Evaluating Fast Food Nutrition and Marketing to Youth

Jennifer L. Harris, Ph.D., M.B.A. Marlene B. Schwartz, Ph.D. Kelly D. Brownell, Ph.D.

Fast Food FACTS: Evaluating Fast Food Nutrition and Marketing to Youth
Authors: Jennifer L. Harris, PhD, MBA Marlene B. Schwartz, PhD Kelly D. Brownell, PhD Vishnudas Sarda, MBBS, MPH Amy Ustjanauskas Johanna Javadizadeh, MBA Megan Weinberg, MA Christina Munsell, MS Sarah Speers Eliana Bukofzer, MPH Andrew Cheyne, MA Priscilla Gonzalez Jenia Reshetnyak, MS Henry Agnew Punam Ohri-Vachaspati, PhD Rudd Center for Food Policy and Obesity November, 2010 Revised December 3, 2010

Acknowledgements
We would like to thank the following people for their valuable assistance in collecting data: Kelly Barrett Hannah Byrnes-Enoch, MPH Casey Carden Ashley Firth, MA Jay Imus Sharon Kirkpatrick, PhD, MHSc Sue Krebs-Smith, PhD, MPH, RD Carly Litzenberger Julie McComish Catherine Montgomery Kathryn OShaughnessy Doug Ranshaus Warren Sethachutkul Hannah Sheehy Kate Stearns Jill Reedy, PhD, MPH, RD Jackie Thompson Shannon Vargo Catherine Wright We would also like to thank our steering committee and other advisors: Frank Chaloupka, PhD William H. Dietz, MD, PhD Lori Dorfman, DrPH Steve Fajen Corinna Hawkes, PhD Shiriki Kumanyika, PhD, MPH Tim Lobstein, PhD Susan T. Mayne, PhD C. Tracy Orleans, PhD Lisa M. Powell, PhD Amelie Ramirez, DrPH Mike Rayner, PhD Mary Story, PhD, RD Stephen Teret, JD, MPH Ellen Wartella, PhD James G. Webster, PhD Jerome D. Williams, PhD Thank you to our colleagues at the Rudd Center, especially Rebecca Oren, Andrea Wilson, Megan Orciari and Tricia Wynne. We thank Cavich Creative, LLC, Chris Lenz, and Marian Uhlman for their assistance in preparing the manuscript and website. Finally, we thank the leadership and staff at the Robert Wood Johnson Foundation, with special thanks to the Childhood Obesity Team.

Support for this project was provided by grants from the Robert Wood Johnson Foundation and the Rudd Foundation.

Table of Contents

List of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv Ranking Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Appendix Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Fast food menus and nutritional quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Marketing practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Marketing outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Overview of fast food market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Fast food menu composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Menu items and special menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Nutritional quality of all menu items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Dollar/value menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Healthy menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Kids meals nutritional quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Best and worst kids' meal choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Traditional media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Advertising spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 TV advertising exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Content analysis of TV advertisements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Ethnic and racial targeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Internet and other digital media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Restaurant websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Banner advertising on third-party websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Social media marketing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Mobile marketing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Marketing inside restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Restaurant signs audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Pricing analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Sales practices audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Marketing outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Restaurant visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Special menus and menu items purchased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Ranking Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 A. Fast food menu composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 B. Traditional media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 C. Internet and other digital media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 D. Marketing inside restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 E. Marketing outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Fast Food FACTS

iii

List of Tables
Table 1: Maximum acceptable calories and sodium for kids meals and individual menu items . . . . . . . . . . . . . . . . . . 20 Table 2: Sales of top 20 fast food restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 3: Number of menu items per restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 4: Special menus by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Table 5: Nutrient content of menu items by food category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Table 6: Nutrient content of menu items by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Table 7: Changes in sizes of soft drinks and french fries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 8: Number of menu items available on dollar/value menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Table 9: Nutrient content of menu items available on dollar/value menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 10: Number of menu items available on healthy menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 11: Nutrient content of menu items available on healthy menus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 12: Number of menu items and combinations available for kids meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 13: Summary nutritional quality information for kids meal combinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 14: Total advertising spending by fast food restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Table 15: Fast food restaurant TV advertising exposure for youth: Ads viewed in 2008 and 2009 . . . . . . . . . . . . . . . . 52 Table 16: Fast food restaurant TV advertising exposure for adults: Ads viewed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 17: Change in TV advertising exposure from 2008 to 2009 by restaurant and age group . . . . . . . . . . . . . . . . . . 54 Table 18: Youth exposure to TV advertising in 2009 by product category and age group . . . . . . . . . . . . . . . . . . . . . . 55 Table 19: Product categories by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Table 20: Restaurants and product categories targeted to children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 21: Restaurants and product categories targeted to teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 22: African American youth exposure to fast food advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 23: Restaurants and product categories targeted to African American children and teens . . . . . . . . . . . . . . . 64 Table 24: Hispanic youth exposure to fast food advertising on Spanish-language TV . . . . . . . . . . . . . . . . . . . . . . . . . 65 Table 25: Restaurants and product categories advertised on Spanish-language TV . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 26: Three most frequently advertised menu items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 27: Total nutrient content of items in TV ads viewed by youth every day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 28: Nutrient content of menu items advertised on TV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 29: Nutrient content of fast food products presented daily in TV ads viewed by African American and white youth on English-language TV and Hispanic youth on Spanish-language TV . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 30: Child-targeted websites ranked by level of engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 31: Main restaurant websites ranked by level of engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Table 32: Average monthly exposure to child-targeted websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 33: Average monthly exposure to main restaurant websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Table 34: Websites with a disproportionate number of African American youth visitors in 2009 . . . . . . . . . . . . . . . . . . 81 Table 35: Banner advertising exposure by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

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Table 36: Exposure to child-targeted banner ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Table 37: Banner ads with a high proportion of ads viewed on youth websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 38: Exposure to racial- and ethnic-targeted banner ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Table 39: Facebook pages and fans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Table 40: Restaurant Twitter accounts and followers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Table 41: Specific menu items mentioned in Twitter accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 42: Restaurant YouTube channels, viewers, and videos posted in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Table 43: Ten mobile websites with the most frequent placement of restaurant banner ads . . . . . . . . . . . . . . . . . . . . . 97 Table 44: Mobile banner ad placements by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table 45: Top five monthly ad placements as measured by ad index for each restaurant . . . . . . . . . . . . . . . . . . . . . . 98 Table 46: Smartphone application functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 47: iPhone application demographic profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Table 48: Average number of featured menu items per restaurant by location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 49: Number of menu type signs per restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table 50: The percentage of menu item signs with theme and promotion messages . . . . . . . . . . . . . . . . . . . . . . . . . 106 Table 51: Percentage of featured menu items on signs for each special menu and food category by restaurant . . . 107 Table 52: Special menu and food category items featured on signs in different store locations . . . . . . . . . . . . . . . . . 107 Table 53: NPI score, and weighted average calories and sodium content of menu items featured in signs at each restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Table 54: The three menu items featured most frequently on signs at each restaurant . . . . . . . . . . . . . . . . . . . . . . . . 109 Table 55: NPI score and weighted average calories and sodium content of menu items featured on restaurant signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table 56: Menu items that appeared on signs with price promotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table 57: Average price, calories, and NPI scores for healthiest and less healthy options at restaurants . . . . . . . . . . 111 Table 58: Restaurants with child-targeted marketing in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Ranking Tables
1: Nutritional quality of food item categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 2: Nutritional quality of beverage categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 3: Nutritional quality of kids' meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 4: Advertising spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 5: Television advertising exposure to children by product category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 6: Television advertising exposure to teens by product category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 7: Television advertising exposure to African American and Hispanic youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 8: Radio advertising exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 9: Restaurant website exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 10: Banner advertising exposure by product . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 11: Social media exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 12: Restaurant signs and nutritional quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167

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Appendix Tables
A1: Adjustments to restaurant menus for menu standardization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 A2: Kids meal menu items and their nutrient information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 B1: Exposure data by demographic group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178 B2: Content analysis of general audience TV ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 B3: Content analysis of child-targeted TV ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 B4: Content analysis of Spanish-language TV ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186 B5: Nutritional quality of TV ads by age and race or ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 C1: Content analysis of child-targeted websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 C2: Content analysis of main restaurant websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 C3: Content analysis of banner ads on third-party websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 D1: Average number of featured items on signs by special menu and food category . . . . . . . . . . . . . . . . . . . . . . . . 200 D2: Individual menu item pricing analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 E1: Menu importance for all quickserve restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 E2: Average calories and sodium per visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206

List of Figures
Figure 1: Spending by fast food restaurants on marketing directly targeted to children and adolescents . . . . . . . . . . . 13 Figure 2: Model of fast food marketing components, strategies, and outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Figure 3: Proportion of menu items offered by food category for the twelve restaurants in our analysis . . . . . . . . . . . . 37 Figure 4: Percentage of menu items by food category that met minimum NPI score, maximum calorie and sodium limits, and all three nutrition criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Figure 5: Percentage of menu items by restaurant that met minimum NPI, maximum calorie and sodium limits, and all three nutrition criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Figure 6: Soft drink sizes by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Figure 7: French fries sizes by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Figure 8: Proportion of dollar/value menu items offered by food category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Figure 9: Percentage of dollar/value menu items that met minimum NPI score, maximum calorie and sodium limits, and all three nutrition criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Figure 10: Proportion of healthy menu items offered by menu category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Figure 11: Percentage of healthy menu items that met minimum NPI score, maximum calorie and sodium limits, and all three nutrition criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Figure 12: Proportion of kids meal combinations that met maximum calories and sodium and all nutrition criteria for elementary and preschool-age children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Figure 13: Advertising spending in 2008 and 2009 by restaurant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Figure 14: Youth TV advertising exposure by restaurant in 2009 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Figure 15: Increase in average annual advertising exposure by age group: 2003 to 2009 . . . . . . . . . . . . . . . . . . . . . 54 Figure 16: Composition of advertising exposure in 2009 by product category and age group . . . . . . . . . . . . . . . . . . 56 Figure 17: Messages in general audience TV advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

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Figure 18: Messages in child-targeted TV advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Figure 19: Messages in Spanish-language TV advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Figure 20: Calories viewed daily in fast food TV ads by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Figure 21: Calories viewed daily in fast food TV ads by age and race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Figure 22: Engagement techniques and featured third parties on child-targeted websites . . . . . . . . . . . . . . . . . . . . . 73 Figure 23: Products and health messages promoted on child-targeted websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Figure 24: Most common products, selling points and messages appearing on main restaurant websites . . . . . . . . . 77 Figure 25: Engagement techniques and featured third parties on main restaurant websites . . . . . . . . . . . . . . . . . . . . 78 Figure 26: Products and nutrition promoted on main restaurant websites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Figure 27: Product types featured in internet banner ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Figure 28: Selling points featured in internet banner ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Figure 29: Banner ads with specific engagement techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Figure 30: Frequency of posts and number of tabs on restaurant Facebook pages . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Figure 31: Facebook wall posts with outbound links to other internet pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Figure 32: Average number of videos and photo albums on Facebook pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Figure 33: Wall posts that mentioned specific products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Figure 34: Examples of customer service-oriented tweets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Figure 35: Examples of restaurant tweets with outbound links . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Figure 36: Examples of Twitter contests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Figure 37: Challenges issued in Wendys Hunt for the Biggest Bacon Lover contest . . . . . . . . . . . . . . . . . . . . . . . . . 93 Figure 38: Main products and messages in 2009 YouTube videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Figure 39: Restaurants with banner advertising on mobile websites by month in 2009 . . . . . . . . . . . . . . . . . . . . . . . . 96 Figure 40: Types of mobile websites on which restaurant banner ads appeared in 2009 . . . . . . . . . . . . . . . . . . . . . . . 97 Figure 41: Selling points and main products on mobile banner ads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Figure 42: Social media footprint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Figure 43: Location of signs at restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Figure 44: Messages and promotions on menu item signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Figure 45: Proportion of featured menu items on signs by special menu and food category . . . . . . . . . . . . . . . . . . . 106 Figure 46: How sides were offered in kids meal orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Figure 47: Sides received with kids meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Figure 48: How beverages were offered in kids meal orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Figure 49: Beverages received with kids meal orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Figure 50: How sides were offered with combo meals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Figure 51: Size of combo meals received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Figure 52: Cheese modifications in fast food orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Figure 53: How often parents reported taking their children to the twelve fast food restaurants . . . . . . . . . . . . . . . . . 116 Figure 54: How often parents reported that their child asked to go to the twelve fast food restaurants . . . . . . . . . . . . 117

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Figure 55: Parents reporting visits to fast food restaurants a few time per month or more often: Restaurants with differences by race and ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Figure 56: Parents reporting that their child requested to go to fast food restaurants a few times per month or more: Restaurants with differences by race and ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Figure 57: Main reason that parents chose to go to fast food restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Figure 58: All fast food restaurant visits by time of day for children and teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Figure 59: Percentage of all fast food restaurant visits by place of consumption and ordering method for children and teens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Figure 60: Parents orders for their child by menu type, restaurant, and age of child . . . . . . . . . . . . . . . . . . . . . . . . . 121 Figure 61: Main reason parents reported choosing a kids meal for their child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Figure 62: Purchases from special menus by youth at all fast food and burger restaurants . . . . . . . . . . . . . . . . . . . . 122 Figure 63: Side dishes ordered with kids meals by restaurant and age of child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Figure 64: Beverages ordered with kids meals by restaurant and age of child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Figure 65: Beverages ordered with kids meals by race and ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Figure 66: Percentage of beverages ordered by size at all fast food restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Figure 67: Percentage of french fries ordered by size at burger restaurants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Figure 68: Menu importance of food and beverage categories by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Figure 69: Menu importance of main dish items by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Figure 70: Menu importance of beverages by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Figure 71: Menu importance of food categories purchased by white, Hispanic, and African American youth (under 18 years) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Figure 72: Menu importance of main dishes purchased by white, Hispanic, and African American youth (under 18 years) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Figure 73: Menu importance of beverages purchased by white, Hispanic, and African American youth (under 18 years) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Figure 74: Excess calories in menu items purchased per visit by restaurant and age group . . . . . . . . . . . . . . . . . . . 128 Figure 75: Excess sodium in menu items purchased per visit by restaurant and age group . . . . . . . . . . . . . . . . . . . 129 Figure 76: Excess calories in menu items purchased per visit by restaurant and race/ethnicity . . . . . . . . . . . . . . . . 129 Figure 77: Excess sodium in menu items purchased per visit by restaurant and age/ethnicity . . . . . . . . . . . . . . . . . . 130

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Executive Summary Why fast food?

The research is clear. Eating fast food harms young peoples health. Children and adolescents who eat fast food consume more calories, fat, sugar, and sugar-sweetened beverages and less fiber, milk, fruit, and vegetables than peers who do not.1-4 If they ate fast food only occasionally, this would not be problematic. But every day, one-third of American children and adolescents eat fast food,5 and fast food contributes 16% to 17% of adolescents total caloric intake.6 Fast food restaurants extensively market to young people.. In 2006, fast food restaurants spent approximately $300 million in marketing specifically designed to reach children and teens, and an estimated $360 million on toys distributed as premiums with childrens meals.7 In 2007, young people viewed more TV ads for fast food than any other food category: 2.9 fast food ads per day for the average child (6-11 years) and 4.1 per day for the average teen (12-17 years).8 These marketing efforts are targeted even to preschoolers.9 In addition, childrens exposure to fast food TV advertising increased by 12% from 2003 to 2007 at the same time that advertisers for most other food product categories reduced their TV ads to children.10 The White House Task Force on Childhood Obesity has stated that restaurants have an important role to play in creating a food marketing environment that supports, rather than undermines, the efforts of parents and other caregivers to encourage healthy eating among children and prevent obesity.11 The fast food industry has responded to this and other calls for change.12 Two of the largest fast food advertisers to children, McDonalds and Burger King, have joined the Childrens Food and Beverage Advertising Initiative (CFBAI), pledging to advertise only better-for-you choices to children.13 Most restaurants have also introduced more nutritious options for both children and adults to their menus.14 But critical questions remain: Do these actions have a positive impact? Or, does the sheer volume of fast food marketing eclipse any of these industry initiatives? and signs outside restaurants. We use syndicated media data from The Nielsen Company (Nielsen), comScore Inc., and Arbitron Inc. When these data were not available, we commissioned or implemented our own studies to measure the extent that restaurants engaged in these practices. In addition, we conducted content analyses to assess the products, target audiences, messages, and techniques in the ads.

In-store marketing presents data to assess marketing practices inside restaurants to push sales of individual menu items. This research includes an audit of more than 1,000 restaurants nationwide to measure in-store signs, pricing practices, and the products and messages promoted. We also conducted a study of restaurant sales practices at 250 restaurants to document the products encouraged at the point-of-sale when ordering kids meals and combo meals.

To measure the outcomes of these marketing practices, we purchased market research data from The NPD Groups CREST service to quantify the types of products most often purchased. We also conducted a survey of parents of 2- to 11-year-olds to measure the frequency of their visits to fast food restaurants with their children, what menu items they buy, and why.

Results
Fast food marketing is relentless.

The fast food industry spent more than $4.2 billion in 2009 on TV advertising, radio, magazines, outdoor advertising, and other media. The average preschooler (2-5 years) saw 2.8 TV ads for fast food every day in 2009; children (6-11 years) saw 3.5; and teens (12-17 years) saw 4.7. Young peoples exposure to fast food TV ads has increased. Compared to 2003, preschoolers viewed 21% more fast food ads in 2009, children viewed 34% more, and teens viewed 39% more. McDonalds and Burger King have pledged to improve food marketing to children. However, both restaurants increased their volume of TV advertising from 2007 to 2009. Preschoolers saw 21% more ads for McDonalds and 9% more for Burger King, and children viewed 26% more ads for McDonalds and 10% more for Burger King. Although McDonalds and Burger King only showed their better-for-you foods in child-targeted marketing, their ads did not encourage consumption of these healthier choices. Instead, child-targeted ads focused on toy giveaways and building brand loyalty. Children saw more than just child-targeted ads. More than 60% of fast food ads viewed by preschoolers and children promoted fast food items other than kids meals and promotions.

Fast Food FACTS

This report addresses the need for comprehensive, reliable, and current information about fast food marketing and how it affects young people. We focus our analyses on the twelve restaurants with the highest sales and advertising to youth in 2009 and document three components of their marketing plans:

Menu composition provides nutrient content data and comparison of all menu items offered as of January 2010, including items on kids meal, dollar/value, and healthy menus. External advertising includes data to measure advertising practices that reach customers outside the restaurant to pull them inside. We examine advertising spending, TV ads, internet marketing, social media, viral marketing,

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Executive Summary
Youth-targeted marketing has spread to company websites and other digital media.

McDonalds web-based marketing starts with children as young as 2 at Ronald.com. McDonalds and Burger King created sophisticated websites with 60 to 100 pages of advergames and virtual worlds to engage children (McWorld.com, HappyMeal. com, and ClubBK.com). McDonalds thirteen websites attracted 365,000 unique child visitors and 294,000 unique teen visitors on average each month in 2009. Nine restaurant Facebook pages had more than one million fans as of July 2010, and Starbucks boasted more than 11.3 million fans. Smartphone apps were available for eight fast food chains, providing another opportunity to reach young consumers anytime, anywhere.

Most restaurants do offer some healthful and lower-calorie choices on their regular and childrens menus, but unhealthy options are the default inside the restaurants.

Just 12 of 3,039 possible kids meal combinations met nutrition criteria for preschoolers; 15 met nutrition criteria for older children. Just 17% of regular menu items qualified as healthful choices. Most of these items were low or no-calorie beverages (e.g., coffee and diet soft drinks). In contrast, 12% of lunch/dinner sides met nutrition criteria, and 5% or less of lunch/dinner main dishes and breakfast items met the criteria. Snacks and dessert items contained as many as 1,500 calories, which is five times more than the 200 to 300 calorie snack recommended by the American Dietetic Association for active teens.15 The average restaurant had 15 signs promoting specific menu items, but just 4% promoted healthy menu items. When ordering a kids meal, restaurant employees at McDonalds, Burger King, Wendys, and Taco Bell automatically served french fries or another unhealthy side dish more than 84% of the time. A healthy beverage was offered less than 50% of the time. Subway offered apple slices or yogurt and low-fat plain milk or 100% juice with their kids meals 60% of the time, making it the only fast food restaurant in our study to routinely provide healthy choices.

Fast food marketing also targets teens and ethnic and minority youth often with less healthy items.

Taco Bell TV and radio advertising reached more teens than adults and Burger King advertised teen-targeted promotions. Dairy Queen, Sonic, and Dominos also reached teens disproportionately with ads for their desserts and snacks. Hispanic preschoolers saw 290 Spanish-language fast food TV ads in 2009 and McDonalds was responsible for onequarter of young peoples exposure to Spanish-language fast food advertising. African American children and teens saw at least 50% more fast food ads on TV than their white peers. That translated into twice as many calories viewed in fast food ads daily compared to white children. McDonalds and KFC specifically targeted African American youth with TV advertising, websites, and banner ads. African American teens viewed 75% more TV ads for McDonalds and KFC compared to white teens.

As a result,

At McDonalds, Burger King and Wendys, approximately two-thirds of parents who ordered a kids meal for their child ordered french fries and one-third to one-half ordered a soft drink. In contrast, two-thirds ordered fruit or yogurt and juice or plain milk with a kids meal at Subway. Parents of elementary school-age children were more likely to order a combo meal or dollar/value menu items for their child than a kids meal. Teens between the ages of 13 and 18 ordered 800 to 1,100 calories in an average fast food visit. This age group ordered many of the highest-calorie, nutrient-poor items on fast food menus, including large and extra-large french fries and soft drinks and large-sized burgers. Teens were also more likely to visit a fast food restaurant for an afternoon or evening snack compared to any other age group; and they purchased the most desserts, breads and sweet breads. At least 30% of calories in menu items ordered by children and teens were from sugar and saturated fat. At most restaurants, young people ordered at least half of their maximum daily recommended sodium intake in just one fast food meal.

Fast food marketing works.

Eighty-four percent of parents reported taking their child to a fast food restaurant at least once in the past week; 66% reported going to McDonalds. Forty-seven percent of parents who went to McDonalds reported that the main reason they went there was because their child likes it. This rate was significantly higher than the percent who reported that they took their child to Burger King, Subway, or Wendys primarily because their child likes it (31%, 20%, 19%, respectively) Forty percent of parents reported that their child asks to go to McDonalds at least once a week; 15% of preschoolers ask to go every day.

Fast Food FACTS

Executive Summary Recommendations

Young people must consume less of the calorie-dense, nutrient-poor foods served at fast food restaurants. Parents and schools can do more to teach children how to make healthy choices. Above all, fast food restaurants must drastically change their current marketing practices so that children and teens do not receive continuous encouragement to seek out food that will severely damage their health. In addition, when young people visit, the restaurants should do more to encourage the purchase of more healthful options.

Restaurants must increase the relative number of lowcalorie, more nutritious items on their menus. Popular items should be reformulated to decrease the saturated fat, sodium, and calories in the average entre. Kids meal options must be developed to meet the nutrition needs of both the preschoolers and older children who consume them.

Fast food restaurants must establish meaningful standards for child-targeted marketing that apply to all fast food restaurantsnot just those who voluntarily participate in the CFBAI

Fast food restaurants must do more to push their lower-calorie and more nutritious menu items inside the restaurants when young people and parents make their final purchase decisions

Restaurants must apply better-for-you standards to kids meals served, not just items pictured in child-directed marketing. Restaurants must redefine child-directed marketing to include TV ads and other forms of marketing viewed by large numbers of children but not exclusively targeted to them. Child-targeted marketing must do more to persuade children to want the healthy options available, not just to encourage them to visit the restaurants. McDonalds must stop marketing directly to preschoolers.

Healthier sides and beverages must be the default option when ordering kids meals. Parents can request french fries and soft drinks if they want, but parents not restaurants should make that decision. McDonalds claims that it sells millions of Happy Meals. Simply making the healthy option the default could reduce childrens consumption by billions of calories per year. The smallest size and most healthful version should be the default option for all menu items. Portion sizes (e.g., small, medium, and large) should be consistent for similar menu items across restaurants.

Fast food restaurants must do more to develop and promote lower-calorie and more nutritious menu items

The focus in all forms of marketing must be reversed to emphasize the healthier options instead of the high-calorie poor quality items now promoted most extensively.

According to the data in this report, fast food restaurants spend billions of dollars in marketing every year to increase the number of times that customers visit their restaurants, encourage visits for new eating occasions and purchases of specific menu items (rarely the healthy options), and create lifelong, loyal customers. By creating more healthful items and marketing them more effectively, fast food restaurants could attract lifelong customers who will also live longer, healthier lives.

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Introduction
Restaurants have an important role to play in creating a food marketing environment that supports, rather than undermines, the efforts of parents and other caregivers to encourage healthy eating among children and prevent obesity,1 according to the White House Task Force on Childhood Obesity.
The harmful effects of food marketing on child and adolescent health have been discussed widely in recent years. In 2006 the Institute of Medicine (IOM) released a report about childrens food marketing beginning with two words, marketing works.2 In the same year, the World Health Organization (WHO) issued a report, noting that exposure to the commercial promotion of energy-dense, micronutrient-poor foods and beverages can adversely affect children's nutritional status.3 Both the IOM and WHO reports highlighted the dire state of childrens food marketing and called for sweeping changes. These reports called into question the assertion by food industry proponents that food marketing to children only affects brand preferences (e.g., purchases at McDonalds instead of Burger King) and does not increase total purchases of food categories such as fast food.4 However, they left open the possibility that food companies might be persuaded by good will, public pressure, or the threat of government regulation to change their marketing practices. Much has transpired since the release of the WHO and IOM reports. In the fast food industry, two of the largest fast food advertisers (McDonalds and Burger King) have joined the Childrens Food and Beverage Advertising Initiative (CFBAI) and pledged to advertise only better-for-you choices to children;5 the majority of restaurants have introduced more nutritious options to their menus for both children and adults;6 and most fast food restaurants will soon be required by federal law to post calories for all items on their menu boards.7 The critical question is whether industry promises will reverse the unhealthy defaults that exist in the current fast food marketing environment.8 Consumption of fast food is associated with a number of negative health consequences, most notably unhealthy diet that increases risk for obesity.9 10 Fast food restaurants spend more than $660 million each year to market their products and brands to children and adolescents.11 This report describes what is being marketed by these restaurants, who they are targeting and how they reach them, and what happens when young people visit fast food restaurants. science-based evaluations of the marketing conducted by specific companies within different food categories, as well as the nutritional quality of the food products promoted. In 2009, we published the Cereal FACTS report that provided a comprehensive review of cereal marketing targeted to children and adolescents (www.CerealFacts.org). We now focus on the fast food industry. Fast Food FACTS quantifies the nutritional quality of fast food restaurant menus and documents the full array of marketing practices used to promote these restaurants and their products to children and adolescents. The data presented in this report provide a means to evaluate current marketing practices and their impact, and offer a metric against which future changes can be monitored. We incorporate the same media measurement data used by advertisers to quantify exposure to TV, radio, and digital marketing. We also include market research data used to monitor competitors product sales. In addition, we conducted our own quantitative and qualitative research to measure menu item nutritional quality; the messages and products presented in TV, internet and other forms of digital marketing; in-store marketing practices; and parent attitudes about fast food restaurants. When possible, we evaluated differences by target populations, focusing on children, adolescents, and African American and Hispanic youth. Although this analysis is the most extensive of its type ever undertaken, we could not evaluate every fast food restaurant. Therefore, we focused our data collection on twelve fast food restaurants, including the ten largest sellers and/or marketers of fast food to young people.

Why fast food?

During the last several decades, food patterns have shifted in the United States with Americans consuming a greater proportion of their total calories outside the home.12 13 In 1994-96, 10% of young peoples caloric intake came from fast food, a five-fold increase compared to twenty years earlier.14 Data from the mid-1990s also showed that one third of young people (4-19 years) ate fast food every day.15 Portion sizes offered by fast food restaurants also grew during this time period, with individual items from two to five times larger than they were when originally introduced.16 More recent data from 2003-04 indicate that fast food now contributes 16% to 17% of adolescents total caloric intake,17 and each meal consumed in a fast food or other restaurant increases adolescents daily intake by 108 calories.18 Given the considerable role fast food plays in young peoples diets, the nutritional quality of menu items offered in fast food restaurants is a critical concern. A recent study of the nutrient quality of childrens meals available at fast food restaurants found that only 3% met the nutrition standards set by the National School Lunch Program for foods served to children eight years of age and younger.19 That study also found that less than one-third of these meals provided adequate calcium or iron and more than half exceeded recommended sodium

Aims and context

In 2008, the Rudd Center for Food Policy and Obesity at Yale University received a grant from the Robert Wood Johnson Foundation to study the amount and impact of food marketing directed at children and youth. The goal was to highlight both helpful and harmful industry practices by conducting objective,

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Introduction
levels. Additionally, restaurants encourage over-consumption of these nutrient-poor foods by promoting combination meals that offer price savings for larger portion sizes and in-store signs that encourage unhealthy eating and overeating.20 There is reason to be concerned about the impact of fast food consumption on young peoples overall nutrition and health. Young people who eat fast food consume more total fat, added sugars, and sugar-sweetened beverages, and less fiber, milk, and fruits and vegetables compared to children who do not eat fast food.21-23 Greater consumption of fast food is also associated with higher energy intake overall and greater risk of future obesity.24-26 Adults who visit fast food restaurants and reside in neighborhoods with a high density of fast food restaurants and low walkability have increased blood pressure over time.27 Furthermore, African American youth, a population that faces some of the highest risks of obesity and obesity-related diseases, consume more fast food compared to white children of the same age.28 29 packaging and in-store marketing; and in-school and events marketing (see Figure 1).35 Fast food brands also commonly use digital marketing techniques, including social media, ingame marketing, and viral media to increase the appeal of their products to young people.36 Schools/events $18 mill. Packaging/in-store Other $22 mill. $7 mill. Promotions $30 mill. Radio $30 mill.

Toy giveaways $360 mill. TV $187 mill.

