摘要：Objectives. To determine the proportion of restaurants that will be required to post calorie information under the Food and Drug Administration’s menu-labeling regulations in 4 New Jersey cities. Methods. We classified geocoded 2014 data on 1753 restaurant outlets in accordance with the Food and Drug Administration’s guidelines, which will require restaurants with 20 or more locations nationwide to post calorie information. We used multivariate logistic regression analyses to assess the association between menu-labeling requirements and census tract characteristics. Results. Only 17.6% of restaurants will be affected by menu labeling; restaurants in higher-income tracts have higher odds than do restaurants in lower-income tracts (odds ratio [OR] = 1.55; P = .02). Restaurants in non-Hispanic Black (OR = 1.62; P = .02) and mixed race/ethnicity (OR = 1.44; P = .05) tracts have higher odds than do restaurants in non-Hispanic White tracts of being affected. Conclusions. Additional strategies are needed to help consumers make healthy choices at restaurants not affected by the menu-labeling law. These findings have implications for designing implementation strategies for the law and for evaluating its impact. The proportion of calories consumed from food sources outside the home, including restaurants, has increased significantly since the 1970s and now constitutes roughly a third of daily calories consumed by both children and adults. 1 Food purchased outside the home is typically larger in portion sizes, higher in fat and calories, and lower in fiber than is food prepared at home. 1–4 Additionally, restaurant meals tend to be energy dense and nutrient poor and often exceed the typical calorie recommendations for single eating occasions. 5–7 Although fast-food restaurants have been shown to contribute the most calories to food consumed away from home 8 and typically serve food of poor dietary quality, 7 some evidence suggests that meals from small chain and independent restaurants are more energy dense than are those from large, national chain restaurants. 6 Furthermore, meal consumption away from home varies by sociodemographic characteristics. Higher-income individuals derive a greater proportion of calories from all sources away from home, but the contribution of calories from fast-food restaurants among lower-income individuals recently surpassed that for higher-income individuals. 8,9 Non-Hispanic Black adults consume significantly more calories when dining out than do non-Hispanic Whites and Hispanics. 10 Overconsumption of calories is a primary risk factor for weight gain and obesity 11 ; thus, it is not surprising that consumption of food away from home is associated with higher body weight. 12 According to National Health and Nutrition Examination Survey data, 36% of adults and 17% of youths aged 2 to 19 years were obese (having a body mass index [defined as weight in kilograms divided by height in meters squared] ≥ 30.0) in 2011 through 2014. 13 Because of the magnitude of the problem, finding strategies to prevent obesity is a public health priority. Restaurants have been identified as possible venues to target obesity prevention efforts, because both adults and children frequently consume meals in restaurants. 14,15 The US surgeon general’s 2001 call to action to prevent obesity first proposed calorie menu labeling in restaurants as a strategy to prevent and decrease the burden of overweight and obesity. 16 Soon after, the Food and Drug Administration (FDA) and the Institute of Medicine encouraged the restaurant industry to enact voluntary menu labeling. 17 State and local governments also began trying to pass menu-labeling laws in 2003; however, these efforts encountered resistance from the restaurant industry. In 2006 New York City was the first local jurisdiction to pass menu labeling, and in 2008 California was the first state to successfully implement a statewide law. 18 By 2010, 20 states and localities had passed varied menu-labeling policies, 19 leading to different stakeholders coming together to negotiate uniform standards across all 50 states that would preempt more restrictive state or city policies. Menu labeling was finally passed into law nationwide as part of the Patient Protection and Affordable Care Act in 2010. 20 The primary goal of menu labeling is to help consumers make informed dietary choices, 1 as studies show the average consumer and even nutrition professionals have trouble estimating the caloric content of meals eaten away from home. 21,22 The FDA, tasked with creating guidelines for implementing menu labeling, released the final rules in December 2014, which require restaurants and similar food establishments with 20 or more locations nationwide to post calorie information on menus and menu boards. 23 The FDA’s final guidance requires eligible restaurants to post calorie information by May 7, 2018. 24 Research shows that in restaurant settings, although the majority of customers notice menu labeling, only 15% to 33% of patrons use the information when determining food or beverage choices. 25–30 Therefore, studies examining the overall impact of menu labeling find no significant reduction in calorie purchases or consumption. 28,31–34 However, studies looking at those who actively use calorie information show that users purchase fewer calories than do nonusers. 26,29,30,35,36 Furthermore, there are disparities in who uses menu labeling. Adults with higher-income levels, 26,30,37,38 adults aged 25 to 44 years, 25 and adults who consume fast food more frequently 37 are more likely to use menu labeling. The format for displaying menu labeling can also influence its effectiveness; for example, use of colors to identify healthier options has been shown to enhance comprehension and reduce caloric intake. 39 As part of the upcoming FDA regulations, restaurants will also be required to add contextual language to help consumers understand menu labeling with respect to daily calorie recommendations (e.g., “2,000 calories a day is used for general nutrition advice, but calorie needs vary” for adults and “1,200 to 1,400 calories a day is used for general advice for children ages 4 to 8 years, but calorie needs vary” for children). 23 Such statements have been shown to be beneficial in informing customers’ purchases. 40 Systematic reviews examining the impact of menu labeling have reported mixed results. 31,39,40 A 2015 meta-analysis concluded that menu labeling has the potential to reduce the number of calories purchased and consumed. 39 Other reviews conclude that menu labeling may work only in specific contexts 40 or may result in very small declines in calories purchased. 31 Irrespective of differences in conclusions, all reviews support menu labeling as a relatively low-cost strategy that may encourage consumers to purchase fewer calories. The FDA projections for the cost benefit attributed to menu labeling in terms of improved health and longevity, primarily related to predicted reductions in obesity prevalence, range from $3.7 billion to $10.4 billion. 1 These depend on the extent to which patrons shift their consumption behaviors toward healthier diets consistent with the Dietary Guidelines for Americans. The FDA and the National Restaurant Association, a long-time supporter of a uniform standard for displaying calorie information at chain restaurants, predict that menu labeling will affect 36% to 40% of US restaurants (approximately 298 600 establishments in 2130 chains). 1,41 Because less than half of all restaurants are projected to be affected, we asked whether all communities would be equally exposed to menu labeling. We sought to determine the proportion of restaurants that will be affected by the new menu-labeling regulations in 4 urban, high-minority, low-income cities in New Jersey. Although other factors may contribute to consumer response to labeling, exposure is a precondition to its use. We also investigated whether such exposure to menu labeling will vary by the income and race/ethnicity of census tracts within these cities. Considering that fast-food restaurants cluster in lower-income and racial/ethnic minority neighborhoods, 42–45 we hypothesized that restaurants in lower-income census tracts and restaurants in census tracts with higher proportions of racial/ethnic minorities will be more likely to be affected by menu labeling.
