Voluntary Kids’ Meal Beverage Standards: Are They Sufficient to Ensure Healthier Restaurant Practices and Consumer Choices?
- McDonald’s (2013): water, milk or juice in Happy Meals ;
- Subway (2014): low-fat or non-fat milk or water ;
- Wendy’s (2015): 1% white or chocolate milk, bottled water and 100% juice ;
- Burger King (2015): fat-free milk, 100% apple juice and low-fat chocolate milk ;
- Dairy Queen (2015): milk and bottled water ;
- McDonald’s (2017): began offering a low-calorie, 42% apple juice product (herein referred to as “diluted juice”) in addition to water and milk in Happy Meals .
2. Materials and Methods
- Only water and/or unflavored milk;
- Water and/or unflavored milk and other drinks;
- Drinks other than water and/or unflavored milk;
- Asks what drink you want (open-ended);
- Does not ask what drink you want, cashier chooses beverage automatically.
Conflicts of Interest
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|Characteristics of QSRs (N = 111)||QSRs with Standards b (n = 70)||QSRs with No Standards b (n = 41)|
|Number of menu boards observed at QSR (n%)|
|0 c||3 (4.29)||12 (29.27)|
|1 (drive-through or inside)||31 (44.29)||12 (29.27)|
|2 (drive-through and inside)||36 (51.43)||17 (41.46)|
|Number of orders placed at QSR (n%)|
|1 (drive-through or inside)||26 (37.14)||9 (21.95)|
|2 (drive-through and inside)||44 (62.86)||32 (78.05)|
|QSR type (n%)|
|Chain||70 (100.00)||30 (73.17)|
|Independent||0 (0.00)||11 (26.83)|
|Characteristics of Restaurants Where Customers were Surveyed (N = 33)|
|QSRs with Standards b (n = 26)||QSRs without Standards b (n = 7)|
|QSR type (n%)|
|Chain||26 (100.00)||6 (85.71)|
|Independent||0 (0.00)||1 (14.29)|
|Characteristics of Respondents to Customer Surveys (N = 84)|
|Respondents at QSRs with Standards b (n = 73)||Respondents at QSRs without Standards b (n = 11)|
|Accompanying Child Demographics|
|Age, years (Mean (SE))||5.77 (0.34)||7.82 (0.49)|
|Hispanic/Latino||43 (58.90)||9 (81.82)|
|White||9 (12.33)||2 (18.18)|
|Mixed/Multiethnic||11 (15.07)||0 (0.00)|
|Asian/Pacific Islander||6 (8.22)||0 (0.00)|
|African-American/Black||2 (2.74)||0 (0.00)|
|Native American/Alaska Native||1 (1.37)||0 (0.00)|
|Other, not specified||1 (1.37)||0 (0.00)|
|Male||38 (52.05)||6 (54.55)|
|Female||34 (46.58)||5 (45.45)|
|Other/Non-binary||1 (1.37)||0 (0.00)|
|Located in the same city or ZIP code that contains city of restaurant||52 (71.23)||4 (36.36)|
|Not located in the same city or ZIP code that contains city of restaurant||19 (26.03)||7 (63.64)|
|Missing||2 (2.74)||0 (0.00)|
|Survey Respondent Demographics d|
|Highest level of education (n%)|
|Elementary school or less||8 (10.96)||1 (9.09)|
|Less than high school||3 (4.11)||0 (0.00)|
|Completed high school/GED||18 (24.66)||3 (27.27)|
|Some college (community college/trade school)||23 (31.51)||3 (27.27)|
|College graduate||19 (26.03)||3 (27.27)|
|Post-graduate/professional degree||2 (2.74)||1 (9.09)|
|Parent, Primary Caregiver or Legal Guardian of Child (n%)||60 (82.19)||10 (90.91)|
|Beverages Shown (Listed or Pictured) on Menu Board (n = Number of Observations for A Given Beverage Category in QSRs with Standards, Number of Observations for A Given Beverage Category in QSRs without Standards)||Menu Boards of QSRs|
with Standards b that Displayed Beverages
|Menu Boards of QSRs without Standards b that Displayed Beverages||p-Value 1|
|Only unflavored milk or water|