Marketing to young people

In light of increased consumption of fast food by young people and its negative influence on their diet and health, public health advocates and government officials have expressed concern about marketing that encourages young people to consume fast food. In 2006, fast food restaurants spent approximately $300 million in marketing specifically designed to reach young people, more than any food category except for carbonated beverages.30 Fast food restaurants spent as much as marketers of juices, non-carbonated beverages and snack foods combined, and nearly two and a half times the amount spent for candy and frozen desserts. In addition, fast food marketers spent an estimated $360 million on toys distributed as premiums with childrens meals. When added to their other marketing expenditures, spending on fast food marketing programs targeted to children and teens totaled $660 million. This amount is more than 200 times the $3 million communications budget for the 5 A Day campaign, a joint venture with the National Cancer Institute (NCI) and the food industry, to encourage fruit and vegetable consumption.31 Approximately two-thirds of fast food marketing budgets was spent on traditional TV and radio advertising.32 In 2007, fast food advertising comprised 22% of TV food ads viewed by children (ages 6 to 11 years) and 28% of those viewed by adolescents.33 Children and adolescents viewed more ads for fast foods than for any other food category. The average U.S. child viewed 1,058 TV ads for fast food annually, or 2.9 ads every day, and adolescents viewed even more: almost 1,500 per year, or 4.1 per day. These marketing efforts begin as early as preschool: 66% of child-targeted advertising during preschool programming promoted fast food restaurants.34 Fast food companies also spent considerable sums on youthtargeted radio advertising; cross-promotions, and other tieins with philanthropies and athletic sponsorships; product

Figure 1: Spending by fast food restaurants on marketing directly targeted to children and adolescents There is considerable evidence that exposure to marketing for fast food is even higher among African American and Hispanic youth.38 African American youth view almost 50% more TV advertisements for fast food than do white children and adolescents.39 Although differences in advertising exposure can be attributed in large part to the greater amount of time that African American and Hispanic youth spend watching television,40 fast food restaurants appear to disproportionately target African Americans and Hispanics with their marketing efforts. For example, fast food ads appear more frequently during African American-targeted TV programming than during general audience programming.41 Fast food advertisements are also prevalent on Spanish-language television networks, comprising nearly half of all ads.42 Billboards for fast food restaurants appear significantly more often in low-income African American and Latino neighborhoods.43 Fast food restaurants located in poorer African American neighborhoods also promote less-healthful foods and have more in-store advertisements compared to restaurants in more affluent, predominantly white neighborhoods.44 The 2010 report by the White House Task Force on Childhood Obesity explicitly addresses the potentially harmful effects of fast food marketing, noting the frequency with which children eat at fast food restaurants and calling on restaurants to consider their portion sizes, improve childrens menus, and make healthy options the default choice whenever possible.45

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Recent restaurant industry initiatives to address childhood obesity
The restaurant industry has responded to concerns about the nutritional quality of their products and the volume of marketing targeted to young people. According to the National Restaurant Association, two-thirds of quickserve operators offer more healthful choices for children than they did two years ago,46 and McDonalds says that, any fair and objective review of our menu and the actions weve taken will demonstrate weve been responsible, were committed to childrens well-being, and well continue to do more.47 The two largest fast food marketers to children, McDonalds and Burger King, joined the Childrens Food and Beverage Initiative (CFBAI), an industry-sponsored program to change the landscape of child-directed advertising.48 As members of the CFBAI, these two restaurants have pledged to depict only pledge-approved, better-for-you products in their child-directed measured media (i.e., television, radio, thirdparty internet and print), company-owned websites and interactive games. These pledges were fully implemented by the beginning of 2009. While the CFBAI represents an industry-led effort to reduce unhealthy marketing to children, numerous omissions and loopholes raise questions about the fast food industrys commitment to change the landscape of childrens food advertising. For example, only McDonalds and Burger King had joined the initiative as of September 2010.49 These two restaurants are the largest advertisers to children on television. However, other restaurants contribute more than half of the fast food ads children view.50 Notably, Subway and YUM! Brands, whose restaurants include KFC, Taco Bell, and Pizza Hut, had not joined the CFBAI at the time of this reports publication. So in spite of reductions in childrens exposure to McDonalds and Burger King advertising on television, childrens exposure to all fast food TV advertising increased by 12% from 2003 to 2007.51 This increase occurred at the same time that childrens exposure to TV advertising for other product categories (including beverages, cereal, candy, and snacks) decreased. Another significant limitation of the CFBAI is that it only addresses advertising to children younger than age 12. As discussed, adolescents view 40% more television advertising for fast food than children do,52 and many young people of this age have the means to visit these restaurants on their own. A survey of middle and high school students found that 77% of boys and 72% of girls reported visiting a fast food restaurant in the past week,53 and a more recent study indicated that 59% of adolescents (12-19 years) consumed fast food on at least one of the two previous days.54 Finally, the CFBAI does not address all forms of marketing to young people. For example, fast food restaurants spent $22 million on packaging and other marketing in the restaurant targeted to young people, as well as $9 million on marketing in schools. However, neither of these forms of marketing is covered by the CFBAI. The initiative also does not include the 91% of fast food restaurants spending on philanthropic marketing programs (more than $10 million) which was reported as youth-targeted marketing expenditures. Similarly, the CFBAI does not address marketing programs that disproportionately appeal to young people if they are not the primary target audience. Examples include TV advertising on general audience programming with wide youth appeal, such as American Idol or Glee, and branded games on company websites (known as advergames). These limitations to the CFBAI and other fast food industry actions have led public health advocates to question whether restaurant industry initiatives are intended to improve public health or merely deflect concerns about their products and marketing efforts. For example, McDonalds pledged to market only apple dippers and 1% low-fat white milk in their Happy Meal advertisements targeted to children. However, a recent examination by the Center for Science in the Public Interest found that 93% of the time shoppers were automatically given french fries when ordering a Happy Meal.55 In addition, the National Restaurant Association lobbied extensively against a recent bill passed in Santa Clara County, California that requires fast food kids meals that come with a toy to meet minimum nutrition standards. Meanwhile, purchases of unhealthy options continue to be the norm at fast food restaurants. During 2008-2009, only 5% of children ordered fruit and 14% ordered plain milk or 100% juice at fast food restaurants.56 Additionally, from 2005 to 2008, the ordering of kids meals by children (under 13 years) declined by 11% while orders of typically higher-calorie items from dollar or value menus increased by 9%, according to The NPD Group (NPD), a market research firm that tracks product purchases at restaurants by age group.57 Snack food purchases also increased during the same period. Kids today want more choices and sophisticated fare, said an NPD spokesperson. Given the damaging effects of fast food on young peoples health, it is imperative that young people consume less of the calorie-dense nutrient-poor foods served at fast food restaurants. The food industry has pledged to offer healthier options for consumers who choose them and to improve their marketing practices targeted to children. They must also curb marketing practices that aggressively promote less healthful products to all young people and implement practices inside restaurants to encourage purchases of the more nutritious options on their menus.

On creating a transparent, open, and objective process

This report addresses the need for comprehensive, reliable, and current information about fast food marketing practices and how these practices affect young peoples fast food purchases. It also examines the nutritional quality of current

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Introduction
fast food menus. The data presented in this report and our methods are described in detail. We use the best available syndicated marketing data and strategic studies to fill important gaps in knowledge. We developed the scope of the report and collected information for it based on detailed reviews of the literature and multiple discussions with experts in the field, including with the nutrition, marketing, and public health experts who serve on our advisory committee. Despite our best efforts, we acknowledge that no piece of scientific work is perfect. We learned a great deal from developing the Cereal FACTS report and have incorporated feedback from that report to build upon and improve the research methods for Fast Food FACTS. In addition, we have revised the methods used to evaluate the nutritional quality of fast food menu items to take into account the complexity of the wide variety of menu items offered. We also developed new methods to evaluate forms of marketing used extensively by the fast food industry, including radio and social and mobile marketing. Finally, we incorporate data in this report to quantify and evaluate fast food purchases by and for young people. Although we provide a thorough evaluation of fast food marketing to young people, it is not possible to quantify all types of fast food marketing targeted to them and evaluate their impact. We invite further feedback from interested parties as we continue to refine our methods and update our data to make the information as valid and accurate as possible.

Fast Food FACTS report

In this report, we examine three elements of fast food marketing plans: specific marketing programs used to promote fast food products, marketing strategies used in these programs, and the impact of these marketing efforts on customer attitudes and behaviors (see Figure 2). We focus our analysis on the twelve restaurants with the highest sales and advertising to youth. We quantify three major marketing components used by fast food restaurants in their marketing plans: menu composition, or the food products offered for sale at the restaurants; external advertising, comprised of marketing practices such as TV advertising and internet marketing designed to pull customers into the restaurants; and in-store marketing, or advertising and promotion that occurs within the restaurant, including signs, pricing, and sales practices, to push sales of individual menu items.

Figure 2. Model of fast food marketing components, strategies, and outcomes Advertising spending Television ads Internet marketing Social media Mobile marketing Outside signs In-store signs Sales practices Pricing

Marketing Components

Individual menu items Special menus Nutritional quality

External advertising

Menu composition Restaurant visits Product choice Brand affinity/loyalty

In-store marketing

Marketing Outcomes

Parent survey NPD purchase data

Marketing Strategies and Tactics

Target audiences Children Teens African American youth Hispanic youth

Marketing messages Kids love it Value Nutrition/health New/unique Eating occasions

Promotions Toy giveaways Other promotions Special pricing

Brand engagement Interactive content Emotional associations

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We also examine marketing strategies used across the different marketing components. These include targeted marketing practices that appeal to different age groups, including preschool children, elementary school-age children, and adolescents, as well as marketing practices that disproportionately reach or appeal to African American and Hispanic youth. These minority populations face higher risks of obesity and obesity-related diseases and, therefore, the nutritional quality of foods targeted to these groups warrant close attention.58 59 We assess the messages commonly used by fast food restaurants to communicate the benefits of their products, including kids love it, good value, healthy or lowcalorie, new or different, and good for specific eating occasions (e.g., snack, breakfast, late-night). We also evaluate promotional tactics frequently used by fast food restaurants, including toy giveaways with kids meals, other tie-ins with entertainment companies and charities, and limited time offers for special pricing or food giveaways for specific menu items. In addition, we examine tactics that encourage brand engagement, or extended involvement with a restaurant brand, such as interactive content in internet and social media or tactics that encourage emotional associations with a restaurant. Finally, we begin to quantify the marketing outcomes encouraged by these marketing practices. When fast food restaurants market their products, they not only encourage frequency of restaurant visits, they also influence consumers product choices, or the menu items ordered during those restaurant visits. Particularly in the case of marketing to young people, these marketing practices may also create brand loyalty and affinity, or long-term preferences and positive feelings about the restaurants. internet marketing (including company-sponsored websites and advertising on third-party websites), social and viral media (including Facebook, Twitter, and YouTube), mobile marketing, and signs outside the restaurants. To quantify young peoples exposure to these different forms of advertising, we used syndicated data from The Nielsen Company (Nielsen), comScore Inc., and Arbitron Inc. When this information was not available, we commissioned or implemented our own studies to measure the extent that individual restaurants engage in these practices. In addition, we conducted content analyses of the different forms of marketing to assess the products, target audiences, messages, and techniques presented in the advertisements.

In-store marketing research presents quantitative and qualitative data to assess marketing practices inside the restaurants that encourage sales of specific products. We present results of an audit of signs located within the restaurants and at drive-thru lanes; a study of restaurant sales practices that documents products encouraged at the point-of-sale when ordering kids meals and combo meals; and special pricing options promoted within the restaurants. We also conducted a content analysis of the products, target audiences, and other promotions presented on instore signs.

Research design
For each of the marketing components, we assess several specific marketing practices and strategies for the twelve restaurants in our analysis. When available, we also provide data for the fast food industry in total.

To measure the outcomes of these practices, we purchased market research data from The NPD Group (NPD) that quantifies the types of food products purchased most often using their Consumer Reports on Eating Share Trends (CREST) data. We combined these numbers with our nutrient content data to evaluate the overall nutritional quality of products purchased by young people at the twelve restaurants in our analysis. We also conducted a survey of parents of 2- to 11-year-olds to understand how often they visit fast food restaurants with their children, what items they purchase for their children, and why. This research is detailed in the following pages and organized into five sections:

Methods details the data sources, procedures, and calculations used to collect and analyze the data; Results presents the detailed findings of each of these analyses; Conclusion summarizes the findings and discusses implications and recommendations for further improvements in fast food restaurant products and marketing practices; Ranking Tables compare the nutritional quality and marketing practices of different restaurants, and The Appendices provide the detailed data that are summarized in the Results.

Menu composition research provides nutrient content data on all regular items on restaurant menus as of January 15, 2010. We also characterize menu items by food category and special menus (i.e., kids meals, dollar/value menus, and healthy menus) and evaluate the nutritional quality of individual menu items. Finally, we compare nutritional quality of food categories and special menus by restaurant. External advertising research includes both quantitative and qualitative data to measure advertising practices that reach consumers outside of the restaurant. These practices include spending on advertising media, TV advertising,

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Methods
We used a variety of data sources and methods to provide the most comprehensive and objective analysis possible of the United States fast food market. These data enabled us to thoroughly document and evaluate the menus and marketing practices of the nations largest fast food restaurants.
Our methods included analyzing the nutritional quality of restaurant menu items; analyzing data on media exposure and spending from syndicated sources (i.e., The Nielsen Company, comScore Inc. and Arbitron Inc); conducting content analyses of TV advertisements, company websites, internet banner advertising, social and viral media, and mobile marketing applications; commissioning an audit of marketing practices inside fast food restaurants across the United States; evaluating syndicated data from The NPD Group, a market research company, documenting menu item purchases; and conducting a survey of parents about their fast food purchases for their children. We supplemented these analyses by collecting information from company websites, monitoring the business and consumer press, and visiting numerous fast food restaurants and calling their consumer helplines. Finally, we combined these data to evaluate the nutritional quality of fast food purchases by and for young people and the marketing environment that influences both healthy and unhealthy fast food consumption. We did not have access to food industry proprietary documents, including privately commissioned market research, media, and marketing plans or other strategic documents. Therefore, we did not attempt to interpret fast food companies goals or objectives for their marketing practices. In this report, we document: 1) fast food restaurant menus and the nutritional quality of menu items; 2) the extent of childrens and adolescents exposure to the most common forms of fast food marketing, including exposure for African American and Hispanic youth; 3) the specific products promoted and marketing messages conveyed in traditional media, new media, and inside the restaurants; and 4) marketing outcomes, including restaurant visits, customer loyalty and the nutritional quality of the menu items purchased by customers. advertising viewed by children for these restaurants in 2008 and 2009 using gross ratings points (GRPs) from Nielsen. In addition to GRPs for companies classified as Quick Serve Restaurants by Nielsen, we also obtained data for Starbucks and Dunkin Donuts, which are included in the QSR Restaurant Top 50, but are classified by Nielsen as coffee/donut retail shops (PCC = G716). We identified twelve restaurants for the comprehensive analysis that included the ten restaurants with the highest sales in 2008 and two additional restaurants that ranked in the top 10 for volume of TV advertising viewed by children in 2009. We also conducted a more limited analysis of the 20 restaurants with the highest sales in 2008. The data reflect marketing practices used to promote fast food restaurants from January 1, 2008, through July 30, 2010. The majority of the analyses assess practices during the calendar year of 2009; specific time frames examined for each type of data are described in the Methods for each analysis. We chose this time frame because the Childrens Food and Beverage Advertising Initiative (CFBAI) was scheduled to be fully implemented by January 1, 2009.2 Food companies that joined the initiative pledged to improve product nutrition and advertising to children. Fast food menu items and marketing practices change continuously. The information presented in this report does not include most new products or product reformulations, advertising campaigns, website redesigns, and other marketing programs introduced after January 2010.

Fast food menus and nutritional quality

We obtained lists of all menu items and corresponding nutrition information for the twelve restaurants in our comprehensive analysis from restaurant menus posted on company websites as of January 15, 2010. Fast food restaurants typically have extensive menus with numerous types of foods. To systematically evaluate these menus, we defined food categories to describe different types of menu items. We also identified special menus, consisting of individual menu items promoted together as a group within the full menu (e.g., a dollar/value menu or healthy menu). As restaurants varied widely in their reporting of nutrition information for individual menu items, we standardized all restaurant menus to include comparable information for items on all menus.

Scope of the analysis

The Nielsen Company (Nielsen) identifies 187 restaurants in the Quick Serve Restaurant (QSR) category (Product Classification Code [PCC] = G330). We could not conduct a comprehensive analysis of such a large number of restaurants; therefore, we identified the restaurants with the highest sales revenues and greatest marketing exposure to examine in detail. We first obtained 2008 sales data for the 50 largest fast food restaurants in the United States using figures estimated for QSR Magazine.1 We then assessed the amount of TV

Food categories
All menu items were assigned to one of fifteen food categories according to whether it appeared on a special menu for children (i.e., kids meal or menu) or the main menu, the eating occasion when the food is typically consumed (breakfast, lunch/dinner or snack), and whether it is typically consumed alone, as a main dish, or as part of a meal in addition to a main dish (i.e., sides). We also classified types of beverages

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separately from food. We defined beverages as any item that could be consumed using a straw.

Menu items offered in kids meals were classified as a kids main dish, kids side or kids beverage. Additional childrens sized items on the menu, but not offered as part of a kids meal, were also classified as kids items. Items traditionally consumed in the morning were classified as breakfast main dishes and breakfast sides (e.g., egg dishes, pancakes and hash browns). Some restaurants serve breakfast items all day and others serve these items only in the morning. Breakfast meals contained more than one breakfast item served together as one menu item, such as a pancake platter with sausage. Items traditionally consumed as the main item in a lunch or dinner meal were classified as lunch/dinner main dishes. Lunch/dinner meals contained a main dish and side served together as one menu item, such as a chicken strip basket with french fries. Lunch/dinner sides and side beverages are items typically consumed in addition to a main dish at lunch or dinner. Common sides include french fries and fruit; common side beverages include soft drinks, milk and water. Menu items that could be consumed on their own at nonmeal times or after a meal were classified as snacks, snack beverages and sweet snacks. Items classified as snacks typically contained the word snack in their name (e.g., McDonalds Snack Wraps or KFC Snackers); snack beverages included ice cream and other frozen beverages; and sweet snacks included all dessert items as well as sweet baked goods, such as donuts and muffins. Due to the number of options available on many of the restaurant menus, coffee beverages were also classified as a separate food category and include lattes, cappuccinos and mochas. Frozen coffee beverages (e.g., frappuccinos) were classified as snack beverages and plain coffee as a side beverage.

individual items also were not categorized as special menus unless they were promoted on the company websites. This categorization was used to identify ongoing restaurant-wide special menus.

Menu standardization
Most of the twelve restaurants in our analyses reported total grams or ounces, calories, fat, saturated fat, trans fat, sugar, sodium, protein, and fiber per menu item or serving. Most restaurants also reported lists of ingredients for many of their menu items. The ingredient lists were needed to obtain the proportion of fruit/vegetable/nuts content for the NPI score, a measure of nutritional quality (see p. 17). When this information was not available on the website and the item appeared to contain unprocessed fruits, nuts, or vegetables, we contacted the restaurant customer service representatives to obtain ingredient lists. In a few instances, we could not determine the fruit/vegetable/nuts content from the ingredients list and purchased the individual menu items to weigh the different food components. To standardize menu items across different chains, we made several adjustments to the items as reported by some restaurants. Appendix A (Table A.1) lists specific adjustments made to each restaurants menu. Following are the general principles applied to all menus.

Only regular menu items are included. If an item was listed as a regional or limited time item, it was not included unless the item was also promoted in both national television and on in-store signs. Regular menu items and kids menu items are listed separately. If an item was only available on the kids menu, it was not included in the regular menu analysis. Kids items that were also available for sale on the regular menu (e.g., a regular hamburger or 16-ounce beverage) were included on both menus. All sizes of all items are listed as separate menu items. This includes drinks, sides, and sandwiches. All individual menu items are listed separately. If a restaurant sold a combination of items as a meal (e.g., a kids meal or combo meal that contains a sandwich, side item, and a drink), those combinations were not included as individual menu items unless they were also listed on the restaurants website menus as one item. Examples of meals listed as individual menu items include breakfast platters (e.g., pancakes and sausage) and chicken strip baskets that automatically come with french fries. Menu items with multiple components that were listed separately on some menus are combined into one item. Examples include salads with dressing and croutons and chicken nuggets with sauce. If the item had a default combination (i.e., specific extra items that were

Special menus
In addition to individual menu items, many restaurants also promote a specific subset of items as a special menu. In addition to kids menus, many restaurants also promote dollar/value menus, or groups of individual items offered at a special price (e.g., Dollar, 99 or $5 Footlong menus). Some restaurants also promote healthy menus, or groups of items designated as healthier in some way (e.g., low(er) in calories, low(er) fat, or diet). Additionally, a few restaurants have menus for special eating occasions (e.g., snack or late-night menus). Researchers identified all special menus presented on company websites as of March 2010. We did not categorize limited time pricing promotions for individual menu items as special menus. Combo meals or special combinations of

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automatically included with the main item), the default combination was used. If the item was typically offered with different choices (e.g., type of salad dressing or sauce), the item is reported as two separate items for both the healthiest and least nutritious options according to NPI score (e.g., chicken nuggets with barbecue sauce and chicken nuggets with ranch sauce). If the menus did not clearly indicate a default option, researchers contacted the restaurant customer service representatives to determine if they did have a default combination.

Menu items are presented in several different ways if consumers typically customize them by choosing individual ingredients (e.g., deli sandwiches or pizzas). Any featured combinations were included as one menu item (e.g., meat lovers or Hawaiian pizza). Additionally, the most and least nutritious combinations of ingredients according to NPI score are listed as two separate menu items. For example, a deli sandwich with whole-grain bread, no cheese, and no sauce, as well as the same sandwich with a high-fat bread, cheese, and mayonnaise are listed separately. Similarly, pizzas with different crust options are listed as separate menu items that include the most and least nutritious crusts. Both the default and healthier options are listed as separate menu items if the restaurant provided an option on its menu to improve the overall nutritional quality of a specific item (e.g., a sandwich without the usual mayonnaise or an egg dish made with egg whites). A menu item is converted to a one-person portion size when listed as one item to be consumed by more than one person (e.g., a large pizza or family-sized appetizer). If the restaurant provided a suggested number of people the item would serve, we divided the nutrition information by that number to calculate one portion. Items indicated as family-sized were divided by 4. For items that did not have a suggested number of servings, we used another menu item that was indicated as a one-person item to identify an appropriate per-person portion. For example, the size of a personal pan pizza was used to calculate a one-person portion size for larger pizzas. A one-person portion size is calculated by combining menu items that were listed individually but are typically consumed in multiples (e.g., chicken pieces). If the restaurant promoted meals containing multiple pieces of the same item, those meal suggestions were used to calculate a one-person portion of the menu item. If the items were typically sold in a family size or bucket, the criteria cited above were used to calculate the one-person portion.

several criteria. The Nutrient Profiling Index (NPI) score provided an evaluation of the overall nutritional composition of individual menu items. The NPI score is based on the nutrition rating system established by Rayner and colleagues for the Food Standards Agency in the United Kingdom.3 We also compared total calories and total sodium for kids meals and menu items against standards established by the Institute of Medicines (IOM) School Meal guidelines to identify reasonable portion sizes for children and adolescents.4 Additionally, we calculated the energy density and the sugar content, saturated fat content, and trans fat content of menu items to highlight differences among individual nutrients within the NPI score. Lastly, we evaluated menu items according to other established criteria for nutritional quality. The following describes each of these criteria in more detail.

NPI score
The NPI score was calculated for each menu item. The score provides a measure of the overall nutritional quality of foods and beverages. It is adapted from the Nutrient Profiling model (NP) currently used by the U.K. Office of Communications (OFCOM) to identify nutritious foods that are appropriate to advertise to children on TV.5 The model has also been approved by Food Standards Australia New Zealand to identify products that are permitted to use health claims in their marketing.6 The NP model provides one score for a product based on total calories and proportion of both healthy and unhealthy nutrients and specific food groups, including saturated fat, sugar, fiber, protein, sodium, and unprocessed fruit, nut, and vegetable content. All menu items, including individual items in kids meals, received individual NPI scores. The NP model has several advantages over other nutrient profiling systems. University of Oxford nutrition researchers developed the model independently of food industry funding. Its development and scoring method is publicly documented and transparent. It has been validated to reflect the judgment of professional nutritionists.7 The model also produces a continuous score that provides a relative evaluation of products, in contrast to threshold models that simply classify foods as good or bad. In addition, the model includes only nutrients that are reasonable and well-justified based on existing nutrition science. In particular, the model does not award points for micronutrient fortification, thereby discouraging companies from adding vitamins and minerals to inherently unhealthy products. Fortification has occurred in some recently introduced products (e.g., Jelly Belly Sport jelly beans with carbohydrates, electrolytes, and vitamins B & C, or Diet Coke Plus with niacin, vitamins B6 & B12, zinc, and magnesium). A detailed description of the model design, scoring method, and benefits is available at www.cerealfacts.org.8 The interpretation of the original scores produced by the NP model are not intuitively obvious to the layperson because the model is reverse scored (i.e., a higher score indicates a

Nutritional quality
We also evaluated the nutritional quality of kids meals and individual menu items on restaurant menus according to

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product of worse nutritional quality). The NP range extends from a high of +34 to a low of 15. In addition, a score of 3 points or lower identifies healthy foods that are allowed to be advertised to children in the United Kingdom. For the purpose of these analyses, we created an NP Index (NPI) score using the following formula: NPI score = (2) * NP score + 70. For example, a relatively nutritious foods with an NP score of -3 would receive an NPI score of 76 (-2 * -3 + 70). This recalculation produces a score from 0 (poorest nutritional quality) to 100 (highest nutritional quality) that is easier to interpret and compare. To identify menu items with a healthy nutrient composition, we used the cut-offs established by the U.K. OFCOM to identify healthy products.9 Only food products with an NP score of 3 or lower and beverages with an NP score of 0 or lower are permitted to be advertised on childrens TV programs in the United Kingdom or during programs with a disproportionate number of viewers under 16 years old. This score translates to a revised NPI score of 64 or higher for food products and 70 or higher for beverages. On an average visit to a fast food restaurant, 36% of children under 6, 21% of children between 6 and 12, and 2% of children between 13 and 17 order kids meals.11 Because preschool-age children require fewer calories compared to older children, we established separate kids meal criteria for elementary school-age and preschool-age children. We assumed that most adolescents would order from the restaurants main menus, and therefore set the criteria for main menu items based on recommended calories and sodium for this age group.

Kids meals for elementary school-age children. The recommended maximum levels for lunch meals served to 5- to 10-year-olds specified in the IOM School Meals report were used to set the limits for elementary school-age children.12 Kids meals for preschool-age children. To calculate maximum acceptable calories and sodium for kids meals served to preschool-age children, we used the same method reported in the IOM School Meals report. The USDA recommends that a moderately active 2- to 5-yearold child should consume 1,275 calories daily13 and should not consume more than 1,700 mg of sodium.14 Children consume on average 32% of their daily calories at lunch;15 therefore, the maximum acceptable levels for kids meals served to preschoolers are 410 calories and 544 mg of sodium. Lunch/dinner main dishes and breakfast items on the regular menu. To set limits for evaluating lunch/dinner and breakfast items for young people from 12 to 17 years, we averaged IOM recommendations for two age groups (11 to 13 and 14 to 18) for maximum amounts of calories and sodium for specific meals on the regular menu. No recommendations are available for individual meal items; therefore, we used recommended maximum amounts for meals to set limits for main dish lunch/dinner and breakfast items. Most visitors to fast food restaurants order 2.4 main dish items on average at an eating occasion.16 As a result, these limits represent the most calories and sodium that any young person should consume from one main dish item, especially if he or she also orders a side and/or beverage.

Calorie and sodium upper limits

We also established maximum acceptable upper limits of calories and sodium for kids meals and individual menu items and identified any menu items that exceeded these upper limits. Childrens menu items were evaluated as part of a total meal that included all possible combinations of individual menu items available with a kids meal (typically a main dish, side, and beverage). All other menu items were evaluated individually. Table 1 provides the maximum acceptable levels of calories and sodium for a) kids meals served to both preschool and elementary school-age children; b) lunch or dinner main dishes or meals; c) breakfast main dishes or meals; and d) sides, beverages, snack foods, and sweet snacks. These criteria are based on the recommendations for upper limits of calories and sodium for school meals served as part of the National School Lunch Program established by the Institute of Medicine (IOM) Committee on School Meals.10

Table 1. Maximum acceptable calories and sodium for kids meals and individual menu items
Kids meals Elementary school-age children (per meal) Preschool-age children (per meal) Regular menu items* Lunch or dinner main dishes (per individual item or meal) Breakfast main dishes (per individual item or meal) Sides, snacks and beverages (per individual item) *Based on recommended upper limits for adolescents. Maximum calories Maximum sodium (mg)

650 410

636 544

700 500 350

720 480 340

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Individual items served as snacks, beverages, or sides. The average daily level recommended for a moderately active 13- to 17-year-old is 2,300 calories;17 and the recommended upper limit for sodium intake is 2,250 mg.18 Because young people consume on average 30% of their daily calories through snacks,19 and children consume on average two snacks per day,20 the maximum acceptable levels for a snack, beverage, or side consumed in addition to a main dish item is 350 calories and 340 mg of sodium for adolescents.

combined items with the lowest calorie content. In addition, we provide estimated grams of added sugar for individual kids meal menu items using restaurants item ingredient lists and comparable products. If the product ingredient list contained only fruit, fruit juice, or plain fruit and no added sugars, we assumed that the item contained no added sugars. We calculated the added sugar in flavored milks by subtracting the sugar contained in the same size and fat content serving of plain milk.

Additional nutritional quality measures

To provide more detailed information about specific nutrients in each kids meal or individual menu item, we also calculated the proportion of sugar by weight in each food or beverage and report grams of saturated fat and trans fat. The tentative nutrition standards proposed by the Interagency Working Group on Food Marketed to Children recommend that foods marketed to children must contain:21

Marketing practices
The analysis of fast food marketing practices documents marketing in traditional media, including TV and radio; in internet and other digital media, including restaurant websites, advertising on third-party websites, social and viral marketing, and mobile marketing; and within the restaurant, including indoor and outdoor signs, pricing and sales practices.

1 g or less and less than 15% of calories from saturated fat 0 g of trans fat No more than 13 g of added sugars, or 26% of total grams of food by weight for foods with a portion size less than 50 g <200 mg of sodium per serving

Fast food product classifications

Fast food restaurants promote a wide variety of products in their marketing communications, including individual menu items and special menus as well as third-party tieins, short-term promotions or the restaurant brand only. To create a systematic evaluation of fast food marketing, we first developed a typology to categorize the products sold by the restaurants. The typology was based on our documentation and content analyses of products and messages commonly presented in fast food marketing. Product type refers to the main product featured in the marketing. Product types include special menus, including dollar/value and healthy menus; meals, consisting of a combination of product categories sold together as one meal (e.g., kids meals, combo meals, or family meals); time of day, encouraging restaurant visits for a specific eating occasion (e.g., breakfast, snack, or late-night); individual menu items or line of items promoted together (e.g., coffee drinks or grilled chicken); and branding only, encouraging restaurant visits without promoting specific food products. In addition, we specified the food category when specific foods or beverages were promoted in the marketing.

Additionally, we calculated the energy density, or calories per gram, of all foods and the calories contributed from added sugar and saturated fat.

