A spatial analysis of the association between restaurant density and body mass index in Canadian adults

Convenience stores: an obesogenic promoter in a metropolitan area of northern Mexico?

Introduction

The prevalence of obesity in the Mexican school-age (5-11 years old) population increased from 8.9 to 18.1% between 1999 and 2022. Although overweight and obesity (OW + Ob) is a complex and multifactorial phenomenon, alongside its increasing trend, changes in eating patterns as a result of obesogenic environments that promote higher energy intake have been documented. The objective of the present study was to detect possible associations between schools and their proximity to and density of convenience stores in Monterrey, Mexico from 2015 to 2018.

Materials and methods

Anthropometric data were obtained from a subset of measurements of the National Registry of Weight and Height (RNPT) performed in the Monterrey Mexico metropolitan area in 2015 and 2018, and obesity prevalence was computed and classified into quintiles at the school level. Convenience store data were obtained from the National Directory of Economic Units (DNUE). The analyses consisted of densities within 400-800 m buffers, distance to the nearest stores, and cartographic visualization of the store's kernel density versus OW + Ob hotspots for both periods.

Results

A total of 175,804 children in 2015 and 175,964 in 2018 belonging to 1,552 elementary schools were included in the study; during this period, OW + Ob prevalence increased from 38.7 to 39.3%, and a directly proportional relationship was found between the quintiles with the higher OW + Ob prevalence and the number of stores for both radii. Hotspots of OW + Ob ranged from 63 to 91 between 2015 and 2018, and it was visually confirmed that such spots were associated with areas with a higher density of convenience stores regardless of socioeconomic conditions.

Conclusion

Although some relationships between the store's proximity/density and OW + Ob could be identified, more research is needed to gather evidence about this. However, due to the trends and the magnitude of the problem, guidelines aimed at limiting or reducing the availability of junk food and sweetened beverages on the school's periphery must be implemented to control the obesogenic environment.

Food environment research in Canada: a rapid review of methodologies and measures deployed between 2010 and 2021

Numerous research methodologies have been used to examine food environments. Existing reviews synthesizing food environment measures have examined a limited number of domains or settings and none have specifically targeted Canada. This rapid review aimed to 1) map research methodologies and measures that have been used to assess food environments; 2) examine what food environment dimensions and equity related-factors have been assessed; and 3) identify research gaps and priorities to guide future research. A systematic search of primary articles evaluating the Canadian food environment in a real-world setting was conducted. Publications in English or French published in peer-reviewed journals between January 1 2010 and June 17 2021 and indexed in Web of Science, CAB Abstracts and Ovid MEDLINE were considered. The search strategy adapted an internationally-adopted food environment monitoring framework covering 7 domains (Food Marketing; Labelling; Prices; Provision; Composition; Retail; and Trade and Investment). The final sample included 220 articles. Overall, Trade and Investment (1%, n = 2), Labelling (7%, n = 15) and, to a lesser extent, Prices (14%, n = 30) were the least studied domains in Canada. Among Provision articles, healthcare (2%, n = 1) settings were underrepresented compared to school (67%, n = 28) and recreation and sport (24%, n = 10) settings, as was the food service industry (14%, n = 6) compared to grocery stores (86%, n = 36) in the Composition domain. The study identified a vast selection of measures employed in Canada overall and within single domains. Equity-related factors were only examined in half of articles (n = 108), mostly related to Retail (n = 81). A number of gaps remain that prevent a holistic and systems-level analysis of food environments in Canada. As Canada continues to implement policies to improve the quality of food environments in order to improve dietary patterns, targeted research to address identified gaps and harmonize methods across studies will help evaluate policy impact over time.

Analysis of the Correlation between Eating Away from Home and BMI in Adults 18 Years and Older in China: Data from the CNNHS 2015

