Promoting Healthier Eating Among Children in Restaurants

NCT04334525 | Completed Results

• 2 other identifiers: STUDY000033561R01HD096748-01A1
• Study Type: interventional
• Target: 554
• Locations: 1 country
• Sites: 1

Brief Summary

Restaurants are normative eating contexts for many families. Restaurant meals tend to be higher in calories and lower in nutritional quality than those prepared at home. Targeting children's food selection in restaurants has the potential to improve diet quality, attenuate excess energy intake, and shape healthy habits. The objective of this study is to make healthier kids' meal options more appealing and easier to choose via an in-restaurant intervention that combines repeated exposure and choice architecture strategies. Six locations of a quick-service restaurant will be paired based on income levels in the surrounding census tracts. A location from each pair will be randomized to each study group (intervention, control). Recruitment and data collection will be conducted across 3 cohorts, with recruitment conducted during a family's regular visit. Study participation will involve 7 more visits to the location where the family was recruited, 6 of which will be during an exposure period of about 2 months. Families in intervention restaurants will receive placemats promoting healthier featured kids' meals. Participating families will also receive a frequent diner card which, after purchasing one of the featured healthier kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period. In the control group, generic placemats will be provided, and participating families will be provided with frequent diner cards that can be used for any kids' meals. The aims of this study are: (1) to test effects of a healthier kids' meal intervention on children's meal orders, and (2) to test effects of a healthier kids' meal intervention on children's dietary intake. It is hypothesized that (1a) children in the intervention restaurants will be more likely than controls to select one of the promoted healthier kids' meals at post-test, (1b) children in the intervention group will order fewer calories and desserts and less saturated fat, sodium, and sugar at post-test versus controls, (1c) the promoted healthier meals will make up a greater percentage of kids' meals ordered in intervention restaurants versus controls, based on sales data across the study period, and (2) compared to controls, children in the intervention group will consume fewer calories and less saturated fat, sodium, and sugar in the restaurant at post-test.

Conditions

Diet, Healthy

Keywords

child; restaurant; nudging; repeated exposure; diet; health

Outcome Measures

Primary Outcomes (12)

• Meal Type Ordered for Child in Restaurant

  Whether a healthier children's meal or other children's meal was ordered (bundled meal including promoted healthy main dish, healthy side, and healthy beverage). Counts reported indicate the number of children who ordered a healthy bundled meal.

  Post-test (about 4 months after recruitment)

• Change in Meal Type Ordered for Child in Restaurant

  Whether a healthier children's meal or other children's meal was ordered. Counts reflect the raw change in number of participants ordering the bundled healthy meal from baseline to post-test, by group.

  Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

• Total Calories Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total calories ordered

  Post-test (about 4 months after recruitment)

• Change in Total Calories Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total calories ordered

  Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

• Total Saturated Fat Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total saturated fat ordered.

  Post-test (about 4 months after recruitment)

• Change in Total Saturated Fat Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total saturated fat ordered.

  Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

• Total Sugar Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sugar ordered.

  Post-test (about 4 months after recruitment)

• Change in Total Sugar Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sugar ordered.

  Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

• Total Sodium Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sodium ordered.

  Post-test (about 4 months after recruitment)

• Change in Total Sodium Ordered for Child in Restaurant

  Nutrition information provided by the restaurant will be combined with parent report of children's orders to calculate total sodium ordered.

  Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

• Dessert Ordered for Child in Restaurant

  Whether or not a dessert was ordered. Counts below reflect the number of children ordering a dessert at post-test.

  Post-test (about 4 months after recruitment)

• Change in Dessert Ordered for Child in Restaurant

  Whether or not a dessert was ordered. Numbers below reflect change in likelihood of ordering dessert from baseline to post-test in the context of the generalized linear mixed model with all time points (baseline, midpoints 1-9, post-test).

  Baseline, midpoints 1-9 (weekly assessments about 2 months after recruitment), post-test (about 4 months after recruitment)

Secondary Outcomes (8)

• Calories Consumed at Restaurant by Child in Restaurant

  Post-test (about 4 months after recruitment)

• Changes in Calories Consumed at Restaurant by Child in Restaurant

  Baseline, post-test (about 4 months after recruitment)

• Saturated Fat Consumed at Restaurant by Child in Restaurant

  Post-test (about 4 months after recruitment)

• Changes in Saturated Fat Consumed at Restaurant by Child in Restaurant

  Baseline, post-test (about 4 months after recruitment)

• Sugar Consumed at Restaurant by Child in Restaurant

  Post-test (about 4 months after recruitment)

Other Outcomes (8)

• Healthier Children's Meals Ordered at Aggregate Level

  Through study completion, an average of 3 years

• Healthier Children's Meals Ordered at Aggregate Level

  Exposure period (lasting from about 2 to about 4 months after participant recruitment)

• Healthier Children's Meals Ordered at Aggregate Level

  Baseline

Study Arms (3)

Generic placemats and frequent diner cards

ACTIVE COMPARATOR

Participants will receive generic placemats listing all of the restaurant's kids' meals. Families will also receive a generic frequent diner card, which after purchasing (any) kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period. Corresponding signage will be displayed in the restaurant.

