title: The Happy Meal® Effect: the impact of toy premiums on healthy eating among children in Ontario, Canada.
abstract: OBJECTIVE
  "Toy premiums", offered with McDonald's Happy Meals®, are a prominent form of food marketing directed at children. Two California jurisdictions recently implemented policies that only permit offering fast-food toy premiums with meals that meet certain nutritional criteria. The primary objective of the current study was to examine elements of this policy in a Canadian context and determine if children select healthier food products if toy premiums are only offered with healthier food options. The study also examined if the impact of restricting toy premiums to healthier foods varied by gender and age.
  
  
  METHODS
  A between-groups experimental study was conducted with 337 children aged 6-12 years attending day camps in Ontario, Canada. Children were offered one of four McDonald's Happy Meals® as part of the camp lunch program: two "healthier" meals that met the nutritional criteria and two meals that did not. In the control condition, all four meals were offered with a toy premium. In the intervention condition, the toy was only offered with the two "healthier" meals.
  
  
  RESULTS
  Children were significantly more likely to select the healthier meals when toys were only offered with meals that met nutritional criteria (OR=3.19, 95% CI: 1.89-5.40). The effect of pairing toys with healthier meals had a stronger effect on boys than girls (OR=1.90, 95% CI: 1.14-3.17).
  
  
  CONCLUSIONS
  Policies that restrict toy premiums to food that meet nutritional criteria may promote healthier eating at fast-food restaurants.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, ON. dhammond@uwaterloo.ca
authors.forename: Erin P
authors.initials: EP
authors.lastname: Hobin
authors.forename: David G
authors.initials: DG
authors.lastname: Hammond
authors.forename: Samantha
authors.initials: S
authors.lastname: Daniel
authors.forename: Rhona M
authors.initials: RM
authors.lastname: Hanning
authors.forename: Steve
authors.initials: S
authors.lastname: Manske
mesh_terms: D000367:Age Factors; D002648:Child; D002755:Choice Behavior; D004032:Diet / Q000523:psychology* / Q000706:statistics & numerical data; D057140:Fast Foods; D005260:Female; D015438:Health Behavior; D006291:Health Policy; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D009864:Ontario; D010988:Play and Playthings; D012737:Sex Factors
keywords: Obesity; fast foods; nutrition policy