much higher than those in high-income countries (54 studies). More research analyses based on microscope data and individual economic levels are needed. This study yields quantitative results, provides policymakers and urban planners with a theoretical support for building resilient and sustainable human settlements, and promotes the translation of research findings from public health to environmental planning.

Personal values, motives, and healthy and sustainable food choices: Examining differences between home meals and restaurant meals.

People are increasingly eating out in restaurants, where meals tend to be higher in calories, less nutritious, and contain more meat. In this paper, we argue that differences in the motivational processes underlying people's food choices could help to explain why food choices made in restaurants are typically unhealthier and less sustainable than at home. Using online survey data from 301 Dutch participants, we compared the influence of stable personal values and transient food choice motives on the healthiness and sustainability of meals chosen in a hypothetical choice task, which was geared to the home and restaurant consumption contexts. As expected, participants opted for unhealthy and meat-based meals more often in the restaurant than the home context. Conservation values related negatively and self-transcendence values positively to choosing sustainable meals both in the home and in the restaurant context, although the relation with self-transcendence values was significantly weaker in the restaurant context. Also, taste and social eating were considered more important for choosing restaurant meals, while health was a more important motive for food choices at home. Finally, model comparisons revealed that motives were better predictors of healthy meal choices in both contexts, while the influence of values and motives on sustainable meal choices was more similar. In conclusion, the results from the present study enhance our understanding of differences between choosing home and restaurant meals by providing an account of the values and motives associated with the healthiness and sustainability of home and restaurant meal choices.

Impact of vaping restrictions in public places on smoking and vaping in the United States-evidence using a difference-in-differences approach.

AIMS: To estimate whether and to what extent extending indoor smoking restrictions to include electronic cigarettes (ECs) impact the use of ECs and cigarette smoking among adults in the United States. DESIGN: Observational study using a linear probability model and applying a difference-in-differences analysis. SETTING: United States. PARTICIPANTS: People aged 18-54 who lived in US counties where comprehensive indoor smoking laws in bars, restaurants and private work-places have been in place prior to 2010 (n = 45 111 for EC use analysis, n = 75 959 for cigarette use analysis). MEASUREMENTS: Data on cigarette smoking, use of ECs and place of residence from the Tobacco Use Supplement of the Current Population Survey (TUS-CPS 2010-11, 2014-15 and 2018-19) were combined with the American Nonsmokers' Rights Foundation (ANRF) database of state and local indoor smoking and vaping restriction laws. FINDINGS: Indoor vaping restriction (IVR) coverage was not significantly associated with the likelihood of adult EC use [coefficient estimate = 0.001; 95% confidence interval (CI) = -0.009, 0.013, P-value = 0.783]. In addition, IVR coverage was not significantly associated with adult cigarette smoking (coefficient estimate = -0.00; 95% CI = -0.016, 0.015, P-value = 0.954). The non-significant results appeared in different socio-demographic subgroups. CONCLUSIONS: IVRs do not appear to decrease electronic cigarette use among US adults. There is no evidence that IVRs increase or decrease cigarette smoking among US adults.