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Perceptions of the effect of an impending restaurant smoking ban on dining-out experience.

BACKGROUND: The introduction of bans on smoking in restaurants is frequently marred by claims that they will lead to a loss of business. METHODS: A representative sample of 3,019 South Australians age 15+ years were asked questions about dining-out frequency and perceived effects of the ban on their dining-out enjoyment and restaurant patronage. RESULTS: Sixty-one percent thought the ban would make dining out more enjoyable, 5% thought it would be less enjoyable, and 34% thought it would make no difference. Overall, 82% thought the ban would make no difference to their likelihood of dining out, 14% would be more likely to dine out, and 4% would be less likely. CONCLUSIONS: These data suggest that the public expects bans on smoking in restaurants to result in both increased enjoyment and increased patronage of restaurants.

Adolescent↗

Effect of a promotional campaign on heart-healthy menu choices in community restaurants.

The research question examined in this study was: Does a promotional campaign impact the sales of heart-healthy menu items at community restaurants? The 8-week promotional campaign used professionally developed advertisements in daily and monthly print publications and posters and table tents in local restaurants. Nine restaurants tracked the sales of selected heart-healthy menu items and comparable menu items sold before and after a promotional campaign. The percentage of heart-healthy items sold after the campaign showed a trend toward a slight increase in heart-healthy menu item selections, although it was not statistically significant. This study and others indicate that dietetics professionals must continue to develop strategies to promote heart-healthy food choices in community restaurants.

Cardiovascular Diseases↗

Increasing fruit and vegetable intake by changing environments, policy and pricing: restaurant-based research, strategies, and recommendations.

BACKGROUND: Restaurants are among the most important and promising venues for environmental, policy, and pricing initiatives to increase fruit and vegetable (F&V) intake. This article reviews restaurant-based environmental, policy and pricing strategies for increasing intake of fruits and vegetables and identifies promising strategies, research needs, and innovative opportunities for the future. METHODS: The strategies, examples, and research reported here were identified through an extensive search of published journal articles, government documents, the internet, and inquiries to leaders in the field. Recommendations were expanded based on discussion by participants in the CDC/ACS-sponsored Fruit and Vegetable, Environment Policy and Pricing Workshop held in September of 2002. RESULTS: Six separate types of restaurant-based interventions were identified: increased availability, increased access, reduced prices and coupons, catering policies, point-of-purchase (POP) information, and promotion and communication. Combination approaches have also been implemented. Evaluation data on these interventions show some significant impact on healthful diets, particularly with point-of-purchase information. However, most published reports emphasize low-fat eating, and there is a need to translate and evaluate interventions focused on increasing fruit and vegetable intake. CONCLUSIONS: Several models for changing environments, policy and pricing to increase fruit and vegetable availability, access, attractiveness and consumption in restaurants have been tested and found to have some promise. There is a need to evaluate fruit and vegetable-specific strategies; to obtain data from industry; to disseminate promising programs; and to enhance public-private partnerships and collaboration to expand on current knowledge.

Commerce↗

Restaurant-associated outbreak of Salmonella typhi in Nauru: an epidemiological and cost analysis.

Typhoid fever is endemic in the South Pacific. We investigated an outbreak in Nauru. Through interviews and medical records, we identified 50 persons with onset between 1 October 1998 and 10 May 1999, of fever lasting > or = 3 days and one other symptom. Salmonella Typhi was isolated from 19 (38%) cases. Thirty-two (64%) patients were school-aged children, and 17 (34%) were in four households. Case-control studies of (a) culture-confirmed cases and age- and neighbourhood-matched controls; and (b) household index cases and randomly selected age-matched controls implicated two restaurants: Restaurant M (matched OR [MOR] = 11, 95% confidence interval [CI] = 1.3-96) and Restaurant I (MOR = 5.8, 95% CI = 1.2-29). Food-handlers at both restaurants had elevated anti-Vi antibody titres indicative of carrier state. The annual incidence was 5.0/1000 persons. Outbreak-associated costs were $46,000. Routine or emergency immunization campaigns targeting school-aged children may help prevent or control outbreaks of typhoid fever in endemic disease areas.

