Does SES influence healthy eating promotions in restaurants?

Purpose: The purpose of this study was to explore relationships among in-store promotional signs, SES, and restaurants types. Methods: Trained surveyors used the Nutrition Environment Measure Survey-Restaurants (NEMS-R) to document nutritional availability and promotional signage in 187 restaurants (85% of total community restaurants) categorized as sit-down (49%) or fast-food (51%), in Fargo ND. Restaurant location was categorized as Low (n=107), Moderate (n=62), or High (n=18) SES based on free and reduced lunch rate of local neighborhoods. Results: Chi-square test showed a significantly greater proportion of High SES restaurants using signs to encourage healthy eating (÷²=10.387, p=.006); unhealthy eating (÷²=9.576, p=.008); over eating (÷²=6.464, p=.039); supersizing (÷²=20.450, p=<.001); and highlighting healthy menu options (÷²=23.242, p=<.001). For restaurant types, chi-square test showed that fast food restaurants were significantly more likely to encourage healthy eating (÷²=26.711, p=<.001); unhealthy eating (÷²=8.241, p=.004); over eating (÷²=5.425, p=.020); supersizing (÷²=15.870, p=<.001); and highlighting healthy menu options (÷²=24.711, p=<.001). Sit-down restaurants were more likely to promote all-you-can-eat (÷²=12.299, p=<.001). Any type of nutritional information was more readily available at fast-food restaurants (÷²=28.052, p=<.001). Discussion: This research shows that food promotions and nutritional information are quite prevalent in fast food restaurants, and more so in high SES locations. However, not all promotions encourage healthy eating habits. In contrast, sit down restaurants rarely offer nutritional information and instead promote all-you-can-eat. These results are important and can be used to influence local policy that discourages unhealthy eating promotions and encourages nutritional information in fast-food and sit-down restaurants.