title: Food marketing to children through toys: response of restaurants to the first U.S. toy ordinance.
abstract: BACKGROUND
  On August 9, 2010, Santa Clara County CA became the first U.S. jurisdiction to implement an ordinance that prohibits the distribution of toys and other incentives to children in conjunction with meals, foods, or beverages that do not meet minimal nutritional criteria. Restaurants had many different options for complying with this ordinance, such as introducing more healthful menu options, reformulating current menu items, or changing marketing or toy distribution practices.
  
  
  OBJECTIVE
  To assess how ordinance-affected restaurants changed their child menus, marketing, and toy distribution practices relative to non-affected restaurants.
  
  
  METHODS
  Children's menu items and child-directed marketing and toy distribution practices were examined before and at two time points after ordinance implementation (from July through November 2010) at ordinance-affected fast-food restaurants compared with demographically matched unaffected same-chain restaurants using the Children's Menu Assessment tool.
  
  
  RESULTS
  Affected restaurants showed a 2.8- to 3.4-fold improvement in Children's Menu Assessment scores from pre- to post-ordinance with minimal changes at unaffected restaurants. Response to the ordinance varied by restaurant. Improvements were seen in on-site nutritional guidance; promotion of healthy meals, beverages, and side items; and toy marketing and distribution activities.
  
  
  CONCLUSIONS
  The ordinance appears to have positively influenced marketing of healthful menu items and toys as well as toy distribution practices at ordinance-affected restaurants, but did not affect the number of healthful food items offered.
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. jotten@stanford.edu
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Otten
authors.forename: Eric B
authors.initials: EB
authors.lastname: Hekler
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Krukowski
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Buman
authors.forename: Brian E
authors.initials: BE
authors.lastname: Saelens
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Gardner
authors.forename: Abby C
authors.initials: AC
authors.lastname: King
mesh_terms: D002140:California; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D057140:Fast Foods; D006293:Health Promotion / Q000331:legislation & jurisprudence; D006801:Humans; D040541:Marketing / Q000331:legislation & jurisprudence*; D018673:Nutrition Policy / Q000331:legislation & jurisprudence*; D010988:Play and Playthings; D012147:Restaurants / Q000331:legislation & jurisprudence*; D014481:United States