Menu comparisons
For each food category on each restaurant menu, we calculated the range of per-item values and medians for the following measures: NPI score; calories; sodium; calories from sugar; and calories from saturated fat. We also calculated the percentage of items that met the minimum NPI score and maximum total calories and total milligrams of sodium compared to the limits for the food category (as defined in Table 1), as well as items that met all three cut-offs. We calculated the same values for all items included in the restaurants value and healthy menus. To evaluate kids meals, we calculated NPI scores for individual items and total calories and sodium for all possible combinations of main dish, side and beverage items. We then identified the combinations of kids meal items that met any and all of the acceptable limits defined in Table 1. We also identified the best and worst kids meal combinations as follows: For each restaurant, we selected the main dish, side and beverage with the highest and lowest NPI scores and combined them to create the three best and three worst kids meal combinations for each restaurant. If more than one combination had the same NPI scores, we chose the

Traditional media
To measure fast food restaurants traditional media marketing practices we conducted several analyses using a variety of data sources, including: 1) licensed Nielsen data for spending in all measured media and exposure to TV advertising by age group and race, including Spanish-language advertising; 2) licensed Arbitron data to measure exposure to radio advertising by age group; and 3) conducted a content analysis of the messages and specific menu items promoted in TV advertising. These data provide an overview of traditional

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media spending and youth exposure to advertising for fast food restaurants in 2008 and 2009, as well as a comprehensive picture of the traditional media marketing practices of the twelve restaurants in our full analysis for 2009. whites in the same age groups. Nielsen does not provide spot market GRPs for African Americans. Finally, we obtained GRPs for advertisements that aired on Spanish-language television for each age group. GRPs for Spanish-language television are calculated based on Nielsens Hispanic audience estimates. Nielsen calculates GRPs as the sum total of all advertising exposures for all individuals within a demographic group, including multiple exposures for individuals (i.e., gross impressions), divided by the size of the population times 100. For an audience not trained in advertising measurement, GRPs may be difficult to interpret. Therefore, we also use GRP data to calculate the following TV advertising measures: Average advertising exposure. This measure is calculated by dividing total GRPs for a demographic group during a specific time period by 100. It provides a measure of ads viewed by the average individual in that demographic group during the time period measured. For example, if Nielsen reports 2,000 GRPs for 2- to 5-year-olds for a restaurant in 2008, we can conclude that the average 2- to 5-year-old viewed 20 ads for that restaurant in 2008. Targeted GRP ratios. As GRPs provide a per capita measure of advertising exposure for specific demographic groups, we also used GRPs to measure relative exposure to advertising between demographic groups. We report the following targeted GRP ratios:

Advertising spending and TV advertising exposure by restaurant

Nielsen tracks media spending on television, radio, magazine, newspaper, free standing insert (FSI) coupons, outdoor advertising and the internet. We licensed these data for 2008 and 2009 for all fast food restaurants, including the 187 companies in Nielsens QSR classification code and Starbucks and Dunkin Donuts. The data provide a measure of all fast food advertising spending. To measure exposure to fast food TV advertising, we also licensed gross rating points (GRP) data from Nielsen for the same period and restaurants. GRPs measure the total audience delivered by a brands media schedule. It is expressed as a percentage of the population that is exposed to each commercial over a specified period of time across all types of TV programming. They are the advertising industrys standard measure to assess audience exposure to advertising campaigns; and Nielsen is the most widely used source for these data.22 GRPs, therefore, provide an objective outside assessment of advertising exposure. In addition, GRPs can be used to measure advertisements delivered to a specific audience, e.g., specific age groups and African Americans (also known as target rating points or TRPs). They provide a per capita measure to examine relative exposure among groups. For example, if a restaurant had 2,000 GRPs in 2009 for 2- to 11-year-olds and 1,000 GRPs for 25- to 49-year-olds, then we can conclude that children saw twice as many ads for that restaurant in 2009 as compared to adults. The GRP measure differs from the measure used to evaluate food industry compliance with their CFBAI pledges. The pledges apply only to advertising in childrens TV programming as defined by audience composition (i.e., programs in which at least 25% to 50% of the audience are under age 12); approximately half of all advertisements viewed by children under 12 years old occur during childrens programming.23 In contrast, GRPs measure childrens total exposure to advertising during all types of TV programming. Therefore, evaluating GRPs will determine childrens exposure to all TV advertising by participating companies, not only advertising that aired during childrens programming. In the TV advertising analyses, we obtained 2008 and 2009 GRP data by age group and race for all fast food restaurants. We first obtained total GRPs for the following age groups: 2-5 years, 6-11 years, 12-17 years, 18-24 years and 25-49 years. These data combine exposure to national (network, cable, and syndicated) and local (spot market) television. In addition, we identified national television GRPs for African Americans (2-11 years, 12-17 years, 18-24 years, and 25-49 years), as well as

Preschool child-to-adult targeted ratio = GRPs for 2-5 years/ GRPs for 25-49 years Child-to-adult targeted ratio = GRPs for 6-11 years/GRPs for 25-49 years Teen-to-adult targeted ratio = GRPs for 12-17 years/GRPs for 25-49 years African-American-to-white child targeted ratio = GRPs for African American 2-11 years/GRPs for white 2-11 years (national GRPs only) African-American-to-white-teen targeted ratio = GRPs for African American 12-17 years/GRPs for white 12-17 years (national GRPs only).

A targeted ratio greater than 1.0 indicates that the average person in the group of interest (e.g., the child in the childto-adult ratio) viewed more advertisements than the average person in the comparison group (the adult). A targeted ratio of less than 1.0 indicates that the person in the group of interest viewed fewer ads. For example, a child-to-adult targeted ratio of 2.0 indicates that children viewed twice as many ads as adults viewed. To assess potential targeted marketing to specific age or racial groups, we compared differences among demographic groups in exposure to advertising for specific restaurants to those that would be expected given each groups average TV viewing time. If the targeted ratio was significantly greater

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than the relative difference in the amount of TV viewed by each group, we can conclude that the advertiser may have designed a media plan to reach this specific demographic group more often than would naturally occur. The average weekly amount of time spent viewing television in 2009 was obtained from Nielsen Market Breaks for each age and demographic group in the analysis.

Individual menu items. Any individual menu items or line of items, not classified as one of the above. Unclear. Specific product type could not be determined

TV advertising content analysis

To evaluate the messages and marketing techniques used in the TV advertisements, we conducted a content analysis of both English- and Spanish-language TV advertising for the twelve restaurants. Using the AdScope database from Kantar Media,24 we obtained digital copies of all fast food advertisements from these companies that aired nationally in the United States from July 1, 2008, through December 31, 2009. Research assistants viewed each ad to remove duplicates, including 15-second shortened versions of 30-second ads. In addition, ads with the same creative execution but different promotions added to the end of the ad were catalogued as duplicates. The basic version of the ad (excluding the promotion) was retained for analysis. Distinct promotions were noted but not included in the final content analysis unless the promotion was present in all versions of the ad. Finally, ads which aired before October 1, 2008, were removed from the analysis, as these were less likely to have continued airing in 2009. We used the coding manual developed for a previous research study to analyze cereal advertising as the basis for the coding manual for the present study.25 Researchers first examined a sample of fast food advertisements to identify additional messages and marketing techniques that appeared in fast food ads but were not included in the previous manual. Three coders were trained to review the advertisements and code them for all items in the manual. In four pre-test group sessions, the project manager and coders evaluated twelve fast food advertisements during each session. These ads were selected from fast food advertisements for the restaurants in our analysis that aired in 2010, immediately following the ads included in our content analysis. Following these sessions, the project manager revised and finalized the coding manual. The final coding manual included eight main categories:

TV advertising exposure by product

In addition to the Nielsen GRP data at the restaurant level described above, we also obtained GRPs at the brand variant level for national advertising in 2009 for the twelve restaurants in our detailed analysis. Nielsen includes up to three specific menu items, promotions (e.g., KFC $4 Fill-up Box), and/or tieins (e.g., SpongeBob SquarePants toy) in their brand variant classification. Therefore, these data also provide exposure to television advertising that promotes specific menu items and promotions. Based on the descriptions provided by Nielsen, we categorized all advertisements into product types. In some cases, Nielsen did not provide enough information to categorize the advertisements. For these advertisements, a researcher viewed copies of individual advertisements to determine the appropriate product type. For advertisements that could be classified as more than one product type, we prioritized in the following order:

Branding only. The restaurant as a whole is the main point of the ad. Food may be pictured, but no specific food products are mentioned. Promotion only. A toy giveaway or other third-party tie-in is the main point of the ad. Food may be pictured, but no specific food products are mentioned. Kids meal. Mentions a kids meal, either with or without specific kids meal menu items. Dollar/value menu. Mentions a value menu, dollar menu or other special pricing for a group of individual menu items, including mentions of the entire menu or specific items included on the value menu. Healthy meal/menu. Mentions a healthy menu, menu item, or healthy version of a meal. Combo/family/value meal. Mentions a meal (for one or more people) that includes more than one type of menu item. Breakfast menu. Mentions more than one individual breakfast item or a breakfast meal. Late-night/snack menu. Mentions items suggested to be consumed late at night or as a snack (either as part of a special menu or as indicated by the item name).

Identifying information, such as restaurant name. Main food in the ad. Main food was selected by choosing the menu item depicted or mentioned most, and/or that played the most integral role in the ad. If multiple items were promoted equally, three items or fewer were listed individually and four or more items were coded as part of a menu/line of items. Selling point, or direct benefit of the product. Coders chose as many selling points as were present in the ad. These included: new/improved if the ad introduced a new product or an improvement in an old one; value/cheap if the ad highlighted the price of the product, such as buy one get one free, now for the low price of or only 99

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cents; health/nutrition included claims about the nutrition, nutrients, or health outcomes of consuming the product; quality food if the ad used natural, fresh, real, quality, or similar words to describe the food; comparison/unique for claims that the product(s) were superior to that of the competition or suggestions that the restaurant and/or menu item were unique; filling/lots of food if the ad suggested that the food promoted was filling or satisfying and/or mentioned the large size of the food or portion; convenience if the ad promoted more than typical fast food convenience, such as using technology to simplify or expedite food purchasing (e.g. ordering online and mobile ordering applications); low-fat/low-calorie for suggestions that the product assists in weight loss and other claims about fat or calorie content; helping the community or others when the ad suggested helping the community, helping others, or portrayed any charitable benefit from purchasing the food; and limited time special offers for short-term price promotions, giveaways, and new products that wont be here long.

specified); other sports for ads that featured a team, sports organization or sporting event (e.g., NBA, Olympics); and other food brands when the ad featured a food brand not owned by the fast food restaurant (e.g., Doritos, Minute Maid). In addition, we coded brand characters for fictional characters or mascots associated specifically with the brand or intrinsic to the identity of the brand (e.g., Ronald McDonald), and spokespeople for individuals who regularly represent the brand in commercials (e.g., Jared from Subway)

Product associations, or indirect benefits of the product suggested in the ad. Coders chose as many product associations as were present in the ad. These included: physical activity when the ad portrayed, suggested or encouraged physical activity in any way; family bonding or promoting family ties, love, spending time together, including separate from mealtimes; fun/cool claims, typically made implicitly by depicting enjoyable social occasions, excitement or adventure, standing out in a crowd, superiority, and pop-culture references; humor if the ad included comedic elements, obvious or subtle, irony or sarcasm; and adults as negative or incompetent if the ad belittled or poked fun at adult figures, parents or other authority figures. Target audience, or the type of person to which the ad appears to appeal most. These included: perceived age group targeted including children, adults-only (reserved for ads clearly targeting adults and no one else), parents, and all other for ads that could appeal to teens and/ or adults; gender as identified by the person in the ad purchasing and/or consuming the food; race as identified by the person in the ad purchasing and/or consuming the food. If actors did not purchase or consume food in the ad, the gender and race of the main character(s) were coded. Third party tie-ins, brand characters and spokespeople. Third party tie-ins included appearances by: celebrities, including famous actors, athletes and musicians; movies/ TV shows/video games when the ad featured any of these; licensed characters when a character from a TV, movie, or video game was featured in the ad as part of a special promotion (e.g., a Shrek toy in a kids meal); charity when charitable organizations (e.g., the Girl Scouts) or donations to a charity were featured in the ad; other entertainment for ads that featured tie-ins with games (e.g., Monopoly), theme parks, or other types of entertainment (not already

Eating behaviors that were portrayed or suggested (or not). These included: family meals, including depictions or suggestions of a family eating a meal together; food consumed to code whether or not food is shown being eaten; place of consumption to describe where the food was apparently consumed (i.e., in the restaurant, at a table, in front of the TV/computer, in the car, or other place); time of consumption to describe when the food was consumed (i.e., breakfast, lunch, dinner, late at night, anytime, snack, or unclear). Additionally, coders indicated whether food was the primary focus of the ad, defined as whether the food was shown up close in the ad more than 50% of the time. Websites referenced, either suggested or depicted on the screen. All references to websites were recorded, including reference to third-party sites.

Formal pilot testing was conducted using a sample of 40 ads from the final inventory. Krippendorfs alpha26 was used to measure inter-rater reliability. As inter-rater reliability results were good, final reliability testing commenced. The final reliability sample included 126 ads, or 20% of the full sample. Each coder coded this same subset of ads. Krippendorfs Alpha values ranged from .33 (fair) to 1.00 (perfect) agreement with 62% of the items receiving substantial to almost perfect agreement (.61 or higher) and only 3% receiving values in the fair range of agreement (.21 to .40). Items with Alpha values lower than .60 were discussed and redefined for clarity prior to moving forward with the final coding. The remaining advertisements were randomly assigned to the three coders and final coding occurred over a three-week period. Spanish-language advertisements. A native Spanish speaker who is fluent in English coded the Spanish-language ads. The Spanish-language coder used the same coding manual and completed the same training as the Englishlanguage coders and also coded a sample of 30 Englishlanguage ads used in the reliability test group. Reliability testing of the responses for the Spanish-language coder showed similar Krippendorfs alpha values as those of the English-language coders: a range of .33 to 1.00, with 49% of the items receiving substantial to almost perfect agreement and only 5% receiving values in the fair range of agreement (.21 to .40). As in the English-language analysis, items with Alpha values lower than .60 were discussed and clarified prior

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to conducting the final Spanish-language coding. Coding occurred over three weeks. foods within each category and added the average of the food categories together. We then used 2009 GRPs by age group and ethnicity for each ad to calculate the weighted average number of total calories, sugar calories, saturated fat calories and sodium per ad viewed by children, teens, adults, and African American youth on English-language TV and Hispanic youth on Spanish-language TV for each restaurant in our analysis. These measures provide a comparison of the nutrient content of foods featured in ads viewed by different demographic groups for different restaurants. We also multiplied the weighted average measures for each ad viewed by the average number of ads viewed per day for each restaurant and demographic group to provide total calories and sodium viewed in fast food TV ads daily.

Nutrient content of menu items in TV ads

To assess the nutrient content of menu items featured in TV ads, we combined the data obtained in the content analysis to identify the main food(s) depicted in the ads, the Nielsen data on national GRPs by age and ethnicity for these ads in 2009, and the nutrient content data obtained in the menu composition analysis. We first obtained the following nutrition information for each main food featured in TV ads that aired nationally in 2009: total calories, sodium (mg), saturated fat (g), and total sugar (g). If the main food in the ad referred to more than one menu item in our menu composition analysis, we calculated the median values of the nutrient information for all applicable menu items. For example, if an ad featured all ice cream sundaes on the restaurant menu, we calculated the median calories, sodium, saturated fat and sugar for all sundaes in our menu composition analysis. Similarly, if the ad did not specify a size or variation of individual foods (e.g., different sauces served with chicken nuggets), we calculated median values for all variations of the menu item in our menu composition analysis. In a few instances, a main food featured on TV ads did not appear on the regular restaurant menus in January 2010 and therefore nutrition data were not available in our menu composition analysis. If the ad was supported by more than 25 GRPs in 2009, we contacted the restaurant to obtain nutrition information for those menu items. If an ad referenced more than one main food, coders viewed the ad to determine whether it appeared to encourage consumption of more than one item or provided examples of different variations of the same type of food. Generally, if the ad prominently featured main foods from more than one food category (e.g., a main dish and a beverage, side or dessert), it was coded as encouraging consumption of items from each food category. However, if the ad depicted more than one version of foods from the same category (e.g., three sandwiches or three sweet snacks), it was coded as encouraging consumption of just one item. To calculate the nutrient content of individual ads, we used different procedures according to whether the ad appeared to encourage consumption of one type of food (e.g., one of a variety of sandwiches) or more than one food (e.g., a sandwich and a side). If the ad encouraged consumption of one food, we averaged the nutrient information for all main foods presented. If the ad encouraged consumption of more than one food, we added the nutrient information for all main foods presented to obtain total calories, sodium, saturated fat and sugar. In a few instances, ads promoted more than one food category and more than one main food within the categories. For those ads, we averaged the nutrient information for main

Radio advertising exposure

To understand young peoples exposure to radio advertising from the twelve fast food restaurants in our analysis, we purchased radio data from two media research firms: Arbitron and Nielsen. Arbitron is the countrys leading provider of radio measurement services. The firm surveys a random sample of households in each of its 300 metropolitan areas (which generally correspond to the Metropolitan Statistical Areas defined by the United States Office of Management and Budget). For the majority of markets, survey participants fill out a paper diary, noting their listening habits over the course of seven days. Survey participants must be aged 12 years or older. In 2009, Arbitron processed over 1.1 million diaries for inclusion in its estimates.27 We obtained a license from Arbitron that covers local spot radio advertising in 2009 for all 300 metropolitan areas. While Arbitron provides listenership data for specific markets, stations, and formats, the firm does not track advertising activities of specific companies. To obtain data on individuals exposure to radio advertising for the twelve restaurants in our analysis, we used Nielsens Monitor-Plus AdViews system. Nielsen uses Arbitrons data and matches it to their own tracking of commercial units to provide radio advertising measurement for local spot radio.28 In 2009, Nielsen monitored radio advertising in 39 markets and covered at least twenty stations in each market. These 39 markets represent 60% of the U.S. population, as estimated by Arbitron;29 and 38 of these covered markets rank in the top 50 by population. Through the AdViews system, we obtained GRPs and impressions (or total advertising exposure for all individuals combined) for each restaurant in each market. Furthermore, we broke out GRPs for the following age groups separately: 12-17 years; 18-24 years; and 25-49 years. AdViews does not provide radio data for children under 12 and does not break out African American listenership separately. To calculate the average exposure by age group for individuals in the 39 markets examined, we first excluded data from markets

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with very low exposure, defined as any markets where the advertiser did not reach a minimum of 100 GRPs in any of the three defined age groups. We then calculated the universal estimate (UE) for each market and age group by dividing impressions by GRPs. The UE is a population estimate for each market. For each advertiser and age group, we added up these UEs to arrive at a total UE. We then added up all impressions for each advertiser and age group and divided it by the total UE. The resulting GRPs provide a snapshot of the level of marketing activity that each advertiser engages in across a significant number of major U.S. markets. We also report the number of major markets that make up these GRPs. We first searched the comScore Media Metrix database to identify the fast food restaurant websites for which exposure data were available from January through December 2009. We collected the following data using the Media Metrix Key Measures Report for available fast food websites during this time period:

Total unique visitors. The estimated number of different individuals who visited any website during the reporting period. Total visits. The total number of times that each unique visitor visited a website with at least a 30-minute break between times of access during the reporting period. Average minutes per visit. The average number of minutes spent on the website for each visit. Average pages viewed per visitor. The average number of pages viewed during a month by each person visiting the website (across all visits during the month). Average visits per unique visitor. The average number of visits to the website during the month per unique visitor.

Internet and other digital media

We analyzed content and exposure for youth-targeted marketing on the internet: restaurant (i.e., company-sponsored) websites, banner advertising on other (i.e., third-party) websites, and social media marketing. Additionally, we provide examples of mobile marketing conducted by fast food restaurants.

Restaurant websites
We located the main website for each restaurant in our analysis by typing the restaurant name into a search engine. We then explored the main pages for any secondary websites linked to that restaurant. For example, links on McDonalds. com connected to secondary sites, including McWorld.com, HappyMeal.com, Ronald.com, 365Black.com, MyInspirasian. com, MeEncanta.com, McDonaldsAllAmerican.com, RMHC. org, and Passport2Play.com. For the purposes of this analysis, a website is defined as all pages containing the same stem URL. For example, HappyMeal.com is the website of interest, and HappyMeal.com/#play is an example of a secondary page contained within the site. We obtained data on exposure to these websites from the comScore Media Metrix Key Measures Report.30 The company captures the internet behavior of a representative panel of about one million users in the United States.31 It is the nations largest existing internet audience measurement panel. The firm collects data at both the household and individual level using Session Assignment Technology, which can identify computer users without requiring them to log in. The company uses these panel data to extrapolate its findings to the total U.S. population. Companies participating with comScore can also have census tags placed on their web content and advertisements to further refine audience estimates. Using the comScore panel, we were able to identify which websites and advertisements individual users were exposed to and examine exposure for both children and adults in the same household. The Media Metrix database provides internet exposure data for any websites visited by at least 30 of their panel members in a given quarter.32 Media Metrix also provides exposure information by visitor age and ethnicity for larger volume websites.

In addition, when enough website traffic was recorded in a given quarter, we also collected these measures separately for children ages 2-11 years, 12-17 years, and all youth (217 years), and for African American youth ages 2-17 years. During the period examined, data were not available from comScore for Hispanic visitors. For each of the demographic groups with data, we also report a composition index, which measures the extent to which child (2-11 years), teen (12- 17 years) or youth (2-17 years) visitors to a website are over- or underrepresented compared to all visitors (over 2 years) and the extent to which African American 2- to 17-year-old visitors to a website are over- or underrepresented compared to all 2- to 17-year-old visitors. For each website in our analysis, we report the following website exposure measures:

Average unique visitors per month for all youth 2-11 years, 12-17 years, 2-17 years and African Americans 2-17 years. This measure was calculated by adding average total unique visitors per month, as reported quarterly by comScore, from January through December 2009 for each demographic group divided by the number of quarters for which these data were available for each website. Average visits per month,33 average pages per month, and average time spent per visit34 for each unique visitor. Average monthly numbers, as reported by comScore for each quarter, were divided by the number of quarters for which data were available for each website. The company only reports these data for the larger demographic groups. If separate data were not available for the specific demographic group, we used the information for the next largest demographic group. For example, if data were not available for 2- to 11-year-olds specifically, we report the

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data for 2- to 17-year-olds or, in a few cases, all persons (ages older than 2).

Composition indices were calculated for all youth 2-11 years, 12-17 years, 2-17 years and for African American youth 2-17 years. We first calculated the percentage of visitors from a particular demographic group visiting a website by averaging the number of monthly unique visitors to the website for that demographic group and dividing this number by the average monthly unique visitors to the total internet during the four quarters of 2009 for the same demographic group. Composition indices were then calculated by dividing the percentage of total internet visitors for each age group (2-11 years, 12-17 years, and 2-17 years) who visited that website by the percentage of all visitors (age 2+) to the total internet who visited the same website. African American composition indices were calculated by dividing the percentage of African Americans 2-17 years on the total internet who visited a particular website by the percentage of all youth 2-17 years on the total internet who visited the same website. This number was then multiplied by 100. Composition indices greater than 100 signify that the demographic group was overrepresented on a website in relation to the comparison group; and composition indices less than 100 signify that it was underrepresented. For example, if 40% of African Americans 2-17 years visited HappyMeal.com, but 20% of all youth 2-17 years visited HappyMeal.com, the African American composition index for HappyMeal.com would be 200. Therefore, the percentage of African American youth visitors to HappyMeal.com would be twice as high as the percentage of all youth visitors to HappyMeal.com; and African American youth would be overrepresented on HappyMeal.com.

In addition to the sites classified as child-targeted because of their content, we added sites that were among the top 10 fast food restaurant websites visited most often by 2- to 17-yearolds during February 2010, according to comScores internet traffic data; all these websites belonged to one of the twelve restaurants in our analysis. The only adjustment we made to this list was to substitute Subway.com with SubwayFreshBuzz. com. While Subway.com had a significant number of visitors, only SubwayFreshBuzz.com appeared on Subways TV advertising. In addition, comScores source/loss data indicated that a substantial portion of traffic was redirected to SubwayFreshBuzz.com from the companys main site. Qualitative analysis confirmed that SubwayFreshBuzz. com appeared to be the companys consumer-oriented site while Subway.com was designed for information about the corporation. Each website has only one homepage but can have many secondary pages. We excluded pages we assessed as irrelevant to the marketing of fast foods. These included corporate content; store locators; search functions; pages about the company or founder; non-U.S. company information; pages containing food allergy and sensitivity information; and privacy policies, terms of use, and official rules. In addition, when more than one page on a site contained very similar content, such as menu items or videos that all featured the same character and format, we only included the first page of the content and noted the number of instances of similar content. During March and April 2010, three coders collected all pages on each website included in this study. They recorded a page as a video if it had movement, or if an activity on the page required clicking the mouse. They recorded it as a PDF if the page was static. Coding procedure. We developed coding criteria for online marketing techniques based on categories described in previous analyses of childrens websites,35 36 digital marketing techniques,37 and online advergames.38 39 We also added questions based on our observations from an initial exploration of the websites, the codebook from the TV content analysis, and the codebook for an analogous content analysis of cereal websites.40 On each site we coded the following five categories:

Restaurant website content analysis

To systematically assess the techniques used to engage children on websites from the restaurants in our analysis, we first used the comScore data to identify the restaurant websites that children visited most frequently and for the longest periods of time. To identify sites focused only on children, we browsed through the pages of each site and categorized all sites based on whether they targeted children directly. Sites targeting children generally had cartoon content with animated characters, interactive games, music, and messages directed specifically at children. A site was not categorized as child-targeted if it predominantly had instructions for mothers, contained only recipes, had no games, had little to no graphical content, or a combination of these characteristics. If a site met the criteria for being childtargeted, but also had content directed towards parents, we included it. However, when child-targeted pages appeared on another primarily adult-targeted website, we did not identify the website as child-targeted. For example, although some pages on the McDonalds main site advertised the Happy Meal, it was not child-targeted overall.

Engagement techniques included (e.g., games, viral videos, Flash animation and music). Featured third parties (including charities, licensed characters, TV/movies and other entertainment), celebrities, brand spokespeople and spokes-characters. Products present including kids' meals, promotions, individual menu items and branding only. Selling points made directly about the restaurants and/or their products including value, health and nutrition claims, new/improved and weight loss.

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Messages (or product associations) that imply other benefits of the restaurants and/or their products including fun, cool, physical activity and humor.

Reliability assessment. Four coders tested the coding instrument on pages included in the study and refined the instrument to address discrepancies. They then coded additional pages from different websites included in the study and final clarifications were made to the coding instrument. The coders reassessed the content of all websites under consideration. We used Krippendorffs alpha intercoder reliability statistic to evaluate the coding of all child-targeted fast-food websites. The statistics on our assessment measures ranged between .7 and 1, indicating substantial to perfect agreement.. Coders resolved any uncertainty they had during coding by consensus discussions.

began reporting these data by product category for fast food restaurants in June 2009; therefore, we were able to obtain information for the ten months from June 2009 through March 2010. During this time period, Ad Metrix did not report demographic information about the individuals who were exposed to these advertisements. Consequently, we cannot differentiate between exposure by any specific age group, including children, adolescents or African Americans. Measures available from comScore for each month include total display ad views, or the number of advertisements fully downloaded and viewed on publisher websites; advertising exposed unique visitors, or the number of different individuals exposed to advertisements on a publisher website; and average frequency of ad views per unique visitor by fast food advertiser. This information is available for the total internet and for individual publisher websites. As we could not separate ads viewed by age group, we identified the websites on which the advertisements appeared that were disproportionately targeted to youth (i.e., youth websites). We defined a youth website as a website that met one of two conditions: 1) It was identified by comScore as an entertainment website for youth ages 2-17 years or as a teen community website during the period examined; or 2) the proportion of visitors ages 2-17 years to the website exceeded the total percentage of visitors to the internet aged 2-17 years during the time period examined. Because we are unable to differentiate between ads viewed by young people versus adults, we instead assume that advertising on youth websites will be viewed disproportionately by young people. From the comScore data, we calculated the following measures for each fast food product (including websites, menu items and promotions) for which banner advertising was found. Total numbers were also calculated for all of a restaurants products:

Banner advertising on third-party websites

Banner advertisements are purchased by companies to promote their products on other companies websites. These banners, which are displayed along the border of a webpage, often invoke attention-grabbing Flash animation. They typically feature a particular menu item or line of items, or a special promotion such as the opportunity to win money or other prizes. An effective banner ad is one that induces a large proportion of viewers to click the ad and consequently be redirected to the advertisers website. Ad Metrix, another comScore product, monitors the same panel of users as comScore Media Metrix, but tracks any advertisements that are completely downloaded and viewable on a users web browser. Ad Metrix, therefore, measures individual exposure to banner ads presented in rich media (SWF files) and traditional image-based ads (JPEG and GIF files). It does not capture text, video, or html-based ads. Ad Metrix also identifies the unique user viewing the advertisement, the thirdparty website on which the advertisement was viewed, and the company sponsoring the advertisement. In addition, Ad Metrix captures copies of the actual ads. The Product Dictionary from comScore was used to determine the banner advertisements of interest. The company provided banner advertisement data for each restaurant in our analysis. For some restaurants, comScore also provided detailed data for specific menu items or promotions. For example, in the case of McDonalds, comScore provided exposure data for Chicken McNugget banner ads and HappyMeal.com banner ads in addition to data for all McDonalds banner ads combined. The company provides data for banner ads for any fast food restaurant, menu item or promotion in its dictionary that was viewed at least ten times by comScore panel members on the internet or on a specific publisher site. Data for exposure to these banner ads were extracted from the comScore Ad Metrix Advertiser Report.41 The company

Average unique viewers per month42 was calculated by taking an average of the monthly unique viewers of a given products advertisements from June 2009 through March 2010. Average number of ads viewed per month was calculated by taking an average of the average frequency of ad views by viewer for the fast food restaurant product each month from June 2009 through March 2010. Percentage of ads viewed on youth websites was calculated by dividing the fast food restaurant products total display ad views that appeared on youth websites by their total display ad views that appeared on all websites from June 2009 through March 2010. Total average ads viewed on youth websites per month was calculated by dividing total display ad views on youth websites by the number of months for which data were available.

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Banner advertising content analysis

We also analyzed the content of the banner ads that appeared on third-party websites. Using a comScore Ad Metrix Advertiser report, we obtained copies of all ads appearing between June 2009 and March 2010 that were produced by the twelve restaurants in our analysis. We organized the ads according to comScores product category definitions. These categories are specific to each restaurant, and generally relate either to a particular menu item (for example Happy Meal), or to a specific website (such as Burger Kings ClubBK.com). After ranking the ads according to number of exposed unique viewers, we selected all ads that met one of the following three criteria: 1) the ad was one of the twenty most often viewed ads for its respective company; 2) the ad was one of the ten most often viewed ads within any category related to children, teens, ethnic groups, or dollar/value menu products; or 3) the ad was one of the five most often viewed ads for any other product category. From this list we eliminated duplicate ads whose content exactly matched the content of an ad that was included in the analysis. We used a modified version of the coding manual used for the TV ads, excluding sections that were not relevant to internet ads and adding new codes as appropriate for the medium. The modified coding manual included five categories from the TV coding manual, as well as a new category for engagement techniques:

Social media
For the purposes of our study, we adopted Kaplan and Haenleins definition of social media: Social Media is a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, and that allow the creation and exchange of User Generated Content.43 We examined marketing activities that fast food restaurants engage in on three major social media websites: Facebook, Twitter, and YouTube. These three are the leading websites in their fields (social networking, micro blogging, and video sharing, respectively) and are used as marketing vehicles for the twelve companies in our analysis. Registration with all three sites is limited to persons aged 13 and older. Facebook is the largest social networking site with more than 500 million users worldwide.44 Members have their own pages where they can present information about themselves, post links to other sites, upload photos and videos, and write messages. Members connect with other members by becoming friends, thereby incorporating them in their network. Similarly, individual Facebook users can become a fan of a brand by clicking a like button on the brands page. A thumbnail photo of that individual is then visible on the brand page in the people who like this section. Any time the brand modifies its page, for example by adding a feature or posting a comment, that activity shows up in the individuals news feed, or personalized Facebook home page. Similarly, anytime the individual interacts with the brand page, this action shows up in the news feeds of all of his or her friends. The brand also shows up on the individuals Facebook page as something that he or she likes. A typical brand page consists of a number of tabs, each containing different content including messages from the brand and from fans of the brand, photos, videos, events, polls, quizzes, and applications. Twitter is a micro blogging service that has more than 145 million registered users worldwide.45 Twitter users publish 140-character messages, called tweets, that are posted on their own profile pages. Users can follow each other. By doing so, an author subscribes to another authors tweets. These followed tweets then are published on the Twitter home pages of all of an authors followers. Twitter users may also access the tweets of authors whom they follow through their mobile phones, with text messages, third-party Twitter applications, or Twitters own mobile platform. While Twitter does have a promoted tweets advertising platform that was launched in 2010 with Starbucks as an initial partner, we focused instead on the microblogging pages, as described above, which fast food restaurants can use, free of charge.

Main product or promotion. Perceived target audience, in particular age and ethnicity groups. Selling points. Engagement techniques. This category included questions about movement within the banner ad (e.g., static versus Flash animation) and interactive features of the ad. Examples of such features are an embedded poll or quiz, a link to order food online, a rollover that responds to movements of the viewers mouse, a game within the ad or a link to a game, a code to unlock features at an advergaming site, a link to a video, and a link to a social networking site.

