title: Child and adolescent fast-food choice and the influence of calorie labeling: a natural experiment.
abstract: OBJECTIVE
  Obesity is an enormous public health problem and children have been particularly highlighted for intervention. Of notable concern is the fast-food consumption of children . However, we know very little about how children or their parents make fast-food choices, including how they respond to mandatory calorie labeling. We examined children's and adolescents' fast-food choice and the influence of calorie labels in low-income communities in New York City (NYC) and in a comparison city (Newark, NJ).
  
  
  METHODS
  Natural experiment: Survey and receipt data were collected from low-income areas in NYC, and Newark, NJ (as a comparison city), before and after mandatory labeling began in NYC. Study restaurants included four of the largest chains located in NYC and Newark: McDonald's, Burger King, Wendy's and Kentucky Fried Chicken.
  
  
  METHODS
  A total of 349 children and adolescents aged 1-17 years, who visited the restaurants with their parents (69%) or alone (31%) before or after labeling was introduced. In total, 90% were from racial or ethnic minority groups.
  
  
  RESULTS
  We found no statistically significant differences in calories purchased before and after labeling; many adolescents reported noticing calorie labels after their introduction (57% in NYC) and a few considered the information when ordering (9%). Approximately 35% of adolescents ate fast food six or more times per week and 72% of adolescents reported that taste was the most important factor in their meal selection. Adolescents in our sample reported that parents have some influence on their meal selection.
  
  
  CONCLUSIONS
  Adolescents in low-income communities notice calorie information at similar rates as adults, although they report being slightly less responsive to it than adults. We did not find evidence that labeling influenced adolescent food choice or parental food choices for children in this population.
authors.affiliation: Division of General Internal Medicine, New York University School of Medicine, 423 East 23rd Street, New York, NY 10010, USA. brian.elbel@nyumc.org
authors.forename: B
authors.initials: B
authors.lastname: Elbel
authors.forename: J
authors.initials: J
authors.lastname: Gyamfi
authors.forename: R
authors.initials: R
authors.lastname: Kersh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002755:Choice Behavior; D057140:Fast Foods / Q000009:adverse effects*; D005260:Female; D005515:Food Labeling / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D008297:Male; D009515:New Jersey / Q000453:epidemiology; D009519:New York City / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D012147:Restaurants; D012959:Socioeconomic Factors