Predictors of Total Calories Purchased at Fast-food Restaurants: Restaurant Characteristics, Calorie Awareness, and Use of Calorie Information

Transcription

1 Predictors of Total Calories Purchased at Fast-food Restaurants: Restaurant Characteristics, Calorie Awareness, and Use of Calorie Information Ian Brissette, PhD, Director Bureau of Chronic Disease Evaluation and Research (BCDER) JNEB Webinar Series March 31, 2014

2 Collaborators Co-authors Ann Lowenfels, MPH; BCDER, New York State Department of Health Corina Noble, MS; Center for Human Services Research, SUNY Albany Deborah Spicer, RD, MPH Healthy Heart Program, New York State Department of Health Funding Support: Center for Disease Control and Prevention 3U58DP S4

3 Americans Eat Out A Lot! The average American eats out six meals a week. The average American consumes about one-third of their calories eating out. Americans spend almost half (48%) of food dollars on away-from-home foods.

4 Trends in Obesity in Adults, Adolescents and Children Over the Past 50 Years Dramatic population changes in where adults and children purchase and consume food have been associated with increases in obesity.

5 Calorie Labeling - Rationale

6 Policy Calorie Labeling: Overall Logic Model Environmental Change Required Calorie content posted on menu boards Potential Cognitive Response Notice calorie postings Understand calorie postings Use calorie postings to guide menu selections Individual Changes Behavior Change Order fewer calories Consume fewer calories at restaurants Decrease overall daily consumption of calories Long-Term Outcomes Reduced Weight Reduced Obesity Reformulation of Items Change in menu items Change in pricing/promotions Social Norm Change Ordering fewer calories at restaurants is desirable, convenient and popular

7 Calorie Labeling New York City Albany County Schenectady County Suffolk County Ulster County Nassau County* Westchester County** * Didn t implement after Federal Law passed **Didn t enforce after Federal Law passed 7

8 Calorie Labeling Past Studies Health Impact Assessment Kuo, et al Am J Public Health September; 99(9): Observational and Quasi-Experimental Awareness & use of posted calorie information Calories Purchased Dumanovsky et al Am J Public Health. 2010;100: ; Elbel et al, Health Aff (Millwood). 2009;28: w1110-w1121.; Pulos E, Leng K. Am J Public Health. 2010;100: Bassett, et al., Experimental Roberto, et al Am J Public Health. 2010;100:

9 Current Study Individual Characteristics Demographics Calorie-Awareness Environmental Characteristics Use of Calorie Information Individual- Environment Transaction Total Calories Purchased Posted Calories Restaurant Offerings

10 Current Study: Purchasing Strategies Ordering small or no fries a low-cal or no beverage ordering 3 or fewer items Purchasing strategies were expected to explain associations between individual factors (demographics, calorie awareness) and use of posted calorie information with total calories purchased

11 Current Study Aim 1: Evaluate the contributions of individual characteristics, environmental characteristics and transaction (calorie use) to total calories purchased at fast food chain restaurant Aim 2: Explore the extent to which purchasing behaviors (strategies) account for variability in total calories purchased and observed associations between individual and environmental characteristics

12 Methods

13 Restaurant Site Visits List of food service establishments was provided by NYS Department of Agriculture and Markets Evaluation focused on fast food chains with restaurants in each county Study eligibility was determined by conducting sites visits and meeting with restaurant managers

14 Design: Cross-Sectional Study County Baseline Restaurants Albany Schenectady Ulster calorie labels 5 locations in Albany 6 (Schenectady & Ulster) Suffolk no calorie labels 8 restaurant locations Oneida no calorie labels 6 restaurant locations

15 Customer Surveys and Receipts

16 Procedures Data Collection occurred 12:00 to 2:30 Monday through Friday Adult pedestrian customers approached as they entered the restaurant; Drive thru excluded $2 incentive was offered to customers providing receipts and completing a brief survey 52% participation rate among customers recruited (site range from 27% to 73%) Reviewed by NYS DOH Institutional Review Board; Signed consent not required

17 Measures Can you tell me what you ordered for yourself today? -- compared with receipts Did you use calorie information to help you decide what to buy today? Used calorie information that day About how many calories do you think you re supposed to consume at each meal? Calorie knowledge When deciding what foods to buy from food stores and restaurants, how often do you consider calories? Calorie awareness In an average week, do you eat at least one meal at a fast food restaurant? Fast food frequency Demographics: Age, Zip Code of Residence, Education, Race/Ethnicity