One research assistant was trained on the coding procedures in a series of practice sessions administered by experienced TV coders who had already established good inter-rater reliability. During each session, both the trainee and the experienced coders coded a sample of advertisements, and then discussed the results. The trainers identified any coding problems or inconsistencies in the trainees coding and clarified areas of confusion. This process was repeated until the project manager determined that the new coder had a thorough understanding of the coding procedure, as evidenced by high percent agreement with experienced coders on the practice coding. The research assistant then coded all banner ads.

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YouTube is a website that enables users to view, upload, and share videos. The fast food restaurants in our analysis have created customized channels on YouTube with playlists of videos available for viewing. While anyone can watch the videos without registering, registered users can subscribe to a channel and receive alerts anytime a new video is posted. YouTube accounted for nearly 40% of the 33.2 billion videos watched online during December 2009.46 Social media data collection. Because social media are so new, and marketing techniques employing them are still evolving, it is difficult to procure data to measure exposure and impact. Among advertisers that use social media, there is no clear consensus on the key metrics to use. Because user information is kept private, none of the sites provide demographic information about followers of a particular brands page. Similarly, comScore does not provide demographic information for any of their measurements at the page level. We identified and tracked fast food restaurant pages on each of the three social media sites over a 29-week period from December 22, 2009 to July 30, 2010, capturing information that is publicly available once a week. For Facebook, we tracked the number of likes for each fast food restaurants page(s). For Twitter, we tracked the number of followers of each brands Twitter page(s). And for YouTube, we recorded the following data: number of subscribers, and upload views (number of views for all uploaded videos). We also conducted content analyses of each media. For Facebook and Twitter, we identified the specific products (special menus, meals, time of day, individual menu items, and lines of items) featured and links included in posts that directed users to external websites. We also identified all value promotions (including coupons, special limited-time price promotions, and any other posts that mentioned specific prices). Finally, we identified the engagement techniques employed by each media. For Facebook, these include tabs, photos, videos, polls, and profile pictures. For Twitter, these include contests specifically designed for Twitter users and customer service interactions. The Facebook content analysis was performed using screen captures saved weekly while gathering the data for brand fans. We looked at pages from January through March 2010 that had at least 100,000 fans. For Twitter, we created a program to download the most recent 3,000 tweets written by each fast food restaurant from Twitters servers to analyze the content of tweets published in 2009. We limited our analysis to accounts that had a minimum of 1,000 followers. We recovered all 2009 tweets for all restaurants, with the exception of Dunkin Donuts and Starbucks (the @ Starbucks account) due to their exceptionally high volume. We downloaded a sizable sample of over 1,941 of Starbucks 2009 tweets (59% of the total 2009); however, we could only download Dunkin Donuts tweets from February 2010, so its tweets are excluded from the content analysis. Wendys @ WendysRestaurant is also excluded from the content analysis because the program was unable to retrieve the restaurants 2009 tweets. To perform the content analysis for YouTube, we used the coding manual for the TV content analysis. We limited our analysis to all videos uploaded to YouTube by the fast food restaurants in 2009 that had a minimum of 5,000 views, Furthermore, we measured the frequency with which restaurants engaged with individuals through social media by presenting the frequency of posts on Facebook from January 1, 2010 through March 31, 2010; the number of tweets per week in 2009; and the number of videos posted on YouTube in 2009. Social media footprint. We also present a footprint of the social media activities of each restaurant, incorporating the quantitative data collected. We created a bubble chart that shows the relative size of each companys installed and engaged fan base as determined by the number of Facebook fans, Twitter followers, and 2009 upload views on YouTube.

Mobile marketing
We examined three methods used by restaurants to target cell phone users: banner ads on mobile web sites, smartphone applications, and text messaging.

Mobile banner ads: These advertisements appear at the top or bottom of third-party mobile web pages. Similar to internet banner ads, they are graphic display ads (commonly accepted file types are GIF, Animated GIF, JPEG, and PNG) that click through to a page designated by the advertiser. Companies typically maintain mobile websites that can be accessed through cell phones and that are separate from their internet websites. Smartphone applications: These are operating systemspecific (e.g. iPhone and Android) applications that may be downloaded to mobile phones. They act as stand-alone programs and may perform a number of different functions, including games, store locators, and ordering platforms. Text messaging: The Short Message Service (SMS) enables brief messages (160 characters or fewer) to be sent between mobile phones and other SMS-enabled devices. While the technology is primarily used to transmit messages between private parties, it can also be used to communicate with companies to make payments, make inquiries from a service provider such as Google or Fandango, and, most significantly for our purposes, to place orders with a restaurant.

Mobile banner ads. We purchased mobile advertising data from comScore. The firms Ad Metrix Mobile product tracks banner ads on more than 1,000 mobile URLs. These sites include all sites linked to a mobile service providers portal (effectively a carrier-specific home page for accessing the mobile internet). The company automatically collects

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data from these defined portal websites every six hours, or approximately 120 times per month. Copies of the advertisements are captured and stored as a static image and classified four ways: by the company that owns the product being advertised, the division responsible for the product being advertised, the brand name of the product being advertised, and the product itself. Another product from comScore, Mobile Metrix, determines the top mobile websites as ranked by number of unique visitors. In order to determine this number, comScore meters the phones of a panel of participants aged 18 years and older and automatically captures their activity. The observed population of metered phones only includes smartphone data from comScore panelists using RIM, Microsoft, Palm, Google, and Symbian platforms. Smartphones are cell phones that run operating systems and offer advanced capabilities with PC-like functionality such as the iPhone. In our analysis, we used a comScore measure from Ad Metrix to describe mobile ad frequency: ad index. Ad index indicates relative share of presence of the advertisement on a given mobile website. This is established by comparing the frequency with which a particular advertisement appears on a mobile website as compared to all other advertisements on the same website. The ad index therefore acts as a benchmark: Any number above 100 indicates a greater observed presence than expected, while a number below 100 indicates the converse. We also used comScores Ad Metrix Mobile to identify fast food mobile website banner ads, the sites that they were advertised on, and the ad index for each restaurant advertiser on each website. We then removed duplicate ads with the same content but formatted as a different size and coded all unique banner ads using the coding manual developed for internet banner ads. Smartphone applications. We purchased an iPhone which we used to download all applications available that were produced by the twelve restaurants in our analysis. Content analysis of these applications documents the features and capabilities of each, including ordering ability, store locators, nutrition information, games, and special offers. The bi-annual iTunes Application Tracker report from comScore details the most popular, as defined by number downloaded, applications available for the iPhone and iPod Touch. The Tracker collects data for more than 5,000 iTunes applications through comScore's panel of two million persons. The product details application-specific information, such as projected total population and projected demographics of application users. For fast food restaurant applications with enough activity, comScore collects data from its online panel of iTunes users to measure the population of 12- to 17-year-olds who have these applications installed on their phones. ComScore has not included individuals who have downloaded applications and then deleted them when calculating the number of projected users; this metric represents the installed user base only. We also report the percentage of all application users who are 12-17 years. Text messaging. Text messaging is used by fast food restaurants as both an advertising medium and an ordering vehicle. In addition to using our iPhone to download applications, we also registered our phone number with fast food restaurants to receive text messages. We report which restaurants use text messaging as an ongoing part of their marketing efforts. We identified restaurants that allow individuals to place orders through text messaging. Some fast food restaurants allow people to send a text message to a short code with the body of the message containing the details of their order. Alongside our report of which restaurants use text messaging regularly to advertise, we also indicate which restaurants have added SMS to their roster of ordering options. To understand the ways in which teens access and use SMS services, we obtained data from comScores MobiLens product. Every month, the company surveys mobile subscribers, aged 13 years and older, to recall their mobile content consumption during the previous month. We use MobiLens to report the proportion of the teen population (13-17 years) who received SMS advertisements on their cell phones each month in 2009. We also report the proportion of the population who received SMS ads for food and for restaurants.

Marketing inside restaurants

We conducted a nationally representative audit of in-store marketing at the twelve fast food restaurants in our analysis to assess marketing messages at the point when consumers decide what menu items to purchase. The audit consisted of three main parts: 1) restaurant signs audit, which detailed menu items, messages and promotions on signs inside and outside the restaurants; 2) pricing analysis to appraise the cost of eight comparable items at each restaurant, and 3) sales practices audit to assess the default sides, drinks and sizes given when ordering a kids meal and a combo meal. We commissioned a market research firm to oversee and conduct the in-person restaurant audits. The research firm specializes in retail research conducted through a nationwide network of trained, experienced field personnel in major metropolitan areas. They maintain a comprehensive quality control program to ensure the collection of accurate data, which includes spot checking the original data and calculations, and restaurant rechecks when necessary. Field personnel audited signs and pricing in a representative sample of 1,050 fast food restaurants in 37 markets across the United States, including 100 different locations for each of the larger restaurants in our analysis (McDonalds, Burger

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King, Subway, Wendys, Starbucks, Taco Bell, Pizza Hut, Dunkin Donuts, and KFC) and 50 locations for each of the smaller restaurants (Sonic, Dominos and Dairy Queen). Only restaurants that were free-standing and open year-round were included in the analysis. Field personnel received the names of the restaurants healthy menus. In addition, field personnel recorded information about any other promotions present in the restaurant.

Restaurant signs audit

The restaurant signs audit documented signs inside and outside the restaurant. Field personnel underwent training in audit procedures and received a comprehensive field form together with detailed instructions. Field forms were customized by restaurant and listed individual menu items compiled from each of the fast food restaurants online menus. In addition, the form included space to record any signs that promoted the following menu types without mentioning specific menu items: breakfast menu for signs promoting availability of breakfast; late-night menu, which included signs referencing availability of a late-night menu or the restaurant having late hours; and dollar/value menu, which included mentions of availability of a dollar/value menu, combo meal or other value mention in the absence of specific menu items. Lastly, the field form provided space to write in any individual menu items present on signs that were not listed on the field form. For each menu item and type, field personnel indicated the number of signs which appeared in each of four areas within the restaurant: 1) the counter area, which included all areas in front of, around and behind the counter inside the restaurant as well as anything in direct view of customers standing in line; 2) all other indoor areas, which included all areas inside the location other than the ordering/counter area; 3) the drivethru area, which included signs located in the drive-thru lane from beginning to end and in the area immediately around the drive-thru menu board; and 4) the other outdoor areas, which included the parking lot, main marquee sign, roof, ground and anything posted in the restaurant windows facing to the outside. In addition, field personnel recorded the number of signs with price or other promotions for each menu item and type. Price promotions included any special price featured with an item and free food giveaways, such as Free fries with the purchase of a burger. Other promotions on signs included non-food giveaways, sweepstakes, celebrity endorsements, licensed characters, movie tie-ins and games advertised. Finally, field personnel indicated the number of signs for each menu item and type that included any of the following messages: value, which included signs that featured value or combo meals, an item or meal at a low or lower price, or the word value; kids, which included specific mention of a kids meal menu item, toys or other mention of kids or children; and health, which included signs that referenced the healthiness of menu items with words such as healthy, low-fat, diet, or lowcalorie as well as any mention of a restaurants healthy menu.

Nutritional quality of menu items on restaurant signs

To assess the nutritional quality of menu items featured on signs at the restaurants, we combined the data obtained in the audit of menu item signs at the restaurants and the nutritional quality data obtained in the menu composition analysis. For each menu item that appeared on restaurant signs, we obtained the following nutrition information: calories, sodium, saturated fat, sugar, and NPI score. For items offered in various sizes or different variations (e.g., different sauces served with chicken nuggets), we calculated median values for all variations of the menu item in our menu composition analysis. In a few instances, a menu item that appeared on restaurant signs in June 2010 did not appear on the regular restaurant menus in January 2010 and therefore nutrition data were not available in our menu composition analysis. If field personnel found more than five signs promoting that menu item, we contacted the restaurant to obtain nutrition information for those menu items. We then used the number of times that each menu item appeared on signs at the restaurants to calculate the weighted average number of total calories, sugar calories, saturated fat calories, and sodium for menu items that appeared on signs at each restaurant in each location and all locations. We doubled the number of menu items that appeared at signs in Sonic, Dominos, and Dairy Queen restaurants as the audit examined 50 restaurants each for these companies, compared to 100 restaurants for the other companies. These measures provide a comparison of the nutritional quality of foods featured in signs at different restaurants and in different locations. Finally, we calculated the percentage of healthy products on signs by dividing the number of menu items with a healthy NPI score that appeared on signs by the total number of menu items that appeared on signs for each restaurant and location within the restaurants.

Pricing analysis
In all locations of the in-store marketing audit (excluding the pizza and coffee restaurants), field personnel recorded the price of eight individual menu items. Researchers provided field personnel with the eight menu items to be priced during the audit. These items were chosen to include similar items across restaurants in the following comparison categories (when available): 1) main dish salad with chicken; 2) healthier and less healthy versions of the restaurants chicken sandwich; 3) the restaurants healthiest, moderately unhealthy, and least healthy beef sandwich; and 4) the healthiest and least healthy side (for most restaurants this included a fried potato and a raw fruit or vegetable side such as apples or

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side salad). Researchers determined the nutritional quality of the items to be priced according to NPI scores and total calories. Researchers chose items with similar serving sizes for comparison. For each item, we calculated the average retail price recorded across all restaurant locations. side, and/or beverage as the default. If the employee asked about specific sizes, sides and/or beverages (e.g., Would you like a small, medium or large?) field personnel ordered the first option suggested. If the employee asked an openended question about the desired size, side and/or beverage, field personnel inquired about the options available and ordered the first one offered. The field personnel recorded all sizes suggested by the employee and all healthy sides offered. Field personnel also recorded any suggestions made by the employee to upsize the combo meal and said yes to these suggestions. In addition, if the employee asked if the field personnel would like to modify the meal by adding or substituting menu items, condiments, or types of bread, these suggestions were recorded. Field personnel recorded the size and price of the combo meal received and the type and size of the side and beverage.

Sales practices audit

The sales practices audit took place in 250 locations of the five largest restaurant chains: 50 each in McDonalds, Burger King, Wendys, Subway and Taco Bell. The audit was conducted Monday through Friday during the week of June 14, 2010. Field personnel ordered two different pre-determined items at each restaurant: a kids meal and a combo meal. They received detailed scripts of how to order each item. The scripts included different menu items to order at each restaurant, but otherwise were identical. Field personnel placed all orders at the counter inside the restaurant and did not identify the purpose of their order. After the order was completed, they recorded employee responses at a location outside the restaurant. Field personnel first ordered a kids meal without specifying a desired side or beverage. Similar kids meals were ordered across restaurants: a hamburger kids meal at McDonalds, Burger King and Wendys; a crunchy beef taco meal at Taco Bell; and a roast beef sandwich meal at Subway. Field personnel recorded whether the employee automatically included a specific side and/or drink with the meal without asking any further questions (i.e., the default item) or if the employee inquired about the side and drink desired. If the employee asked whether the shopper wanted a particular side(s) or drink(s) (e.g., Would you like fries or onion rings with that?), the field personnel ordered the first side or beverage offered. If the employee asked an open-ended question about what side or beverage the shopper wanted, the field personnel asked, What sides/drinks can I get? and ordered the first side or beverage suggested. Researchers provided field personnel with information about the healthier side and drink options available at each restaurant; and field personnel recorded all healthy sides and drinks offered by the employee during the conversation. In addition, field personnel recorded any suggestions made by the employee to modify the order such as type of bread, condiments, ordering a larger size, or ordering additional items. Finally, field personnel recorded the type and size of side and beverage received as well as the size and price of the kids meal. After ordering the kids meal, field personnel then ordered a combo meal without requesting a specific side, beverage, or size. Similar meals were ordered across restaurants: Quarter Pounder combo meal at McDonalds, Whopper value meal at Burger King, quarter pound single combo meal at Wendys, crunchy taco combo meal at Taco Bell, and 6-inch roast beef combo meal at Subway. Field personnel recorded whether the employee automatically provided a specific size combo meal,

Marketing outcomes
To measure the outcomes of restaurants marketing practices, we present data from two different sources: 1) a survey of parents of 2- to 11-year-olds to understand how often they visit fast food restaurants with their children, the menu items they purchase, and why; and 2) market research data purchased from The NPD Groups CREST service to quantify the types of prepared food and beverage products purchased most often.

Fast food restaurants visits

We surveyed parents of 2- to 11-year-old children to understand how often they purchase fast food for their children and which restaurants they frequent. We also asked what menu items they purchased for their children during their last visit and why they chose that fast food restaurant and those menu items. We examined differences between parents of preschool-age children (2-5 years) and elementary school-age children (6-11 years). We also looked at differences between white, African American, and Hispanic parents. We collected data on visits to the four largest fast food restaurants: McDonalds, Burger King, Subway and Wendys. The survey was conducted on the internet from August 27 to September 2, 2010. We recruited a national sample of 300 parents and augmented the sample to ensure it included at least 100 Hispanic parents and 100 African American parents. Survey Sampling International (SSI) distributed the survey to its panel of consumers who agree to participate in ongoing survey research.47 SSI recruits its panel members through thousands of websites to obtain a representative sample of the online population. The company screens panelists to provide highquality respondents and minimize fraud. To ensure more honest responses, panelists do not receive a direct reward for completing individual surveys. Instead, participants receive compensation for being active panelists. These rewards range from charitable donations and information to monetary and

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point rewards for overall participation. All participants in this survey were anonymous, and the procedures were approved by Yale University's Human Subjects Committee.. Participants accessed the survey on the computer through an email link. The internet was used to distribute the survey because it provides access to a large, well-represented sample of the national population, including Hispanics and African Americans. Furthermore, internet surveys generally produce responses of equal or better quality compared to telephone surveys.48 Survey questions. After completing an informed consent form, participants first confirmed that they were the parent of at least one child (2-11 years). Parents then indicated whether they had purchased lunch or dinner from McDonalds, Burger King, Subway, or Wendys for one or more of their children within the past week. Parents who answered yes continued to provide information about their most recent visit to one of the fast food restaurants. Those who had not visited one of these restaurants in the past week then answered questions about how often they usually buy fast food for their children from the twelve restaurants in our analysis and provided demographic information. Parents who had purchased lunch or dinner from one of the four fast food restaurants in the past week for their children were then asked about their most recent visit, including on which day of the week the visit occurred, where the restaurant was located, how they ordered the food, where they consumed the food, and why they chose that restaurant. Respondents then provided information about the youngest child for whom they purchased food during that visit. They indicated if and why that child wanted to visit the restaurant and what type of menu they ordered for the child (i.e., kids meal, dollar/ value menu, combo meal or other). If they ordered from the kids meal or the dollar/value menu, they were then shown a list of items available on each menu for the restaurant they visited and selected the items they ordered for their youngest child. They also indicated why they chose to order from that menu and why they chose each of the items they ordered. Respondents then answered the questions about frequency of fast food restaurant visits and demographic information. Group comparisons. In addition to comparing survey responses by restaurant visited most recently, we also compared responses for parents of 2- to 5-year-olds versus 6- to 11-year-olds, and white, African American and Hispanic parents when sample size permitted. We used chi-square analyses and Z-tests for proportions to identify significant differences between restaurants and demographic groups. largest privately owned market research companies.49 NPD provides restaurant behavior data obtained through online surveys taken by panelists about their meals and snacks prepared away from home yesterday.50 NPDs panel consists of more than 1.8 million registered adults and teens who have agreed to participate in its surveys, and the panel is updated daily to add new recruits and exclude poor-quality respondents. The company recruits panelists using only opt-in sources (e.g., email, website banner ads, etc). Once they register, panelists must opt-in two more times, demonstrating their commitment, before they are added to the panel and receive surveys. Every day, NPD receives approximately 2,000 surveys from panelists, including 1,900 adults and 100 teens (13- to 17-yearolds).51 Parents report the behavior of their children under 13. Of all respondents, approximately 45% indicate purchasing a meal or snack (which could include a beverage-only occasion) the day before taking the survey.52 NPD reports approximately 285,000 quick-serve restaurant visits annually (including orders at the restaurant and orders from other locations such as by phone or the internet), including 62,000 for children and teens. Panelists provide the name and location of the restaurant they visited the previous day, and note the time of visit and how the food was obtained, such as by drive-thru, delivery, or carry-out.53 They also answer questions about the food they purchased such as total price paid, promotions used, special menu, and meal type (e.g., combo meal, kids meal or dollar/value menu), and whether the food items purchased were described as healthy.54 For major chain restaurants, the survey then displays a current menu for the restaurant visited, and respondents select the items they purchased the previous day. A few specific questions about menu items are asked such as size of french fry orders and beverages, specific toppings on pizzas, and condiments on sandwiches.55 NPD projects the survey panel data to the U.S. population, using geographic and demographic targets from the U.S. Census Bureau.56 The data are also calibrated according to individual restaurant sales and traffic data, to accurately represent each restaurants presence within the industry. We purchased NPD CREST menu item data for each restaurant in our analysis and for all major fast food restaurants combined. NPD defines a major fast food restaurant as one with at least 250 transactions in its sample during a given year. In 2009, 79 restaurants fell into this category. We report measures for the following demographic groups: Under 6 years, 6-12 years, under 13 years, 13-17 years, 18-24 years, 25-49 years, all respondents, African American under 18 years, Hispanic under 18 years, and Caucasian under 18 years.

Menu items purchased at fast food restaurants

To identify and evaluate the menu items ordered at fast food restaurants we obtained data from NPD, one of the worlds

Descriptive information about fast food orders by demographic group

We report the following measures by demographic group for all fast food restaurant orders during 2009:

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Methods

Items per eater. Average number of items ordered per visit per individual. Time of day. Percentage of visits during the following dayparts: morning meal, lunch, supper, and PM snack. Where ordered/where eaten. Percentage of visits where food was ordered at the restaurant, outside the restaurant, and by carry-out, drive-thru, and delivery. Special meal type. Percentage of visits that include combo meals, items from the dollar menu, kids menu or other type of menu. We report this measure for all fast food restaurants and all fast food restaurants that serve hamburgers.

the two-year period from January 2008 through December 2009 for preschool-age children (under 6 years), children (612 years), teens (13-17 years), young adults (18-24 years), adults (25-49 years), and African American, Hispanic and white youth (under 18 years).

Nutritional quality of menu items purchased at the restaurants in our analysis

Finally, we used NPDs data on menu importance by food type to analyze the nutritional quality of the foods ordered by various demographic groups at each restaurant in our analysis. NPD provided a list of the specific menu items ordered by more than 25 individuals at each restaurant for each food type from January 2008 through December 2009. We then matched these menu items to the menu composition analysis for each restaurant to obtain their nutrient information. For food types that included more than one menu item at a restaurant, we calculated median calories, saturated fat, sugar, sodium, protein, fiber, and NPI score for each restaurant and food type. We then multiplied these medians by menu importance for each food type, divided by 100, and added the resulting numbers to obtain a weighted average total content of each of these nutrients for foods purchased during fast food visits. We calculated these numbers by restaurant for the following demographic groups: preschool-age children (under 6 years), children (6-12 years), teens (13-17 years), young adults (18-24 years), adults (25-49 years), and white youth (2-17 years), African American youth, and Hispanic youth. For the childrens age groups (under 6 and 6-12 years) we provide a best case version of the nutrition of foods consumed by using the nutrition information for foods on the childrens menu whenever they were available.

We provide the following measures for the two-year period from January 2008 through December 2009:

Beverage size. Percentage of meals that included a beverage in one of the following sizes: can/bottle, small cup/glass, medium cup/glass, large cup/glass, extra large cup/glass, or in a box/pouch. Total fry size. Percentage of meals that included french fries from the dollar menu, from a kids meal, small, medium, large, or extra large.

We also quantify the types of foods ordered by different demographic groups across all fast food restaurants. NPD classifies all restaurants individual menu items by food type. For example, McDonalds Big Mac and Burger Kings Whopper with cheese would both be classified as a large cheeseburger. By categorizing food in this manner, types can be compared across restaurants. NPD calculates menu importance by demographic group for the food types most commonly ordered, which is defined as the percentage of meals or snacks ordered by the specific demographic group that included a specific food (or beverage) type. Only food types ordered by at least 50 panelists in the demographic group of interest are reported. We present these data for

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Results Overview of fast food market

Fast food market Fast food restaurant Fast food segment Definitions Fast food restaurants feature a common menu above the counter; they provide no wait staff; and customers typically pay before eating and choose and clear their own tables. These restaurants are also known as quick serve restaurants (QSRs). Main type of food sold at the restaurant, including burgers, sandwiches, snacks, Mexican food, and pizza. sales. The next four, Subway, Burger King, Starbucks, and Wendys, had $8 to $10 billion each in sales and 6% to 7% of the market. The three YUM! Brands restaurants in the top 20 (Taco Bell, Pizza Hut, and KFC) ranked sixth, seventh, and ninth individually. Together their sales totaled $16.7 billion, or 12% of the market, and placed YUM! Brands in second place behind McDonalds. The restaurants in our analysis represent several different segments of the fast food market including burgers (McDonalds, Burger King, Wendys, Sonic, and Dairy Queen), sandwiches (Subway), snacks (Starbucks and Dunkin Donuts), Mexican food (Taco Bell), pizza (Pizza Hut and Dominos), and chicken (KFC).4 The number of U.S. locations of these twelve restaurants totaled almost 100,000 and ranged from approximately 3,500 Sonic restaurants to almost 24,000 Subway restaurants. These twelve restaurants comprised 41% of locations for the top 50 restaurants.

Table 2 presents 2008 and 2009 sales data for the twenty largest fast food restaurants in the United States and highlights the twelve restaurants included in our full analysis. In addition to the ten restaurants with the highest sales in 2008 and 2009, we have also included Dominos and Dairy Queen in our analysis due to the large number of TV advertisements seen by children for these restaurants. In 2008, Dominos ranked ninth in the amount of TV advertising seen by children, Arbys ranked tenth and Dairy Queen ranked eleventh. In 2009, Arbys reduced its TV advertising by 40% and fell to thirteenth whereas Dairy Queen rose to tenth. Therefore, we have included Dairy Queen, but not Arbys, in the full analysis. The top 20 fast food restaurants totaled $117 billion in sales in 2009, 85% of sales for the top 50 restaurants; and sales for the twelve restaurants in our full analysis totaled $98 billion representing 71% of sales. McDonalds led the market with $30 billion in sales, a 22% share of the top 50 restaurant Table 2: Sales of top 20 fast food restaurants
2008 sales ranking Parent company Restaurant 1 McDonalds McDonalds 2 Doctors Associates Subway 3 TPG Capital Burger King 4 Starbucks Corporation Starbucks 5 Wendys Arbys Group Wendys 6 YUM! Brands Taco Bell 7 YUM! Brands Pizza Hut 8 Dunkin Brands Dunkin Donuts 9  YUM! Brands  KFC 10 Sonic Corp. Sonic 11 Wendys Arbys Group Arbys 12 Jack in the Box Jack in the Box 13 Dominos Pizza Dominos 14 Chick-fil-A Chick-fil-A 15 Panera Bread Panera Bread 16 Berkshire Hathaway  Dairy Queen 17 Papa Johns Papa Johns 18 CKE Restaurants Hardees 19 Quiznos Corporation Quiznos 20 AFC Enterprises Popeyes Twelve restaurants in our analysis  Top 20 restaurants Top 50 restaurants Source: QSR News (2009, 2010)

2008 sales (mill)1 $30,025 $9,600 $9,348 $8,750 $8,013 $6,700 $5,500 $5,500 $5,200 $3,811 $3,372 $3,080 $3,055 $2,962 $2,648 $2,519 $2,034 $1,680 $1,660 $1,593 $98,021 $117,050 $137,411

2009 sales Number of (mill)2 U.S. locations3 $31,000 13,980 $10,000 23,034 $9,000 7,250 $8,347 11,128 $8,388  5,877 $6,800  5,604 $5,000 7,566 $5,700 6,566 $4,900 5,162 $3,837 3,544 $3,229 3,596 $3,072 2,212 $3,031 4,937 $3,217 1,480 $2,797 1,304 $2,640 4,540 $2,057 2,781 $1,660 1,905 $1,777 4,203 $1,597 1,576 $98,643 99,188 $118,049 118,245 $138,536 243,693

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Results Fast food menu composition

In the following menu composition analysis, we first describe the range of individual menu items and special menus that were available on January 15, 2010 at the twelve restaurants. We then evaluate the nutritional quality of restaurants regular menus, dollar/value menus, healthy menus, and kids meals.

Menu items and special menus

Fast food menus Menu items Lunch/dinner sides Definitions Each food or beverage item listed on restaurants regular menus and posted on their websites on January 15, 2010. A menu item consists of all components of each food item even if they were listed separately on the menus, for example, salads with dressing and croutons or chicken nuggets with sauce. The size and flavor of each food or beverage was listed as a separate menu item, as were foods listed with different available options (e.g., egg sandwiches available with egg whites or regular eggs, a sandwich available with or without mayonnaise). Food items customized by the customer (e.g., pizzas and deli sandwiches) were listed as two menu items, including the most and least healthy versions. Foods sold as a family-sized item were converted to one-person portion sizes. Menu items typically consumed together with a main dish for lunch or dinner.

Lunch/dinner main dishes Individual menu items and meals typically consumed for lunch or dinner. Side beverages Individual beverages typically consumed together with a main dish (e.g., soft drinks, juices, milk). Breakfast items Individual items (including main dishes and sides) and breakfast platters. Snack item Individual items suggested for late-night consumption or as a snack. Also includes sweet snacks (including desserts) and snack beverages (e.g., shakes and frozen beverages). Coffee drink Special menus Any specialty coffee drink, including cappuccinos, lattes, mochas, and flavored coffees (hot or iced). Plain coffee is categorized as a side beverage and frozen coffee drinks are categorized as snack beverages. Neither was included in this category. Subsets of items from the overall menu promoted for consumption at a certain time of day (e.g., breakfast, snack, late-night) or for a certain type of customer (e.g., kids, dieters), or offered at a special price (e.g., dollar menus, special value meals). We only evaluated menus on company websites in January 2010. Special menus offered for a limited amount of time or only available at some restaurant locations were not included in the analysis. Figure 3. Proportion of menu items offered by food category for the twelve restaurants in our analysis

A total of 2,781 menu items were evaluated from the twelve restaurants in our analysis. The number of items per restaurant ranged from 123 (Taco Bell) to 388 (Sonic). On average, each restaurant offered 232 different menu items. Complete information about menu items offered by each restaurant in our analysis by food category is available at www. fastfoodmarketing.org/menuitems. Specific items offered on special menus and full nutrition information for items are also presented. Due to the low volume of menu items in some food categories originally specified (e.g., meals and breakfast sides), we placed the items into six food categories: Lunch/dinner main dishes (including meals), lunch/dinner sides, breakfast items, snack items (including snack foods, sweet beverages and sweet snacks/desserts), and coffee beverages (see Figure 3). Among the twelve restaurants, lunch/dinner main dishes comprised the largest food category followed by snacks and side beverages. More than half the menu items were typically sold for lunch or dinner (57% including sides and beverages), followed by snacks (22%) and breakfast (21% including coffee drinks).

