Marketing to Children Inside Quick Service Restaurants: Differences by Community Demographics.

Introduction In the U.S., children regularly consume foods from quick-service restaurants, but little is known about the marketing strategies currently used inside quick-service restaurants. This study aims to validate a child-focused Environmental Assessment Tool for quick-service restaurants, evaluate marketing strategies inside and on the exterior of quick-service restaurants, and examine differences by community race/ethnicity or income. Methods The inter-rater and test–retest reliability of the Environmental Assessment Tool were assessed across the top 5 national quick-service restaurant chains. Marketing techniques in 165 quick-service restaurants (33 per national chain) in socioeconomically and racially/ethnically diverse communities throughout New England were examined in 2018–2019. Mixed methods ANOVA examined the differences in marketing techniques in 2020. Results The inter-rater and test–retest reliability of the Environmental Assessment Tool were high (Cohen's κ>0.80). Approximately 95% of quick-service restaurants marketed less healthy foods, whereas only 6.5% marketed healthy options. When examining the differences by community demographics, there were significantly more price promotion advertisements inside and on the exterior of quick-service restaurants in lower-income communities. In addition, there was a greater number of child-directed advertisements with cartoon or TV/movie characters as well as fewer healthy entree options and more sugar-sweetened beverage and dessert options on the children's menu inside quick-service restaurants in communities with higher minority populations. Conclusions Environmental Assessment Tool is a valid tool to evaluate marketing inside quick-service restaurants. Results suggest that there is a substantial amount of unhealthy food and beverage marketing inside quick-service restaurants, with differences in the number and types of techniques used in lower-income and minority communities. Policies that limit quick-service restaurant marketing to children should be considered.