Behavioral: Active comparator

Placemats and frequent diner cards promoting healthier meals

EXPERIMENTAL

Participants will receive placemats promoting healthier featured kids' meals and the opportunity to redeem their kids' meal token for a toy instead of dessert. Families will also receive a frequent diner card, which after purchasing one of the featured healthier kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period. Corresponding signage will be displayed in the restaurant.

Behavioral: Choice architecture + repeated exposure

Pilot phase

NO INTERVENTION

Pilot (taste testing) phase completed before the trial to finalize the healthier meals that would be promoted in the intervention.

Interventions

Active comparator BEHAVIORAL

Participants receive generic placemats and frequent diner cards that do not promote any specific kids' meal.

Generic placemats and frequent diner cards

Choice architecture + repeated exposure BEHAVIORAL

Participants will receive placemats promoting healthier featured kids' meals and the opportunity to redeem their kids' meal token for a toy instead of dessert. Families will also receive a frequent diner card, which after purchasing one of the featured healthier kids' meals across 6 occasions, makes them eligible for a free kids' meal of their choice during a predetermined redemption period.

Placemats and frequent diner cards promoting healthier meals

Eligibility Criteria

• Age: 4 Years - 8 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Fluent in English (parent/guardian \& child)
• years or older (parent/ guardian)
• Between the ages of 4-8 years (child)
• Eats food from restaurants at least 2-3 times per month (child)
• Does not have allergies that preclude safe participation in the study (child)
• Eating a meal in the restaurant at the time of recruitment/baseline assessment
• Did not participate in pilot phase of this study, which involved taste tests of possible healthier meal options at the same restaurant chain

You may not qualify if:

• Is under 18 years of age (parent/ guardian)
• Does not have a child in the range of 4-8 years
• Does not speak English fluently (parent/guardian \& child)
• Does not eat food from a restaurant at least 2-3 times per month (child)
• Has food allergies that preclude safe participation in the study (child)
• Not eating a meal in the restaurant at recruitment/baseline
• Participated in pilot phase of this study, which involved taste tests of possible healthier meal options at the same restaurant chain

Sponsors & Collaborators

• State University of New York at Buffalo: lead
• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): collaborator

Study Sites (1)

State University of New York at Buffalo

Buffalo, New York, 14214, United States

Location

Related Publications (1)

• Anzman-Frasca S, Tauriello S, Epstein L, Ferrante MJ, Gampp A, Goldsmith J, Haines J, Leone LA, Paluch R. Promoting Healthier Meal Selection and Intake Among Children in Restaurants: Protocol for a Cluster-Randomized Trial. JMIR Res Protoc. 2025 Oct 10;14:e73618. doi: 10.2196/73618.

  PMID: 41072006 DERIVED

Results Point of Contact

• Title: Stephanie Anzman-Frasca
• Organization: SUNY Buffalo

safrasca@buffalo.edu

716-829-6692

Study Officials

• Stephanie Anzman-Frasca, PhD

  University at Buffalo

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Participants know which kids' meals are being promoted based on the materials received in each study group -- e.g., placemats and frequent diner cards promoting two featured (healthier) meals vs. all kids' meals -- but the health focus and research questions are not stated explicitly to the participants.
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: A cluster-randomized design will be used. 6 locations of Anderson's, a regional quick-service restaurant in the Buffalo, New York, area will be paired based on income levels in the surrounding census tracts. A location from each pair will be randomized to each study group (intervention, control). Phased data collection will occur, with each pair of restaurants assigned to a cohort. There is also a pilot arm, consisting of separate children participating in taste tests prior to randomization to finalize the healthier meals to be promoted in the intervention.

Study Record Dates

• First Submitted: March 31, 2020
• First Posted: April 6, 2020
• Study Start: November 13, 2019
• Primary Completion: November 22, 2024
• Study Completion: November 24, 2024
• Last Updated: June 10, 2026
• Results First Posted: June 10, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)