The purpose of this study is to examine the relationship between the frequency of eating away from home (EAFH) and Body mass index (BMI) in adults. The data were collected from 2015 China Adult Chronic Disease and Nutrition Surveillance (CNNHS 2015). Adults aged 18 and above who had complete dietary frequency questionnaire data were recruited as the research objects. The frequency of EAFH among different genders and BMI groups were compared, and multiple linear regression method was used to analyze the correlation between frequency of EAFH and BMI of adults aged 18 years and above with different gender, age, family per capita annual income, education level, marital status, and occupation level. The frequency of EAFH was higher for adults aged 18–44, eastern region, urban, family per capita annual income of 20,000 RMB or more, highly educated, unmarried, school students, employed people, and obese adults, which were 3.64, 3.30, 3.71, 4.30, 5.92, 5.64, 9.29 and 2.68 times per week, respectively. The highest frequency of EAFH was obese men in urban areas aged 18–44 years, which was 5.63 times per week. Multiple linear regression analysis showed that the frequency of EAFH for breakfast was not associated with BMI (p > 0.05), the frequency of EAFH for lunch was negatively correlated with BMI (β = −0.024, p = 0.008), and the frequency of EAFH for dinner was positively correlated with BMI (β = 0.040, p = 0.004).The frequency of EAFH of male (β = 0.013, p = 0.008), 60 years old and above (β = 0.022, p = 0.021), family per capita annual income less than 10,000 RMB (β = 0.019, p = 0.005), junior high school education or below (β = 0.012, p = 0.009), and unemployed/retired (β = 0.029, p = 0.003) adults were positively correlated with BMI. While for women, the frequency of EAFH (β = −0.019, p = 0.001) was negatively correlated with BMI. In terms of frequency of EAFH for breakfast, female (β = 0.027, p = 0.041), people aged 45–59 years (β = 0.042, p = 0.002), aged 60 and above (β = 0.047, p = 0.017), eastern China (β = 0.034, p = 0.010), junior high school education or below (β = 0.045, p = 0.001), married/cohabiting (β = 0.024, p = 0.008) adults’ frequency of EAFH for breakfast of was positively correlated with BMI. In terms of frequency of EAFH for lunch, female (β = 0.056, p = 0.001), people aged 45–59 years (β = 0.024, p = 0.005), eastern China (β = 0.034, p = 0.004), rural areas (β = 0.035, p = 0.006), moderate and high family per capita annual income (β = 0.043, p = 0.007; β = 0.029, p = 0.039), high education level (β = 0.039, p = 0.034), married/cohabiting (β = 0.028, p = 0.001), on-the-job personnel (β = 0.033, p = 0.001) frequency of EAFH for lunch were negatively correlated with BMI. In terms of the frequency of EAFH for dinner, the frequency of EAFH for dinner had a significant positive influence on the BMI of males (β = 0.061, p = 0.001). The frequency of dinner EAFH for 18–44 years old (β = 0.042, p = 0.028), central region (β = 1.000, p < 0.001), rural areas (β = 0.055, p = 0.013), married/cohabiting (β = 0.048, p = 0.001), on-the-job personnel (β = 0.037, p = 0.035) adults were positively correlated with BMI. The frequency of EAFH in urban obese men aged 18–44 was the highest. The frequency of EAFH for breakfast was not correlated with BMI, the frequency of EAFH for lunch was negatively correlated with BMI, and the frequency of EAFH for dinner was positively correlated with BMI. The analysis between EAFH according to the current definition and health-related outcomes is mixed. It is suggested that relevant authorities redefine EAFH from the perspective of health outcomes.

Price discounting as a hidden risk factor of energy drink consumption

OBJECTIVES

Global consumption of caffeinated energy drinks (CED) has been increasing dramatically despite increasing evidence of their adverse health effects. Temporary price discounting is a rarely investigated but potentially powerful food marketing tactic influencing purchasing of CED. Using grocery transaction records generated by food stores in Montreal, we investigated the association between price discounting and purchasing of CED across socio-economic status operationalized by education and income levels in store neighbourhood.

METHODS

The outcome, log-transformed weekly store-level sales of CED, was modelled as a function of store-level percent price discounting, store- and neighbourhood-level confounders, and an interaction term between discounting and each of tertile education and income in store neighbourhood. The model was separately fit to transactions from supermarkets, pharmacies, supercentres, and convenience stores.

RESULTS

There were 18,743, 12,437, 3965, and 49,533 weeks of CED sales from supermarkets, pharmacies, supercentres, and convenience stores, respectively. Percent price discounting was positively associated with log sales of CED for all store types, and the interaction between education and discounting was prominent in supercentres: -0.039 [95% confidence interval (CI): -0.051, -0.028] and -0.039 [95% CI: -0.057, -0.021], for middle- and high-education neighbourhoods relative to low-education neighbourhoods, respectively. Relative to low-income areas, the associations of discounting and log CED sales in supercentres for neighbourhoods with middle- and high-income tertile were 0.022 [95% CI: 0.010, 0.033] and 0.015 (95% CI: -0.001, 0.031), respectively.

