title: Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting.
abstract: OBJECTIVE
  To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants.
  
  
  METHODS
  Quasi-experimental.
  
  
  METHODS
  Low-income neighborhoods of Baltimore, Maryland.
  
  
  METHODS
  Seven carryouts (three intervention, four comparison).
  
  
  METHODS
  Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals.
  
  
  METHODS
  Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined).
  
  
  METHODS
  Logistic and Poisson regression models with generalized estimating equations.
  
  
  RESULTS
  In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05).
  
  
  CONCLUSIONS
  Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.
authors: Seung Hee
authors: SH
authors: Lee-Kwan
authors: Sara N
authors: SN
authors: Bleich
authors: Hyunju
authors: H
authors: Kim
authors: Elizabeth
authors: E
authors: Colantuoni
authors: Joel
authors: J
authors: Gittelsohn
mesh_terms: D015142:Baltimore; D003132:Commerce / Q000706:statistics & numerical data; D005518:Food Preferences; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D011203:Poverty; D015397:Program Evaluation; D012147:Restaurants
keywords: Environmental Approaches to Obesity; Health focus: nutrition; Intervention; Low-Income; Manuscript format: research; Maryland; Menu Labeling; Outcome measure: behavioral, financial; Point of Purchase; Prepared Food Sources; Prevention Research; Research purpose: intervention testing/evaluation; Restaurants; Setting: community; Strategy: multiphased environmental intervention; Study design: quasi-experimental; Target population age: adults; Target population circumstances: low-income African-Americans in Baltimore; Urban