Sociodemographic Disparities among Fast-Food Restaurant Customers Who Notice and Use Calorie Menu Labels

Background: As part of the recently passed Patient Protection and Affordable Care Act, chain restaurants with 20 or more locations nationwide will soon be required to post calorie information on menus with the aim of helping customers make healthier food choices. To be effective, this policy must affect all customers, especially those most at risk for poor health and diet outcomes. Objective: To determine whether noticing or using calorie menu labels was associated with demographic characteristics of customers at a national fast-food chain currently implementing calorie menu labeling. Design: Cross-sectional analysis. Participants/setting: Customer receipts and survey data were collected from 329 participants using street-intercept survey methodology at 29 McDonald's restaurant locations in low- and high-income neighborhoods throughout the Phoenix, AZ, metropolitan area. Outcome measures: Calorie menu labeling awareness and use were assessed. The total number of calories purchased was evaluated using participants' itemized receipts. Statistical analyses: Multivariate logistic regression analyses were used to calculate the odds of customers noticing or using calorie menu labels. Results: Approximately 60% of participants noticed calorie menu labels, whereas only 16% reported using the information for food or beverage purchases. Higher-income individuals had twice the odds of noticing calorie labels (P=0.029) and three times the odds of using them (P=0.004). Significant positive associations were found between individuals with a bachelor's degree or higher and use of calorie menu labels (odds ratio 3.25; P=0.023). Noticing calorie menu labels was not associated with purchasing fewer calories; however, those who reported using calorie information purchased 146 fewer calories than those who did not (P=0.001). Conclusions: Using calorie menu labels is associated with purchasing fewer calories. However, there are significant socioeconomic disparities among customers who notice and use calorie menu labels. Targeted education campaigns are needed to improve the use of menu labeling across all sociodemographic groups.