title: Impact of San Francisco's toy ordinance on restaurants and children's food purchases, 2011-2012.
abstract: BACKGROUND
  In 2011, San Francisco passed the first citywide ordinance to improve the nutritional standards of children's meals sold at restaurants by preventing the giving away of free toys or other incentives with meals unless nutritional criteria were met. This study examined the impact of the Healthy Food Incentives Ordinance at ordinance-affected restaurants on restaurant response (eg, toy-distribution practices, change in children's menus), and the energy and nutrient content of all orders and children's-meal-only orders purchased for children aged 0 through 12 years.
  
  
  METHODS
  Restaurant responses were examined from January 2010 through March 2012. Parent-caregiver/child dyads (n = 762) who were restaurant customers were surveyed at 2 points before and 1 seasonally matched point after ordinance enactment at Chain A and B restaurants (n = 30) in 2011 and 2012.
  
  
  RESULTS
  Both restaurant chains responded to the ordinance by selling toys separately from children's meals, but neither changed their menus to meet ordinance-specified nutrition criteria. Among children for whom children's meals were purchased, significant decreases in kilocalories, sodium, and fat per order were likely due to changes in children's side dishes and beverages at Chain A.
  
  
  CONCLUSIONS
  Although the changes at Chain A did not appear to be directly in response to the ordinance, the transition to a more healthful beverage and default side dish was consistent with the intent of the ordinance. Study results underscore the importance of policy wording, support the concept that more healthful defaults may be a powerful approach for improving dietary intake, and suggest that public policies may contribute to positive restaurant changes.
authors.affiliation: University of Washington School of Public Health, Nutritional Sciences Program, Box 353410, Seattle, WA 98115. E-mail: jotten@uw.edu.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Otten
authors.affiliation: University of Washington and Seattle Children's Research Institute, Seattle, Washington.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Saelens
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Kristopher I
authors.initials: KI
authors.lastname: Kapphahn
authors.affiliation: School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Hekler
authors.affiliation: School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Buman
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldstein
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Krukowski
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Laura S
authors.initials: LS
authors.lastname: O'Donohue
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Gardner
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Abby C
authors.initials: AC
authors.lastname: King
mesh_terms: D015992:Body Mass Index; D002151:Calorimetry; D017028:Caregivers; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D005260:Female; D005502:Food / Q000191:economics*; D005522:Food Services / Q000191:economics*; D037921:Gift Giving; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007881:Legislation, Food; D008297:Male; D009042:Motivation; D010287:Parent-Child Relations; D010290:Parents; D010988:Play and Playthings; D012147:Restaurants / Q000331:legislation & jurisprudence*; D012495:San Francisco; D011795:Surveys and Questionnaires