18 Measures Calorie information Calorie information was obtained from online menus appropriate for month of data collection and linked with receipt data 7% of receipts had discrepancies between receipt and customer survey; discrepancies were handled in a uniform manner Purchasing Behaviors were coded from receipt and customer surveys: ordering small or no fries, low-cal (< 10 cal) or no beverage,3 or fewer items

19 Statistical Analyses Ordinary least squares regression (OLS) bivariate analyses to describe associations multivariate models with blocks of predictors added in steps evaluation of individual parameters and D in model R 2 with added predictors

20 Results: Restaurant Characteristics

21 Total Calories Ordered Restaurant Characteristics Mean Total Calories Ordered by Posted Calories Calories Labeled No Label

22 Total Calories Ordered Restaurant Characteristics Mean Total Calories Ordered by Restaurant Chain 1, , Total Chain A Chain B Chain C Chain D

23 Results: Participant Characteristics Significant differences among males and females, and between adults of different age groups and educational attainment No differences in calories purchased by race/ethnicity

24 Total Calories Ordered Participant Demographics Mean Total Calories Ordered by Customer Age , years years years years 55+ years

25 Total Calories Ordered Participant Demographics Mean Total Calories Ordered by Customer Educational Attainment High School or Less Some Colllege Bachelor's Degree or More

26 Results: Participant Characteristics Continued

27 Mean Calories Ordered by Calorie Awareness and Use of Calorie Information Calorie Use in General - Calorie Awareness Use of Calorie Information At Restaurant Today Always Sometimes Never Yes No

28 calories ordered Mean calories ordered, by purchasing strategy used strategy did not use strategy low cal or no beverage small or no fries fewer than three items 28

29 Factors Associated With Mean Calories Purchased at Fast Food Restaurants Multivariate Analyses: Model 1 Restaurant Characteristics Restaurant chain and calorie posting were both significant predictors of total calories purchased

30 Factors Associated With Mean Calories Purchased at Fast Food Restaurants Multivariate Analyses: Model 2 Participant Characteristics

31 Factors Associated With Mean Calories Purchased at Fast Food Restaurants Multivariate Analyses Individual Characteristics and Behaviors Customer age, sex and education were each independently associated with total calories ordered; Both calorie awareness (b = -.07, p =.02) and use of calorie information that day (b = -.06, p =.04) were independently associated with total calories ordered; Customer characteristics and calorie use accounted for an additional 6% of the variance in calories ordered beyond restaurant characteristics;

32 Factors Associated With Mean Calories Purchased at Fast Food Restaurants Multivariate Analyses Evaluation of Individual Purchasing Strategies Evaluation of Changes in Model R 2

33 Factors Associated With Mean Calories Purchased at Fast Food Restaurants Multivariate Analyses Changes in predictor with inclusion of strategies Age, Education and sex remained significant predictors of total calories ordered Calorie Awareness and Use of Calorie Information Only calorie use remained a significant predictor of total calories ordered

34 Discussion of Key Findings Evidence for restaurant characteristics, individual characteristics and individual-environment interaction contributed to explaining variation in total calories purchased. Calorie use and calorie awareness were independent predictors of total calories purchased Knowledge of daily calorie requirements was not associated with total calories purchased

35 Discussion of Key Findings: Restaurant Characteristics Restaurant chain was a robust predictor of calories ordered Small burger with fries 480 calories in one chain 1,100 calories in another

36 Discussion of Key Findings: Purchasing 1: Order fewer items. Strategies 2. Choose small fries or no fries 3. Select a low calorie beverage or water Each strategy was an independent predictor of total calories ordered. Together they accounted for 40% of total calories ordered. Accounted for association between calorie awareness and total calories ordered but not the association between calorie use and total calories ordered.

37 Limitations Design: Cross-sectional design, self-selected sample, only pedestrian customers, 4 chains, only Englishspeaking customers Measures: single-item measure of calorie awareness, measured calories ordered and not ordered, only considered a subset of purchasing strategies and did not explicitly ask customers about them;

38 Implications Actionable information to accompany posted calories; Education to promote calorie awareness and to promote use of calorie information at fast food restaurants and other venues; Purchasing strategies, including choosing where to eat represent a way to help customers order less; Environmental change: portion sizes and menu offerings predictors of calories purchased;

39 Return to the Logic Model Policy Environmental Change Required Calorie content posted on menu boards Potential Cognitive Response Notice calorie postings Understand calorie postings Use calorie postings to guide menu selections Individual Changes Behavior Change Order fewer calories Consume fewer calories at restaurants Decrease overall daily consumption of calories Long-Term Outcomes Reduced Weight Reduced Obesity Reformulation of Items Change in menu items Change in pricing/promotions Social Norm Change Ordering fewer calories at restaurants is desirable, convenient and popular

40 Thank You! questions comments concerns