(as allowed under California legislation) c
(n = 97, 46)
|Only milk (unflavored or flavored), water or unsweetened juice|
(as allowed under voluntary standards) d
(n = 86, 46)
|Any milk (n = 100, 44)||93||93.00||19||43.18||0.004|
|Unflavored milk (n = 100, 44)||92||92.00||19||43.18||0.005|
|Any flavored milk (n = 87, 42)||25||28.74||2||4.76||0.407|
|Any water (n = 95, 43)||57||60.00||14||32.56||0.036|
|Any unsweetened juice (n = 95, 43)||53||55.79||10||23.26||0.100|
|Any sugar-sweetened beverage (SSB) e|
(n = 86, 44)
|Generic “drink”/”kids’ drink”|
(n = 103, 46)
|Diet drinks (n = 86, 43)||1||1.16||8||18.60||0.144|
|Orders at QSRs|
with Standards a
|Orders at QSRs without Standards a||p-Value 1|
|Beverages Initially Offered by Cashier When Meal Order Placed (n = 113 orders at 70 QSRs with standards, 72 orders at 41 QSRs without standards)|
|Only unflavored milk and/or water||6||5.31||0||0.00||NA 2|
|Water and/or unflavored milk and other drinks||17||15.04||1||1.39||0.024|
|Beverages other than unflavored milk or water||19||16.81||4||5.56||0.090|
|Asked what drink (s) the customer wanted with kids’ meal||60||53.10||45||62.50||0.278|
|Cashier provided a beverage or fountain cup without offering any options (cashier-chosen beverage) b||11||9.73||22||30.56||NA 2|
|Beverages Offered by Cashier When Asked What are the options? or Are there any other options? (98 orders at 64 QSRs with standards, 51 orders at 37 QSRs without standards)|
|Sugar-sweetened beverages (SSBs) c||69||70.41||45||88.24||0.087|
|None d||5||5.10||0||0.00||NA 2|
|Customer Orders at QSRs with Standards c|
|Customer Orders at QSRs without Standards c|
(n = 11)
|n (%)||n (%)|
|How Order Was Placed|
|Inside, with cashier||59 (80.82)||10 (90.91)|
|Inside, at electronic kiosk||12 (16.44)||0 (0.00)|
|Using the restaurant app||1 (1.37)||0 (0.00)|
|Missing||1 (1.37)||1 (9.09)|
|Beverage Ordered d|
|Water||0 (0.00)||1 (9.09)|
|Unflavored milk||5 (6.85)||0 (0.00)|
|No beverage ordered||0 (0.00)||1 (9.09)|
|Juice (100% or diluted) e||27 (36.99)||0 (0.00)|
|Regular, non-diet soda||19 (26.03)||5 (45.45)|
|Other pre-sweetened drinks f||21 (28.77)||4 (36.36)|
|Diet drinks g||1 (1.37)||0 (0.00)|
|Unflavored milk, water or juice h||32 (43.83)||2 (18.18)|
|Unflavored milk or water i||5 (6.85)||2 (18.18)|
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Harpainter, P.; Hewawitharana, S.C.; Lee, D.L.; Martin, A.C.; Gosliner, W.; Ritchie, L.D.; Woodward-Lopez, G. Voluntary Kids’ Meal Beverage Standards: Are They Sufficient to Ensure Healthier Restaurant Practices and Consumer Choices? Int. J. Environ. Res. Public Health 2020, 17, 5275. https://doi.org/10.3390/ijerph17155275
Harpainter P, Hewawitharana SC, Lee DL, Martin AC, Gosliner W, Ritchie LD, Woodward-Lopez G. Voluntary Kids’ Meal Beverage Standards: Are They Sufficient to Ensure Healthier Restaurant Practices and Consumer Choices? International Journal of Environmental Research and Public Health. 2020; 17(15):5275. https://doi.org/10.3390/ijerph17155275Chicago/Turabian Style
Harpainter, Phoebe, Sridharshi C. Hewawitharana, Danielle L. Lee, Anna C. Martin, Wendi Gosliner, Lorrene D. Ritchie, and Gail Woodward-Lopez. 2020. "Voluntary Kids’ Meal Beverage Standards: Are They Sufficient to Ensure Healthier Restaurant Practices and Consumer Choices?" International Journal of Environmental Research and Public Health 17, no. 15: 5275. https://doi.org/10.3390/ijerph17155275