- Author: Mike Hsu
Lack of specific language for online context makes assessing compliance difficult
Beverages offered on fast-food restaurant websites and platforms such as DoorDash, GrubHub and UberEats often do not adhere to the spirit of California's healthy beverage law for children's meals, according to a new study from University of California researchers.
California's healthy-by-default beverage law (SB1192), which went into effect at the beginning of 2019, requires restaurants to offer only plain or sparkling water with no added sweeteners, unflavored milk, or unflavored non-dairy milk as the default beverage in “kids meals.” The law also requires that menus, menu boards and advertisements for those meals include only approved default options.
The law was passed to address increasing rates of childhood obesity and related chronic diseases, with sugary beverages factoring as a significant contributor to those poor health outcomes.
“Healthy-by-default beverage laws work by making the healthiest choice, the easiest choice for families,” said the study's lead author, Hannah Thompson, senior epidemiologist for the UC Nutrition Policy Institute and assistant adjunct professor at the UC Berkeley School of Public Health. “Drinking sugar-sweetened beverages like sodas has been directly linked to health problems such as Type II diabetes, heart disease and cavities.”
Researchers at the NPI – a program of UC Agriculture and Natural Resources – found that most fast-food restaurants serving low-income census tracts did not offer beverages online in a way that is consistent with SB1192. The study focused on those neighborhoods because children from low-income families consume sugar-sweetened beverages in greater quantities, likely exacerbating health disparities.
Published online in the journal Public Health Nutrition, the study looked at a random sample of 254 “quick service restaurant” sites and collected observations from their restaurant-specific websites and three of the most popular online platforms that deliver their menu items – DoorDash, GrubHub and UberEats.
Researchers developed four increasingly restrictive criteria – incorporating beverage availability, upcharges and presentation of beverage options – to assess the implementation of SB1192 in these online ordering contexts. Half of their observations met their most lenient criteria, while less than 6% were consistent with their most restrictive – findings that Thompson called “discouraging.”
“It means families have to work harder to make the healthiest drink choices for their children,” she said. “This also means the law is likely not nearly as successful as it could be in its intent to help reduce sugary drink consumption by kids.”
The researchers had to create their own criteria for “compliance” with the law because, as written, SB1192 does not specifically mention online ordering, which has become increasingly popular due to the COVID-19 pandemic.
“Part of what makes it hard in the online context is that the law was written using language very specific to the in-restaurant physical space, making interpretation of compliance with the law for meals sold online challenging,” Thompson explained. “I'd love to see amended language in the law specific to meals sold online.”
Thompson also said she would like to see “clear and effective” communication with fast food restaurants and online delivery platforms so that they fully understand the healthy beverage law – as well as the use of a monitoring system that could help ensure compliance.
“Laws, which target system-level changes, are one of the most important public health tools we have to reduce sugary drink consumption and improve health for youth of all backgrounds,” she said. “But laws are only as strong as the structures in place to ensure their successful implementation.”
The other NPI-affiliated authors of the study are Senior Evaluators Anna Martin and Ron Strochlic, Evaluation Associate Sonali Singh, and Associate Director of Research Gail Woodward-Lopez, the principal investigator.
/h2>- Author: Danielle L. Lee
- Contributor: Gail Woodward-Lopez
A new study from University of California researchers suggests that most fast food restaurants in low-income neighborhoods in California are not offering beverages online in a way that is consistent with the state's healthy beverage law for children's meals sold on the restaurant's website and popular online ordering platforms like DoorDash, GrubHub, and UberEats. California's Healthy-By-Default Beverage law requires restaurants to offer only plain or sparkling water with no added sweeteners, unflavored milk or unflavored non-dairy milk as the default beverage in children's meals. The law also requires that menus, menu boards and advertisements for children's meals include only approved default options. Researchers found that less than six percent of the observations they made on the online ordering platforms of 245 fast food restaurants across low-income California neighborhoods were offering children's meal beverages that were consistent with the Healthy-By-Default Beverage law in its most restrictive interpretation. This is cause for concern as online ordering platforms are gaining popularity. The study was published online in the journal Public Health Nutrition by Nutrition Policy Institute researchers Hannah Thompson, Anna Martin, Ron Strochlic, Sonali Singh, and Gail Woodward Lopez as part of the NPI CalFresh Healthy Living evaluation.
