Measuring the fast food environment: Results from a reliability study

Background: Numerous studies have shown that the community food environment is related to rates of overweight and obesity. Fast food restaurants are increasingly prevalent and are a common source of food for youth and others. Methodology: An inter-rater reliability study was conducted in a sample of 131 fast food restaurants throughout the Chicago MSA. Data were collected by observation for food and beverage availability and pricing, exterior advertising, availability and promotion of healthier options, menu labeling, and other restaurant characteristics. Findings: Preliminary results indicate that reliability was high for the availability of specific food (Kappa ≥ 0.90) and beverage (Kappa ≥ 0.78) products, as well as food and beverage pricing (ICC ≥ 0.84 and 0.70, respectively). Menu labeling measures were found to be highly reliable, including provision of calorie information on menu boards or via other media at point of purchase (Kappa ≥ 0.77) and the provision of any statement regarding suggested daily calories (Kappa ≥ 0.93). Inter-rater agreement was mixed for determining availability of healthier food options, including fruit and vegetable sides and salads (Kappa between 0.53 and 0.96). Advertising measures, including counts of food and beverage ads and price promotions as well as presence of child-targeted marketing and health and quality claims also had mixed reliability (ICC or Kappa between 0.35 and 0.95). Conclusion: Results indicate that most measures of the fast food environment can be reliably collected using observational methods. Lessons learned will be discussed and applied to an upcoming nationwide study of both the food and physical activity environments in 150-200 communities per year.