CONCLUSION

Price discounting is an important driver of CED consumption and has a varying impact across community education and income.

Fast food restaurant density and weight status: A spatial analysis among Filipina migrant workers in Macao (SAR), People's Republic of China

BACKGROUND

Female migrant populations are at high risk of being overweight or obese. Beyond individual risk factors, exposure to the neighborhood food environment may contribute to their unhealthy weight status in the host region. Incorporating spatial analysis, this study examined the association between exposure to fast food restaurants and unhealthy weight status among Filipina domestic workers in Macao (SAR), China.

METHODS AND FINDINGS

Data were collected from 1388 Filipina domestic workers recruited using respondent-driven sampling between November 2016 to August 2017. Self-reported data on demographic characteristics, residential mailing address, and health-related behaviors were collected using tablet devices. Height and weight were objectively measured at the study site. Restaurant locations and resident addresses were geocoded and integrated into a shapefile for residential locations using ArcGIS. Nearly 64% of participants were classified as being overweight or obese, with 25.02% overweight and 38.96% obese. Adjusted multivariable logistic regression indicated that increased fast food restaurant density within a 0.5-mile buffer zone around a residential address was positively associated with higher odds of being overweight and obese (aOR = 1.07; 95% CI [1.01-1.14].

CONCLUSIONS

Increased fast food restaurant density was associated with unhealthy weight status among Filipina domestic workers in Macao (SAR), China. Providing healthy working environment, including access to healthy food, is indicated to improve the health of this population.

Neighborhood Food Outlet Access and Dietary Intake among Adults with Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort Study

BACKGROUND

Healthy diet is essential in the management of chronic kidney disease (CKD) and preventing related comorbidities. Food outlet access has been studied in the general population; however, the influence of the local food environment on dietary intake among people with CKD has not been evaluated.

OBJECTIVES

This study examined the associations of food outlet density and type of outlets with dietary intake in a multicenter cohort of racially and ethnically diverse patients with CKD.

METHODS

The Chronic Renal Insufficiency Cohort Study is a multicenter prospective study of patients with CKD that used a validated food frequency questionnaire to capture dietary intake at the baseline visit. This is a cross-sectional analysis of 2,484 participants recruited in 2003-2006 from seven Chronic Renal Insufficiency Cohort Study centers. Food outlet data were used to construct a count of the number of fast-food restaurants, convenience stores, and grocery stores per 10,000 population for each geocoded census block group. Multivariable linear and logistic regression models were used to evaluate the associations between measures of food outlet availability and dietary factors.

RESULTS

The proportion of participants living in zero-, low-, and high-food outlet density areas differed by gender, race or ethnicity, and income level. Among male subjects, living in areas with zero or the highest number of outlets was associated with having the highest caloric intakes in multivariable models. Male subjects living in areas with zero outlets consumed the highest levels of sodium and phosphorous. Female subjects living in areas with zero outlets had the lowest average intake of calories, sodium, and phosphorous. Among low-income female subjects, close proximity to more outlets was associated with higher calorie consumption. Among all participants, access to fast-food restaurants was not associated with an unhealthy diet score, and access to grocery stores was not associated with a healthy diet score.

CONCLUSIONS

Average caloric and nutrient intakes differed by outlet availability; however, there were no strong associations with type of food outlet. This should be considered when developing food-focused public health policies.

Interaction of DRD2/ANKK1 Taq1A Genotype with in-Store Retail Food Environment Exposures on Diet Quality in a Cohort of Quebec Adults

BACKGROUND/AIMS

Gene-environment interactions may be relevant for nutrition outcomes. This study assessed the interaction between DRD2/ANKK1 Taq1A genotype and exposures to in-store retail food environment on diet quality.

METHODS

CARTaGENE biobank data (n = 3,532) were linked to provincial food retail data. The Canadian adaptation of the Healthy Eating Index 2010 (HEI-C) was calculated from food frequency questionnaires. Generalized linear models adjusted for sociodemographic factors, anthropometrics, and energy intake were used to assess interactions between the Taq1A variant and retail food measures.