Coffee beverages Lunch/dinner 13% main dishes 29% Snack items 22% Side beverages 21% Lunch/ dinner sides 7%

Breakfast items 8%

Source: Menu composition analysis (January 2010)

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Results
All restaurants offered side beverages and, with the exception of Starbucks, they offered lunch/dinner main dishes and sides on their menus (see Table 3). Eight offered breakfast items. McDonalds, Starbucks, and Dunkin Donuts offered extensive coffee menus with 90 or more coffee drinks. All restaurants also offered some snack items, but two restaurants had extensive sweet snack menus. Dairy Queen offered the most sweet snacks (149 foods and 59 beverages), followed by Sonic (24 foods and 150 beverages). Table 3. Number of menu items per restaurant
Lunch/dinner Restaurant main dishes McDonald's 44 Subway 140 Burger King 72 Starbucks 0 Wendy's 33 Taco Bell 76 Pizza Hut 123 Dunkin' Donuts 9 KFC 84 Sonic 51 Domino's 162 Dairy Queen 39 Twelve restaurants 833 Lunch/dinner sides 6 23 11 0 14 3 64 0 29 26 5 5 186 Side beverages 33 51 29 66 70 40 12 23 98 112 10 34 578 Breakfast items 30 43 32 12 7 0 0 58 0 13 0 19 214 Snack items 33 9 21 43 25 4 3 72 28 162 2 208 610 Coffee beverages 113 0 1 132 0 0 0 90 0 24 0 0 360 All items 259 266 166 253 149 123 202 252 239 388 179 305 2,781

Special menus
Special menus also varied across restaurants (see Table 4). Eight restaurants offered kids meals. McDonalds segmented the category further with versions for kids and big kids. In 2010, Burger King also introduced a kids breakfast meal.5 Except for KFC and Dairy Queen, the restaurants offered a toy or some other giveaway with their kids meals. Three restaurants served breakfast all day (Starbucks, Dunkin Donuts, and Sonic), and five offered special breakfast menus

Source: Menu composition analysis (January 2010)

Table 4: Special menus by restaurant

Restaurant Breakfast Kids meal Dollar/value menu Healthy menu Late-night/snack items McDonalds Morning Happy Meal* Dollar Menu Snack Wraps Mighty Kids Meal* Breakfast Dollar Menu Subway Morning Kids Fresh Fit Meal* $5 Footlongs Fresh Fit menu Burger King Morning BK Kids Meal* BK Value Menu Late-night menu Breakfast Value Menu Starbucks All day Delicious Drinks under 200 calories Favorite Foods under 350 calories Wendys Morning Wendys Kids Meal* Super Value Menu Taco Bell Taco Bell Kids Meal* Why pay more! Drive-thru 4th meal** Value Menu Diet menu Fresco menu Pizza Hut Big Eat Fit n Delicious Tiny Price-Menu Pizzas Dunkin Donuts All day DDSmart menu KFC Kids Laptop Meal Value menu 395 Calorie KFC Snacker Combo Sonic All day Wacky Pack Everyday Balanced Kids Meal* Value Menu Choices Dominos Lighter Options Dairy Queen Morning DQ Kids Meal Sweet Deals menu *Includes toy or other giveaway **Most menu items are available in Taco Bells late-night menu Source: Menu composition analysis

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Results
in the morning. Nine restaurants offered some type of dollar/ value menu nationally that included specific items available at a low price (typically around $1). McDonalds and Burger King also offered a special breakfast value menu. Seven restaurants promoted a healthy menu with lower-calorie options; and KFC promoted one lower-calorie meal option. A few restaurants also promoted menus for late-night (Burger King and Taco Bell) and all-day snacks (McDonalds and KFC).

Nutritional quality of all menu items

Nutritional quality analysis Nutrient Profile Index (NPI) score Calorie limits Sodium limits Definitions Measure of overall nutritional quality that considers positive and negative nutrients in foods. Scores range from 0 (very poor) to 100 (excellent). This scoring system is based on one developed by researchers in the United Kingdom for the Office of Communications (OFCOM) guidelines prohibiting junk food advertising to children. The United Kingdom allows TV advertising to children only for food products with a score of 64 or higher and beverages with a score of 70 or higher. In this report, we use these scores to identify foods and beverages with a healthy nutrient composition. Based on the Institute of Medicine (IOM) Committee on School Meals guidelines, calories per item should not exceed 700 for lunch/dinner main dishes, 500 for breakfast main dishes, and 350 for sides, snack items, and beverages.6 These guidelines are based on the calorie requirements for a moderately active 13- to 17-year-old. Based on the IOM Committee on School Meals guidelines, sodium milligrams per item should not exceed 720 for lunch/dinner main dishes, 480 for breakfast main dishes, and 340 for sides, snack items, and beverages.7 of sodium. Overall, 45% of coffee beverages and 38% of side beverages met all three nutrition criteria. In all other food categories, few menu items met all three nutrition criteria. Lunch/dinner sides tended to have the healthiest nutrition profiles of the food items; and 81% did not exceed maximum calorie limits. Lunch/dinner main dishes and sides also provided some overall healthy options with NPI scores as high as 84. However, the median NPI score for both categories was just 48 and one-third met the minimum NPI score of 64; some main dishes had more than 1,600 calories and some sides as many as 790. The sodium levels in these products were also extremely high. More than half the lunch/ dinner main dish and side combinations exceeded 2,130 mg of sodium, which is close to the recommended upper limit for sodium intake for adolescents for an entire day (2,250 mg). As a result, 12% of lunch/dinner sides and 5% of lunch/dinner main dishes met all three nutrition criteria.

Table 5 presents NPI score, calories, and sodium for all menu items by food category and Figure 4 summarizes the results of the analysis of menu items for healthy nutrient composition (measured by NPI score), maximum calories, and maximum sodium. Ranking Tables 1 and 2 present median NPI scores, calories, and sodium content by food category and restaurant and ranks the restaurants according to the percentage of items that met all nutrition criteria. Side and coffee beverages were the healthiest menu items with median NPI scores of 68 and the lowest calories and sodium. Fewer than 20% of these beverages exceeded the maximum calories, and just 2% exceeded maximum sodium levels. In addition, 46% of coffee beverages and 39% of side beverages achieved an NPI score of 70 or higher the minimum for an overall healthy beverage. However, these categories also included diet and no-calorie drinks, which influenced median levels, as well as beverages with up to 880 calories and 849 mg Table 5. Nutrient content of menu items by food category
Side beverages Coffee beverages Snack beverages Lunch/dinner main dishes Lunch/dinner sides Snack foods Breakfast NPI score Range 58-78 40-74 44-74 30-80 24-86 14-82 20-78

Calories Median 160 190 540 587 244 390 430 Range 0-880 0-780 110-1,390 80-1,640 20-790 40-1,530 35-1,370 Median 50 110 200 1,420 710 280 1,060

Sodium Range 0-840 0-440 0-780 230-5,520 0-2,080 10-990 105-3,790

Median 68 68 60 48 48 46 44

Source: Menu composition analysis (January 2010)

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Figure 4. Percentage of menu items by food category that met minimum NPI score, maximum calorie and sodium limits, and all three nutrition criteria
Coffee beverages Side beverages Lunch/dinner sides Lunch/dinner main dishes Breakfast items Snacks 0% 20% 40% 60% 80% 100%

However, the worst nutrient content belonged to the breakfast items, which had a per item median NPI score of 44 and median sodium content of 1,060 mg. In total, 11% had a healthy NPI score of 64 or higher and 3% met the three nutrition criteria. High saturated fat and sodium content generally contributed to the poor nutritional quality of breakfast items.

Differences by restaurant
Table 6 presents NPI score, calories, and sodium for all menu items by restaurant. NPI scores for beverages varied little among restaurants. However, overall nutrient quality of food items differed greatly. Subway and Taco Bell items had the highest median NPI score per item and reasonable median calories. However, Subway items had high sodium levels. One menu item alone (12 The Feast sandwich with Parmesan Oregano Bread, American cheese and mayonnaise) contained 5,520 mg of sodium. Wendys had the third highest median NPI score for foods (52), followed by KFC, Sonic, Dominos, McDonalds, Burger King, and Dairy Queen, all with median NPI scores of 46 to 49. The two coffee restaurants (Dunkin Donuts and Starbucks) had the lowest NPI scores due to the higher proportion of breakfast and snack items on their menus. The pizza restaurants (Dominos and Pizza Hut) had the highest median sodium levels and were among the highest in median calories. The traditional fast food restaurants had similar nutrition profiles (see Figure 5). Among these restaurants, McDonalds menu items had the best overall nutritional quality. Still, just 24% of its menu items met all three nutrition criteria. Dairy Queen had the worst: 4% met all criteria. Between 12% and 18% of menu items for the remaining traditional fast food restaurants met all criteria. Subway achieved the highest percentage of menu items with a healthy NPI score (51%). However, 73% of its menu items exceeded the maximum sodium criteria. Dairy Queen also

Calories Sodium NPI score All criteria

Menu items that met criteria

Source: Menu composition analysis (January 2010)

Compared to other beverages, snack beverages scored a somewhat lower median NPI score of 60 and had far more calories with a median of 540 and a maximum of 1,390. These products contributed significantly more calories than should be consumed outside of a main meal. More than half of all snack foods also exceeded the maximum calories for snacks. Approximately 96% of snack items were sweet snacks and snack beverages and therefore had high levels of sugar. In addition, 64% exceeded the maximum 350 calories. Just 4% of snacks (including foods and beverages) had a healthy NPI score and 2% met the three criteria.

Table 6. Nutrient content of menu items by restaurant

Restaurant Subway  Taco Bell Wendy's KFC Sonic Domino's  McDonald's  Burger King Dairy Queen Pizza Hut Dunkin' Donuts Starbucks NPI score (foods) Median Range 64 18-78 64 38-80 52 24-80 49 18-86 48 24-82 48 22-70 46 18-74 46  24-74 46 20-82 42 28-78 40 14-72 36 20-72 NPI score (beverages) Median Range 68 66-76 66 66-70 66  44-72 66 66-70 66 56-76 66 66-70 68 40-78 68 54-76 62 56-72 66 66-70 68 58-72 70 64-74 Calories Median Range 415 0-1,420 340 0-1,000 460 0-1,330 260 0-1,040 340 0-1,110 690 0-1,120 235 0-1,370 400 0-1,310 570 0-1,640 560  0-1,590 235  0-860 230 0-550 Sodium Median Range 1,170 0-5,520 650 0-2,310 220 0-3,150 290 0-3,120 110 0-2,310 1,547 40-2,720 140 0-2,335 765 0-2,350 310 0-3,690 1,448 40-4,090 160 0-3,790 120 0-1,140

Source: Menu composition analysis (January 2010)

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Figure 5. Percentage of menu items by restaurant that met minimum NPI score, maximum calorie and sodium limits, and all three nutrition criteria
Traditional fast food restaurants
McDonalds

stood out as the traditional fast food restaurant with the highest calories and worst overall nutrition scores: 34% of its items met the maximum calorie limits and 6% had a healthy NPI score. The coffee and pizza restaurants differed considerably from the traditional fast food restaurants. Starbucks and Dunkin Donuts offered the most menu items that met all three nutrition criteria (53% and 25%, respectively). Starbucks also had the most menu items that met the healthy NPI score cut-off (55%) and the maximum sodium limits (93%). Dominos and Pizza Hut had the fewest items that met all three criteria (3% and 1%, respectively). In addition, just 15% of Dominos menu items and 6% of Pizza Huts had healthy NPI scores, and 7% to 8% of the items on their menus met maximum sodium limits.

Wendys

Taco Bell

KFC

Sizes of soft drinks and french fries

Soft drinks and french fries were the two most frequently ordered items at fast food restaurants in 2008 and 2009: 43% of youth (ages 6-17) and 29% of preschoolers (under 6 years) ordered soft drinks during their visit; and 30% of children under 12 years and 20% of teens (ages 13-17) ordered french fries.8 However, we found wide variation in the sizes of soft drinks and french fries offered at the different restaurants. Figure 6 illustrates the size variation of soft drinks available at each restaurant that sold fountain soft drinks (i.e., those dispensed from a machine, not in cans or bottles). Restaurants offered up to six different soft drink sizes, ranging from Wendys child-sized beverage (8 oz.) to KFCs Mega Jug (64 oz.). All restaurants offered a small (average 16.3 oz.), medium (average 21.5 oz.), and large (average 31.5 oz.) size. In addition, four restaurants (Subway, Taco Bell, KFC, and Sonic) offered an extra large size (average 48 oz).

Sonic

Burger King

Calories Sodium NPI score All criteria

Subway

Dairy Queen 0% 20% 40% 60% 80% 100%

Menu items that met nutrition criteria

Pizza and coffee restaurants

Starbucks

32 oz.

21 oz.

21 oz.

21 oz.

20 oz.

20 oz.

12 oz.

Dunkin Donuts

Medium soft drinks at fast food restaurants

Calories Sodium NPI score All criteria

Dominos

Pizza Hut

0%

20%

40%

60%

80%

100%
12 oz. 64 oz. 44 oz. 40 oz.

Menu items that met nutrition criteria

Source: Menu composition analysis (January 2010)

Extra large soft drinks

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Figure 6. Soft drink sizes by restaurant
80 70 60 50 Ounces 40 30 20 10 0
Child Value Small Medium Large Extra Large

McDonalds

Subway

Burger King

Wendys

Taco Bell

KFC

Sonic

Dairy Queen

Pizza Hut

Source: Menu composition analysis (January 2010)

Figure 7: French fries sizes by restaurant

200 180 160 140 120 Grams 100 80 60 40 20 0 Kids Value Small Medium Large

McDonalds Burger King Wendys Sonic Dairy Queen

information for its fountain beverages that included room for ice in the cup (i.e., the cup size was larger than the ounces of soft drink indicated for that size). Therefore, customers in Wendys restaurants with self-service soda machines could fill their cup with more soda than was specified in Wendys nutrition tables. Restaurants also offered numerous sizes of french fries (see Figure 7). Again, the child-sized fries were always the smallest size available. However, four of the five restaurants with childsized french fries also served the same size on their regular menu. The smallest regular menu size was labeled either a value (Burger King and Wendys) or small (McDonalds and Sonic) size. Regardless of its label, the approximately 110 gram portion was the smallest size available with the restaurants combo meals. The largest portions were offered by Burger King, Wendys and Dairy Queen (more than 180 grams). Changes in sizes since 2002. In 2007, Young and Nestle9 examined sizes of french fries and soft drinks offered by McDonalds, Burger King and Wendys. They found that in spite of requests from health authorities to reduce portion sizes, only McDonalds responded by eliminating its supersized beverages and french fries during the time from 2002 to 2006. Burger King made no changes, but Wendys renamed its sizes and even increased the size of its largest soft drink. Wendys 142 grams medium-sized french fries became small, its Biggie 32 oz. soft drink became a medium, and its 190 grams Great Biggie french fries became a large. It also added a 42 oz. large soft drink that was larger than its former Biggie size. Table 7 compares the sizes of soft drinks and french fries that Young and Nestle found in 2002 and 2006 to the sizes we found in 2010. Since 2006, McDonalds made only one small

Source: Menu composition analysis (January 2010)

The child-sized beverage was typically the smallest size offered (average 12.6 oz.). Five restaurants offered a child size that was smaller than their small beverages. The child-sized Taco Bell and KFC beverages were the same size as their small beverage (16 oz. each). Two restaurants (Burger King and Wendys) also offered a value-sized beverage (average 13.7 oz.) that was smaller than their small beverage. In total, 85% of the soft drink sizes offered were larger than a 12 oz. soft drink can. Only Wendys offered a soft drink size smaller than 12 oz. that was not labeled a child-sized drink. However, Wendys was also the only restaurant that provided nutrition

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Results

116 grams

117 grams

142 grams

117 grams

148 grams

Medium french fries vary by restaurant the actual portion offered. In addition, its medium became a small, large became a medium, and king became a large. Wendys also changed some names as well as some portion sizes. The reported portion sizes of all Wendys soft drinks have been reduced; however, the size of its cups has not changed and Wendys now reports their portion sizes with ice. Therefore, it is not clear whether the portion sizes have changed; adding ice to soft drinks is not a new practice. However, Wendys has reduced the portion sizes on all its french fries by 3% (large size) to 22% (kids size).

Burger King small and McDonalds medium french fries change to its portion sizes and names: The medium soft drink increased by 1 oz. (to 22 oz.). Burger King, however, followed Wendys previous strategy of renaming, but not changing, the size of different options. Burger King changed its small sized soft drinks and french fries to a value size without changing Table 7. Changes in sizes of soft drinks and french fries*

200210 200611 Soft drinks Name Fl. oz. Name Fl. oz. Name McDonalds Child 12 Child 12 Child Small 16 Small 16 Small Medium 21 Medium 21 Medium Large 32 Large 32 Large Supersize 42 Burger King Kiddie 12 Kiddie 12 Kiddie Small 16 Small 16 Value Medium 21 Medium 21 Small Large 32 Large 32 Medium King 42 King 42 Large Wendys Kid 12 Kid 12 Kid Small 16 Value Medium 20 Small 20 Small Biggie 32 Medium 32 Medium Large 42 Large 200210 200611 French fries Name McDonalds Small Medium Large Supersize Burger King Small Medium Large King Wendys Kids Medium Biggie Great Biggie Grams Name 68 Small 150 Medium 179 Large 201 74 Small 116 Medium 162 Large 196 King 91 Kids 142 Small 159 Medium 190 Large Grams Name 68 Small 113 Medium 170 Large 74 Value 116 Small 147 Medium 181 Large 91 Kids 142 Small 159 Medium 190 Large

2010 Fl. oz. 12 16 22 32 12 16 21 32 42 8 11 13 20 27 2010 Grams 71 117 154 74 116 147 181 71 113 142 184

*Bold indicates a change from the previous year Source: Young & Nestle (2007) and menu composition analysis (January 2010)

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Dollar/value menus
Dollar/value menus Definition Dollar/value menus Individual menu items promoted together as a group within the full menu offered at a special price (e.g., Dollar, 99-cent, or $5 Footlong menus) Nine restaurants offered some form of dollar or value menu (see Table 8). Most restaurants dollar/value menus featured a limited number of smaller items for a low price (typically $1). However, Subway and Pizza Hut had the opposite value menu strategy; they offered larger items for a discounted price. Three-quarters of all items on dollar/value menus were items typically consumed at lunch or dinner and one-quarter were snack items (see Figure 8). Breakfast items comprised 5% of dollar/value menu items. Dollar/value menu items comprised approximately 10% of the menu items offered by the nine restaurants with a dollar/ value menu, averaging 23 items per restaurant. Taco Bell had the fewest dollar/value menu items (11) and Sonic and Dairy Queen had the most (49 and 31, respectively) (see Table 8). Lunch/dinner main dishes were available on all nine restaurants dollar/value menus, and lunch/dinner sides on seven. Snack items were also available on six dollar/value menus. The only food category which was not available on any dollar/value menu was coffee beverages. Table 9 lists the median NPI score, calories, and sodium for each restaurants dollar/value menu. With the exception of Pizza Hut, all restaurants did offer at least one option with a healthy NPI score on their dollar/value menus, including side salads (Dairy Queen, KFC and Burger King); low-fat chicken sandwiches (KFC, McDonalds, and Subway); and fruit (fresh banana at Sonic and Fruit n Yogurt Parfait at McDonalds). When compared to items on their regular menus, the dollar/ value menu items at McDonalds, Burger King, Wendys, Taco Bell, Sonic and Dairy Queen had lower average serving sizes Table 8. Number of menu items available on dollar/value menus
Restaurant Item price McDonald's $1 Subway $5 (footlong) Burger King $1 Wendy's 99 Taco Bell 89 - 99 Pizza Hut $10 (3-toppings pizza) KFC 99 - $1.99 Sonic $1.00+ Dairy Queen 2 for $3, 3 for $4, 4 for $5 Twelve restaurants Source: Menu composition analysis (January 2010) Lunch/dinner main dishes 2 16 2 8 9 17 5 3 4 66 Lunch/dinner sides 3 0 4 1 0 2 3 2 4 19 Side beverages 8 0 6 11 0 0 0 29 10 64 Breakfast items 4 0 5 0 0 0 0 1 0 10 Snack items 4 0 1 0 2 0 12 14 13 46 All items 21 16 18 20 11 19 20 49 31 205

Figure 8. Proportion of dollar/value menu items offered by food category

Breakfast 5%

Snacks 22%

Lunch/dinner main dishes 33%

Side beverages 31%

Lunch/ dinner sides 9%

Source: Menu composition analysis, January 2010

and calories; although only Sonic and Dairy Queen dollar/ value menu items had a higher average NPI score for overall nutritional quality.12 Subway and Pizza Hut dollar/value menu items, however, had substantially higher calories and sodium (more than 80% higher) as compared to their overall menu. Overall, 20% of dollar/value menu items met all three nutrition criteria, as compared to 17% of all restaurant menu items; 28% of items qualified as healthy according to NPI score, and just 15% exceeded maximum calorie levels. More than 24% of dollar/value menu items at Burger King, Sonic, McDonalds, and Wendys met all three criteria, and 90% or more did not exceed maximum calorie levels (see Figure 9). Although nearly all of Taco Bell, Dairy Queen, and KFC dollar/ value menu items did not exceed the maximum calorie limits, these restaurants items were less likely to meet the maximum sodium and overall nutritional quality criteria. Therefore, approximately 10% of their dollar/value menu items met all three criteria. None of Subways or Pizza Huts dollar/value menu items met all three criteria. All their items exceeded the maximum sodium levels and 81% of Subways items exceeded the maximum calories.

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Table 9. Nutrient content of menu items available on dollar/value menus
NPI score (foods) NPI score (beverages) Restaurant  Median Range Median Range Subway  59 38-60 Dairy Queen 56 40-80 67 66-70 Sonic 54 40-64 66 64-76 Taco Bell 52 38-72 KFC  50 18-78 Burger King 44 24-70 70 70-76 Wendy's 44 38-64 66 66-70 Pizza Hut 44 32-62 McDonald's  40 24-70 70 66-70 Source: Menu composition analysis (January 2010)  Calories Median Range 960 460-1,400 240 0-400 150 0-420 260 170-550 280 20-520 255 5-490 120 0-390 1,050 245-1,590 275 0-430 Sodium Median Range 2,515 830-4,240 105 10-920 30 0-790 640 200-1,640 520 120-1,060 393 5-1,090 28 0-880 2,300 695-4,090 375 0-1,080

Figure 9. Percentage of dollar/value menu items that met minimum NPI score, maximum calorie and sodium limits, and all three nutrition criteria
Sonic

Healthy menus
Healthy menus Healthy menu Definition Groups of items from the main menu designated by the restaurant as healthier in some way, including low(er) in calories, low(er) fat, and diet.

Burger King

McDonalds

Wendys

Approximately 7% of menu items were designated as healthy options by the eight restaurants that offered a healthy menu. Two-thirds of all items on the healthy menu were items typically consumed at lunch or dinner and 25% were breakfast items or coffee beverages (see Figure 10). Snacks comprised 10% of healthy menu items. Restaurants healthy menus averaged 43 items (see Table 10). Four restaurants had ten or fewer items on their healthy menus (Pizza Hut, Taco Bell, KFC, and Dominos), while the other four restaurants each offered 29 to 52 items. Six of the restaurants offered lunch/dinner main dishes on their healthy menus, four offered side beverages, and the remaining food categories were offered by two to four of the restaurants. Table 11 presents NPI scores, calories, and sodium by restaurant for all items on the healthy menu. Menu items on restaurants healthy menus were generally of acceptable nutritional quality, especially when compared to the items on their regular menus. With the exception of the pizza restaurants, the median calories for items on healthy menus did not exceed 300; and all restaurants healthy menu items had fewer average calories than their regular menu items. In addition, median NPI score for restaurants healthy menu items exceeded the median score for their other regular menu items. With the exception of Subway and KFC, these differences were all statistically significant. However, median milligrams of sodium for items on restaurants healthy menus were comparable or even somewhat higher than sodium levels for all their menu items. Overall, 96% of items on healthy menus did not exceed the maximum calorie criteria and 68% met maximum sodium levels

KFC

Dairy Queen

Taco Bell

Subway

Calories Sodium NPI score All criteria

Pizza Hut 0% 20% 40% 60% 80% 100%

Dollar/value menu items that met nutrition criteria

Source: Menu composition analysis (January 2010)

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Figure 10. Proportion of healthy menu items offered by menu category

Regular menu overview

As is apparent from the large number of menu items offered at fast food restaurants, the blurring of traditional food categories across different types of restaurants, and the continual introduction of new products, fast food restaurant menus are an important marketing tool in this very competitive market. Traditional fast food restaurants now offer extensive coffee, breakfast, and snack menus. The majority of restaurants also offer dollar/value menus with individual items priced around one dollar or discounts on larger items.

Coffee beverages Lunch/dinner 15% main dishes 26% Snack items 10% Breakfast items 10% Lunch/ dinner sides 3%

Side beverages 36%

Source: Menu composition analysis (January 2010)

and minimum NPI scores. With the exception of Pizza Hut and Dominos, at least one-third of the restaurants healthy menu items met all three nutrition criteria (see Figure 11). The figure was higher for Dunkin Donuts (65%) and Sonic (73%). All of Dominos and Pizza Huts items exceeded the maximum sodium limits and therefore did not meet all three nutrition criteria.

However, just 17% of menu items met all three nutrition criteria. Calorie and sodium limits were achieved more often (69% and 54%, respectively), but only 27% met healthy NPI scores. Nutritional quality varied widely by food category and restaurant. Breakfast items and snacks had the worst nutritional quality, whereas coffee and side beverages had the best. At most restaurants, sodium levels for some lunch/ dinner main dishes and sides were extremely high, ranging from 230 mg. to 5,520 mg. In addition, many snack foods and beverages had extremely high calories. Snack items had as many as 1,500 calories, the calories that most teens should consume in two meals. Pizza restaurants and Dairy Queen had the worst overall quality of the restaurants analyzed; and Starbucks, Dunkin Donuts, and McDonalds had the

Table 10. Number of menu items available on healthy menus

Restaurant Subway Starbucks Taco Bell Pizza Hut Dunkin Donuts KFC Sonic Dominos Twelve restaurants Lunch/dinner main dishes 16 0 7 6 0 8 4 10 51 Lunch/dinner sides 3 0 0 0 0 0 2 0 5 Side beverages 10 6 0 0 12 0 40 0 68 Breakfast items 0 7 0 0 13 0 0 0 20 Snack items 0 13 0 0 1 0 6 0 20 Coffee beverages 0 10 0 0 20 0 0 0 30 All items 29 36 7 6 46 8 52 10 194

Source: Menu composition analysis (January 2010)

Table 11. Nutrient content of menu items available on healthy menus

NPI score NPI score (foods) (beverages) Calories Restaurant  Median Range Median Range Median Range Subway  70 50-76 70 70-72 300 0-540 Taco Bell 68 64-74 180 150-340 Sonic 68 64-82 70 60-76 10 0-670 Pizza Hut 64 60-68 427 400-480 Domino's  64 50-66 541 480-640 KFC 60 46-68 175 80-480 Dunkin' Donuts 54 36-72 70 66-72 80  0-500 Starbucks 42 28-72 70 66-72 210 0-350 Source: Menu composition analysis (January 2010) Sodium Median Range 910 0-1,690 740 350-1,410 25 0-1,513 1,480 1,067-1,893 1,252 867-1,520 505 230-1,200 75 0-1,180 125 0-1,140

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Figure 11. Percentage of healthy menu items that met minimum NPI score, maximum calorie and sodium limits, and all three nutrition criteria.
Starbucks

KFC

Therefore, ordering from the dollar/value menu would be a good strategy for adolescents and adults at some restaurants, including Burger King, Sonic, McDonalds, and Wendys. Healthy menus also tended to feature menu items with the best overall nutritional quality, and most healthy menu items were lower in calories. However, healthy menu options at Subway and the pizza restaurants were high in sodium and most of the coffee restaurants healthy options did not have high NPI scores.

Dominos

Kids meals nutritional quality

Kids meals Definitions A menu of items specifically designed for children. Kids meals typically contain a main dish, side, and beverage. Many also come with a toy or other giveaway. Possible combinations of main dishes, sides and beverages that can be ordered in one kids meal. Kids meal Kids meal combinations

Pizza Hut

Sonic

Dunkin Donuts

Subway

Taco Bell 0% 20% 40% 60% 80% 100%

Healthy menu items that met nutrition criteria

Calorie limits Maximum acceptable calories for kids meals are based on the Institute of Medicine (IOM) Committee on School Meals guidelines.13 Kids meals served to elementary school-age children should not exceed 650 calories and those served to preschool age children should not exceed 410. Sodium limits Based on the IOM Committee on School Meals guidelines,14 kids meals served to elementary school-age children should not exceed 636 mg of sodium and those served to preschool-age children should not exceed 544 mg.

Calories

Sodium

NPI score

All criteria

Source: Menu composition analysis (January 2010)

best. However, these restaurants all had a high proportion of coffee beverages on their menus, which skewed their results positively. Unfortunately, coffee beverages are not menu items that should be encouraged for child and teen consumption. The sizing of soft drinks and french fries (the most commonly ordered items) is confusing and differs greatly among restaurants. Burger King and Wendys practice of providing larger portions than offered by their competitors for the same size name (e.g., medium and large) likely encourages greater consumption of french fries and/or soft drinks at these restaurants. In addition, four restaurants offered soft drinks sized 40 oz. or more (Subway, Burger King, Taco Bell, KFC and Sonic); the equivalent of five or more servings of soft drink. With the exception of Subway and Pizza Hut, dollar/value menu items tended to be lower in calories and some restaurants dollar/value menus were higher in overall nutritional quality.

Eight of the restaurants in our analysis offered kids meals: McDonalds, Subway, Burger King, Wendys, Taco Bell, KFC, Sonic, and Dairy Queen. Appendix A (Table A.2) lists all kids meal items with nutrient information. We included each version of a menu item as a separate item: for example, chicken nuggets with the most and least healthy sauce options; three separate flavors of KFC chicken; and two versions of each Subway sandwich, one with wheat bread and vegetables only and one with white bread and cheese. Most kids meals included a main dish, side, and beverage. The KFC kids meal also came with a string cheese snack, and Dairy Queens kids meal included an ice cream cone or other novelty ice cream. Table 12 lists the number of kids meal options available. This number varied greatly; for

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example, KFC offered only popcorn chicken and a drumstick (in three flavors) as a main dish, whereas Burger King and McDonalds each offered seven different main dish options. Taco Bell offered one side option (cinnamon twists), but KFC had ten options. Similarly, Subway offered just two drink options (100% juice and low-fat milk) but Sonic offered 37, including juice, milk, soft drinks, and slushes (frozen ice beverages with syrup). We did not include any diet drinks that contained artificial sweeteners in the kids meal choices although they were generally available. A total of 3,039 kids meal combinations were available at these eight restaurants, ranging from 32 combinations at Subway to 875 at Sonic and 880 at Dairy Queen. The nutritional quality of menu items offered with kids meals from the different restaurants varied widely (see Table 13). As measured by NPI score, Subways options had the highest overall quality: All its kids sandwiches, sides, and beverages scored higher than the minimum NPI score to be classified as healthy. In contrast, only one of Dairy Queens items qualified as healthy (applesauce). Total calories for the entire kids meals ranged from 155 (KFCs Kids Laptop Meal with a grilled chicken drumstick, green beans, string cheese and iced tea) to 973 for a DQ Kids Meal with a cheeseburger, french fries, sugar-sweetened soft drink, and Dilly ice cream bar. The sodium in all kids meals was generally high. The median sodium content for McDonalds Mighty Kids meals, KFC, and DQ kids meals were all greater than 1,000 mg. Figure 12 presents the proportion of kids meal combinations that met the maximum criteria for calories and sodium, and minimum NPI score for overall nutritional quality. Just 15 of the 3,039 possible kids meal combinations (0.5%) met all three nutrition criteria for elementary school-age children and 12 (0.4%) met the criteria for preschool-age children. Subway had the best overall quality meals: 28% of its kids meal combinations met all three criteria for elementary schoolage children and 19% met them for preschool-age children. Burger King was the only other restaurant that had a kids meal option that met all three criteria: macaroni and cheese, apple fries, and plain fat-free milk or apple juice. One-third or fewer of restaurants kids meal combinations stayed below the maximum sodium criteria of 636 mg for elementary schoolage children. None of McDonalds Mighty Kids meals, or DQ Kids meals met the sodium limits. The majority of kids meal combinations did not exceed the 650-calorie maximum for elementary school-age children; however, only Subway had more than 25% of kids meal combinations that fell below the 410 calorie limit for preschool-age children. Because of the ice cream snack, only one DQ Kids meal combination was below 650 calories (at 647).

