The children's menu assessment: development, evaluation, and relevance of a tool for evaluating children's menus

Restaurant foods represent a substantial portion of children's dietary intake, and consumption of foods away from home has been shown to contribute to excess adiposity. This descriptive study aimed to pilot-test and establish the reliability of a standardized and comprehensive assessment tool, the Children's Menu Assessment, for evaluating the restaurant food environment for children. The tool is an expansion of the Nutrition Environment Measures Survey-Restaurant. In 2009-2010, a randomly selected sample of 130 local and chain restaurants were chosen from within 20 miles of Little Rock, AR, to examine the availability of children's menus and to conduct initial calibration of the Children's Menu Assessment tool (final sample: n=46). Independent raters completed the Children's Menu Assessment in order to determine inter-rater reliability. Test-retest reliability was also examined. Inter-rater reliability was high: percent agreement was 97% and Spearman correlation was 0.90. Test-retest was also high: percent agreement was 91% and Spearman correlation was 0.96. Mean Children's Menu Assessment completion time was 14 minutes, 56 seconds ± 10 minutes, 21 seconds. Analysis of Children's Menu Assessment findings revealed that few healthier options were available on children's menus, and most menus did not provide parents with information for making healthy choices, including nutrition information or identification of healthier options. The Children's Menu Assessment tool allows for comprehensive, rapid measurement of the restaurant food environment for children with high inter-rater reliability. This tool has the potential to contribute to public health efforts to develop and evaluate targeted environmental interventions and/or policy changes regarding restaurant foods.