RESULTS

A significant inverse interaction was observed between Taq1A and ice cream store displays on HEI-C score (estimate: -15.46 [95% confidence interval (CI): -24.83, -6.10], p = 0.0012) where, among allele carriers, increasing exposure to ice cream displays was associated with a lower HEI-C score as compared to allele carriers with a lower exposure. A significant positive interaction between Taq1A and price of vegetables was also observed, where, among allele carriers, increasing exposure to a higher price was associated with a higher HEI-C score compared to allele carriers with exposure to a lower price (estimate: 2.46 [95% CI: 0.78, 4.14], p = 0.0041). The opposite pattern was observed among non-carriers.

CONCLUSIONS

DRD2/ANKK1 Taq1A is associated with adaptive responses to ice cream displays and vegetable prices, suggesting a differential susceptibility to retail environment food cues.

A scoping review on the relations between urban form and health: a focus on Canadian quantitative evidence

INTRODUCTION

Despite the accumulating Canadian evidence regarding the relations between urban form and health behaviours, less is known about the associations between urban form and health conditions. Our study aim was to undertake a scoping review to synthesize evidence from quantitative studies that have investigated the relationship between built environment and chronic health conditions, self-reported health and quality of life, and injuries in the Canadian adult population.

METHODS

From January to March 2017, we searched 13 databases to identify peer-reviewed quantitative studies from all years that estimated associations between the objectively-measured built environment and health conditions in Canadian adults. Studies under-taken within urban settings only were included. Relevant studies were catalogued and synthesized in relation to their reported study and sample design, and health outcome and built environment features.

RESULTS

Fifty-five articles met the inclusion criteria, 52 of which were published after 2008. Most single province studies were undertaken in Ontario (n = 22), Quebec (n = 12), and Alberta (n = 7). Associations between the built environment features and 11 broad health outcomes emerged from the review, including injury (n = 19), weight status (n = 19), cardiovascular disease (n = 5), depression/anxiety (n = 5), diabetes (n = 5), mortality (n = 4), self-rated health (n = 2), chronic conditions (n = 2), metabolic condi-tions (n = 2), quality of life (n = 1), and cancer (n = 1). Consistent evidence for associations between aggregate built environment indicators (e.g., walkability) and diabetes and weight and between connectivity and route features (e.g., transportation route, trails, pathways, sidewalks, street pattern, intersections, route characteristics) and injury were found. Evidence for greenspace, parks and recreation features impacting multiple health outcomes was also found.

CONCLUSION

Within the Canadian context, the built environment is associated with a range of chronic health conditions and injury in adults, but the evidence to date has limitations. More research on the built environment and health incorporating rigorous study designs are needed to provide stronger causal evidence to inform policy and practice.

Susceptibility to price discounting of soda by neighbourhood educational status: an ecological analysis of disparities in soda consumption using point-of-purchase transaction data in Montreal, Canada

Introduction

Price discounting is a marketing tactic used frequently by food industries and retailers, but the extent to which education modifies the effect of discounting on the purchasing of unhealthy foods has received little attention. We investigated whether there was a differential association of price discounting of soda with store-level soda purchasing records between 2008 and 2013 by store-neighbourhood education in Montreal, Canada.

Methods

Using data on grocery purchase transactions from a sample of supermarkets, pharmacies, supercentres and convenience stores, we performed an ecological time-series analysis, modelling weekly store-level sales of soda as a function of store-level price discounting, store- and neighbourhood-level confounders and an interaction term between discounting and categorical education in the neighbourhood of each store.

Results

Analysis by store type (n = 18 743, 12 437, 3965 and 49 533 store-weeks for superstores, pharmacies, supercentres and convenience stores, respectively) revealed that the effect measure modification of discounting by neighbourhood education on soda purchasing was lower in stores in the more educated neighbourhoods, most notably in pharmacies: -0.020 [95% confidence interval (CI): -0.028, -0.012] and -0.038 (95% CI: -0.051, -0.025), for middle- and high-education categories, respectively). Weaker effect modification was observed in convenience stores. There was no evidence of effect modification in supercentres or superstores.

Conclusions

Price discounting is an important environmental risk factor for soda purchasing and can widen education inequalities in excess sugar intake across levels of education. Interventions to regulate price discounting warrant further investigation as a public health strategy to improve population nutrition, particularly in lower-education neighbourhoods.

