title: Child-directed marketing inside and on the exterior of fast food restaurants.
abstract: BACKGROUND
  Children who eat fast food have poor diet and health outcomes. Fast food is heavily marketed to youth, and exposure to such marketing is associated with higher fast food consumption.
  
  
  OBJECTIVE
  To examine the extent of child-directed marketing (CDM) inside and on the exterior of fast food restaurants.
  
  
  METHODS
  Data were collected from 6,716 fast food restaurants located in a nationally representative sample of public middle- and high-school enrollment areas in 2010, 2011, and 2012. CDM was defined as the presence of one or more of seven components inside or on the exterior of the restaurant. Analyses were conducted in 2014.
  
  
  RESULTS
  More than 20% of fast food restaurants used CDM inside or on their exterior. In multivariate analyses, fast food restaurants that were part of a chain, offered kids' meals, were located in middle- (compared to high)-income neighborhoods, and in rural (compared to urban) areas had significantly higher odds of using any CDM; chain restaurants and those located in majority black neighborhoods (compared to white) had significantly higher odds of having an indoor display of kids' meal toys. Compared to 2010, there was a significant decline in use of CDM in 2011, but the prevalence increased close to the 2010 level in 2012.
  
  
  CONCLUSIONS
  CDM inside and on the exterior of fast food restaurants is prevalent in chain restaurants; majority black communities, rural areas, and middle-income communities are disproportionately exposed. The fast food industry should limit children's exposure to marketing that promotes unhealthy food choices.
authors.affiliation: Arizona State University School of Nutrition and Health Promotion, Phoenix, Arizona. Electronic address: pohrivac@asu.edu.
authors.forename: Punam
authors.initials: P
authors.lastname: Ohri-Vachaspati
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Isgor
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Leah
authors.initials: L
authors.lastname: Rimkus
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Powell
authors.affiliation: Barker Bi-Coastal Health Consultants Inc., Calabasas, California.
authors.forename: Dianne C
authors.initials: DC
authors.lastname: Barker
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; Department of Economics, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Chaloupka
mesh_terms: D000293:Adolescent; D002648:Child; D002669:Child Welfare / Q000191:economics*; D002675:Child, Preschool; D004032:Diet / Q000009:adverse effects* / Q000706:statistics & numerical data; D057140:Fast Foods / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D040541:Marketing / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010988:Play and Playthings; D012111:Residence Characteristics; D012147:Restaurants / Q000145:classification / Q000191:economics* / Q000706:statistics & numerical data; D012574:Schools; D012959:Socioeconomic Factors; D014481:United States