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Am J Public Health. 2015 Mar;105(3):546-53. doi: 10.2105/AJPH.2014.302262. Epub 2015 Jan 20.

Changes in awareness and use of calorie information after mandatory menu labeling in restaurants in King County, Washington.

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Roxana Chen, Michael Smyser, Nadine Chan, and Myduc Ta are with Public Health-Seattle & King County, Washington. James Krieger is with Action for Healthy Food, Washington. Brian E. Saelens is with Seattle Children's Hospital Research Institute, University of Washington. Roxana Chen, Michael Smyser, Nadine Chan and James Krieger are also with the University of Washington, Seattle.



We examined population-level impact on customer awareness and use and explored potential disparities in outcomes regarding the King County, Washington, regulation requiring chain restaurants to provide calorie information.


We analyzed 2008 to 2010 Behavioral Risk Factor Surveillance System data from 3132 English-speaking King County residents aged 18 years and older who reported eating at a regulated chain. We used regression models to assess changes in calorie information awareness and use from prepolicy to postpolicy implementation by customer demographics, health status, and restaurant type.


Calorie information awareness and use increased significantly from 2008 to 2010. Unadjusted analyses indicated that the proportion who saw and used calorie information tripled, from 8.1% to 24.8%. Fully adjusted analyses confirmed significant increases. After policy implementation, White, higher income, and obese respondents had greater odds of seeing calorie information. Women, higher income groups, and those eating at a fast-food versus a sit-down chain restaurant were more likely to use this information.


Significant increases in calorie information awareness and use following regulation support the population-wide value of this policy. However, improvements varied across race, income, and gender.

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