Describing Food and Beverage Restaurants: Creating A Reliable Coding Tool

Objective

To develop an informed, reliable data collection tool to code restaurants found within the youth food environment.

Methods

Registered Dietitians were surveyed and academic literature review was reviewed to determine health centric food environment features. Features were incorporated into an electronic data collection tool. Inter-rater reliability was tested across coders of varying nutrition training on all restaurants located within a half-mile of three high schools.

Results

Sixteen restaurant food environment codes were generated. Data collection had a mean inter-rater reliability of 90.7% agreement (range=81.3-100%), suggesting that regardless of nutrition training, the restaurant food environment can be reliability coded.

Conclusions

Academic and public health professionals can use this tool to collect reliable, informed local restaurant food environment data.

Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores

Background: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students’ dietary intentions/behaviors, and body mass index (BMI). Methods: Through multilevel structural equation modeling, a comparison was made of students’ healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. Results: Controlling for gender, HMI was negatively associated with SSBs (β = −0.859) and %kcal/fat (β = −1.057) and positively with whole-grains (β = 0.186) and fruits/vegetables intake (β = 0.267); %Kcal/fat was positively (β = 0.098) and fruits/vegetables intake (β = −0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (β = 0.214, β = 0.129) and directly/negatively to BMI (β = −2.657, β = −1.124). Conclusions: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.

Local Spatial Analysis and Dynamic Simulation of Childhood Obesity and Neighbourhood Walkability in a Major Canadian City

Body weight is an important indicator of current and future health and it is even more critical in children, who are tomorrow's adults. This paper analyzes the relationship between childhood obesity and neighbourhood walkability in Calgary, Canada. A multivariate analytical framework recognizes that childhood obesity is also associated with many factors, including socioeconomic status, foodscapes, and environmental factors, as well as less measurable factors, such as individual preferences, that could not be included in this analysis. In contrast with more conventional global analysis, this research employs localized analysis and assesses need-based interventions. The one-size-fit-all strategy may not effectively control obesity rates, since each neighbourhood has unique characteristics that need to be addressed individually. This paper presents an innovative framework combining local analysis with simulation modeling to analyze childhood obesity. Spatial models generally do not deal with simulation over time, making it cumbersome for health planners and policy makers to effectively design and implement interventions and to quantify their impact over time. This research fills this gap by integrating geographically weighted regression (GWR), which identifies vulnerable neighbourhoods and critical factors for childhood obesity, with simulation modeling, which evaluates the impact of the suggested interventions on the targeted neighbourhoods. Neighbourhood walkability was chosen as a potential target for localized interventions, owing to the crucial role of walking in developing a healthy lifestyle, as well as because increasing walkability is relatively more feasible and less expensive then modifying other factors, such as income. Simulation results suggest that local walkability interventions can achieve measurable declines in childhood obesity rates. The results are encouraging, as improvements are likely to compound over time. The results demonstrate that the integration of GWR and simulation modeling is effective, and the proposed framework can assist in designing local interventions to control and prevent childhood obesity.

Distribuição espacial da obesidade em área urbana no Brasil

Resumo A distribuição espacial de uma doença é importante para o diagnóstico e o conhecimento epidemiológico da situação e das tendências de saúde, permitindo uma melhor compreensão acerca dos fatores que determinam o estado de saúde das populações. O objetivo do estudo foi analisar a distribuição espacial da obesidade em adultos em Belo Horizonte, a partir da base de dados do Sistema de Vigilância de Fatores de Risco e de Proteção para Doenças Crônicas por Inquérito Telefônico de 2008 a 2010. A obesidade foi definida como índice de massa corporal 30 kg/m2. Foi desenvolvida uma base georreferenciada com os dados ambientais a partir do endereço e CEP do local. Empregou-se a estatística de varredura espacial. Uma análise comparativa das variáveis ambientais referentes aos conglomerados de maior e menor prevalência de obesidade foi realizada. Foi encontrado um conglomerado de indivíduos obesos na área central da cidade, sem significância estatística. Verificou-se, também, agrupamento significativo de indivíduos não obesos no leste da cidade. Esses resultados sugerem que as razões para a baixa prevalência de obesidade em áreas urbanas brasileiras podem estar relacionadas à melhor organização social e alta disponibilidade de comércios de alimentos e de locais para a prática de atividade física.