The American Public Health Association (APHA) Annual Meeting and Expo is the largest yearly gathering of public health professionals. This year, the annual meeting is being held virtually October 24-28, 2020. Researchers from the University of California, Division of Agriculture and Natural Resources, Nutrition Policy Institute will be presenting their work on a variety of collaborative food and nutrition policy studies related to the child care food environment, school meals, the federal Supplemental Program for Women, Infants and Children (WIC), and more. A full list of on-demand poster presentations and live oral presentations is below.
Child care food environment:
- California childcare centers and homes in the federal child and adult care food program offer more nutritious foods to infants
Presenters: Danielle Lee, Klara Gurzo, Lilly Nhan, Elyse Homel Vitale, Sallie Yoshida, Lorrene Ritchie
Poster presentation - Online training increases child care provider knowledge of healthy beverage policy and practices for young children
Presenters: Kaela Plank, Danielle Lee, Abbey Alkon, Marisa Neelon, L. Karina Diaz Rios, Katherine Soule, Lorrene Ritchie
Poster presentation
School meals:
- Impact of a district-wide chocolate milk removal policy on students' milk selection and consumption
Presenters: Hannah Thompson, Lorrene Ritchie, Kristine Madsen, Esther Park, Wendi Gosliner
Oral presentation, Wednesday, October 28, 2020, 8:15-8:30 AM PDT
WIC:
- Families with children 1-5 years old: WIC program perspectives on nutrition education and food benefits
Presenters: Marisa Tsai, Lorrene Ritchie, Shannon Whaley, Catherine Martinez, Martha Meza, Lauren Au, Hallie Randel-Schreiber, Susan Sabatier
Oral presentation, Wednesday, October 28, 2020, 8:00-8:15 AM PDT - Children on WIC followed through age 4 years: What are they eating?
Presenters: Lorrene Ritchie, Lauren Au, Shannon Whaley, Christine Borger
Oral presentation, Wednesday, October 28, 2020, 9:30-9:50 AM PDT - Feeding beliefs and practices among low-income caregivers: Findings from year 4 of the WIC infant and toddler feeding practices study-2
Presenters: Courtney Paolicelli, Christine Borger, Lorrene Ritchie, Shannon Whaley
Oral presentation, Wednesday, October 28, 2020, 9:50-10:10 AM PDT
- Prevalence of overweight and obesity among children receiving WIC
Presenters: Christine Borger, Shannon Whaley, Lorrene Ritchie
Oral presentation, Wednesday, October 28, 2020, 10:10-10:30 AM PDT - Longer participation in WIC is associated with healthier outcomes for children at age 4 years
Presenters: Shannon Whaley, Christine Borger, Lauren Au, Lorrene Ritchie
Oral presentation, Wednesday, October 28, 2020, 10:30-10:50 AM PDT
Other topics:
- Exploring housing and food insecurity among California university students: A holistic and comprehensive definition of students' basic needs
Presenters: Suzanna Martinez, Erin Esaryk, Laurel Moffat, Lorrene Ritchie
Oral presentation, Tuesday, October 27, 12:00-12:15 PM PDT - Healthy default beverages in kids' meals: Evaluating policy implementation and impact in California and Delaware
Presenters: Allison Karpyn, Wendi Gosliner, Laura Lessard, Kathleen McCallops, Marisa Tsai, Tara Tracy, Phoebe Harpainter, Danielle Lee, Anna Martin, Lorrene Ritchie, Gail Woodward-Lopez
Oral presentation, Tuesday, October 27, 4:45-5:00 PM PDT - Perceived produce availability and child fruit and vegetable intake: The healthy communities study
Presenters: Laurel Moffat, Lorrene Ritchie, Wendi Gosliner, Kaela Plank, Lauren Au
Oral presentation, Wednesday, October 28, 2020, 10:15-10:30 AM PDT - Limited progress found in healthy checkout among food stores in economically disadvantaged California neighborhoods, 2011-2017
Presenters: Wendi Gosliner, Sriddharshi Hewawitharana, Janice Kao, Sadie Costello, Gail Woodward-Lopez
Poster presentation - A replication study of school-based SNAP-ed programmatic efforts to address student nutrition and physical activity outcomes
Presenters: John Pugliese, Lauren Whetstone, Sridharshi Hewawitharana, Gail Woodward-Lopez
Poster presentation
- Author: Danielle L. Lee
