title: Menu labeling regulations and calories purchased at chain restaurants.
abstract: BACKGROUND
  The federal menu labeling law will require chain restaurants to post caloric information on menus, but the impact of labeling is uncertain.
  
  
  OBJECTIVE
  The goal of the current study was to examine the effect of menu labeling on calories purchased, and secondarily, to assess self-reported awareness and use of labels.
  
  
  METHODS
  Single-community pre-post-post cross-sectional study. Data were collected in 2008-2010 and analyzed in 2011-2012.
  
  
  METHODS
  50 sites from 10 chain restaurants in King County, Washington, selected through stratified, two-stage cluster random sampling. A total of 7325 customers participated. Eligibility criteria were: being an English speaker, aged ≥ 14 years, and having an itemized receipt. The study population was 59% male, 76% white non-Hispanic, and 53% aged<40 years.
  
  
  METHODS
  A regulation requiring chain restaurants to post calorie information on menus or menu boards was implemented.
  
  
  METHODS
  Mean number of calories purchased.
  
  
  RESULTS
  No significant changes occurred between baseline and 4-6 months postregulation. Mean calories per purchase decreased from 908.5 to 870.4 at 18 months post-implementation (38 kcal, 95% CI=-76.9, 0.8, p=0.06) in food chains and from 154.3 to 132.1 (22 kcal, 95% CI=-35.8, -8.5, p=0.002) in coffee chains. Calories decreased in taco and coffee chains, but not in burger and sandwich establishments. They decreased more among women than men in coffee chains. Awareness of labels increased from 18.8% to 61.7% in food chains and from 4.4% to 30.0% in coffee chains (both p<0.001). Among customers seeing calorie information, the proportion using it (about one third) did not change substantially over time. After implementation, food chain customers using information purchased on average fewer calories compared to those seeing but not using (difference=143.2 kcal, p<0.001) and those not seeing (difference=135.5 kcal, p<0.001) such information.
  
  
  CONCLUSIONS
  Mean calories per purchase decreased 18 months after implementation of menu labeling in some restaurant chains and among women but not men.
authors.affiliation: Public Health Department of Seattle and King County, Chronic Disease and Injury Prevention Section, 401 5th Avenue, Suite 900, Seattle, WA 98104, USA. james.krieger@kingcounty.gov
authors.forename: James W
authors.initials: JW
authors.lastname: Krieger
authors.forename: Nadine L
authors.initials: NL
authors.lastname: Chan
authors.forename: Brian E
authors.initials: BE
authors.lastname: Saelens
authors.forename: Myduc L
authors.initials: ML
authors.lastname: Ta
authors.forename: David
authors.initials: D
authors.lastname: Solet
authors.forename: David W
authors.initials: DW
authors.lastname: Fleming
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D005515:Food Labeling / Q000331:legislation & jurisprudence*; D033161:Government Regulation; D006801:Humans; D008297:Male; D008612:Menu Planning; D012147:Restaurants; D014481:United States; D014861:Washington