Do schools in Quebec foster healthy eating? An overview of associations between school food environment and socio-economic characteristics

Objective

A school environment that encourages students to opt for food with sound nutritional value is both essential and formative in ensuring that young people adopt healthy eating habits. The present study explored the associations between the socio-economic characteristics of the school environment and the school food environment.

Design

A cross-sectional survey was conducted in 2008–2009. Descriptive and bivariate analyses were performed on data from public primary and secondary schools.

Setting

Quebec, Canada. The school food offering was observed directly and systematically by trained research assistants. Interviews were conducted to fully describe food offerings in the schools and schools’ child-care services.

Subjects

A two-stage stratified sampling was used to build a representative sample of 143 French-speaking public schools. The response rate was 66·2 %.

Results

The primary and secondary schools in low-density areas were more likely to be located near diners (primary:P=0·018; secondary:P=0·007). The secondary schools in deprived areas were less likely to have a regular food committee (P=0·004), to seek student input on menu choices (P=0·001) or to have a long lunch period (P=0·010). The primary schools in deprived areas were less likely to have a food service (P=0·025) and their meal periods were shorter (P=0·033).

Conclusions

The schools in areas with lower socio-economic status provided an environment less favourable for a healthy diet. From a public health perspective, the results of this analysis could assist policy makers and managers to identify actions to support the creation of favourable school environments.

Association between neighbourhood fast-food and full-service restaurant density and body mass index: a cross-sectional study of Canadian adults

OBJECTIVE

Frequent fast-food consumption is a well-known risk factor for obesity. This study sought to determine whether the availability of fast-food restaurants has an influence on body mass index (BMI).

METHODS

BMI and individual-level confounding variables were obtained from the 2007-08 Canadian Community Health Survey. Neighbourhood socio-demographic variables were acquired from the 2006 Canadian Census. The geographic locations of all restaurants in Canada were assembled from a validated business registry database. The density of fast-food, full-service and non-chain restaurants per 10,000 individuals was calculated for respondents' forward sortation area. Multivariable regression analyses were conducted to analyze the association between restaurant density and BMI.

RESULTS

Fast-food, full-service and non-chain restaurant density variables were statistically significantly associated with BMI. Fast-food density had a positive association whereas full-service and non-chain restaurant density had a negative association with BMI (additional 10 fast-food restaurants per capita corresponded to a weight increase of 1 kilogram; p&lt;0.001). These associations were primarily found in Canada's major urban jurisdictions.

CONCLUSIONS

This research was the first to investigate the influence of fast-food and full-service restaurant density on BMI using individual-level data from a nationally representative Canadian survey. The finding of a positive association between fast-food restaurant density and BMI suggests that interventions aiming to restrict the availability of fast-food restaurants in local neighbourhoods may be a useful obesity prevention strategy.

Price, promotion, and availability of nutrition information: a descriptive study of a popular fast food chain in New York City

Legislation in NYC requires chain restaurants to post calorie information on menu boards in an effort to help consumers make more informed decisions about food and beverage items they are purchasing. While this is a step in the right direction in light of the current obesity epidemic, there are other issues that warrant attention in a fast food setting, namely the pricing of healthy food options, promotional strategies, and access to comprehensive nutrition information. This study focused on a popular fast-food chain in NYC. The study’s aims were threefold: (1) to determine the cost differential between the healthiest meal item on the chain’s general menu and meal items available specifically on a reduced cost menu for one dollar (US$1.00); (2) to identify and describe the promotions advertised in the windows of these restaurants, as well as the nutrition content of promoted items; and (3) to ascertain availability of comprehensive nutrition information to consumers within the restaurants. We found the healthiest meal item to be significantly higher in price than less nutritious meal items available for $1.00 (t = 146.9, p < .001), with the mean cost differential equal to $4.33 (95% CI $4.27, $4.39). Window promotions generally advertised less healthful menu items, which may aid in priming customers to purchase these versus more healthful options. Comprehensive nutrition information beyond calorie counts was not readily accessible prior to purchasing. In addition to improving access to comprehensive nutrition information, advertising more of and lowering the prices of nutritious options may encourage consumers to purchase healthier foods in a fast food setting. Additional research in this area is needed in other geographic locations and restaurant chains.