Marketing to Children Inside Quick Service Restaurants: Differences by Community Demographics

• Published in: American journal of preventive medicine 2021-07, Vol.61 (1), p.96-104
• Main Authors: Cohen, Juliana F.W., Cooksey Stowers, Kristen, Rohmann, Marlaina, Lapierre, Nicole, Rimm, Eric B., Cash, Sean B., Davison, Kirsten K., McInnis, Kyle, Economos, Christina D.
• Format: Article
• Language: English
• Subjects: Advertisements; Chain stores; Children; Community; Ethnicity; Evaluation; Healthy food; Market strategy; Marketing; Minority & ethnic groups; Pediatrics; Preventive medicine; Race; Racial differences; Reliability; Restaurants; Sugar
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2021.01.035

In the U.S., children regularly consume foods from quick-service restaurants, but little is known about the marketing strategies currently used inside quick-service restaurants. This study aims to validate a child-focused Environmental Assessment Tool for quick-service restaurants, evaluate marketing strategies inside and on the exterior of quick-service restaurants, and examine differences by community race/ethnicity or income. The inter-rater and test–retest reliability of the Environmental Assessment Tool were assessed across the top 5 national quick-service restaurant chains. Marketing techniques in 165 quick-service restaurants (33 per national chain) in socioeconomically and racially/ethnically diverse communities throughout New England were examined in 2018–2019. Mixed methods ANOVA examined the differences in marketing techniques in 2020. The inter-rater and test–retest reliability of the Environmental Assessment Tool were high (Cohen's κ>0.80). Approximately 95% of quick-service restaurants marketed less healthy foods, whereas only 6.5% marketed healthy options. When examining the differences by community demographics, there were significantly more price promotion advertisements inside and on the exterior of quick-service restaurants in lower-income communities. In addition, there was a greater number of child-directed advertisements with cartoon or TV/movie characters as well as fewer healthy entrée options and more sugar-sweetened beverage and dessert options on the children's menu inside quick-service restaurants in communities with higher minority populations. Environmental Assessment Tool is a valid tool to evaluate marketing inside quick-service restaurants. Results suggest that there is a substantial amount of unhealthy food and beverage marketing inside quick-service restaurants, with differences in the number and types of techniques used in lower-income and minority communities. Policies that limit quick-service restaurant marketing to children should be considered.