Table 12. Number of menu items and combinations available for kids meals
Restaurant  cDonalds Happy Meal M McDonalds Mighty Kids Meal Subway Kids Fresh Fit Meal BK Kids Meal Wendys Kids Meal Taco Bell Kids Meal KFC Kids Laptop Meal Sonic Wacky Pack Kids Meal DQ Kids Meal Main dishes 4 3 8 9 5 5 4 5 5 Sides 3 3 2 5 2 1 10 5 2 Beverages 9 9 2 12 12 9 19 37 8 Other 0 0 0 0 0 0 1 0 11 Total combinations 108 81 32 138 120 45 760 875 880

Source: Menu composition analysis (January 2010)

Table 13. Summary nutritional quality information for kids meal combinations
Restaurant McDonalds Happy Meal  McDonalds Mighty Kids Meal Subway Kids Fresh Fit Meal BK Kids Meal Wendys Kids Meal Taco Bell Kids Meal KFC Kids Laptop Meal Sonic Wacky Pack Kids Meal DQ Kids Meal % with healthy NPI scores Main dishes Sides Beverages 0% 100% 44% 0% 100% 56% 100% 100% 100% 11% 60% 50% 0% 100% 8% 40% 0% 0% 0% 50% 5% 0% 60% 17% 0% 50% 0% Calories Median Range 465 275-700 595 365-840 383 285-470 548 285-950 520 360-730 580 500-780 550 155-820 560 250-760 784 593-973 Sodium Median Range 755 520-1,060 1,030 855-1,460 763 295-1,120 755 340-1,480 723 515-1,050 880 570-1,680 1,120 425-2,210 825 530-1,490 1,175 778-1,615

Source: Menu composition analysis (January 2010)

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Figure 12. Proportion of kids meal combinations that met maximum calories and sodium and all nutrition criteria for elementary and preschool-age children
Elementary school-age criteria
Subway Subway

Preschool-age criteria

Burger King

Burger King

Wendys

Wendys

McDonalds Happy Meal

McDonalds Happy Meal

Calories Sodium All three criteria

Sonic

Sonic

KFC

KFC

Taco Bell

Taco Bell

McDonalds Mighty Kids Meal Dairy Queen 0% 20% 40% 60%

Calories Sodium All three criteria

McDonalds Mighty Kids Meal Dairy Queen

80%

100%

0%

20%

40%

60%

80%

100%

Percentage of combinations that met nutrition criteria

Percentage of combinations that met nutrition criteria

Source: Menu composition analysis (January 2010)

Best and worst kids meal choices

Although few available kids meal combinations offered a high-quality nutritious meal for children, better and worse options were available at most restaurants. Ranking Table 3 lists the best and worst kids meal combinations available for each age group at the restaurants in our analysis. The best combinations listed all met the calorie limits for preschool and/or elementary school-age children. Most restaurants, with the exception of Taco Bell and Dairy Queen, had at least one option that met the preschool calorie criteria. Few combinations met the recommended sodium limits, but those that did are indicated in the table. In addition, we included on the best option list some meals that were better than most available even though they did not meet the NPI criteria for overall nutritional quality.

Main dishes. Subway sandwiches and Burger Kings macaroni and cheese offered the best overall nutritional quality of main dish options. However, when combined with a healthy side and beverage, kids meals with these main dishes provided 300 to 350 calories which might be too few calories for older, more active children. Most other restaurants offered main dish items with approximately 250 to 300 calories that would be appropriate for preschool or elementary school-age children. However, due to their high sodium and/or saturated fat content, these meals did not meet the criteria for overall nutritional quality. The larger-sized items offered at McDonalds and Burger King (double cheeseburgers and six-piece chicken nuggets) contained 350 to 460 calories alone, which neared the maximum recommended limits. When combined with a larger soft drink (as Burger King provides) and french fries, they exceeded recommended limits for older children by almost 200 calories. For chicken nuggets, ranch dipping sauces were the

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worst choice as they contained the most fat and lowest NPI scores of the sauces. Barbecue, honey mustard, and sweet and sour sauces contained less fat and fewer calories, but they were also predominantly composed of sugar. Sides. With the exception of Taco Bell, all restaurants offered at least one healthy side with their kids meals, generally a fruit. KFC also offered non-fried vegetables. McDonalds, Burger King, and Sonic provided caramel dipping sauce with their side of apples; but this sauce provided unnecessary added sugar and calories. Subway was the only restaurant that did not offer a form of fried potatoes with their kids meals. However, as noted before, the nutritional quality of french fries offered by the different restaurants varied significantly. McDonalds and Wendys fries received a good NPI score for overall nutritional quality and contained less saturated fat and sodium than other restaurants fries. However, they also contained more than 200 calories which, when combined with a main dish and beverage, caused the meal to exceed recommended calorie limits. Beverages. All restaurants, except KFC, Taco Bell, and Dairy Queen, offered plain low-fat or fat-free milk or 100% juice with their kids meals. Subway alone offered only these healthy options. The other restaurants also provided a soft drink option (both sugar-sweetened and diet). Soft drinks provided with kids meals ranged from 8 oz. (Wendys) to 16 oz. (Taco Bell, KFC, and Burger King with its double cheeseburger and six-piece nuggets).15 With the exception of Subway, restaurants that offered plain milk also provided chocolate milk as an option. In addition, Wendys offered Frostys (a frozen ice cream beverage) and Sonic offered Slushes (frozen ice beverages with syrup) as a kids meal beverage. None of the restaurants offered bottled water with their kids meals.

Kids meals overview

At McDonalds, Subway, Burger King, Wendys, and Sonic it was possible to select a kids meal that contained a healthy side and beverage and met recommended calorie limits for preschool and elementary school-age children. However, with the exception of Subway and one option at Burger King, main dishes offered with kids meals did not qualify as nutritious options that should be served to children regularly. In addition, again with the exception of Subway, kids meals at these restaurants all included nutritionally poor side and drink options and several high-calorie main dish items. Taco Bell, KFC, and Dairy Queen did not provide healthy drink options with their kids meals, and Taco Bell did not provide a healthy side of fruit or vegetables.

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Results Fast food marketing practices

To understand the scope and potential impact of fast food marketing practices, we examined young peoples exposure to traditional media, internet marketing, social media and mobile marketing, and marketing within restaurants, including the products, messages, and techniques presented in each. absolute increase. From 2008 to 2009, McDonalds increased its media spending by $100 million, or 13%. Sonic and Dunkin Donuts also increased their spending by 12% and 10%, respectively. Pizza Hut had the greatest decline (-16%). TV advertising accounted for 86% of total media spending by fast food restaurants: $3.6 billion in 2009, including $217 million in Spanish-language advertising (see Table 14). The twelve restaurants in our analysis purchased 75% of all fast food TV advertising. McDonalds bought the most TV media ($698 million, or 19% of all TV spending), followed by Subway ($374 million, or 10%). Radio and outdoor advertising were the next most frequently purchased media, but far behind television. In 2008, fast food restaurants spent $214 million on radio advertising, representing 5% of all advertising spending. McDonalds purchased 30% of all radio media, followed by Subway, Wendys, and Burger King. Together, these four restaurants accounted for 60% of radio advertising. Fast food restaurants also spent $156 million on outdoor advertising (e.g., billboards, transit signs), or 4% of fast food advertising spending. Spending on outdoor advertising was even more concentrated among the top 4 restaurants, which spent 64% of the total. McDonalds alone purchased 47% of all outdoor media.

Traditional media Advertising spending

Traditional Media Advertising spending Definition Amount spent on measured media, including television, magazines, radio, newspapers, freestanding insert coupons, and outdoor advertising. Data were licensed from The Nielsen Company.

Table 14 presents advertising spending by fast food restaurants. In 2009, 189 different fast food restaurants spent $4.2 billion in advertising across all measured media, a 2% increase from 2008. This spending was highly concentrated: The top 20 restaurants accounted for $3.8 billion, or 91% of total spending; and the twelve restaurants in our analysis spent $3.2 billion, or 76% of all fast food advertising spending. Ranking Table 4 presents advertising spending for the top 20 fast food restaurants. McDonalds far outspent all other restaurants at almost $900 million, or 21% of the total (see Figure 13). Subway followed with $424 million in total spending; and five additional restaurants (Wendys, Burger King, KFC, Taco Bell, and Pizza Hut) spent more than $200 million each. The three YUM! Brands restaurants in the top 20 (KFC, Taco Bell, and Pizza Hut) spent a combined $734 million, just 18% less than McDonalds budget and 72% more than Subways. In spite of its position as fourth in fast food sales, Starbucks spent only $28 million in measured media. Compared to 2008, eight of the twelve restaurants increased their media spending in 2009. Dominos had the largest percentage increase (+36%), but McDonalds had the greatest

Advertising spending overview

McDonalds dominates fast food advertising spending across all media with a budget of almost $1 billion. In fact, McDonalds spent more on radio and outdoor advertising alone ($138 million in total) than eleven of the top 20 fast food restaurants spent on all advertising combined. Subway had the second highest media expenditures in 2009 with an impressive budget totaling less than half of McDonalds ($425 million). Burger King and Wendys both spent almost $300 million in 2009; and the remaining restaurants spent less than $200 million. Starbucks media spending was notable; just $29 million to support sales of $8.3 billion. Compared to other restaurants, McDonalds also spent the lowest proportion of its total budget on TV advertising (78%) compared to 89% of all top 20 restaurants budgets. Fast food restaurant advertising spending increased by 2% in 2009 compared to 2008; however, the twelve restaurants in our analysis increased spending by 5% overall, and McDonalds spending alone increased by $100 million.

Table 14. Total advertising spending by fast food restaurants

Twelve restaurants Top 20 restaurants All fast food restaurants Total spending ($000) % 2008 2009 change $3,061,465 $3,214,299 5% $3,716,890 $3,820,715 3% $4,145,005 $4,217,710 2% 2009 spending by medium ($000) All TV Spanish- advertising Radio Outdoor language TV $2,738,684 $168,084 $115,581 $200,355 $3,297,050 $184,263 $132,474 $217,331 $3,636,501 $213,692 $155,922 $217,331

Source: The Nielsen Company

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Figure 13. Advertising spending in 2008 and 2009 by restaurant
$1,000,000 $900,000 $800,000 Advertsing spending ($000) $700,000 $600,000 $500,000 $400,000 $300,000 $200,000 $100,000 +3% +4% -4% -5% -16% +12% +36% +10% +0% +45% +3% +13%

2008 2009

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Source: The Nielsen Company

TV advertising exposure
TV advertising exposure Definitions Gross ratings points (GRPs) Average advertising exposure Targeted ratio: Preschoolers to adults Targeted ratio: Children to adults Targeted ratio: Teens to adults Measure of the per capita number of TV advertisements viewed by a specific demographic group over a period of time across all types of programming. GRPs for specific demographic groups are also known as target rating points (TRPs). Data were licensed from Nielsen. GRPs divided by 100. Provides a measure of the number of ads viewed by the average individual in the demographic groups of interest during the time period measured. GRPs for 2- to 5-year-olds divided by GRPs for 25- to 49-year-olds. Provides a measure of relative exposure for preschool-age children versus adults. GRPs for 6- to 11-year-olds divided by GRPs for 25- to 49-year-olds. Provides a measure of relative exposure of elementary school-age children to adults. GRPs for 12- to 17-year-olds divided by GRPs for 25- to 49-year-olds. Provides a measure of relative exposure of adolescents to adults.

Table 15 presents average exposure to fast food TV advertising for preschoolers, children, and teens in 2008 and 2009, and Table 16 presents exposure for young adults (18-24 years) and adults. The average U.S. preschooler viewed 2.8 TV ads for fast food restaurants every day in 2009; the average child

viewed 3.5 fast food ads every day; and the average teen viewed 4.7 every day. The average young adult viewed 5.0 fast food ads every day, only 6% more than the average teen. Adults viewed the most fast food ads: 5.7 ads in total every day. By comparison, preschoolers viewed approximately one-

Table 15. Fast food restaurant TV advertising exposure for youth: Ads viewed in 2008 and 2009
Twelve restaurants Top 20 restaurants All fast food restaurants Source: The Nielsen Company Preschoolers 2-5 years 2008 2009 % change 806 865 7% 899 948 6% 979 1,021 4% Children 6-11 years 2008 2009 % change 997 1,079 8% 1,117 1,187 6% 1,208 1,272 5% Teens 12-17 years 2008 2009 % change 1,356 1,404 4% 1,551 1,599 13% 1,696 1,723 2%

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Table 16. Fast food restaurant TV advertising exposure for adults: Ads viewed
Twelve restaurants Top 20 restaurants All fast food restaurants Source: The Nielsen Company Young adults 18-24 years 2008 2009 % change 1,392 1,463 5% 1,640 1,687 3% 1,820 1,841 1% 2008 1,435 1,731 1,979 Adults 25-49 years 2009 1,592 1,865 2,095 % change 11% 8% 6%

half that many, children viewed 61%, and teens viewed 82%. These numbers are comparable to the differences in overall TV viewing among these age groups. On average, adults watch 4:35 hours of TV every day; children (2-11 years) watch 25% less (3:27 hours); and teens watch 24% less (3:20 hours).16

Figure 14. Youth TV advertising exposure by restaurant in 2009

2,000 1,800 1,600 Ads viewed in 2009

TV ad exposure comparison by restaurant

For all age groups, exposure was concentrated among the top 20 fast food restaurants. These restaurants accounted for approximately 90% of all youth, young adult and adult advertising exposure. In 2009, the twelve restaurants in our analysis produced 85% of all preschool and child exposure to fast food advertising, and 81% of teen exposure. Appendix B (Table B.1) presents all exposure data by demographic group for the restaurants in our analysis. Ranking Tables 5 and 6 present 2009 exposure to TV advertising for the top 20 restaurants for preschoolers, children, and teens. McDonalds was the most frequent advertiser to all age groups: The average child viewed one McDonalds ad on television every day in 2009, preschoolers viewed .85 McDonalds ads every day, and teens viewed .78 ads. Burger King was the second most frequently advertised restaurant, with the average child and teen viewing one Burger King ad every two days and preschoolers viewing one every 2.4 days. Subway followed; the average preschooler viewed 1.9 Subway ads per week, the average child viewed 2.4 per week, and the average teen viewed 3.4 per week (one every two days). The three YUM! Brands restaurants in our analysis, KFC, Pizza Hut, and Taco Bell, placed fourth, fifth, and sixth, respectively, in advertising exposure for all age groups. However, when combined, these three restaurants were responsible for more ads viewed by all three age groups than Burger King. Teens viewed even more YUM! Brands ads (1.1 per day) than McDonalds ads (see Figure 14). Ranking Tables 5 and 6 also present targeted ratios for youth exposure to restaurant advertising compared to adult exposure. Children were exposed to more McDonalds and Burger King ads than adults were (25% and 9% more, respectively). Preschoolers viewed 5% more McDonalds ads and just 11% fewer Burger King ads compared to adults. McDonalds, Burger King, and Taco Bell also appear to be targeting teens. Teens viewed 11% more Burger King ads and 4% more Taco Bell ads as compared to adults; in contrast, teens viewed 4% fewer McDonalds ads.

1,400 1,200 1,000 800 600 400 200 0

All other Remaining 20 Remaining 12 Subway Burger King YUM! Brands McDonalds

10% 10% 9% 15% 16% 30%

Preschoolers

15% 17% 29%

Children

11% 24%

16%
Teens

Source: The Nielsen Company

Changes in fast food advertising exposure

Across all age groups, exposure to fast food advertising increased in 2009 from 2008. Total preschool and child exposure increased by 4% to 5%; teen and young adult exposure increased by 1% to 2%; and adult exposure increased by 6%. The twelve restaurants in our analysis also had higher than average rates of increase in advertising exposure for all age groups with a combined increase of 7% or more for preschoolers, children, and adults (see Tables 15 and 16). Changes in advertising exposure varied widely across the twelve restaurants in our analysis (see Table 17). Six restaurants increased their TV advertising to children, teens, and adults: Dominos, KFC, Taco Bell, McDonalds, Burger King, and Sonic. Of these six, Dominos, KFC, and Taco Bell increased advertising to children at a higher rate than their advertising to adults, whereas McDonalds and Burger King had a lower rate of increase for children. Only Dairy Queen and Pizza Hut reduced their advertising to all age groups. Dunkin Donuts, Subway, and Wendys were notable for reducing their TV advertising to children and teens while increasing advertising to adults.

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Table 17. Change in TV advertising exposure from 2008 to 2009 by restaurant and age group
Restaurant Dominos KFC Taco Bell McDonalds Burger King Sonic Dunkin Donuts Subway Dairy Queen Pizza Hut Wendys Starbucks Source: The Nielsen Company Ads viewed by children 2008 2009 % change 28 46 62% 63 78 23% 56 69 23% 317 368 16% 168 185 10% 34 37 9% 15 15 -3% 132 127 -3% 31 27 -14% 82 69 -16% 70 58 -17% 0 1 778% Ads viewed by teens 2008 2009 % change 59 85 44% 120 146 21% 130 140 8% 240 284 18% 177 189 7% 69 68 -1% 34 28 -18% 172 177 3% 60 48 -20% 158 125 -21% 137 113 -18% 0 1 1034% Ads viewed by adults 2008 2009 % change 69 96 40% 164 189 15% 127 135 6% 234 295 26% 146 170 17% 80 84 5% 41 53 29% 189 210 11% 61 56 -8% 192 164 -15% 131 137 4% 0 3 720%

Figure 15. Increase in average annual advertising exposure by age group: 2003 to 2009
450 400 Annual TV advertising exposure 350 300 250 200 150 100 50 0 2003 2007 2008 2009

Preschoolers (2-5 years) McDonalds YUM! Brands Burger King Subway

Annual TV advertising exposure

450 400 350 300 250 200 150 100 50 0 2003

Children (6-11 years)

2007

2008

2009

450 400 Annual TV advertising exposure 350 300 250 200 150 100 50 0 2003

Teens (12-17 years)

Source: The Nielsen Company; Powell et al. (2010)

In addition to 2008 and 2009 advertising exposure data, we obtained data for 2003 and 2007 for the larger restaurants in our analysis. These numbers were reported by Powell and colleagues17 using the same Nielsen GRP data by age group and restaurant that we report. Figure 15 presents average annual advertising exposure increases for McDonalds, Burger King, Subway, and the three YUM! Brands restaurants in our analysis (KFC, Pizza Hut, and Taco Bell) from 2003 to 2009. McDonalds, Burger King, Subway, and YUM! Brands each increased its advertising to all youth from 2003 to 2009. Subway had the largest increases for all age groups, ranging from 67% for teens to 147% for preschoolers. McDonalds advertising to

2007

2008

2009

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preschoolers declined from 2003 to 2007, but increased by 21% from 2007 to 2009. Exposure to McDonalds advertising also increased by 26% for children and teens from 2007 to 2009. In 2009, the average child viewed 87 more ads for McDonalds than they viewed in 2003. Burger King advertising to children and teens exhibited a steadier rise from 2003 to 2009, including a 10% increase from 2007 to 2009 for children (6-11 years). While preschoolers exposure to Burger King ads also increased during this period, the increase was relatively low (7%). YUM! Brands had its greatest increase in advertising to youth prior to 2007, with increases of 14% to preschoolers and children and 39% to teens from 2003. Since then, YUM! Brands advertising to preschoolers and children has leveled off, but its advertising to teens has continued to increase.

TV ad exposure by product category

Product categories Definitions Kids meal Individual items and meals offered on a special menu for kids. Meals typically include a main dish, side, and beverage, and most come with a toy giveaway. Value/combo meal Menu item food categories Healthy option Promotion only Branding only A menu of specially priced items (e.g., dollar menu), individual items promoted as part of a value menu, and combo meals (including family and value meals) that include more than one food category purchased together for a special price (e.g., a main dish, side, and beverage). Dollar/value menus include individual items offered for lunch/dinner, breakfast, and snacks. Type of menu item, including lunch/dinner main dishes, lunch/dinner sides, and snacks; items promoted specifically for breakfast (main dish, sides, and combos) or kids (main dish, sides, and beverages); and beverages (side beverages, coffee beverages, and snack beverages). A healthy menu, menu items, or healthy version of a meal. Typically promoted as an item low in fat and/or calories. Advertisement mentions only a promotion and does not mention a specific food. Food may be pictured in the ad. Advertisement only mentions the restaurant and does not mention a specific food or promotion. Food may be pictured in the ad.

In addition to the numbers of ads viewed by age group, we also analyzed exposure to advertising on national television by product category. To identify the product category and individual menu items advertised in each TV ad, we matched the individual ads examined in the TV content analysis to the brand variety and creative descriptions available in the Nielsen AdViews database. Due to a low advertising volume for some product categories originally specified in our analysis, several categories were combined. We report the following product

categories: kids meals, branding only, promotion only, value/combo meals, breakfast, snacks, and coffee drinks. Although the advertising volume for healthy options was relatively low, we also included this category in the analysis. The advertised product could not be identified for 1% of the general audience advertisements and 2% of the Spanishlanguage advertisements; these ads were excluded from this analysis. Table 18 presents the number of restaurants and youth exposure to TV ads for each product category.

Table 18. Youth exposure to TV advertising in 2009 by product category and age group*
Product category Kids meals Lunch/dinner items Value/combo meals Branding only Snacks Healthy options Promotion only Coffee drinks Breakfast items Ads viewed in 2009 Number of restaurants Preschoolers Children Teens 3 296 350 160 11 228 298 585 9 117 153 299 2 61 70 39 9 39 54 101 5 26 34 51 3 16 22 39 3 14 19 35 3 8 10 18 Preschoolers to adults 4.54 0.37 0.36 2.58 0.38 0.46 0.38 0.32 0.34 Targeted ratios Children to adults 5.37 0.48 0.47 2.99 0.52 0.61 0.53 0.43 0.43 Teens to adults 2.45 0.94 0.91 1.66 0.97 0.92 0.95 0.79 0.78

*National TV only Source: The Nielsen Company

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Figure 16. Composition of advertising exposure in 2009 by product category and age group*
Other items Healthy option Branding only Value/combo meal Lunch/dinner item Kids meal

items than for kids meals. Preschoolers and children viewed approximately one ad for healthy options every two weeks. Teens viewed ads for lunch/dinner menu items most often (1.6 ads per day). Value/combo meals followed with .8 ads viewed per day and kids meals with less than one ad every two days. Teens viewed far more kids meal ads and branding only ads than adults, but approximately half the number viewed by children. Teens also were overexposed to ads for most menu items compared to adults. Despite watching 24% less TV than adults, teens viewed just 10% fewer ads for lunch/ dinner items, value/combo meals, snacks, healthy options and promotions only. Only breakfast and coffee drinks did not appear to be targeted to teens. Figure 16 presents the composition of advertising exposure for each age group by product category. Although it appears that companies primarily targeted kids meals and branding only ads to children, these two categories comprised just 44% and 42% of preschoolers and childrens fast food advertising exposure. More than half the ads viewed by children were for products that appeared to be targeted to an older audience. Child-targeted product categories represented just 15% of ads viewed by teens. Two-thirds of teens advertising exposure was for lunch/dinner items and value/combo meals, and ads for snacks and promotions only were viewed relatively more often by teens than by adults. The twelve restaurants advertised a total of 47 product categories. McDonalds advertised all nine product categories, and Burger King and Subway each advertised six categories. Taco Bell, Dominos, and Starbucks Coffee advertised the fewest categories (one or two each) (see Table 19).

1,400 1,200 2009 advertising exposure 1,000

23%
800 600 400 200 0

25%

15% 15% 30% 28% 44% 47% 35% 12%

Children Teens

37%
Preschoolers

5%
Adults

*National TV only Source: The Nielsen Company

Not surprisingly, preschoolers and children viewed the most ads for kids meals: approximately 1 ad per day for children and .8 per day for preschoolers. These ads also were targeted to children who viewed 4.5 to 5.4 times as many ads for kids meals as adults viewed. Branding only ads also appeared to be aimed at children. Preschoolers and children viewed approximately one of these ads per week a figure that is 2.6 to 3 times the number of branding only ads viewed by adults. Although ads for lunch/dinner items were not targeted to preschoolers and children (i.e., adults viewed more of these ads than children viewed), these items were the second most commonly viewed product category for this age group. Children viewed just 15% to 25% fewer ads for lunch/dinner Table 19. Product categories by restaurant

TV ad exposure overview
Children and teens were exposed to more than 1,000 TV ads for fast food restaurants in 2009. Even preschoolers viewed on average 2.8 fast food ads every day, and children

Restaurant Count Product categories McDonalds 9 Kids meal, branding only, lunch/dinner item, coffee drink, value/combo meal, promotion only, breakfast, snack, healthy option Burger King 6 Kids meal, lunch/dinner item, value/combo meal, promotion only, snack, breakfast Subway 6 Kids meal, value/combo meal, healthy option, lunch/dinner item, promotion only, snack Pizza Hut 4 Lunch/dinner item, value/combo meal, snack, healthy option Dunkin Donuts 4 Snack, coffee drink, breakfast, healthy option KFC 3 Value/combo meal, lunch/dinner item, healthy option Wendys 3 Lunch/dinner item, value/combo meal, snack Sonic 3 Value combo meal, snack, lunch/dinner item Dairy Queen 3 Snack, value/combo meal, lunch/dinner item Taco Bell 2 Lunch/dinner item, value/combo meal Dominos 2 Lunch/dinner item, snack Starbucks 1 Coffee drink Source: The Nielsen Company

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and teens viewed even more: 3.5 and 4.7 ads per day, respectively. Young people view more ads for fast food than for any other food category. In 2007, advertising for fast food restaurants comprised 22% of all food ads viewed on TV by children and 30% of those viewed by teens.18 In spite of food industry pledges to reduce unhealthy food marketing to children, young peoples exposure to fast food advertising on TV continues to increase. Compared to 2003, preschoolers viewed 20% more fast food ads on TV in 2009 (an additional .5 ads every day), and children and teens viewed 35% to 38% more (.9 additional ads per day for children and 1.3 for teens).19 Fast food advertising to young people on TV was highly concentrated among a few restaurants: McDonalds, Burger King and YUM Brands! (Taco Bell, KFC and Pizza Hut) contributed 60% of all fast food ads seen by children and 50% of those seen by teens. McDonalds alone aired 30% of fast food TV ads seen by children, and children viewed more ads for McDonalds than adults viewed. Although both McDonalds and Burger King have pledged to improve food marketing targeted to children,20 both companies marketed their products disproportionately to young people compared to adults, and both have increased their volume of advertising to children substantially since 2007 (the pledges were first implemented in 2008).21 During that time, McDonalds advertising to children (ages 6-11) increased by 26% and Burger King by 10%. Based on relative exposure compared to adults, both Burger King and Taco Bell also target teens with their TV advertising. Children (ages 2-11) are more likely to view ads for kids meals and restaurant branding only (i.e., those that do not promote a specific food) compared to adults; however, these two product categories comprised just one-third of fast food ads viewed by children. More than half of the fast food ads they saw were for presumably adult-targeted products, especially lunch/dinner main dishes and value/combo meals. Across all age groups, 5% or fewer of TV ads viewed promoted healthy options on restaurants regular menus.

Content analysis of TV advertisements

TV content analysis Definitions

Child-targeted ads If the ad met one or more of the following conditions: Only children were shown consuming the advertised product; only children were the main character(s) in the ad; the narrators spoke directly to children; and/or a toy or other childrens product was promoted with the food. General audience ads Selling points Product associations Third party tie-ins All ads that were not clearly targeted to children. These ads could arguably appeal to teens and adults. Any direct benefit of the product communicated in the ad, including new/improved, value/cheap, health/nutrition, quality food, comparison/unique, filling/lots of food, convenience, low-fat/low-calorie, helping the community, and limited time special offer. Any indirect attributes or messages about the product implied in the ad, including physical activity, family bonding, fun/cool, humor, and adults as negative or incompetent. Featured appearances by outside (non brand-related) persons, characters or other companies/ organizations, including celebrities, movies/TV shows/video games, licensed characters, charities, other entertainment or sports, and other food brands.

Brand spokes-characters Brand-specific characters (e.g., Ronald McDonald) and spokespeople (e.g., Jared from Subway). and spokespeople Eating behaviors presented Portrayals or suggestions of eating behaviors in the ad, including family meals, place of food consumption, time of consumption, and food as a primary focus (i.e., present on the screen in at least 50% of the ad).

To assess the messages presented in these TV ads, we analyzed the content of all unique ads from the twelve restaurants in our analysis. A total of 1,041 English-language ads first appeared on TV between October 1, 2008 and December 31, 2009. After removing duplicates, we obtained 627 unique ads for content analysis. Of these ads, 57 were identified as childtargeted. The content analyses examined common selling points that appeared in these ads, product associations, target

audience, the use of third parties and brand characters and spokespeople, and eating behaviors presented.

Content of general audience TV ads

McDonalds and Sonic had the most general audience ads (86 and 85, respectively); followed by Subway with 78. Starbucks and Dairy Queen had the fewest (8 and 6, respectively).

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Figure 17 depicts the most common messages portrayed in general audience advertising. Product selling points that appeared most often were value/cheap, new/improved, and quality food. Appendix B (Table B.2) details the percentage of ads from each restaurant that included each message. Dominos and Pizza Hut promoted their products as a good value and/or inexpensive in the majority of their ads (83% and 82%, respectively). Taco Bell, Dominos, KFC, and Pizza Hut promoted their products as new and/or improved in 50% or more of their ads. Subway and Wendys highlighted the quality of their products ingredients more than other restaurants (82% and 63%, respectively). Additional selling points commonly featured in some restaurants advertising included convenience, low-fat/lowcalorie, helping the community, and limited time special offers. The pizza restaurants were the only ones to promote convenience; 17% of Dominos ads promoted its online ordering application and 5% of Pizza Hut ads promoted a new iPhone ordering application. In addition, 61% of Pizza Huts ads promoted its company website (PizzaHut.com) and Dominos.com was featured in 48% of Dominos ads. Both of these websites featured online ordering applications. Subway Figure 17. Messages in general audience TV advertising
Value/ cheap New/ improved Selling points Quality food Limited time special offers Comparison/ unique Low-fat/ low-calorie Humor Product associations Fun/cool Males Target audience Parents Other food brands Third party tie-ins Movies/TV/ video games Celebrities Consumption time unclear Eating behaviors Consumption other place Consumption at table 0% Source: TV ad content analysis 10% 20% 30% 40% 50% 60% 70%

and KFC promoted healthy messages that featured their low-fat and/or low-calorie products in 18% and 13% of ads, respectively. Subway did so in a group of humorous ads which compared the restaurants fresh fit selections to greasy fast food items such as the can my butt look any bigger meal and more of me to love combo. KFC advertised its grilled chicken combo meal for under 400 calories. Subway also highlighted its website, SubwayFreshBuzz.com, in 51% of its ads. Starbucks, Dominos, and Subway promoted limited time special offers in one-third to one-half of their ads. These were mainly menu items available for a short time or pricing offers. More than one-half of fast food ads used humor to sell their products; Dairy Queen, Burger King, and Dominos used it in more than 80% of their ads. The fun/cool message was used most by McDonalds (35%) and Subway (23%) in their general audience ads. Food was featured most prominently (i.e., appearing onscreen for more than 50% of the time) in approximately one-quarter of general audience ads, including 35% of Sonic ads and almost one-third of Pizza Hut, Dunkin Donuts, KFC, Dairy Queen, and Taco Bell ads. Food was shown being consumed in nearly half of ads. This consumption occurred in a non-traditional

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location (e.g., park bench, living room couch) in 21% and at an unspecified time of day in 39% of ads. Just 12% of ads depicted eating at a table, and only 2% suggested or depicted family meals. The majority of Sonic ads (54%) depicted patrons eating in their cars. Wendys and Pizza Hut showed eating at the table more than any other restaurants (28% and 24%, respectively). Taco Bell, Sonic, and Burger King commonly promoted their late-night menus and encouraged eating late at night (in 28%, 11% and 9% of ads, respectively). Fewer than half of fast food ads appeared to specifically target men or women, but gender-specific ads targeted males 4.5 times as often as females; 38% of ads were male targeted, compared to 8% that were female targeted. Taco Bell and Wendys appeared to target a male audience the most (in 54% of their ads). Just eight ads targeted parents directly. Half of these ads were for McDonalds and one each for Wendys, Subway, Dairy Queen, and Sonic. McDonalds parent-targeted ads focused on making children happy by buying them a Happy Meal. In one of these ads, a mother and child were shown eating together. The mother ate a salad while her child enjoyed his Happy Meal. The female announcer proclaimed, He always wants a Happy Meal, and with apples and low-fat milk, Im happy to get it. The Subway ad depicted Jared flanked by little leaguers discussing the problem with overweight children in our country and the importance of exercise and eating right. Third parties were featured in just 29% of general audience ads; however, some restaurants used this strategy more than others. For example, Subway featured celebrity athletes in 19% of ads; and Burger King featured racecar driver Tony Stewart in four ads (10%). Burger King also featured tie-ins with other entertainment, including the movies, Transformers and StarTrek, in 21% of its general audience ads. Burger Kings usage of entertainment tie-ins was higher than any other restaurant. Starbucks featured a charity promotion in 25% of its ads, in which the restaurant promised to donate 5 cents of each coffee drink to Product Red, a charity that fights Aids in Africa. Dairy Queen featured cross-promotions with the Girl Scouts and the Childrens Miracle Network, a non-profit organization that raises funds for children's hospitals, to sell its Blizzard ice cream treats in 31% of its ads. In one ad, children were shown being cured of serious health issues, while Dairy Queen touted that all proceeds from sales of Blizzards (Dairy Queens most magical treat) sold on one day would go to the Childrens Miracle Network. In addition, Dairy Queen and Burger King used brand characters in their ads. Dairy Queens talking mouth character appeared in 88% of ads; and Burger King featured the King in 25% of ads.

