Correlates of sugar-sweetened beverages purchased for children at fast-food restaurants

Objectives. To determine consumer and fast-food purchase characteristics associated with the purchase of a sugar-sweetened beverage, as well as calories and grams of sugar, for children at a fast-food restaurant. Methods. We completed cross-sectional analyses of fast-food restaurant receipts and point-of-purchase surveys (n = 483) collected during 2013 and 2014 in New York City and Newark and Jersey City, New Jersey. Results. Caregivers purchased beverages for half of all children in our sample. Approximately 60% of these beverages were sugar-sweetened beverages. Fast-food meals with sugar-sweetened beverages had, on average, 179 more calories than meals with non-sugar-sweetened beverages. Being an adolescent or male, having a caregiver with a high school degree or less, having a caregiver who saw the posted calorie information, ordering a combination meal, and eating the meal in the restaurant were associated with ordering a sugar-sweetened beverage. Purchases that included a combination meal or were consumed in the restaurant included more beverage grams of sugar and calories. Conclusions. Characteristics of fast-food purchases appear to have the largest and most important association to beverage calories for children at fast-food restaurants. Targeting fast-food restaurants, particularly combination meals, may improve childhood obesity rates.