title: Community-based restaurant interventions to promote healthy eating: a systematic review.
abstract: BACKGROUND
  Eating in restaurants is associated with high caloric intake. This review summarizes and evaluates the evidence supporting community-based restaurant interventions.
  
  
  METHODS
  We searched all years of PubMed and Web of Knowledge through January 2014 for original articles describing or evaluating community-based restaurant interventions to promote healthy eating. We extracted summary information and classified the interventions into 9 categories according to the strategies implemented. A scoring system was adapted to evaluate the evidence, assigning 0 to 3 points to each intervention for study design, public awareness, and effectiveness. The average values were summed and then multiplied by 1 to 3 points, according to the volume of research available for each category. These summary scores were used to determine the level of evidence (insufficient, sufficient, or strong) supporting the effectiveness of each category.
  
  
  RESULTS
  This review included 27 interventions described in 25 studies published since 1979. Most interventions took place in exclusively urban areas of the United States, either in the West or the South. The most common intervention categories were the use of point-of-purchase information with promotion and communication (n = 6), and point-of-purchase information with increased availability of healthy choices (n = 6). Only the latter category had sufficient evidence. The remaining 8 categories had insufficient evidence because of interventions showing no, minimal, or mixed findings; limited reporting of awareness and effectiveness; low volume of research; or weak study designs. No intervention reported an average negative impact on outcomes.
  
  
  CONCLUSIONS
  Evidence about effective community-based strategies to promote healthy eating in restaurants is limited, especially for interventions in rural areas. To expand the evidence base, more studies should be conducted using robust study designs, standardized evaluation methods, and measures of sales, behavior, and health outcomes.
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Valdivia Espino
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Natalie
authors.initials: N
authors.lastname: Guerrero
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Natalie
authors.initials: N
authors.lastname: Rhoads
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: Norma-Jean
authors.initials: NJ
authors.lastname: Simon
authors.affiliation: University of California, Los Angeles, California.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Escaron
authors.affiliation: University of Wisconsin-Madison and Wisconsin Obesity Prevention Network, Madison, Wisconsin.
authors.forename: Amy
authors.initials: A
authors.lastname: Meinen
authors.affiliation: University of Wisconsin-Madison, Madison, Wisconsin.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
authors.affiliation: 610 Walnut St, 605 WARF, Madison, WI 53705, Email: martinezdona@wisc.edu.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Martinez-Donate
mesh_terms: D002755:Choice Behavior; D003132:Commerce; D003153:Community Health Services; D005247:Feeding Behavior; D005523:Food Supply / Q000592:standards*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D012147:Restaurants; D014481:United States; D014505:Urban Population