Adolescent↗

Nicotine and 3-ethenylpyridine concentrations as markers for environmental tobacco smoke in restaurants.

The Finnish Tobacco Act has restricted smoking in public places since 1976, and in 1994 the Act was amended to include workplaces as well. In 2000, the Tobacco Act will be expanded further to restaurants. In Finland, the exposure of clients and employees to the vapor phase environmental tobacco smoke (ETS) in restaurants has not been systematically studied before by measuring ETS markers in indoor air. However, in these establishments the concentrations of ETS are expected to be much higher than in other workplaces. Gaseous nicotine and 3-ethenylpyridine were used as indicators of ETS in three different types of restaurants. Mean concentrations of nicotine ranged from 1.4-42.2 micrograms/m3 and 3-ethenylpyridine 1.4-6.3 micrograms/m3. In addition, concentrations of total volatile organic compounds (TVOC), CO and CO2 were measured and concentrations were 183-2215 micrograms/m3, 0.9-3.1 mg/m3 and 600-880 ppm, respectively. The concentrations of ETS markers were highest in discos and nightclubs and lowest in restaurants. The concentrations of total volatile organic compounds were highest in discos and nightclubs, especially when smoke generators were used.

Carcinogens↗

An international survey of indoor air quality, ventilation, and smoking activity in restaurants: a pilot study.

During a pilot study of indoor air quality in restaurants, a survey was performed in 34 medium-priced restaurants in six countries in Asia, Europe, and North America using a uniform protocol. The concentration of selected constituents of environmental tobacco smoke (ETS) present in occupied areas was determined during lunch and dinner periods by measuring the levels of four particulate-phase markers and two gas-phase markers. The particulate-phase markers determined were respirable suspended particles, ultraviolet particulate matter, fluorescing particulate matter, and solanesol particulate matter. The gas-phase markers were nicotine and 3-ethenylpyridine (3-EP). Correlation between the markers was investigated to explore an improved monitoring approach. It was concluded that at least one marker in each phase was necessary to describe adequately the ETS load. An assessment was made of the ventilation system in each restaurant, and effective ventilation rates were determined based on CO(2) measurements. Smoking activity was also monitored. These data were used to model nicotine and 3-EP concentrations that resulted in a satisfactory prediction of their levels, especially at the higher concentrations. A total number of 1370 questionnaires were returned by the restaurant patrons in five countries. In some countries, dissatisfaction rates above 20% were observed for draft, freshness of air, and noise. The dissatisfaction rates related to tobacco smoke were less than 20%, which is lower than would be predicted based on measured ETS levels. Based on the results of this international pilot study, recommendations are given for future studies of this type.

Air Pollution, Indoor↗

Factors influencing restaurant worker perception of floor slipperiness.

Falls are responsible for a substantial injury burden in the global workplace. Restaurant environments are particularly challenged by slips, trips, and falls. This study explored those factors that could influence workers' self-reports of slipperiness in U.S. fast-food restaurants. One hundred and twenty-six workers employed in 10 fast-food restaurants in the northeastern United States participated in the study representing a study-wide response rate of 87.5%. Participants' ratings of floor slipperiness and occupational slip history within the past 4 weeks were collected through written questionnaire. Additional factors collected by questionnaire included age, gender, shift length, and shoe type. Shoe condition (wear) and shoe contamination were visually assessed by the investigators. Floor friction was also measured. Lower restaurant mean coefficient of friction and the presence of contamination on workers' shoe soles were environmental factors significantly associated with workers reporting more slippery conditions. A recent workplace history of slipping with or without a subsequent fall was also significantly associated with workers reporting more slippery conditions. Workers over the age of 45 reported conditions to be significantly less slippery than younger workers. The results suggest that worker ratings of slipperiness are influenced not only by the actual level of friction but also by the other individual and environmental factors noted above. Recommendations for future studies would include a longitudinal design to better capture the temporal sequence between these variables. More field research is needed to better understand the association between workplace conditions, worker perception of slipperiness, and slipping at work.