A recent study by Nutrition Policy Institute (NPI) researchers assessed differences in quick-service, or fast-food, restaurants with and without voluntary healthy default beverage standards for kids' meals. ‘Voluntary standards' are restaurant commitments to offer healthier drinks with kids' meals. Researchers evaluated the beverages shown on kids' meal menu boards, beverages offered by cashiers with kids' meals, and kids meal beverages selected by customers in 111 quick-service restaurants--70 with voluntary standards and 41 without--in SNAP-Ed eligible neighborhoods in 11 California counties. Data was collected by menu board and cashier order observations and customer surveys in December 2018 prior to the January 2019 implementation of a new California law (SB-1192) that requires all restaurants offering a kids' meal make the default beverage offered water, unflavored milk or a nondairy milk alternative and that only these beverages be displayed on kids' meal menus or advertisements.
Results from the study showed that significantly more quick-service restaurants with voluntary healthy default beverage standards for kids' meals offered unflavored milk or water on their menu boards compared to restaurants without voluntary standards. Customers at restaurants with voluntary standards reported purchasing healthier drinks and less soda compared with customers at restaurants without voluntary standards. These results suggest the voluntary healthy default beverage standards were effective at positively influencing restaurant practices and customer behavior. However, not all quick-service restaurants followed their own standards and much room for improvement remains. Additional intervention may be necessary to support full implementation of the standards and to maximize the impact on customer behavior and jurisdictions passing healthy default beverage laws for restaurant kids' meals may need to provide education and outreach alongside enforcement to ensure full implementation. The study was published online on July 22, 2020 in the International Journal of Environmental Research and Public Health by NPI researchers Phoebe Harpainter, Sridharshi Hewawitharana, Danielle Lee, Anna Martin, Wendi Gosliner, Lorrene Ritchie and Gail Woodward-Lopez. Read the full study online.
- Author: Jeannette E. Warnert
With a bachelor's degree in home economics from California State University, Sacramento, Martin took a part-time position in 1993 as an educator with the Expanded Food and Nutrition Education program in San Joaquin County. A year later, she was elevated to full time to also work on the Food Stamp Nutrition Education Program, which is now called CalFresh Healthy Living, UC. Both programs are federally funded initiatives administered by UC Cooperative Extension to help low-income families use their food budgets to put healthful meals on the table.
In 2001, Martin completed a master's degree in community nutrition and was named to the academic position she held in San Joaquin County the next 19 years.
“I designed my program to promote individual, community, system and environmental changes to positively impact the health behaviors of low-income youth and families,” Martin said. “Working with my colleagues across the state, we sought to understand and address obesity and chronic disease prevention, health disparities, food safety and food insecurity.”
Martin studied the health behaviors of low-income populations to develop curricula, delivery methods, evaluation tools and other materials that could be incorporated into the education programs. Over the years, Martin co-authored 26 peer-reviewed publications, 62 abstracts or posters, and 52 non-peer reviewed publications or reports.
Despite these many achievements, Martin said she most valued the interactions with current and past co-workers and colleagues in San Joaquin County and across the state, the people she describes as her “work family.”
“I think the experience has been so positive because we come together around projects and programs that make a difference in the health and welfare of the families we serve,” Martin said. “My years with Cooperative Extension have created strong bonds within UC Agriculture and Natural Resources and within my community that I foresee will last a lifetime.”