Developing an Environmental Scan Tool for Monitoring Calorie Posting and Sodium Labeling in Los Angeles County Restaurants

Background: In light of recently adopted state (California Senate Bill 1420) and federal menu labeling requirements (Affordable Care Act of 2009), the need for reliable methods to monitor restaurant compliance with these new regulations is growing. The Los Angeles County Department of Public Health recently developed a pilot program to monitor menu labeling in the region's restaurants. As part of this program, an environmental scan tool was developed for use by health inspectors. This paper describes preliminary findings from feasibility testing of this tool. Methods: Using a five-stage development and feasibility evaluation approach, we: 1) systematically identified concepts specific to the state and federal menu labeling provisions; 2) operationalized and constructed variables from these concepts; 3) formulated instrument measures from these variables; 4) adapted several other items from a previously validated restaurant environment inspection tool (NEMS-R); and 5) assigned five trained staff to pre-test the tool. Results: Tool users generally rated the environmental scan instrument as easy to use, and on average, took approximately 20 minutes to complete. The tool's inter-rater reliability (kappa= .60) suggests substantial agreement between users. Conclusions: Although further refinements are needed, preliminary findings indicate this tool is straightforward and shows promise as an instrument that can be incorporated into the existing Los Angeles County restaurant hygiene inspection process to monitor menu labeling in restaurant chains that must comply with state and federal laws. The tool may be adapted in the future to other jurisdictions interested in implementing similar menu labeling monitoring programs.