Accidental Falls↗

A large outbreak of Brainerd diarrhea associated with a restaurant in the Red River Valley, Texas.

BACKGROUND: In June 1996, an outbreak of chronic diarrhea was reported to the Texas Department of Health (Austin). METHODS: We initiated active case finding, performed 2 case-control studies, and conducted an extensive laboratory and environmental investigation. RESULTS: We identified 114 persons with diarrhea that lasted > or = 4 weeks. Symptoms among 102 patients who were studied included urgency (87%), fatigue (86%), fecal incontinence (74%), and weight loss (73%); the median maximum 24-h stool frequency was 15 stools. Diarrhea persisted for > 6 months in 87% and for > 1 year in 70% of patients who were observed. Fifty-one (89%) of 57 ill persons had eaten at a particular restaurant within 4 weeks before onset, compared with 8 (14%) of 59 matched control subjects (matched odds ratio [OR], undefined; 95% confidence interval [CI], 11.2-infinity). At the restaurant, patients were more likely than their unaffected dining companions to have drunk tap water (OR, 2.8; 95% CI, 1.0-9.9) and to have eaten several specific food items, and they were less likely to have drunk iced tea made from boiled water and store-bought ice (OR, 0.3; 95% CI, 0.05-1.0). A multivariable model that included consumption of tap water and salad bar tomatoes best fit the data. The restaurant had multiple sanitary and plumbing deficiencies. Extensive laboratory and environmental testing for bacterial, parasitic, mycotic, and viral agents did not identify an etiologic agent. CONCLUSIONS: The clinical, laboratory, and epidemiologic findings are consistent with those of previous outbreaks of Brainerd diarrhea. To our knowledge, this is the largest reported outbreak of Brainerd diarrhea associated with a restaurant.

Case-Control Studies↗

Exposure to cooking fumes in restaurant kitchens in norway.

OBJECTIVES: The purpose of this study was to assess exposure to fat aerosols and aldehydes in kitchens and to study the variations in exposure between different types of kitchen. METHODS: Measurements were made in four hotel kitchens, two hamburger chain restaurants, 10 à la carte restaurants and three small local restaurants serving mostly fried food. The measurements were performed as personal measurements and each person carried two sampling devices connected to pumps. One pump was connected to a filter cassette with a 37 mm glassfibre filter and the other to a sampling device for aldehydes. The measurements were repeated on 3 days in each kitchen. Variables which could influence the level of exposure were recorded by the occupational hygienist. RESULTS: The level of fat aerosols varied between the different types of kitchen. The highest measured level of fat aerosol was 6.6 mg/m(3), in a small local restaurant. The arithmetic mean for all the kitchens was 0.62 mg/m(3). The highest level of the sum of the aldehydes was 186 micro g/m(3) (0.186 mg/m(3)), while the arithmetic mean was 69 micro g/m(3). CONCLUSIONS: The exposure to fat aerosols was modest, but could be up to 50% of the Norwegian threshold limit value (TLV) for nuisance dust (10 mg/m(3)). Fat aerosols from frying will, however, contain a mixture of heat- and water-treated fat from the meat which is being fried, hydrolysed vegetable fat and other degradation products, such as fatty acids, other organic acids and aldehydes. As a consequence of this, cooking fumes should be regarded as harmful to the lungs. The levels of formaldehyde, acetaldehyde and acrolein were well below the TLVs.

Aerosols↗

Genotoxicity and polynuclear aromatic hydrocarbon analysis of environmental tobacco smoke samples from restaurants.