Content of child-targeted TV ads

Ranking Table 5 presents advertising exposure for children by restaurant and product category. McDonalds, Burger King, and Subway were the only restaurants with child-targeted ads, and only five products had child-to-adult targeted ratios higher than 1.0, meaning children viewed more ads for those products than adults viewed (see Table 20). Children viewed the most ads for McDonalds kids meals, Burger King kids meals, and McDonalds branding only. Subway kids meal ads and McDonalds healthy options also appeared to be targeted to children with child-to-adult targeted ratios of 7.2 and 2.2., respectively. However, these two items ranked low, tenth and forty-first, in advertising exposure to children. YUM! Brands products (Pizza Hut and Taco Bell lunch/dinner items and KFC value/combo meals) ranked fourth through sixth in volume of advertising exposure to children. Combined, these YUM! Brands products totaled 146 ads viewed in 2009, overtaking Burger King kids meals as the second most advertised product category to children. However, children viewed fewer of these ads than adults viewed. With the exception of Subways healthy options which ranked thirteenth, healthy options ranked in the bottom 25% of product categories advertised to children. McDonalds aired 31 child-targeted ads, Burger King aired 23, and Subway aired just 3. Figure 18 presents the most common messages that appeared in these child-targeted TV ads. Appendix B (Table B.3) presents detailed results of the child-targeted ads content analysis. Compared to ads targeting a general audience, child-targeted ads rarely promoted direct benefits of fast food products. Instead, these ads focused primarily on communicating positive associations with the restaurants and their kids meals. As found with general audience ads, child-targeted ads used humor and fun/cool product associations most often. Burger

Table 20. Restaurants and product categories targeted to children

Restaurant Subway McDonalds Burger King McDonalds McDonalds *National TV only Source: The Nielsen Company Product category Kids meals Kids meals Kids meals Branding only Healthy options Ads viewed by children in 2009* 32 192 125 70 2 Targeted ratio: children to adults 7.23 5.40 5.00 2.99 2.17

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Figure 18. Messages in child-targeted TV advertising
Fun/cool
Product associations

Humor Adults as negative

Target audience

Males Movies/TV/ video games Other food brands Licensed characters Consumption at table Consumption other place Consumption time unclear Family meals

Third party tie-ins

Eating behaviors

0%
Source: TV ad content analysis

10%

20%

30%

40%

50%

60%

70%

King child-targeted ads used both (humor in 91% and fun/cool in 57%), whereas McDonalds ads used fun/cool messages more often (69%). Subway ads associated its products with physical activity in two of its three ads. More than two-thirds of Burger King ads portrayed adults as negative or incompetent. In one ad, two children looked into a magic slime mirror which showed their reflection after being slimed. When the father tried to look into the mirror, buckets of slime poured onto his head. A similar ad showed a father acting like the Pink Panther and trying to steal toys from his kids. In one scene a child slapped his hand and in another the father fell onto the table as the children rolled their eyes and laughed at him. Third party tie-ins featured in child-targeted ads differed from those that appeared in general audience ads. These ads did not use celebrities or charity tie-ins, but tie-ins with movies, TV shows, and video games occurred in one-third of ads targeted to children. About 44% of Burger King child-targeted ads and 28% of McDonalds featured a licensed character toy

available in kids meals. For example, Burger King featured a SpongeBob toy kids meal promotion in 17% of its childtargeted ads. Other food brands were also present in one-third of ads. In 70% of its ads, Burger King featured Hersheys plain milk or Minute Maid juice; and McDonalds promoted Dasani water in two child-targeted ads. Subway did not include thirdparty tie-ins in any ads. Ronald McDonald was the only brand character used in child-targeted ads, and he appeared in just two McDonalds ads. Whereas food was the primary focus in many general audience ads, it was never the primary focus in child-targeted ads. McDonalds and Burger King only depicted their better for you foods in child-targeted advertising as specified in their CFBAI pledges; however, these foods were often presented only briefly or in the background of the scene. Although 35% of child-targeted ads showed food consumed at the table, just 7% showed families eating a meal together at the table. Burger King depicted eating at the table in 48% of its ads and

Burger King child-targeted ad with negative portrayal of a parent.

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Burger King Pinkalicious promotion, based on the popular book for preschoolers.

While McDonalds depicted better-for-you foods in child-targeted ads, they were rarely the main focus.

family meals in 13%; and McDonalds showed eating at the table in 31%, but family meals in only 3% of its ads. Subway did not depict eating in its child-targeted ads. In two-thirds of child-targeted ads, the time of consumption was unclear. One-third of child-targeted ads directed children to a website. Although McDonalds had the most ads targeted to children, it did not promote any of its own websites, but did feature two third-party sites (AmericanGirl.com and Linerider.com). In contrast, 61% of Burger King ads directed children to ClubBK. com, its child-targeted website. One Subway ad directed children to the restaurants own website, SubwayKids.com, and one featured a third-party website called GetAnimated. com. The Cartoon Network sponsored this site for its Move it Movement which featured Bas Rutten (a former UFC champion and martial artist) who encouraged healthy eating and physical activity in a series of brief educational videos. Interestingly, to view the videos online, children first had to watch an advertisement, including one for Froot Loops cereal.

meals) ranked sixth, eighth, eleventh, and twenty-seventh in teen exposure. Twelve additional product categories had teen-to-adult targeted ratios greater than 1.0, meaning that teens viewed more ads for these product categories than adults viewed (see Table 21). The product categories that appeared to be targeted to teens were: All Taco Bell products, most restaurants snacks (with the exception of those from McDonalds, Dunkin Donuts, and Wendys), Burger King promotion only ads, and Dairy Queen, Subway, and Sonic lunch/dinner items. These teen-targeted product categories totaled 444 ads viewed in 2008 and represented 33% of all teen exposure to fast food advertising. Table 21. Restaurants and product categories targeted to teens*
Product Restaurant category Subway Kids meals McDonalds Kids meals Burger King Kids meals McDonalds Branding only Taco Bell Snacks Burger King Promotion only Taco Bell Value/combo meals Dairy Queen Snacks Taco Bell Lunch/dinner items Sonic Snacks Dominos Snacks Subway Lunch/dinner items Sonic Lunch/dinner items Ads viewed by teens in 2009* 14 87 59 39 10 15 11 27 111 15 10 31 10 Targeted ratio: Teens to adults 3.16 2.44 2.34 1.66 1.44 1.22 1.15 1.11 1.10 1.05 1.05 1.03 1.02

Teen-targeted advertising
Ranking Table 6 presents advertising exposure for children and teens by restaurant and product category. Teens viewed advertising for a much different set of fast food restaurants and products as compared to children. YUM! Brands products (Taco Bell and Pizza Hut lunch/dinner items and KFC value/combo meals) ranked first, second, and third among product categories most frequently advertised to teens. Combined, they totaled 301 ads, contributing 23% of total teen exposure in 2009. The most frequently advertised childtargeted product categories (McDonalds and Burger Kings kids meals, McDonalds branding only, and Subway kids

* Categories with average exposure of 10 or more ads in 2009; National TV only Source: The Nielsen Company

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Taco Bell teen-targeted ad parodied the Diddy song All About the Benjamins

Burger King teen-targeted ad featured a Twilight: New Moon fan-pack promotion with purchase of a 6 Burger Shots combo meal. Content analyses of the ads that promoted these teen-targeted products revealed several that also appeared to be designed to appeal specifically to teens. For example, a Taco Bell ad was a spoof on Diddys All about the Benjamins (slang for $100 bills) single in which the singer rapped on the importance of money and wealth. In Taco Bells version, the theme song was All about the Roosevelts (dimes) or the cheapness of the food. The ad depicted young people singing and dancing provocatively. A promotion only ad from Burger King featured a tie-in with Twilight New Moon, a popular teen movie. It promoted a fan pack containing a Twilight water bottle with images of two Twilight teen heartthrobs, Edward and Jacob, that could be obtained with the purchase of a 6 Burger Shots combo meal. Another Burger King promotion only ad featured the Transformers movie, with a contest to transform your way to win $1 million and other prizes. While the content of other ads was not as obviously teentargeted, Dairy Queen, Dominos, and Sonic ads frequently used more juvenile humor to promote their products. Dairy Queen featured a talking mouth brand character in 88% of its ads in which slapstick humor was prevalent and the talking mouth was often the butt of jokes. Sonic ads also often featured humorous, sarcastic conversations in cars, in which one character is made to look rather daft. Two Sonic ads also featured the Sticky Bun Dough Blast, an ice cream mix-in treat, that was promoted together with The Hills TV show on MTV. Dairy Queens ads for its snack products prominently featured its Blizzard ice cream treats; and 94% of Dairy Queens ads referred viewers to one of its websites, including 44% to BlizzardFanClub.com.

Content analysis of TV advertising overview

General audience advertising primarily featured three selling points: value or cheap food, new or improved items, and food quality. The pizza restaurants also commonly promoted the convenience of online and other means of ordering. More than one-half of fast food ads targeted to a general audience used humor to sell their products, including more than 80% of ads for Dairy Queen, Burger King, and Dominos. Fewer than onehalf of ads specifically targeted men or women, but genderspecific ads targeted males 4.5 times as often as females. Just eight ads targeted parents directly, and half of these were from McDonalds. Only three restaurants had TV ads directly targeted to children: McDonalds, Burger King, and Subway. Compared to ads targeting a general audience, child-targeted ads rarely promoted direct benefits of fast food products. Rather, these ads communicated positive associations with restaurants kids meals and the restaurant brand primarily through messages such as fun, cool and humor. Child-targeted ads also commonly featured third party tie-ins with movies, TV shows, games and licensed characters. Interestingly, food was never the primary focus in child-targeted ads. McDonalds and Burger King did picture its better-for-you foods as they pledged to do as part of the CFBAI; however, these foods usually appeared briefly or in the background of a scene. While McDonalds did not promote its websites in child-targeted ads, 61% of Burger King ads directed children to ClubBK.com, its child-targeted website.

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Taco Bell, Burger King, Dairy Queen and Sonic targeted teens as assessed by teens higher exposure to these ads relative to adults and the content of the ads. Taco Bell and Dairy Queen promoted their snack items more often to teens, and Burger King advertised its promotions in teen-targeted ads.

African American youth TV advertising exposure

In 2009, African American children viewed 4.1 TV ads for fast food restaurants on national television every day and teens viewed 5.2 fast food ads (see Table 22). These figures understate total exposure to fast food advertising by an estimated 7% because Nielsen AdViews does not provide GRPs by race for spot market television. On average, 93% of all youth advertising exposure occurred on national television.23 Compared to white youth of the same age, African American children saw 56% more fast food advertisements on national television and African American teens viewed 46% more. The difference can be largely explained by differences in TV viewing by African American and white youth: African American children watch approximately 45% more television per week compared to white youth of the same age; African American teens watch 54% more.24 Based on these differences, however, African American children were exposed to somewhat higher than expected levels of fast food advertising and teens were exposed to somewhat less than expected. The twelve restaurants in our analysis contributed 87% to 89% of all exposure to fast food advertising for African American youth. Exposure by restaurant and product category followed similar patterns as exposure to advertising for these restaurants by all youth (see Ranking Table 7). African American youth viewed the most ads for McDonalds (approximately 1.1 ads every day), followed by Burger King (.6 ads per day for children and .7 for teens). Subway was third in most frequently advertised restaurant to African American children, but KFC surpassed Subway in advertising exposure to African American teens. With the exception of McDonalds, Burger King, and Subway, targeted ratios of exposure by African American to white children by restaurant were considerably higher than 1.45 (the difference between African American and white childrens television viewing). Therefore, relative to white children, African American children were exposed to more fast food advertising from these restaurants than can be explained by their higher overall TV viewing. A different pattern emerges for African American teens. Targeted ratios of African American to white teens were generally comparable to or lower than 1.5 a ratio that would be expected given their differences in TV viewing. However McDonalds and KFC were two notable exceptions. African American teens were exposed to 75% more television advertising for these two restaurants than their white peers. Ranking Table 7 also presents exposure to advertised product categories for African American children and teens, including targeted ratios. Although the ranking of product categories resembled the rankings for all children and teens, some restaurants appeared to be targeting specific product categories more frequently to African Americans.

Ethnic and racial targeting

Ethnic and racial targeting on TV Targeted ratio: African American to white children Targeted ratio: African American to white teens Spanish-language television Targeted ratio: Spanish language to other television advertising Definitions GRPs for African American 2- to 11-year-olds divided by GRPs for white 2- to 11-year-olds. Provides a measure of relative exposure to TV advertising for African American children compared to white children. GRPs for African American 12- to 17-year-olds divided by GRPs for white 12- to 17-year-olds. Provides a measure of relative exposure to TV advertising for African American children compared to white children. Television programming presented in Spanish cable and broadcast programming (e.g., Univision or Telemundo). GRPs for Spanishlanguage television are calculated based on the number of Hispanic persons in Nielsens viewer panel. GRPs for Spanish-language TV divided by GRPs for national and spot market TV. Ratios were calculated for preschoolers (2-5 years), children (6-11 years), and teens (12-17 years). Provides a measure of exposure to advertising on Spanish-language television among Hispanic viewers compared to exposure to advertising on all other television for all viewers.

This section documents exposure to fast food TV advertising by African American youth on English-language TV and Hispanic youth on Spanish-language TV. We identified TV advertising targeted to African American youth according to two measures:22 If African American youth viewed relatively more ads for targeted products than their white peers viewed, after accounting for higher levels of TV viewing, the ads were identified as targeted to African Americans. TV ads with African American main characters were also identified as targeted ads.

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Table 22. African American youth exposure to fast food advertising*
Twelve restaurants Top 20 restaurants All fast food restaurants *National TV only Source: The Nielsen Company Ads viewed in 2009 Children Teens 2-11 years 12-17 years 1,330 1,911 1,449 2,128 1,499 2,201 Targeted ratios African American African American to white children to white teens 1.56 1.51 1.57 1.48 1.56 1.46

For example, compared to white children of the same age, African American children saw more than twice as many ads for fifteen different product categories from Taco Bell, KFC, Dominos, Burger King, McDonalds, and Sonic (see Table 23). Similarly, African American teens saw at least twice as many ads for McDonalds lunch/dinner items, branding only, value/combo meals, and breakfast, and KFC healthy options compared to white teens. The largest differences occurred for McDonalds value/combo meals and KFC healthy options.

directed viewers to its black-targeted website (365Black.com) in 5%. One of these ads depicted caf mocha beverages with whipped cream, and the remaining three featured three large-sized burgers (Angus Bacon & Cheese, Double Quarter Pounder with cheese, Big Mac) in each. Additionally, McDonalds was the only restaurant to feature African American children as the main characters in child-targeted ads. These two ads promoted a Happy Meal toy giveaway. Dairy Queen also featured African American main characters in 19% of its ads, and Subway featured African Americans in 10% of ads. Dairy Queens ads depicted two varieties of Blizzards and an ice cream cake. In the Blizzard ads, the treat was presented as an addictive substance. In one, a mothers thought process was hijacked by images of the Blizzard, she lost her train of thought and had to have the treat immediately. In another, the Blizzard caused a man to mentally check out of a real world conversation with his wife into a heavenly place where he experienced extreme pleasure. Subway featured

Content analysis of TV ads with African American main characters

Despite more frequent exposure to fast food advertising by African American youth, just 45 ads in the general audience content analysis (8% of the total) featured African American main characters. McDonalds used African American main characters in the highest proportion of its ads (23%) and

Table 23. Restaurants and product categories targeted to African American children and teens*
Restaurant Product category McDonalds Value/combo meals KFC Lunch/dinner items Taco Bell Snacks Burger King Promotion only KFC Value/combo meals Sonic Snacks Sonic Lunch/dinner items McDonalds Coffee drinks Burger King Value/combo meals KFC Healthy options McDonalds Lunch/dinner items McDonalds Breakfast Taco Bell Lunch/dinner items Taco Bell Value/combo meals Dominos Lunch/dinner items Burger King Lunch/dinner items McDonalds Branding only Burger King Snacks *National TV only; targeted ratios higher than 2.0 Source: The Nielsen Company African American children Ads viewed Targeted ratio: in 2009 to white children 29 2.51 26 2.50 7 2.38 11 2.30 84 2.29 12 2.18 8 2.13 25 2.10 13 2.10 8 2.09 47 1.94 7 1.96 77 2.04 7 2.03 25 2.02 69 2.01 81 1.28 5 2.00 African American teens Ads viewed Targeted ratio: in 2009 to white teens 58 2.33 49 1.88 13 1.45 21 1.42 157 1.89 23 1.67 15 1.72 44 1.92 25 1.45 14 2.30 75 2.05 13 2.05 150 1.46 14 1.42 133 1.79 125 1.45 66 2.00 9 1.31

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KFC ad for Fiery Grilled Wings featuring a black main character.

African American celebrity athletes in two ads, including one with a contest to win an autograph. Subway also depicted African American characters in ads for a Scrabble promotion to win $100,000, $5 Footlongs and a jazz-type poetry reading about its sandwiches. Whereas general audience ads promoted a low-fat/low-calorie selling point in just 5% of ads, this feature appeared in 13% of ads with African American main characters. For example, three KFC ads asked if the viewer was watching his or her calories and compared the calories in its new under-400 calorie meal with similarly advertised but higher calorie items at other restaurants. Dunkin Donuts featured its under-300 calorie egg white flatbread sandwich and getting back into a smart routine. Subway also pushed its low-fat options in two ads. In contrast to other general audience ads, ads with African American main characters were targeted more often to females than to males. For example, the KFC ads for its under-400 calorie meal depicted a female eating and enjoying the meal.

average, Hispanic children watch one hour of Spanishlanguage TV for every two hours of English-language cable and broadcast TV viewed in 2009; and teens watched one hour of Spanish-language TV for every three hours of Englishlanguage TV.25 Nine restaurants produced all fast food advertising on Spanishlanguage television: McDonalds, Burger King, Subway, KFC, Pizza Hut, Wendys, Dominos, Sonic, and Popeyes (see Ranking Table 7). Hispanic youth were exposed to the most Spanish-language advertising for McDonalds, followed by Burger King and Subway. The average ratio of Spanish-language TV ad exposure to English-language TV ad exposure was .22 for preschoolers, .15 for children and .11 for teens. These ratios were lower than expected given the ratios of Spanish-language to English-language television viewing for these age groups. Ranking Table 7 also presents Hispanic youth exposure to Spanish-language advertising by restaurant and product category, including targeted ratios. Compared to children watching English-language television, Hispanic children were more likely to view ads for for Dominos, Burger King and Sonic lunch/dinner items, McDonalds and Wendys value/combo meals, Sonic snacks, and McDonalds coffee drinks on Spanish-language television (see Table 25). Among Hispanic teens, Sonic lunch/dinner items and McDonalds coffee drinks had higher than expected ratios of Spanish- to English-language TV given Hispanic teens relative viewing of these media.

Spanish-language TV advertising exposure

The average Hispanic child and teen was exposed to one fast food television ad approximately every two days on Spanishlanguage television in 2009 (See Table 24). The number was even higher for preschool-age children who viewed on average .74 fast food advertisements every day on Spanishlanguage television. These ads were in addition to the ads viewed by Hispanic youth on other forms of television. On

Table 24. Hispanic youth exposure to fast food advertising on Spanish-language TV

Targeted ratios: Spanish-language Ads viewed in 2009 to all other television Preschoolers Children Teens 2-11 years 6-11 years 12-17 years Preschoolers Children Teens Overall television viewing 0.51 0.46 0.34 Twelve restaurants 260 174 170 0.23 0.16 0.12 All fast food restaurants 269 181 197 0.22 0.15 0.11 Source: The Nielsen Company

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Table 25. Restaurants and product categories advertised on Spanish-language TV*
Restaurant Product category Dominos Lunch/dinner items Burger King Lunch/dinner items McDonalds Lunch/dinner items McDonalds Value/combo meals McDonalds Coffee drinks Sonic Value/combo meals Subway Lunch/dinner items Sonic Snacks Wendys Value/combo meals Sonic Lunch/dinner items McDonalds Promotion only McDonalds Breakfast McDonalds Snacks Hispanic children (6-11 years) Ads viewed Targeted ratio: in 2009 to all other TV 29 .62 28 .66 14 .46 11 .75 10 .64 8 .40 7 .46 7 .87 6 .72 6 1.07 3 .46 2 .52 2 .53 Hispanic teens (12-17 years) Ads viewed Targeted ratio: in 2009 to all other TV 26 .29 27 .29 14 .32 11 .39 11 .43 7 .19 5 .18 6 .39 5 .28 5 .50 3 .31 2 .31 2 .38

*Ads with the highest ratio of Spanish-language TV to other TV advertising; Bold numbers indicate higher than expected ratios given relative television viewing Source: The Nielsen Company

Spanish-language content analysis

We identified 204 Spanish-language ads that first appeared on TV between October 1, 2008 and December 31, 2009 and 135 unique ads for the Spanish-language content analysis. McDonalds had the most Spanish-language ads (35), followed by Dominos (22), and Burger King and Subway (16 each). We found few overall differences in the messages used in Spanish-language compared to English ads. Figure 19 depicts the most common messages used. Appendix B (Table B.4) presents detailed results of the Spanish-language content analysis. Spanish-language ads most frequently used the same three selling points as the general audience ads: value/cheap, new/ improved, and quality food. However, Sonic and McDonalds featured a selling point not seen in other ads, old favorites. This message appeared in four Sonic ads and three McDonalds ads. Physical activity was also promoted in 11% of Spanish-language ads versus only 4% of general audience ads. Several additional differences were observed when comparing individual restaurants Spanish-language ads to their general audience ads. Subway used a low-fat/low-calorie message more often in Spanish-language advertising (44% versus 18% in general audience ads). In addition, 31% of Subways Spanish-language ads promoted a physical activity message, although none of these ads featured a celebrity athlete as did 19% of its English-language ads. Dominos, Wendys and Pizza Hut also used a physical activity message in 10% or more of its Spanish-language ads, whereas they rarely or never used this message in their general audience ads. McDonalds and Subway were also more likely to use the

helping the community message in their Spanish-language ads (11% and 13%, respectively) compared to their Englishlanguage ads (5% and 3%). Although Sonic used humor in 62% of its general audience ads, it did not use this technique in any of its Spanishlanguage ads. Sonics Spanish-language ads appeared to focus on families. In addition, while the restaurants general audience ads depicted only two people in a car, the Spanishlanguage ads often depicted families of four or groups of four friends together. Also, rather than highlighting a specific menu item or line of items, as the general audience ads typically did, the characters each called out several items they were craving. The simplicity of the ordering experience was also highlighted in most of these ads. Interestingly, the majority of Burger Kings Spanish-language ads (69%) were maletargeted compared to 45% of its general audience ads. Featured third parties, brand characters and spokespeople rarely appeared in Spanish-language advertising. Approximately 25% of Subway ads showed other food brands (Dasani water, Dannon Light and Fit yogurt, Lays, Sunchips, Coke). Subway was also the only restaurant with a Spanishlanguage charity tie-in. These two ads did not verbally mention the charity, but included a written statement at the end of the ad that Subway was a proud sponsor of the Hispanic Heritage Foundation. One-third of Spanish-language ads referenced a website, including the majority of Pizza Hut and Subway ads. Burger King, McDonalds, and Pizza Hut directed viewers to a Spanish-language website, including McDonalds MeEncanta.com (11%), BurgerKingMusica.com (6%) and Espanol.PizzaHut.com (90%). Eating behaviors portrayed in Spanish-language advertising varied by restaurant and often differed from English-language

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Figure 19. Messages in Spanish-language TV advertising
Value/ cheap New/ improved
Selling points

Quality food Limited time special offers Low-fat/ low-calorie Comparison/ unique Humor

Product associations

Fun/cool Physical activity

Target audience

Males Parents Other food brands Movies/TV/ video games Celebrities Consumption time unclear

Third party tie-ins

Eating behaviors

Consumption other place Consumption at table 0 10 20 30 40 50 60

Source: TV ad content analysis

ads. For example, food was never the primary focus of Sonics Spanish ads , although it was the focus in more than one-third of the restaurant's general audience ads. In contrast, Pizza Hut, Subway, and Wendys portrayed food as the primary focus about twice as often in Spanish-language ads. Wendys depicted eating at the table more often than any other restaurant in both Spanish-language and general audience ads, but did so more in its Spanish-language ads (40% vs. 28% of general audience ads). Just four Spanish-language ads were targeted to children and all featured McDonalds Happy Meals. As in its Englishlanguage child-targeted ads, food was not the primary focus of these ads. McDonalds promoted fun in all the ads and physical activity in three of four. Additionally, one McDonalds ad targeted parents and depicted a mother coming home from work late and announcing it to be a Happy Meal night.

from McDonalds and KFC that appeared to be targeted to African Americans because of higher relative exposure compared to white youth and the use of African American main characters in the ads. African American youth viewed 75% more ads for McDonalds and KFC overall compared to white youth, and more than twice as many ads for McDonalds value/combo meals, lunch/dinner items, breakfast and branding only and KFC healthy options. In TV ads with African American main characters, McDonalds featured large-sized burgers, coffee and Happy Meal toys, whereas KFC featured its under-400 calorie meal. Dairy Queen and Subway also aired TV ads with African American main characters. Hispanic children and teens were exposed to approximately one ad per day on Spanish-language TV in addition to ads viewed on English-language TV. Nine fast food restaurants advertised on Spanish-language TV, but McDonalds was the most frequent advertiser, accounting for one-quarter of youth exposure to Spanish-language fast food ads. Products that were advertised relatively more frequently on Spanishlanguage as compared to English-language TV included Dominos, Burger King, McDonalds and Sonic lunch/dinner items, McDonalds value/combo meals and coffee drinks, and Sonic snack items. We found few differences overall in the

Ethnic and racial targeting overview

African American children and teens viewed 56% and 46% more ads for fast food restaurants in 2009 compared to their white peers. This difference can largely be attributed to higher levels of television viewing. However, we also identified ads

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messages used to promote fast food products in Spanish, although several restaurants were more likely to use physical activity, low-fat/low-calorie and helping the community messages in their Spanish-language ads. Every day, the average preschooler viewed a total of 1,124 calories and 2,146 mg of sodium in fast food TV ads (see Table 27). Children viewed somewhat more: Approximately 1,400 calories and 2,700 mg. of sodium. However, teens viewed more than 2,100 calories and 4,200 mg. of sodium in fast food ads every day. In all age groups, one-third or more of these calories were from sugar and saturated fat. Table 28 presents the weighted average calories and sodium contained in the menu items promoted in TV ads seen by children and teens for each restaurant. KFC featured full meals more often in its ads, whereas other restaurants tended to feature individual menu items; therefore, KFC had the highest calories per ad viewed of any restaurant. Dunkin Donuts had the lowest calories per ad because its

Television advertising nutrient content analysis

Finally, we examined the nutrient content of menu items that appeared in each restaurants TV advertising. Table 26 presents the three individual menu items or lines of items that were advertised most often to children and teens for each restaurant (excluding items with fewer than five ads viewed by either age group), as well as the nutritional quality of these items.

Table 26. Three most frequently advertised menu items (excluding kids meal items)
Ads viewed by children Ads viewed Restaurant Menu item (2-11 years) by teens NPI Score Calories McDonalds McChicken Sandwich 12 23 50 360 Big Mac 11 18 48 540 Mochas 10 17 66-70 240-400 Burger King Whopper Jr. 47 33 46-68 260-390 Double Cheeseburger 44 30 38 460 Combo Value Meal 8 18 various various Subway Subway Club 6 10 62-72 247-960 Tuscan Chicken Melt 5 11 62-72 390-596 Pizza Hut Tuscani pastas 13 25 62-66 510-640 Pepperoni PANormous Pizza 8 12 44 1,110 EDGE Pizza 6 11 32-62 640-900 Dunkin Donuts Brewed/iced coffee 2 5 66-70 5-120 KFC 2-piece meals 20 40 various various Value boxes 11 21 various various Original and grilled chicken 10 21 various various Wendys Double Stack/ 16 33 42 360 Crispy Chicken/ 48 460 Jr. Bacon Cheeseburger (in the same ad) 48 310 Wings 11 20 42-44 520-580 Frostys 5 9 60 150-520 Sonic Jr. Deluxe Burger 9 20 64 350 Route 44 Drink Upgrade 5 10 66-70 0-480 Jr. Breakfast Burrito 4 9 40 330 Dairy Queen Blizzards 13 24 40-60 440-1,530 Sweet Deals Value Menu 5 10 40-80 0-400 Chicken Strip Basket 2 4 48-50 1,360-1,640 Taco Bell Grilled Chicken Burrito 8 19 52 650 Volcano Menu 6 14 48-56 240-1,000 Gordita Crunch 6 12 50 500 Dominos Specialty pizzas 12 23 various various Breadbowl Pastas 11 21 50-66 672-740 Oven Baked Sandwiches 11 19 38-48 668-889 Starbucks VIA Ready Brew 1 1 70 0 Source: The Nielsen Company (ad exposure data); menu composition analysis Sodium (mg) 830 1,040 125-190 460-750 990 various 1,160-3,300 1,190-3,360 1,170-1,670 2,550 1,760-2,480 5-45 various various various 810 1,150 670 1,990-2,630 70-240 440 0-200 790 180-970 10-920 2,910-3,690 2,180 470-2,010 880 various 910-1,420 1,990-2,660 50

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Table 27. Total nutrient content of items in TV ads viewed by youth every day
Fast food ads viewed daily Total calories Total Total from sugar and calories sodium saturated fat Preschoolers (2-5 years) 1,124 2,146 416 Children (6-11 years) 1,414 2,727 511 Teens (12-17 years) 2,144 4,357 736 Source: The Nielsen Company (ad exposure data); menu composition analysis

Figure 20. Calories viewed daily in fast food TV ads by age group
2,500

2009 advertising exposure

2,000

Other five Dominos Burger King Subway McDonalds YUM! Brands

1,500

1,000

12% 23% 40% 31%

6-11 years 12-17 years

500

25% 31%

Table 28. Nutrient content of menu items advertised on TV

Average calories per ad viewed 6-11 12-17 years years KFC 1,242 1,196 Dominos 799 789 Dairy Queen 777 775 Sonic 763 752 Pizza Hut 728 730 Wendys 631 626 Taco Bell 566 570 Subway 493 635 McDonald's 457 454 Burger King 407 439 Dunkin Donuts 249 241 Eleven restaurants* 582 657 Average mg of sodium per ad viewed 6-11 12-17 years years 2,008 1,967 1,707 1,691 623 632 978 959 1,843 1,847 1,518 1,491 978 1,374 1,399 1,854 800 821 607 742 472 423 1,122 1.336
0

2-5 years

Source: The Nielsen Company (ad exposure data); menu composition analysis

Nutrient content of ads viewed by African American and Hispanic youth

Table 29 presents differences in the overall nutrient content of products presented in TV ads viewed by white and African American youth on English-language television and by Hispanic youth on Spanish-language TV. Ads viewed by African American children contained 7% more calories per ad than those viewed by white children, whereas African American and white teens viewed ads for products with similar numbers of calories per ad. However, due to higher levels of television viewing, both African American children and teens viewed almost twice as many calories in fast food ads every day as compared to their white peers. African American children viewed ads totaling almost 2,000 calories every day and teens viewed more than 3,000 per day, including more than 1,000 calories from sugar and saturated fat. In addition, the sodium content of fast food menu items in ads viewed daily by African American teens totaled more than 6,000 mg. Spanish-language ads viewed by teens promoted somewhat lower calorie items compared to ads viewed by teens on English-language TV. Due to fewer ads viewed by youth on this medium, daily calories and sodium viewed in fast food ads on Spanish-language TV was significantly lower than those viewed on other TV programming. Figure 21 presents calories viewed for each restaurant per day and compares African American and white children and teens. The relative contribution of calories viewed by restaurant was comparable for African American and white teens; however, African American children viewed a set of ads that were more similar to those viewed by all teens than by white children. For example, all ads from YUM! Brands

*Excluding Starbucks Source: The Nielsen Company (ad exposure data); menu composition analysis

ads often featured coffee beverages and snack foods which were lower in calories than the main dishes typically featured by other restaurants. Ads from the remaining restaurants averaged 630 to 800 calories per ad. Appendix B (Table B.5) presents calorie and sodium information for ads viewed by demographic group and restaurant. Figure 20 presents total calories viewed per day by restaurant. YUM! Brands restaurants accounted for 31% of calories viewed by preschoolers and children, and 40% of those viewed by teens. KFC ads alone comprised 20% of calories viewed by teens. McDonalds followed with 25% and 23% of calories viewed by preschoolers and children, but only 12% of calories viewed by teens. Burger King ads contributed 14% of calories viewed by preschoolers and children, and 9% of calories viewed by teens. Subway was responsible for the third or fourth highest calories viewed by all age groups, ranging from 9% for preschoolers to 11% for teens.

