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A comparative analysis of the restaurant consumer food environment in Rochester (NY, USA) and London (ON, Canada): assessing children’s menus by neighbourhood socio-economic characteristics

  • Catherine M DuBreck (a1), Richard C Sadler (a2), Godwin Arku (a1), Jamie Seabrook (a3) (a4) and Jason Gilliland (a1) (a3) (a5)...

To assess restaurant children’s menus for content and nutritional quality; and to investigate the relationship between the restaurant consumer food environment for children and neighbourhood-level socio-economic characteristics within and between one Canadian city and one US city.


Cross-sectional observational study.


London, ON, Canada and Rochester, NY, USA.


Restaurant children’s menus were assessed, scored and compared using the Children’s Menu Assessment tool. We quantified neighbourhood accessibility to restaurants by calculating 800 m road-network buffers around the centroid of each city census block and created a new Neighbourhood Restaurant Quality Index for Children (NRQI-C) comprising the sum of restaurant menu scores divided by the total number of restaurants within each area. After weighting by population, we examined associations between NRQI-C and neighbourhood socio-economic characteristics using correlations and multiple regression analyses.


Nutritional quality of children’s menus was greater, on average, in Rochester compared with London. Only one variable remained significant in the regression analyses for both cities: proportion of visible minorities had a positive effect on neighbourhood NRQI-C scores in London, whereas the reverse was true in Rochester.


Results suggest the presence of a socio-economic disparity within Rochester, where children in more disadvantaged areas have poorer access to better nutritional quality restaurant choices. In London, results suggest an inverse relationship across the city where children in more disadvantaged areas have better access to better nutritional quality restaurant choices. Given these disparate results, research on restaurant nutritional quality for children requires additional consideration.

