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PubMed1999

Overeating in America: association between restaurant food consumption and body fatness in healthy adult men and women ages 19 to 80.

PURPOSE: To examine the association between the frequency of consuming restaurant food and body fatness in adults. RESEARCH METHODS AND PROCEDURES: Usual free-living dietary intake and the frequency of consuming food from seven different restaurant types (fried chicken, burger, pizza, Chinese, Mexican, fried fish, and "other") were assessed by food frequency questionnaire in 73 healthy men and women [ages 19 to 80, body mass index (BMI) 18 to 33]. In addition, body fatness (percent weight) was determined by hydrostatic weighing, and physical activity and other lifestyle parameters were assessed by questionnaire. The relationship between the frequency of consuming restaurant food and body fatness was determined after controlling for age, sex, and other confounders by using multiple regression techniques. RESULTS: Restaurant food consumption averaged 7.5+/-8.5 (Standard Deviation) times/month. After controlling for age and sex, the frequency of consuming restaurant food was positively associated with body fatness (partial r = 0.36, p = 0.003). The strength of this association did not change after controlling for education level, smoking status, and alcohol intake, but after additionally controlling for physical activity, the partial r increased to 0.42 (p = 0.004). Total daily intakes of energy, fat, and fiber were significantly associated with restaurant food consumption frequency (r = 0.59, 0.28, and -0.45, respectively, p = 0.02 to 0.0001). DISCUSSION: The frequency of consuming restaurant food was positively associated with increased body fatness in adults. The increasing proportion of household food income spent on food prepared away from home in the United States may therefore help explain the rising national prevalence of obesity.

Adipose Tissue↗
PubMed1997

Lower-fat menu items in restaurants satisfy customers.

OBJECTIVE: To evaluate a restaurant-based nutrition program by measuring customer satisfaction with lower-fat menu items and assessing patrons' reactions to the program. DESIGN AND SETTING: Questionnaires to assess satisfaction with menu items were administered to patrons in eight of the nine restaurants that volunteered to participate in the nutrition program. One patron from each participating restaurant was randomly selected for a semistructured interview about nutrition programming in restaurants. SUBJECTS: Persons dining in eight participating restaurants over a 1-week period (n = 686). STATISTICAL ANALYSES PERFORMED: Independent samples t tests were used to compare respondents' satisfaction with lower-fat and regular menu items. Two-way analysis of variance tests were completed using overall satisfaction as the dependent variable and menu-item classification (ie, lower fat or regular) and one of eight other menu item and respondent characteristics as independent variables. Qualitative methods were used to analyze interview transcripts. RESULTS: Of 1,127 menu items rated for satisfaction, 205 were lower fat, 878 were regular, and 44 were of unknown classification. Customers were significantly more satisfied with lower-fat than with regular menu items (P < .001). Overall satisfaction did not vary by any of the other independent variables. Interview results indicate the importance of restaurant during as an indulgent experience. CONCLUSIONS: High satisfaction with lower-fat menu items suggests that customers will support restaurant providing such choices. Dietitians can use these findings to encourage restaurateurs to include lower-fat choices on their menus, and to assure clients that their expectations of being indulged are not incompatible with these choices.

Adult↗
PubMed1993

Salmonella enteritidis outbreak in a restaurant chain: the continuing challenges of prevention.

In 1990, a Salmonella enteritidis (SE) outbreak occurred in a restaurant chain in Pennsylvania. To determine its cause(s), we conducted a case-control study and a cohort study at one restaurant, and a survey of restaurants. Egg dishes were associated with illness (P = 0.03). Guests from one hotel eating at the restaurant had a diarrhoeal attack rate of 14%, 4.7-fold higher than among those not eating there (P = 0.04). There were no differences in egg handling between affected and unaffected restaurants. Eggs supplied to affected restaurants were medium grade AA eggs from a single farm, and were reportedly refrigerated during distribution. Human and hen SE isolates were phage type 8 and had similar plasmid profiles and antibiograms. We estimate the prevalence of infected eggs during the outbreak to be as high as 1 in 12. Typical restaurant egg-handling practices and refrigeration during distribution appear to be insufficient by themselves to prevent similar outbreaks.

