Overview

This study seeks to improve cancer-preventive diets of customers who frequent independently-owned restaurants in predominantly low-income urban neighborhoods. The study leverages systems science approaches to working with independently-owned restaurants to increase access to and promotion of healthful foods in their establishments.

Goals

  • Use systems science approaches to refine the adaptation of FRESH to two low-income urban sites (Baltimore and the DC metro area).
  • Assess implementation of FRESH in 24 independently-owned restaurants. Per site, 8 neighborhoods will be selected and randomized to intervention or comparison. FRESH will be implemented for 16 months. We will collect detailed process data to inform the System Dynamics (SD) model.
  • Use a multisite cluster randomized controlled trial to assess the impact of FRESH on dietary quality (primary outcome), health indicators, psychosocial factors of regular customers (n=576), psychosocial factors and behaviors of kitchen staff and owners, and on restaurant offerings, sales, and weekly revenues.
  • Develop and apply the restaurant intervention SD model to other urban contexts. The initial SD model will be parameterized using baseline data. Process and impact data will be used to calibrate the model. We will develop a web-based user-friendly dashboard to widely disseminate the SD model to other urban settings.

Partner Site

Diet Disparities Lab partnered with Healthy Food Systems, through the Johns Hopkins Bloomberg School of Public Health.

Phases

The primary purpose of this phase is to engage and build rapport with restaurant owners and staff through a process of menu and recipe review, leading to redesigns of posted menus, a strategy we have used successfully in the past. We will create and post a unique QR code for each restaurant to promote their enhanced online menu and FRESH items.

This phase will focus on decreasing added sugars by increasing customer access to and promotion of noncaloric beverages, including bottled water, flavored waters, and other unsweetened beverages. Study team members will work with intervention restaurants and their suppliers to make sure that noncaloric beverages are procured and to assess the supply quantity in terms of the demand in each restaurant (Food Access component).

This phase will focus on increasing customer access to, and promotion of, healthier side dishes that include primarily fruits and vegetables, in addition to encouraging the introduction of whole grains, beans, and nuts. Healthier side options will be promoted through bilingual visual materials and taste tests at the point of purchase.

The final phase will focus on increasing customer access to, and promotion of, healthier entree(s) that meet the DGA. Interventionists will work with owners and cooks to modify existing entrees or prepare new entrees, so that at least two new healthy entrees are added. We will work with the restaurants to offer reduced prices, smaller portion combination meals (suitable as a kid’s meal), a healthier combination meal, or provide water for free.

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