Acetone-extracted samples of airborne particulate matter collected in three restaurants were analysed for their content of polynuclear aromatic hydrocarbons (PAH) and related polynuclear aromatic compounds (PAC) as well as for genotoxic activity using the Salmonella/microsome assay (strains TA98 and TA100) and sister chromatid exchange (SCE) induction in Chinese hamster ovary (CHO) cell cultures. The total particulate matter varied considerably in the restaurants, being 1.37 mg/m3 at the highest; in the same restaurant the highest amount of total PAHs (168 ng/m3) was also detected. Altogether, 13-22 individual PACs were identified in the samples, ranging from phenanthrene to benzothionaphthene. All of the six samples caused significant increases both in bacterial revertant and SCE frequencies. In the Salmonella assay, the mutagenic activity detected was primarily with metabolic activation. However, in the CHO cell cultures the induction of SCEs was also seen without an exogenous metabolic activation system. The cytotoxicity of the extracts limited the concentration range tested in the SCE assay. Only a partial correspondence of the total PAH content with the genotoxic activity of the samples was found. The genotoxicity of restaurant air exceeded by one to two orders of magnitude the previously reported activities detected by similar methods in urban outdoor and indoor air samples.

Animals↗

Restaurant-associated type A botulism: transmission by potato salad.

In the period November 13-18, 1978, seven cases of type A botulism occurred in persons who had eaten in a restaurant in Colorado. The outbreak was recognized when two persons who had independently eaten at the restaurant were hospitalized with an illness compatible with botulism. Surveillance efforts identified five additional cases. Potato salad made at the restaurant and available for service during an 11-day period was epidemiologically incriminated as the vehicle of botulinal toxin transmission (p less than 0.00001). Laboratory studies showed that Clostridium botulinum spores on the surface of potatoes could survive baking in the manner used by the restaurant and that botulinal toxin could be produced in potatoes contaminated with C. botulinum spores.

Botulism↗

Epidemic of restaurant-associated illness due to Salmonella newport.

In June and July 1982, a large outbreak of gastroenteritis associated with a barbecue restaurant involved 120 persons in central Arkansas. The illness was characterized by diarrhea, abdominal pain, and vomiting; 23 patients (19%) were hospitalized. Epidemiologic investigation showed that persons who became ill were more likely to have eaten ham or pork sandwiches at the restaurant before their illness than those who remained well. Stool cultures from 19 customers and each of the eight restaurant employees were positive for Salmonella newport. Cultures of a ham slice obtained from the restaurant and a partially consumed pork sandwich obtained from one ill person both grew Salmonella of same serotype.

Adult↗

Evaluation of a parent training programme for teaching mentally retarded children age-appropriate restaurant skills: a preliminary investigation.

A programme designed to train parents to teach their mentally retarded children age-appropriate restaurant skills was developed and evaluated. After participating in a brief training programme, three mothers attempted to facilitate greater independence in their developmentally delayed children during meals at a fast-food restaurant. The programme was evaluated by assessing the mothers' and children's performance in restaurants using a multiple-probe design. The results indicated that the parents' teaching interactions were influenced by the training programme and that their children's restaurant skills were enhanced. The results were discussed in the context of the normalization principle and deinstitutionalization movement.

Behavior Therapy↗

Worries in restaurant managers.

This paper explores the concept of job specific worries (JS worries) in managers in the restaurant industry. The focus of interest in the present explorative study was the degree and content of restaurant managers' worries. Of a total of 58 eligible managers in a Norwegian (fast food) restaurant chain, 57 (representing an equal number of restaurants) were surveyed for JS worries and personal worries. These managers also judged aspects of their relation to the organization they work for, such as perceived organizational hierarchy, job commitment and perceived risk at work. The results indicate that the concept of JS worry is state dependent as opposed to personal worry, which may be regarded as a trait. In addition, the observed correlations indicate a connection between characteristics of perceived job environment and the respondents' degree of JS worry, whereas no such correlations were observed between trait worry and job environment.

Adult↗

Smoking behaviours and attitudes among male restaurant workers in Boston's Chinatown: a pilot study.