Adolescent↗
PubMed2000

Fast food restaurant use among women in the Pound of Prevention study: dietary, behavioral and demographic correlates.

OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 891 adult women. DESIGN: A survey was administered at baseline and 3 y later as part of a randomized, prospective intervention trial on weight gain prevention. SUBJECTS: Women (n = 891) aged 20-45 y who enrolled in the Pound of Prevention study. MEASUREMENTS: Frequency of fast food restaurant use, dietary intake, demographic and behavioral measures were self-reported. Dietary intake was measured using the 60-item Block Food Frequency Questionnaire. Body weight and height were directly measured. RESULTS: Twenty-one percent of the sample reported eating > or = 3 fast food meals per week. Frequency of fast food restaurant use was associated with higher total energy intake, higher percentage fat energy, more frequent consumption of hamburgers, French fries and soft drinks, and less frequent consumption of fiber and fruit. Frequency of fast food restaurant use was higher among younger women, those with lower income, non-White ethnicity, greater body weight, lower dietary restraint, fewer low-fat eating behaviors, and greater television viewing. Over 3 y, increases in frequency of fast food restaurant use were associated with increases in body weight, total energy intake, percentage fat intake, intake of hamburgers, French fries and soft drinks, and with decreases in physical activity, dietary restraint and low-fat eating behaviors. Intake of several other foods, including fruits and vegetables, did not differ by frequency of fast food restaurant use. CONCLUSION: Frequency of fast food restaurant use is associated with higher energy and fat intake and greater body weight, and could be an important risk factor for excess weight gain in the population.

Adult↗
PubMed2002

Health promotion practices of restaurants and cafés in Australia: changes from 1997 to 2000 using an annual telemarketing intervention.

This study looked at whether rates of health promotion practices among restaurants and cafés in the Hunter Region of New South Wales (NSW), Australia, increased between 1997 and 2000. During the project period all restaurants and cafés in the region were offered an annual direct marketing telephone interview (1997, 1998 and 1999), during which resources were offered to assist in the adoption of health promotion practices. Owners or managers of restaurants and cafés completed phone interviews that assessed 18 health promotion practices relating to: environmental tobacco smoke (two practices); responsible service of alcohol (five practices); healthy food choices (one practice); food safety (four practices); occupational health and safety (three practices); and the prevention of infectious diseases (three practices). Changes in practices were examined by comparing data from cross-sectional samples in 1997 (before any offers of resources) and 2000 (after up to three annual telemarketing calls), and among a cohort interviewed in both 1997 and 2000. Ninety-one per cent of restaurants and cafés (321) participated in the 1997 survey and 239 (81%) participated in the 2000 survey. A cohort of 122 restaurants and cafés participated in both surveys. Significant increases were present for 14 of the 18 health promotion initiatives in the cross-sectional sample and for 10 of the 18 health promotion initiatives in the cohort. For both cross-sectional and cohort samples, a change in at least one practice in each area was evident, with the exception of nutrition. The proportion of restaurants and cafés in the project region that undertake health promotion initiatives is increasing. A telephone-based intervention may contribute to such an increase. The suggestion that the prevalence of health promotion initiatives in restaurants and cafés can be increased highlights the potential for health promotion to be more actively involved in this setting.

Alcohol Drinking↗
PubMedDate not supplied

Diffusion of local restaurant smoking regulations in Massachusetts: identifying disparities in health protection for population subgroups.