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      A comparative analysis of the restaurant consumer food environment in Rochester (NY, USA) and London (ON, Canada): assessing children’s menus by neighbourhood socio-economic characteristics
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1. Santoro, N & Caprio, S (2016) Insulin resistance and type 2 diabetes in pediatric populations. In Childhood Obesity: Causes, Consequences, and Intervention Approaches, 1st ed., pp. 273280 [MI Goran, editor]. Boca Raton, FL: CRC Press.
2. McCrindle, BW (2015) Cardiovascular consequences of childhood obesity. Can J Cardiol 31, 124130.
3. Vikraman, S, Fryar, CD & Ogden, CL (2015) Caloric intake from fast food among children and adolescents in the United States, 2011–2012. National Center for Health Statistics Data Brief no. 213. (accessed May 2017).
4. Glanz, K, Sallis, JF, Saelens, BE et al. (2005) Healthy nutrition environments: concepts and measures. Am J Health Promot 19, 330333.
5. Story, M, Kaphingst, KM, Robinson-O’Brien, R et al. (2008) Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health 29, 253272.
6. Gilliland, JA, Rangel, CY, Healy, MA et al. (2012) Linking childhood obesity to the built environment: a multi-level analysis of home and school neighbourhood factors associated with body mass index. Can J Public Health 103, 1521.
7. Cummins, S & Macintyre, S (2006) Food environments and obesity – neighbourhood or nation? Int J Epidemiol 35, 100104.
8. Heart & Stroke (2017) The kids are not alright. How the food and beverage industry is marketing our children and youth to death. 2017 Report on the Health of Canadians. (accessed May 2017).
9. Tomalty, R & Mallach, A (2016 ) America’s Urban Future: Lessons from North of the Border . Washington, DC: Island Press.
10. Reese, LA (2014) Local Economic Development Policy: The United States and Canada. Abingdon: Routledge.
11. DuBreck, CM, Sadler, RC, Arku, G et al. (2018) Examining community and consumer food environments for children: an urban–suburban–rural comparison in Southwestern Ontario. Soc Sci Med 209, 3342.
12. Engler-Stringer, R, Le, H, Gerrard, A et al. (2014) The community and consumer food environment and children’s diet: a systematic review. BMC Public Health 14, 522.
13. Larson, NI, Story, MT & Nelson, MC (2009) Neighborhood environments: disparities in access to healthy foods in the US. Am J Prev Med 36, 7481.
14. Black, C, Moon, G & Baird, J (2014) Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment? Health Place 27, 229242.
15. Walker, RE, Keane, CR & Burke, JG (2010) Disparities and access to healthy food in the United States: a review of food deserts literature. Health Place 16, 876884.
16. Heath Canada (2013) Measuring the food environment in Canada. (accessed May 2017).
17. Saelens, BE, Glanz, K, Sallis, JF et al. (2007) Nutrition environment measures study in restaurants (NEMS-R): development and evaluation. Am J Prev Med 32, 273281.
18. Hobin, E, Lebenbaum, M, Rosella, L et al. (2015) Availability, location, and format of nutrition information in fast-food chain restaurants in Ontario, Canada. Can J Diet Pract Res 76, 4448.
19. Wang, J, Engler-Stringer, R & Muhajarine, N (2016) Assessing the consumer food environment in restaurants by neighbourhood distress level across Saskatoon, Saskatchewan. Can J Diet Pract Res 77, 916.
20. Partington, SN, Menzies, TJ, Colburn, TA et al. (2015) Reduced-item food audits based on the nutrition environment measures surveys. Am J Prev Med 49, 2333.
21. Pereira, RF, Sidebottom, AC, Boucher, JL et al. (2014) Assessing the food environment of a rural community: baseline findings from the Heart of New Ulm Project, Minnesota, 2010–2011. Prev Chronic Dis 11, E36.
22. Saelens, B, Chan, N, Krieger, J et al. (2012) Nutrition-labeling regulation impacts on restaurant environments. Am J Prev Med 43, 505511.
23. Krukowski, RA, Eddings, K & Smith West, D (2011) The Children’s Menu Assessment: development, evaluation, and relevance of a tool for evaluating children’s menus. J Am Diet Assoc 111, 884888.
24. Statistics Canada (2016) Census of Canada. Ottawa, ON: Statistics Canada.
25. Bureau of the Census (2015 ) United States Census . Suitland, MD: US Census Bureau.
26. He, M, Tucker, P, Irwin, JD et al. (2012) Obesogenic neighbourhoods: the impact of neighbourhood restaurants and convenience stores on adolescents’ food consumption behaviours. Public Health Nutr 15, 23312339.
27. He, M, Tucker, P, Gilliland, J et al. (2012) The influence of local food environments on adolescents’ food purchasing behaviors. Int J Environ Res Public Health 9, 14581471.
28. Sadler, RC, Clark, AF, Wilk, P et al. (2016) Using GPS and activity tracking to reveal the influence of adolescents’ food environment exposure on junk food purchasing. Can J Public Health 107, Suppl. 1, eS14eS20.
29. New York State Department of Health (2016) Obesity and related indicators – Monroe County 2012–2014. (accessed May 2017).
30. American Planning Association (2007) APA Policy Guide on Community and Regional Food Planning. (accessed May 2017).
31. Canadian Institute of Planners (2013) Healthy Communities Practice Guide. (accessed May 2017).
32. City of London (2017) The London Plan. (accessed January 2019).