OBJECTIVE: Asian American immigrants experience high rates of cigarette smoking. A community based survey was conducted to understand the smoking behaviours, knowledge, and attitudes of restaurant workers in Boston's Chinatown. DESIGN: Cross sectional survey in Chinese of a convenience sample of 54 restaurant workers recruited through extensive outreach activities. RESULTS: All 54 of the workers were male immigrants. 45 (83.3%) reported smoking cigarettes regularly, and the remaining nine were former smokers. 36 of the smokers (80.0%) started smoking before entering the USA. The workers were aware that cigarettes are addictive (98.1%), cause lung cancer (79.6%), and lead to heart disease (64.8%). However, a substantial number reported that smoking was relaxing (75.9%) and enhanced concentration (66.7%). Nearly half believed low tar and low nicotine cigarettes to be safer than standard brands. The vast majority of workers believed that smoking was not socially acceptable for women. Smokers reported they received information on quitting most commonly from friends (60%), newspapers (53.5%), and television (44.4%). The restaurant workers most often saw advertising against smoking in Chinese newspapers (63%). CONCLUSION: Despite high rates of smoking, Chinese American restaurant workers were generally aware of the health risks and were interested in quitting. Community based research can set the stage for targeted public health efforts to reduce smoking in immigrant communities.

Adult↗

Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) Four Country Survey.

OBJECTIVE: To explore determinants of support for and reported compliance with smoke-free policies in restaurants and bars across the four countries of the International Tobacco Control (ITC) Four Country Survey. DESIGN: Separate telephone cross-sectional surveys conducted between October and December 2002 with broadly representative samples of over 2000 adult (>or=18 years) cigarette smokers in each of the following four countries: the United States, Canada, the United Kingdom, and Australia. OUTCOME MEASURES: Support for smoke-free policies in restaurants and pubs/bars and reported compliance with existing policies. RESULTS: Reported total bans on indoor smoking in restaurants varied from 62% in Australia to 5% in the UK. Smoking bans in bars were less common, with California in the USA being the only major part of any country with documented bans. Support for bans in both restaurants and bars was related to the existence of bans, beliefs about passive smoking being harmful, lower average cigarette consumption, and older age. Self-reported compliance with a smoking ban was generally high and was associated with greater support for the ban. CONCLUSIONS: Among current cigarette smokers, support for smoking bans was associated with living in a place where the law prohibits smoking. Smokers adjust and both accept and comply with smoke-free laws. Associates of support and compliance are remarkably similar across countries given the notably different levels of smoke-free policies.

Adolescent↗

Teaching the handicapped to eat in public places: acquisition, generalization and maintenance of restaurant skills.

This study examined classroom-based instruction in restaurant skills for handicapped persons. Three male students were taught each of four skill components in sequential order: locating, ordering, paying, and eating and exiting. Training was implemented in a multiple baseline design across subjects and consisted of modeling and role playing in conjunction with photo slide sequences and a simulated ordering counter. The use of a menu containing general item classes and a finger matching procedure for identifying errors in the delivery of change greatly reduced the reading and math skills necessary to enter and complete the program. Periodic probes were conducted in a McDonald's restaurant prior to, during, and up to one-year following the termination of training. In addition, two probes (overt and covert observation) were conducted in a Burger King restaurant to assess further generalization to a location different from the one depicted throughout training. Results showed that students' performance on restaurant probes improved as a result of training, generalized to novel settings, maintained over an extended period of time, and was comparable to that of a normative sample of nonretarded persons.

Adolescent↗

Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants.

OBJECTIVES: Requiring restaurants to present nutrition information on menus is under consideration as a potential way to slow the increasing prevalence of obesity. Using a survey methodology, we examined how accurately consumers estimate the nutrient content of typical restaurant meals. Based on these results, we then conducted an experiment to address how the provision of nutrition information on menus influences purchase intentions and reported preferences. METHODS: For both the survey and experiment, data were analyzed using analysis of variance techniques. RESULTS: Survey results showed that levels of calories, fat, and saturated fat in less-healthful restaurant items were significantly underestimated by consumers. Actual fat and saturated fat levels were twice consumers' estimates and calories approached 2 times more than what consumers expected. In the subsequent experiment, for items for which levels of calories, fat, and saturated fat substantially exceeded consumers' expectations, the provision of nutrition information had a significant influence on product attitude, purchase intention, and choice. CONCLUSIONS: Most consumers are unaware of the high levels of calories, fat, saturated fat, and sodium found in many menu items. Provision of nutrition information on restaurant menus could potentially have a positive impact on public health by reducing the consumption of less-healthful foods.

Adult↗