OBJECTIVES: The objectives of this study were to examine the diffusion of smoke-free restaurant regulations and identify socioeconomic and racial/ethnic disparities in health protection from secondhand smoke exposure in restaurants. METHODS: We examined the relationship between adoption of local smoking regulations by restaurants for each of the 351 cities and towns in Massachusetts and a number of individual variables over nine time points, starting when there were no 100% smoke-free restaurant regulations and ending with the eventual imposition of the statewide ban on smoking in restaurants and bars. RESULTS: We found that over the 10 years before the statewide ban went into effect, only 36 percent of the total population was covered by local regulations that protected them from secondhand smoke exposure in restaurants. We also observed a substantial disparity in protection based on educational status, with up to 7 percentage points fewer nongraduates protected by local smoke-free restaurant regulations.

Diffusion of Innovation↗
PubMed2001

Actual and perceived impacts of tobacco regulation on restaurants and firms.

OBJECTIVE: To examine the actual and anticipated costs of a law regulating workplace smoking and smoking in restaurants, taking into consideration observed and anticipated infrastructure costs, lost productivity, increased absenteeism, and loss of clientele. SETTING AND DESIGN: A survey of 401 Québec restaurants and 600 Québec firms conducted by the Québec Ministry of Health before the enactment of the law was used to derive costs incurred by those who had already complied and anticipated by those that did not. RESULTS: Direct and indirect costs associated with tobacco regulation at work and in restaurants were minimal. Annualised infrastructure costs amounted to less than 0.0002% of firm revenues and 0.15% of restaurant revenues. Anticipated costs were larger and amounted to 0.0004% of firm revenues and 0.41% of restaurant revenues. Impacts on productivity, absenteeism, and restaurant patronage were widely anticipated but not observed in currently compliant establishments. CONCLUSION: Firms and restaurants expected high costs to result from strict tobacco regulation because of infrastructure costs, decreased productivity, and decreased patronage. That none of these were actually observed suggests that policy makers should discount industry claims that smoking regulations impose undue economic hardship.

Canada↗
PubMed2006

Marketing fast food: impact of fast food restaurants in children's hospitals.

OBJECTIVES: The objectives of this study were (1) to determine fast food restaurant prevalence in hospitals with pediatric residencies and (2) to evaluate how hospital environment affects purchase and perception of fast food. METHODS: We first surveyed pediatric residency programs regarding fast food restaurants in their hospitals to determine the prevalence of fast food restaurants in these hospitals. We then surveyed adults with children after pediatric outpatient visits at 3 hospitals: hospital M with an on-site McDonald's restaurant, hospital R without McDonald's on site but with McDonald's branding, and hospital X with neither on-site McDonald's nor branding. We sought to determine attitudes toward, consumption of, and influences on purchase of fast food and McDonald's food. RESULTS: Fifty-nine of 200 hospitals with pediatric residencies had fast food restaurants. A total of 386 outpatient surveys were analyzed. Fast food consumption on the survey day was most common among hospital M respondents (56%; hospital R: 29%; hospital X: 33%), as was the purchase of McDonald's food (hospital M: 53%; hospital R: 14%; hospital X: 22%). McDonald's accounted for 95% of fast food consumed by hospital M respondents, and 83% of them bought their food at the on-site McDonald's. Using logistic regression analysis, hospital M respondents were 4 times more likely than respondents at the other hospitals to have purchased McDonald's food on the survey day. Visitors to hospitals M and R were more likely than those at hospital X to believe that McDonald's supported the hospital financially. Respondents at hospital M rated McDonald's food healthier than did respondents at the other hospitals. CONCLUSIONS: Fast food restaurants are fairly common in hospitals that sponsor pediatric residency programs. A McDonald's restaurant in a children's hospital was associated with significantly increased purchase of McDonald's food by outpatients, belief that the McDonald's Corporation supported the hospital financially, and higher rating of the healthiness of McDonald's food.

Food-Processing Industry↗
PubMed1993

Smoking control in restaurants: the effectiveness of self-regulation in Australia.