33. Sharkey, JR, Johnson, CM, Dean, WR et al. (2011) Focusing on fast food restaurants alone underestimates the relationship between neighborhood deprivation and exposure to fast food in a large rural area. Nutr J 10, 10.
34. Oliver, LN, Schuurman, N & Hall, AW (2007) Comparing circular and network buffers to examine the influence of land use on walking for leisure and errands. Int J Health Geogr 6, 41.
35. Sadler, RC, Gilliland, JA & Arku, G (2011) An application of the edge effect in measuring accessibility to multiple food retailer types in rural Southwestern Ontario, Canada. Int J Health Geogr 10, 34.
36. Timperio, AF, Ball, K, Roberts, R et al. (2009) Children’s takeaway and fast-food intakes: associations with the neighbourhood food environment. Public Health Nutr 12, 19601964.
37. Jilcott, SB, Wade, S, McGuirt, JT et al. (2011) The association between the food environment and weight status among eastern North Carolina youth. Public Health Nutr 14, 16101617.
38. Hill, JL, Olive, NC, Waters, CN et al. (2015) Lack of healthy food options on children’s menus of restaurants in the health-disparate Dan River region of Virginia and North Carolina, 2013. Prev Chronic Dis 12, E40.
39. Otten, JJ, Hekler, EB, Krukowski, RA et al. (2012) Food marketing to children through toys: response of restaurants to the first US toy ordinance. Am J Prev Med 42, 5660.
40. Diedrich, S (2015) Restaurant response to the San Francisco Toy Ordinance: changes in toy marketing and children’s menu options. MPH Thesis, University of Washington.
41. Crixell, SH, Friedman, B, Fisher, DT et al. (2014) Improving children’s menus in community restaurants: best food for families, infants, and toddlers (Best Food FITS) intervention, South Central Texas, 2010–2014. Prev Chronic Dis 11, E223.
42. Ayala, GX, Castro, IA, Pickrel, JL et al. (2016) A restaurant-based intervention to promote sales of healthy children’s menu items: the Kids’ Choice Restaurant Program cluster randomized trial. BMC Public Health 16, 250.
43. McGuffin, LE, Price, RK, McAdam, L et al. (2013) How healthy are children’s menus on the island of Ireland? Proc Nutr Soc 72, E171.
44. Claeys, ER (2004) Euclid lives? The uneasy legacy of progressivism in zoning. Fordham Law Rev 73, 731770.
45. Hilmers, A, Hilmers, DC & Dave, J (2012) Neighborhood disparities in access to healthy foods and their effects on environmental justice. Am J Public Health 102, 16441654.
46. Van Hook, J, Baker, E, Altman, CE et al. (2012) Canaries in a coalmine: immigration and overweight among Mexican-origin children in the US and Mexico. Soc Sci Med 74, 125134.
47. Van Hook, J, Quiros, S, Frisco, M et al. (2016) It is hard to swim upstream: dietary acculturation among Mexican-origin children. Popul Res Policy Rev 35, 177196.
48. Greater Rochester Health Foundation (2007) Strategic Plan for the Prevention of Childhood Overweight and Obesity in Monroe County, NY, 2007–2017. (accessed May 2017).
49. Sodano, V (2012) Food policy beyond neo-liberalism. In Sociological Landscape – Theories, Realities and Trends, pp. 375402. Rijeka, Croatia: InTech.
50. Bellinger, WK & Wang, J (2011) Poverty, place or race: causes of the retail gap in smaller US cities. Rev Black Polit Econ 38, 253270.
51. Goodman, MK (2009) Contemporary food matters? A review essay. Int Plan Stud 14, 437442.
52. Jetter, KM & Cassady, DL (2006) The availability and cost of healthier food alternatives. Am J Prev Med 30, 3844.
53. Muller, M, Tagtow, A, Roberts, SL et al. (2009) Aligning food systems policies to advance public health. J Hunger Environ Nutr 4, 225240.
54. Reidpath, DD, Burns, C, Garrard, J et al. (2002) An ecological study of the relationship between social and environmental determinants of obesity. Health Place 8, 141145.
55. White House Task Force on Childhood Obesity (2010) Solving the Problem of Childhood Obesity within a Generation. (accessed May 2017).
56. Gortmaker, S, Swinburn, B, Levy, D et al. (2011) Changing the future of obesity: science, policy and action. Lancet 67, 68.
57. Johnson, EJ, Shu, SB, Dellaert, BGC et al. (2012) Beyond nudges: tools of a choice architecture. Mark Lett 23, 487504.
58. Sadler, RC, Arku, G & Gilliland, JA (2015) Local food networks as catalysts for food policy change to improve health and build the economy. Local Environ 20, 11031121.
59. Strom, S (2013) With tastes growing healthier, McDonald’s aims to adapt its menu. The New York Times, 26 September 2013. (accessed May 2017).
60. Sadler, RC & Gilliland, JA (2015) Comparing children’s GPS tracks with geospatial proxies for exposure to junk food. Spat Spatiotemporal Epidemiol 14, 5561.
61. Biro, A (2015) Did the junk food tax make the Hungarians eat healthier? Food Policy 54, 107115.
62. Colchero, MA, Popkin, BM, Rivera, JA et al. (2016) Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study. BMJ 352, 6704.
63. Triggle, N (2016) Sugar tax: how it will work? (accessed May 2017).
64. World Cancer Research Fund (2016) NOURISHING Framework – Use economic tools to address food availability and purchase incentives. (accessed May 2017).
65. World Cancer Research Fund (2016) NOURISHING Framework – Set incentives and rules to create a healthy retail and food service environment. (accessed May 2017).
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