OBJECTIVES: The provision of smoke-free areas in restaurants has been a controversial issue; the restaurant industry largely opts for a self-regulation approach. This study aimed to examine the effectiveness of self-regulation as a strategy in meeting the industry's and customers' perceived needs. METHODS: Restaurateur and customer perspectives on the provision of smoke-free areas in restaurants were examined by survey among 365 restaurateurs and 1327 customers in New South Wales, Australia. RESULTS: Less than 2% of restaurants were totally smoke-free; 22% provided some smoke-free areas. Customers were much more likely than owners to think that smoke-free areas should be provided. Owners appeared to be unaware of customers' views about smoke-free areas in restaurants. CONCLUSIONS: Little evidence was found to support the effectiveness of the self-regulation policy adopted by the restaurant industry. Characteristics of restaurants and owners associated with the provision of smoke-free areas are presented and implications of the findings are discussed.

Attitude↗
PubMed2004

Restaurant inspection scores and foodborne disease.

Restaurants in the United States are regularly inspected by health departments, but few data exist regarding the effect of restaurant inspections on food safety. We examined statewide inspection records from January 1993 through April 2000. Data were available from 167,574 restaurant inspections. From 1993 to 2000, mean scores rose steadily from 80.2 to 83.8. Mean inspection scores of individual inspectors were 69-92. None of the 12 most commonly cited violations were critical food safety hazards. Establishments scoring <60 had a mean improvement of 16 points on subsequent inspections. Mean scores of restaurants experiencing foodborne disease outbreaks did not differ from restaurants with no reported outbreaks. A variety of factors influence the uniformity of restaurant inspections. The restaurant inspection system should be examined to identify ways to ensure food safety.

Food Handling↗
PubMed2003

Outbreak of Salmonella Potsdam associated with salad dressing at a restaurant.

Between 27 January and 7 February 2002, 12 cases of Salmonella Potsdam infection were notified to NSW Health of which nine were residents of the Hunter Health Area. Interviews with two cases notified by two local doctors initiated the investigation and revealed exposure to foods from the same restaurant (restaurant A). All New South Wales S. Potsdam cases, those accompanying cases to restaurant A and people from restaurant A booking lists were interviewed. Of the 34 people interviewed, 17 met the case definition. The epidemiological investigation did not detect a food source of S. Potsdam infection, however, shell egg-based Caesar salad dressing and mayonnaise, and a swab of a cap from a mayonnaise bottle collected at restaurant A tested positive for S. Potsdam. Environmental and laying hen feed samples from the egg supplier to restaurant A and meat meal, (the major component of laying hen feed) tested positive for various Salmonella serotypes. The investigation identified problems of inadequate cleaning, time-temperature abuse, and ignorance of the hazardous nature of raw shell eggs at the restaurant level, poor sanitation and a lack of hygiene inspections at the egg production level, and problems with cleaning, storage and lack of bacterial monitoring of final product at the animal rendering plant. Investigation of 12 notified cases of Salmonella resulted in public health interventions, which likely prevented further cases of foodborne disease due to Salmonella and other pathogens in the Hunter Health Area and elsewhere in New South Wales.

Disease Outbreaks↗
PubMedDate not supplied

The relationship between obesity and the prevalence of fast food restaurants: state-level analysis.

PURPOSE: Obesity accounts for approximately 300,000 deaths a year in the United States, and prevalence rates have been increasing over the past decade. The nutrition environment may be contributing to this epidemic. This study examined the relationship between fast food restaurants and obesity on a state-wide basis. DESIGN: A one-time cross-sectional analysis of secondary data was used for this study. SETTING: The setting for this study was the United States. SUBJECTS: State-level data were used as the unit of analysis. Alaska was excluded as an outlier, and the District of Columbia was added (N = 50). MEASURES: Measures included aggregate state-level means for square miles per fast food restaurant, population per fast food restaurant, population density, ethnicity, age, gender, physical inactivity, fruit and vegetable intake, and obesity rates. Data were obtained from the 2002 Behavioral Risk Factor and Surveillance Survey, the 2000 U.S. Census, and the 2002 U.S. Yellow Pages. RESULTS: Multiple hierarchal regressions revealed that square miles per fast food restaurants and residents per restaurant accounted for 6% of the variance in state obesity rates after controlling for population density, ethnicity, age, gender, physical inactivity, and fruit and vegetable intake. The entire model explained 70% of the total variance in state obesity rates. CONCLUSIONS: These results indicate a correlational relationship between both the number of residents per fast food restaurant and the square miles per fast food restaurants with state-level obesity prevalence. Limitations include the use of correlational aggregate data.

Adolescent↗
PubMed1993

Restaurant wheelchair accessibility.

This study was designed to determine the compliance of restaurants to the wheelchair accessibility standards set forth in the Uniform Federal Accessibility Standards. The standards that were operationalized in this study are also found in Title III of the Americans With Disabilities Act of 1990. The data were collected at 120 sites in three midwestern states. For one who uses a wheelchair, parking the car is often an obstacle to eating out. Only 53% of the restaurants surveyed provide handicapped parking. Entering the building may also be a problem. Of the restaurants that required a ramp, only 66% provided them. Inside the restaurant, the key problems were accessible rest-rooms and the height of tables. The study provided comparisons between restaurants in rural and urban settings, as well as comparisons between conventional restaurants and fast food restaurants. No notable differences emerged for these comparisons.

Architectural Accessibility↗
PubMed1995

Assessment of the impact of a 100% smoke-free ordinance on restaurant sales--West Lake Hills, Texas, 1992-1994.

Exposure to environmental tobacco smoke (ETS), which is associated with adverse health effects among nonsmokers (1), is a health hazard of particular concern for patrons and employees in restaurants (2). To protect nonsmokers, many local governments have enacted ordinances requiring restaurants to be smoke-free. However, the potential economic impact of these laws on restaurants is an important concern for restaurant owners. On June 1, 1993, the city of West Lake Hills (a suburb of Austin), Texas (1995 population: 3000), implemented an ordinance requiring a 100% smoke-free environment in all commercial establishments to which the public has access, including all restaurants and restaurants with bar areas. This report summarizes an assessment of sales in restaurants during June 1993-December 1994 compared with January 1992-May 1993.

Commerce↗
PubMedDate not supplied

Where's the beef? The role of cross-contamination in 4 chain restaurant-associated outbreaks of Escherichia coli O157:H7 in the Pacific Northwest.

BACKGROUND: From March through August 1993, outbreaks of Escherichia coli O157:H7 occurred at 4 separate Oregon and Washington steak and salad bar restaurants affiliated with a single national chain. OBJECTIVE: To determine the cause of outbreaks of E coli O157:H7 at 4 chain restaurants. METHODS: Independent case-control studies were performed for each outbreak. Available E coli O157:H7 isolates were subtyped by pulse-field gel electrophoresis and by phage typing. RESULTS: Infection was not associated with beef consumption at any of the restaurants. Implicated foods varied by restaurant but all were items served at the salad bar. Among the salad bar items, no single item was implicated in all outbreaks, and no single item seemed to explain most of the cases at any individual restaurant. Molecular subtyping of bacterial isolates indicated that the first 2 outbreaks, which occurred concurrently, were caused by the same strain, the third outbreak was caused by a unique strain, and the fourth was multiclonal. CONCLUSIONS: Independent events of cross-contamination from beef within the restaurant kitchens, where meats and multiple salad bar items were prepared, were the likely cause of these outbreaks. Meat can be a source of E coli O157:H7 infection even if it is later cooked properly, underscoring the need for meticulous food handling at all stages of preparation.

Adolescent↗
PubMed2004

Neighborhood playgrounds, fast food restaurants, and crime: relationships to overweight in low-income preschool children.

BACKGROUND: We examined the relationship between overweight in preschool children and three environmental factors--the proximity of the children's residences to playgrounds and to fast food restaurants and the safety of the children's neighborhoods. We hypothesized that children who lived farther from playgrounds, closer to fast food restaurants, and in unsafe neighborhoods were more likely to be overweight. METHODS: This was a cross-sectional study of 7,020 low-income children, 36 through 59 months of age living in Cincinnati, OH. Overweight was defined as a measured body mass index > or =95th percentile. The distance between each child's residence and the nearest public playground and fast food restaurant was determined with geographic information systems. Neighborhood safety was defined by the number of police-reported crimes per 1,000 residents per year in each of 46 city neighborhoods. RESULTS: Overall, 9.2% of the children were overweight, 76% black, and 23% white. The mean (+/- SD) distances from a child's home to the nearest playground and fast food restaurant were 0.31 (+/- 0.22) and 0.70 (+/- 0.38) miles, respectively. There was no association between child overweight and proximity to playgrounds, proximity to fast food restaurants, or level of neighborhood crime. The association between child overweight and playground proximity did not differ by neighborhood crime level. CONCLUSIONS: Within a population of urban low-income preschoolers, overweight was not associated with proximity to playgrounds and fast food restaurants or with the level of neighborhood crime.

Child, Preschool↗
PubMed2001

The economics of vaccinating restaurant workers against hepatitis A.

The economics of vaccinating restaurant workers against hepatitis A were studied using Monte Carlo simulation models, one with a restaurant-owner perspective, and one with a societal perspective. The restaurant model allowed for a different size, number of employees and employee turnover rate. Benefits were the avoidance of loss of business (including the possibility of bankruptcy) after publicity linking the restaurant to an outbreak associated with a case of hepatitis A in a food handler. Additional benefits in the societal model included reductions in costs of food handler-associated cases of hepatitis A. The outcome used was Net Present Value (NPV), allowing comparison between models. Regardless of the cost of vaccination ($50-140/employee), for a restauranteur to ensure that all employees were vaccinated at all times substantial costs were involved (i.e. negative NPV). Even a 75% probability of bankruptcy still resulted in negative NPVs at the 95th percentiles. For society, vaccination was only cost-saving (i.e. positive NPV) if done only during epidemics and if it cost < $20/employee. Vaccinating restaurant employees is unlikely to be economical from either the restaurant owner or the societal perspective, even during hepatitis A epidemics.

Costs and Cost Analysis↗
PubMed2000

The influence of recipe modification and nutritional information on restaurant food acceptance and macronutrient intakes.

OBJECTIVE: To examine the influences of nutritional information and consumer characteristics on meal quality expectations, food selection and subsequent macronutrient intakes of consumers offered a reduced-fat option in a restaurant. DESIGN: A target, full-fat (FF) main restaurant meal option was developed in a version substantially reduced in fat and energy (RF). Restaurant patrons were randomly placed into one of four treatment groups varying in provision of menu information about the target dish, and the actual version of that dish served (if ordered). A full-fat blind (FFB) control group was given no nutritional information in the menu and was served the FF version. The other three groups were all served the modified RF version: (i) reduced-fat blind (RFB), who were given no nutritional information; (ii) reduced-fat informed (RFI), who were given nutritional information; and (iii) reduced-fat informed with details (RFID), who were given the same nutritional information plus recipe modification details. Subjects rated their expected and actual liking, the pleasantness of taste, texture and appearance of the dish, how well the dish matched their expectations, and the likelihood of purchase again. Additional measures included the other dish selections, sociodemographic and attitudinal information. SETTING: A silver service (training) restaurant. SUBJECTS: Members of the public (n = 279) consuming meals in the restaurant. RESULTS: The presence of nutritional information on the menu did not significantly increase subsequent intakes of energy and fat from the rest of the meal, and did not significantly influence sensory expectations or post-meal acceptance measures (which also did not differ between the FF and RF versions). Consumer characteristics relating to fat reduction attitudes and behaviours were significantly related to the selection of different dishes. CONCLUSIONS: Provision of RF alternatives in a restaurant can have significant positive dietary benefits. Menu nutritional information did not affect measures of meal acceptance. Further studies should identify which types of information formats might be most effective in enhancing the selection of 'healthy' options.

Cooking↗