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Table 29. Nutrient content of fast food products presented daily in TV ads viewed by African American and white youth on English-language TV and Hispanic youth on Spanish-language TV
Calories viewed per ad Total calories Total calories from sugar and saturated fat Total sodium White 575 1,160 425 2,219 Children (2-11 years) African American Spanish-language 617 591 2,099 307 736 80 3,896 425 White 657 1,939 664 3,948 Teens (12-17 years) African American Spanish-language 666 584 3,184 289 1,127 76 6,373 637

Source: The Nielsen Company (ad exposure data); menu composition analysis

Figure 21. Calories viewed daily in fast food TV ads by age and race
3,500 3,000 2009 advertising exposure 2,500 2,000 1,500 1,000 500 0

Other five Dominos Burger King Subway McDonalds YUM! Brands

13%

20% 25% 30%

White African American

11% 41% 40%

White African American

for menu items presented in the ads to provide a complete picture of the nutrient content of ads viewed by young people. Preschoolers and older children viewed fast food TV ads with 1,100 and 1,400 calories and 2,100 and 2,700 mg. of sodium per day. Teens viewed 2,100 calories per day and 4,400 mg of sodium. Approximately one-third of the calories in TV ads viewed by all young people were from sugar and saturated fat. Compared to white children and teens, total ads viewed by African American youth contained 64% to 80% more calories and sodium. KFC, Dominos, and Dairy Queen ads contained the most calories per ad, and YUM! Brands ads comprised 31% of all calories in ads viewed by children and 40% of those viewed by teens. Although children and teens viewed more ads for McDonalds than for any other restaurant, teens viewed the most calories per day in ads from KFC.

35%

Radio advertising exposure

The restaurant product category as a whole, including fast food restaurants, ranked third in spending on local and national radio ads in 2009, behind the automotive and communications industries.26 The twelve fast food restaurants in our analysis all advertised on the radio in 2009; and on average, teens were exposed to 277 radio ads in 2009 for these restaurants. Ranking Table 8 presents radio advertising exposure by restaurant and age group. Data were only available for teens and adults, as the Nielsen panel does not monitor radio listening by children. The top 5 radio advertisers matched the top 5 TV advertisers: McDonalds, Burger King, Wendys, Taco Bell, and Subway. McDonalds, in particular, used radio aggressively. Exposure to McDonalds radio advertising outstripped its nearest competitor at a rate of nearly 4:1 in every demographic group. On average, teens listened to two McDonalds radio ads per week. As found in TV advertising, Taco Bell was the only advertiser that advertised more often to teens as compared to both young adult and adult audiences. Its radio advertising skewed to a younger audience, ranking second (as established by GRPs) in both the 12-17 and 18-24 age groups, but sixth with 2549 year olds. The other fast food restaurants maintained the same rank in advertising to all age groups.

2-11 years

12-17 years

Source: The Nielsen Company (ad exposure data); menu composition analysis

restaurants accounted for 25% of calories viewed daily by white children and 35% to 40% of calories viewed by African American children and all teens; and African American children and all teens viewed more calories from KFC ads than from any other restaurant, whereas white children viewed the most calories from McDonalds ads. As found overall, both African American and white children viewed the third highest number of calories from Burger King ads (11% and 14%, respectively); and teens viewed the second or third highest number calories from Subway ads (10% for African American teens and 12% for white teens).

Television advertising nutrient content overview

This analysis combines data on the number of TV ads viewed by age, race and ethnicity with nutrient information

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Internet and other digital media
We evaluated four types of digital fast food restaurant marketing: restaurant-sponsored websites, banner advertising on third-party websites, social media marketing, and mobile marketing. We examined these forms of marketing for youth-targeted content and measured child and adolescent exposure when data were available. racial and ethnic minorities; and eight entertainment sites with viral videos, music and social networking features. The remaining restaurant websites included blog, shopping, customer satisfaction, store locator, and corporate giving sites. Exposure data were available for 40 of the 55 websites. Because of low website traffic, comScore did not report information about the fifteen remaining sites. We first describe the content of child-targeted websites, followed by that of main restaurant websites visited most often by children and adolescents, and evaluate these sites use of features that are likely to appeal to children and adolescents. We then quantify youth exposure to all fast food restaurant websites and present evidence of targeted marketing to African American and Hispanic youth.

Restaurant websites
We identified 55 websites sponsored by the twelve restaurants in our analysis: thirteen main restaurant websites; eight childtargeted sites; eight additional websites promoting learning, charity and scholarships to youth; five websites targeted to

Child-targeted website content analyses

Website content analyses Definitions Child-targeted website Main restaurant website Sites targeting children were determined based on their content. Features that indicated childtargeted sites included cartoons, animated characters, interactive games, music, and messages directed at children specifically. The restaurants primary website for consumers. These sites often included the restaurant name in the URL, such as BurgerKing.com or KFC.com.

Engagement techniques The interactive features integrated on the website to engage users. Popular techniques included music, Flash animation, games, videos, and viral features.

We analyzed the messages and engagement techniques used in eight child-targeted websites: three McDonalds sites (HappyMeal.com, McWorld.com, and Ronald.com); two Dairy Queen sites (DeeQs.com and BlizzardFanClub.com); and one Burger King site (ClubBK.com), one Subway site (SubwayKids. com), and one Sonic site (SonicZooTots.com). Appendix C (Table C.1) presents the detailed results of the content analysis. Although KFC also maintained a childrens website URL, Kids.KFC.com, it did not qualify as a child-targeted site.

The site was just a one-page advertisement for KFCs kids meals and was included in the analysis of KFCs main website, KFC.com. Table 30 ranks the child-targeted websites based on a qualitative assessment of engaging content. McDonalds and Burger King most actively targeted children with their websites. ClubBK.com invited kids to explore, find games, and create an avatar. McDonalds sponsored three different child-targeted sites. McWorld.com provided a

ClubBK.com had the highest level of engagement of the child-targeted websites.

McWorld.com included an elaborate virtual world, full of games, entertainment tie-ins, and subtle advertising.

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Table 30. Child-targeted websites ranked by level of engagement
Rank: Website (restaurant) Number of pages coded Description 1: ClubBK.com (Burger King) Site visitors could create an avatar and explore an elaborate virtual world for children. It was 63 pages unique from other virtual worlds in this study because the user could not simply click on a link to be taken to a game. Instead, the user needed to find links to shops and games, increasing his or her time on the site. The user moved his or her avatar around a page, jumping on mountain tops and descending underwater in a videogame-like fashion. Since the user searched for content, he or she could continually discover new features on the site, including dozens of games and cross-promotions with popular Pinkalicious, NASCAR driver Tony Stewart, and Nickelodeons Kids Choice Awards. Users earned points to purchase games and items. ClubBK.com also allowed the user to interact with others on the site. Although introductory pages advertised Burger Kings healthier kids meal option, consisting of macaroni and cheese and apple slices with caramel sauce, site registration led users to a coupon for a hamburger kids meal, the restaurants less healthy option. 2: McWorld.com (McDonalds) McWorld.com also created an elaborate virtual world for its users, complete with a map of areas 93 pages the user could enter with a click of the mouse. The site was highly integrated among its pages. The user, for example, could be asked to move from one area to another to find hidden items, earning points to buy virtual items on the site. The site also had entertainment tie-ins with Star Wars and iCarly, and cross-references with another McDonalds child site, HappyMeal.com. In contrast to ClubBK.com, the branding on this site was subtle and integrated into the pages scenery. For example, a double rainbow might appear in the background as a depiction of the ubiquitous golden arches. Though engaging, it did not have the video game-like quality of ClubBK.com. 3: DeeQs.com (Dairy Queen) While McWorld.com had a subtle advertising background, DeeQs.com explicitly advertised food. 28 pages Food items were also prominent in the background scenery: a game space with ice cream and cheese dripping onto burgers. The virtual world effectively turned food into a fun fantasyland. 4: HappyMeal.com (McDonalds) This site contained content similar to McWorld.com such as cross-promotions to iCarly and 93 pages Star Wars and cross-references to its sister site. However, in contrast to McWorld.com, this site was not a virtual world. It still earned its spot on this list because of the ubiquitous presence of the Happy Meal box on almost every page and videos of children enjoying a Happy Meal. 5: BlizzardFanClub.com (Dairy Queen) Dairy Queens site targeted to somewhat older children promoted the Blizzard ice cream treat 15 pages on each of its fifteen pages. Its interactive features included social media promotions, interactive polling, and tie-ins with Oreo cookies and a Facebook page to follow a real-world Blizzard bus promotional tour. Despite these promotions, however, the site had few interactive features such as games or virtual worlds. 6: Ronald.com (McDonalds) This site was the only one in our study specifically targeting preschoolers. It contained a 35 pages significant amount of educational content, including games to teach kids how to type and count. The site also provided downloadable activities and encouraged families to use the site together. However, the site was heavily branded with McDonalds spokes-character, Ronald McDonald, who has resonated with small children for decades. 7: SubwayKids.com (Subway) This site ranked low on our list because more than half its pages were aimed at parents, not 74 pages children. The site had a significant health focus, including specific games intended to teach kids about nutritious foods and physical activity. The site also had tie-ins with athletes and Jared, the well-known restaurant spokesperson who famously lost 245 pounds by eating a diet of Subway sandwiches. 8: SonicZooTots.com (Sonic) This site was notable because it contained little direct marketing to children. The site had about 10 pages ten pages, contained no images of food, and featured a twenty question-style game in which children could guess which animal another player was thinking. The animals on the site were dressed up as tater tots, earning them the name Zoo Tots.

virtual world for children with games, opportunities to chat with friends, cross-promotions to the Star Wars movies and the childrens TV sitcom, iCarly, and a visual map of virtual areas they could explore. ClubBK.com and McWorld. com were the most engaging fast food websites. Though not a virtual world, McDonalds other child-targeted site, HappyMeal.com, contained games, polls, other activities, cross-promotions with Happy Meals, and a launching pad to other McDonalds websites, including McWorld.com. Ronald. com was the only site specifically targeting preschoolers in our study. It integrated the iconic Ronald McDonald character into educational alphabet and counting games. In 2009, McDonalds also hosted McDTween.com, a website targeted

to tweens (i.e., 8- to 12-year-olds). However, this site was not available in 2010 when the content analyses were conducted. Dairy Queen was notable for its heavy promotion of unhealthy foods on its child-targeted websites. In DeeQs.coms virtual world of cheeseburgers, Dilly bars, ice cream, and french fries, children walked on clouds and collected soft drinks as they explored. Apparently targeted to a somewhat older child audience, BlizzardFanClub.com promoted Dairy Queens signature Blizzard, a soft-serve ice cream treat with candy and other various mix-ins, on every page of the small site. SubwayKids.com had content aimed at parents and kids. For children, the focus was on games, cross-promotions with

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Figure 22. Engagement techniques and featured third parties on child-targeted websites
Engagement techniques
Fun Flash animation Music Charity cross-promotion Other entertainment cross-promotion (park, zoo, etc.) Movie/ TV show/ video game Spokescharacter Licensed character Other food brand Other sports crosspromotions Company spokesperson 0% 20% 40% 60% 80% 100%

Featured third parties

Games

Advergames Viral marketing Downloadable content Customization of page Behavioral targeting Other advertising (TV commercials, Facebook) 0% 20% 40% 60% 80% 100%

Percent of pages

Source: Website content analysis (March/April 2010)

Percent of pages

Dairy Queens DeeQs.com: a virtual world filled with cheeseburgers, Dilly bars, ice cream, and french fries.

such figures as pro athletes, and the restaurant spokesperson Jared Fogel. These pages frequently promoted healthy foods and physical activity, echoing the restaurants TV advertising message. Finally, Sonics child-targeted site, SonicZooTots. com, was small and had games involving the restaurants tots characters, but no direct marketing to children. Figure 22 presents the most common engagement techniques and third parties present on fast food restaurant child-

targeted websites. Most of these websites sought to create a fun way for children to engage with the brand. In fact, the most commonly promoted message on these sites was fun, which appeared on 91% of pages. Flash animation was present on 74% of pages and music on 45%. Approximately one-third of pages contained games, appearing most often on McDonalds sites: 77% of Ronald.com, 44% of McWorld.com, and 44% of HappyMeal.com pages (see Appendix C, Table C.1). Most of the games on child-targeted sites, including the preschoolertargeted Ronald.com, were advergames containing branded messages about the sponsoring restaurants. Many childtargeted websites also included features to enable children to connect with fellow online visitors. For example, McWorld. com and ClubBK.com provided chat features; and 80% of BlizzardFanClub.com pages, 69% of SubwayKids.com pages, and 40% of HappyMeal.com pages included viral marketing features which invited children to send an email message to a friend about a game or other feature on the website. Childtargeted websites also frequently contained videos, polls, and quizzes to further engage visitors. Behavioral targeting techniques, or features such as site registration that required the user to enter his or her personal information, appeared on seven of the eight child-targeted sites (all except Ronald.com) for a total of 11% of child-targeted pages. Yet only two sites

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Figure 23. Products and health messages promoted on child-targeted websites
Branding only Any food (branded or not) Branded food product Kids meal Individual menu item Health and nutrition Physical activity 0% 20% 40% 60% 80% 100% Percent of pages

Products

Health messages

Source: Website content analysis (March/April 2010)

required parental approval to submit personal information (DeeQs.com and ClubBK.com; 0.7% of child-targeted pages). Brand messages, without mention of specific branded food items, appeared on at least 89% of child-targeted website pages with two exceptions. ClubBK.com featured branding on 70% of pages and, notably, SubwayKids.com included brand messages on just 35% of pages. Every page on Ronald.com contained both the McDonalds logo and its spokes-character, Ronald McDonald. Overall, child-targeted fast food websites contained branding on 98% of pages; and 75% primarily featured the brand (see Figure 23). A page could be coded as branding only as well as food presented, if the only foods depicted were non-branded, such as an image of a banana used in a game. Specific branded foods, such as Sonics apple slices and Burger Kings macaroni and cheese kids meal, appeared on 21% of child-targeted website pages. Dairy Queens BlizzardFanClub.com and SonicZooTots.com stood out as containing food on all of their pages. When sites promoted food products, they often presented the healthier options available in kids meals. For example, ClubBK.com promoted the restaurants macaroni and cheese. Yet while HappyMeal. com was named for McDonalds Happy Meal kids meal, it mainly depicted the Happy Meal box or icon as a branding mechanism integrated into the background of the site without showing any specific kids meal menu items. Food images often appeared as cartoon-like representations of menu items rather than identifiable products. SubwayKids.com also promoted other Subway food items in addition to its kids meal, and Dairy Queens two child-targeted websites promoted individual menu items extensively. Some child-targeted fast food websites encouraged specific product purchases more explicitly. For instance, McWorld.com

Children were invited to enter codes from their Happy Meal toy to win a prize. and ClubBK.com provided incentives to purchase products by requiring children to enter codes from their kids meal packages to unlock extra levels of games and features on the websites that could not otherwise be accessed. SubwayKids. com similarly requested that children enter codes from kids meals, but also provided the option to obtain codes by playing games online. To unlock its vaults, DeeQs.com encouraged children to find codes hidden in Dairy Queen restaurants. SubwayKids.com and SonicZooTots.com were the only child-targeted websites that extensively promoted health and nutrition messages, including 61% of SubwayKids.com pages and 90% of SonicZooTots.com pages. Physical activity was also promoted on approximately 13% of child-targeted website pages, most frequently on SubwayKids.com, DeeQs. com and Ronald.com (see Appendix C, Table C.1).

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McDonalds Happy Meal bag promotes two of its childtargeted websites: HappyMeal.com and McWorld.com.

Burger King kids meal bag with a cross-promotion for the movie Eclipse, a sweepstakes, and a link to a special website for the promotion, BKEclipse.com.

Subways kids meal bag with a cross-promotion with National Geographic and a link to SubwayKids.com.

Subway.com), and Wendys.com. Appendix C (Table C.2) presents detailed results of this analysis. Table 31 ranks these main restaurant websites based on a qualitative assessment of each site, with higher rankings representing the sites with the most engaging content. Among sites which were not primarily targeted to children, Burger Kings main website, BurgerKing.com, was the most engaging. Its numerous promotions included humor, celebrity and entertainment tie-ins, and viral content, all of which could potentially appeal to teens. It also included ethnic targeting via its Futbol Kingdom section directed at Hispanics using Spanish language and Futbol (soccer). While less extensive than BurgerKing.com, McDonalds.com was also engaging and interactive and promoted specific foods such as the McCafe Menu and Quarter Pounders. The two pizza sites, Dominos.com and PizzaHut.com, heavily promoted the ability to order food online and have it delivered to the home. This

McDonalds Happy Meal toys come with codes to unlock features on McWorld.com and HappyMeal.com.

Main restaurant website content analysis

We also conducted content analyses of the eight main restaurant websites with highest youth exposure: BurgerKing. com, Dominos.com, KFC.com, McDonalds.com, PizzaHut. com, Starbucks.com, SubwayFreshBuzz.com (in place of

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appeal to instant gratification and convenience was used almost exclusively on these two sites, making them prominent internet marketers in this study. Dominos.com featured the restaurants heavily promoted Pizza Turnaround campaign that was also supported by a TV campaign and a separate, dedicated website not analyzed here. The campaign described the restaurants efforts to re-engineer its pizzas in response to dissatisfied customer feedback. KFC.com stood out for its Pride 360 campaign, which overtly targeted the African-American community through community pride appeals. Otherwise, the site largely resembled the industry leaders, focusing on promoting new products, cross-promoting other food brands (especially soft drinks), and consistently using graphic renderings of the restaurant spokesperson, the Colonel. The SubwayFreshBuzz.com site offered a large amount of nutrition information, including the Fresh Fit Meal Builder which provided customizable nutrition information that

Burger Kings main company site allowed viewers to customize the levels of fun, food, and king.

Table 31. Main restaurant websites ranked by level of engagement

Rank: Website Number of pages coded Description 1: BurgerKing.com This site was an elaborate and extensive collection of promotions, most of which could stand as whole 144 pages sites on their own. One area on the site featured NASCAR driver Tony Stewart performing a lie-detector test. Another targeted Hispanics with the Futbol Kingdom, which had elements of a virtual world. A third was a cross-promotion with Star Trek, featuring humorous videos of how to resist Kingons, Burger King characters who resembled the shows Klingons. Even in non-promotional areas of the site, BurgerKing.com displayed several funny viral video campaigns, including the Whopper Freakout (a video depicting what happens when a Burger King franchise claims to have discontinued the Whopper), the Whopper Virgins (a documentary-style film of a trip into remote areas of the world to introduce people to Whoppers), and the Whopper Flame (a sexy promotion for Whopper-scented body spray). Finally, the site featured integrated advertising with TV commercials. 2: McDonalds.com This extensive site had different promotional areas similar to BurgerKing.com, featuring menu items such 133 pages as the McCafe menu. It had fewer entertainment tie-ins than BurgerKing.com, but also made use of humor in its promotions for Snack Wraps and Quarter Pounders with Cheese. Its engaging videos featured content demonstrating how the restaurant produces certain menu items and describing the quality of the food. 3: PizzaHut.com Though this site featured mostly static pages with little Flash animation or promotions other than pictures 28 pages of the food itself, it was notable for its use of online ordering. With a few clicks of the mouse, site users could order a pizza for delivery to their door without leaving their couch. In addition, the site featured banner ads for its pizza on many of its pages. 4: Dominos.com This site also allowed users to buy food from the comfort of their homes with online ordering features. In 25 pages contrast to PizzaHut.com, Dominos site did not feature banner ads, but had video content advertising a reformulation of its pizza. 5: KFC.com The KFC site was notable because it was the only main restaurant site to extensively target African 63 pages Americans through the Pride 360 section of its website. Every page of the Pride 360 section featured a banner ad with a price promotion, which did not appear elsewhere on the site. In addition, the site had an engaging campaign to collect signatures for a petition aimed at getting the restaurants founder, Colonel Sanders, onto a U.S. stamp. 6: SubwayFreshBuzz.com This site was low on the list because it focused on healthier Fresh Fit menu items. However, it also 93 pages included content featuring its Meatball Marinara sandwich, cookies, and sandwich platters and heavily promoted its $5 Footlong sandwich menu. Interactive and engaging content included videos and close-ups of sandwiches, cross-promotions with athletes and celebrities, and a mobile application promoting the restaurants breakfast menu. It also included customizable nutrition information such as number of calories and sandwich ingredients. 7: Wendys.com This site mainly featured static advertising that focused on the restaurants food, such as images of the 54 pages Wendys burger. It emphasized the quality of ingredients and the importance of eating meals as a family. Like other sites that emphasized the nutritional content of the brands foods, users could customize a nutrition list based on menu items ingredients. Overall, this site was not dynamic. The most engaging content allowed users to sign up for a newsletter email and integrated TV advertisements. 8: Starbucks.com This site stood out as the least enticing to children based on content. Videos included features about 66 pages coffee harvesting, roasting, and preparing. The focus was on the quality of the beans. Nutrition lists were static; the overall content of this site seemed targeted toward coffee aficionados.

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Customers could place a delivery or carryout order at Pizza Huts main site.

Like Pizza Hut, Dominos encouraged site visitors to place an order online.

allowed users to compare Subway sandwiches to competitors products such as the Big Mac. However, the site also heavily promoted the restaurants least healthy options, including the Meatball Marinara sandwich, and featured many of the same cross-promotions as SubwayKids.com. The sites interactive content advertised the sandwiches through videos and closeup imagery. Wendys.com and Starbucks.com were the least engaging of the main restaurant websites examined. The content focused primarily on the quality of their food. However, Starbucks website contained numerous videos explaining how their coffee is prepared.

Main fast food restaurant websites differed greatly from the restaurants child-targeted websites. Fun messages appeared on just 17% of main restaurant website pages. Instead, these sites focused primarily on specific menu items and the quality of their food (46% of pages) (see Figure 24). Dominos.com had the highest percentage of web pages promoting individual menu items (80%), followed by Starbucks.com (62%). Health and nutrition messages appeared on 32% of pages, followed by value messages which appeared on almost one-quarter of main restaurant website pages (24%). Physical activity and weight loss messages each appeared on 15% of pages.

Figure 24. Most common products, selling points and messages appearing on main restaurant websites
Messages
Any food mention

Products

Cool/hip Individual menu items Quality of food Health/ nutrition Value Fun

Motivation

Physical activity

Selling points

Weightloss Special offer/ limited time New/ improved Fills you up 0% 20% 40% 60% 80% 100%

Humor

Personal stories 0% 20% 40% 60% 80% 100%

Percent of pages

Source: Website content analysis (March/April 2010)

Percent of pages

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Figure 25. Engagement techniques and featured third parties on main restaurant websites
Engagement techniques
Flash animation
Other food crosspromotion Company spokesperson Charity crosspromotion Movie/ TV show/ video game Famous athlete crosspromotion Other entertainment cross-promotion Spokescharacter 0% 20% 40% 60% 80% 100%

Featured third parties

Integrated advertising Viral marketing

Customization of page

Downloadable content

Music

Mobile

Percent of pages

Video

Source: Website content analysis (March/April 2010)

0%

20%

40%

60%

80%

100%

Percent of pages

SubwayFreshBuzz.com most frequently promoted these messages (50% featured physical activity and 29% featured weight loss) and provided motivational messaging through stories about personal weight loss. Messages about online convenience and ordering appeared on almost 10% of pages, primarily concentrated on the pizza restaurant sites. In further contrast to the child-targeted sites, the majority of main restaurant sites were comprised primarily of specific food-related content and promotional messages, while entertaining and engaging content appeared less frequently (see Figure 25). Flash animation appeared on approximately half of pages, and most restaurants allowed users to customize pages. Many sites also provided music, videos, features to upload or view photos, games, quizzes, polls, and blogs. The sites also provided opportunities to expose visitors to other forms of advertising such as TV commercials, social media websites, or mobile phone applications. These forms of integrated advertising appeared on 43% of pages. Viral marketing, which allowed users to tell a friend or connect on social media websites was used on 40% of main restaurant website pages: most commonly on Starbucks.com and SubwayFreshBuzz.com. Tie-ins with movies, TV shows and video games were present on 92% of Dominos.com pages and 82% of SubwayFreshBuzz.com pages. Restaurants also

Figure 26. Products and nutrition promoted on main restaurant websites

Food present

Individual item

Branding only Nutrition customization feature Nutrition info: static list Kids meal 0% 20% 40% 60% 80% 100%

Percent of pages

Source: Website content analysis (March/April 2010)

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promoted charities on 20% of their main restaurant website pages. Unlike the child-targeted sites, behavioral targeting was one of the least prevalent features, appearing on less than 6% of main restaurant pages. Restaurants typically devoted large portions of their main websites to displaying their menu items (see Figure 26). Food, primarily individual menu items, was present on almost four of five pages of main restaurant sites. Although branding was still prominent, branding only messages appeared on fewer than one-quarter of main restaurant pages, compared to threefourths of child-targeted website pages. Main restaurant sites also included more nutrition features, including the ability to customize individual items and static nutrition information that mirrored packaged food nutrition labels. Burger King had the most advanced menu features, allowing users to add tomatoes, pickles, and various other condiments to a Whopper, create meals and obtain nutritional information. The main websites for Dominos, McDonalds, Starbucks, Wendys and Subway also enabled visitors to create meals and obtain nutritional

This page on Burger Kings site allowed visitors to build customized food items.

information, but were less customizable than Burger Kings site. Pizza Hut and KFC, in contrast, only provided nutrition information in PDF format (see Appendix C, Table C.2).

Exposure to fast food restaurant websites

Website exposure Average unique visitors per month Average visits per month27 Average pages per month28 Average time spent per visit29 Composition index by age30 Composition index for African American youth Definitions Average number of different individuals visiting the website each month in 2009. Data are reported for the following demographic groups: 2-11 years, 12-17 years, 2-17 years, and African American 2-17 years. Average number of times each unique visitor (in each demographic group) visited the website each month. Average number of pages viewed each month per visitor (in each demographic group) to the website. Average number of minutes each visitor (in each demographic group) spent on the website each time he or she visited. The percentage of children (2-11 years) and teens (12-17 years) who visited the website compared to the percentage of all visitors. A composition index greater than 100 for 2-11 years indicates that children were more likely to visit the website compared to all visitors. The percentage of African American (2-17 years) who visited the website as compared to all youth (2-17 years). A composition index greater than 100 indicates that a site appeals disproportionately to African American youth.

Ranking Table 9 ranks each of the restaurant websites with available comScore data on youth exposure. Of these 40 websites, young people most often visited the two pizza restaurant sites, PizzaHut.com and Dominos.com. Three McDonalds websites followed: McDonalds.com, HappyMeal. com and McWorld.com. McDonalds averaged more than 659,000 unique visitors (2-17 years) every month to all thirteen of its websites.31 More than 55% of these visitors (365,000) were children under 12 years old. Burger Kings child-targeted site, ClubBK.com, was No. 6 in youth exposure. Child-targeted websites. Six of the eight child-targeted websites in our content analysis had enough young visitors on the comScore panel to measure exposure (see Table 32). The

three most popular of these sites, McWorld.com, HappyMeal. com, and ClubBK.com, were disproportionately visited by children (2-11 years). Children were 3 to 3.5 times more likely than adults to visit HappyMeal.com and McWorld.com and twice as likely as adults to visit ClubBK.com. McDonalds two child-targeted websites, HappyMeal.com and McWorld. com, received 248,000 and 128,000 unique young visitors per month, respectively. Engagement with both HappyMeal. com and ClubBK.com was high. Young people spent eleven to twelve minutes each month on these sites and visited nine HappyMeal.com pages and thirteen ClubBK.com pages. Youth traffic to Dairy Queens and Subways childtargeted websites was substantially lower. DeeQs.com,

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Table 32. Average monthly exposure to child-targeted websites
Website HappyMeal.com McWorld.com ClubBK.com DeeQs.com BlizzardFanClub.com SubwayKids.com Average unique visitors per month (000) 2-11 12-17 years years 189.3 58.2 100.9 27.0 35.2 14.7 3.4 6.0 4.4 4.3 1.4 2.3 Composition index 2-11 12-17 years years 299 81 347 82 195 72 72 110 45 39 27 40

Average time spent (min) 6.1 3.2 7.5 3.2 2.0 0.9

Source: comScore Media Metrix Key Measures Report (January-December 2009)

BlizzardFanClub.com, and SubwayKids.com each were visited by fewer than 10,000 young people on average each month. Website exposure data were not available for SonicZooTots.com and McDonalds Ronald.com. McDonalds tween-targeted website, McDTween.com, which existed only in 2009, also did not receive a substantial amount of youth traffic; therefore comScore data were not available. Main restaurant websites. It is interesting to note the extent that children and adolescents visited the main restaurant websites, in some cases even more often than restaurants child-targeted sites (see Table 33). Both PizzaHut.com and Dominos.com received on average more than 430,000 unique young visitors every month in 2009 and 40% to 45% of them were under 12 years old. PizzaHut.com also had the highest average minutes per visit (7.6) of all restaurant websites. McDonalds.com received approximately 260,000 unique young visitors every month. Racial and ethnic targeting. Of the 39 fast food restaurant websites with available comScore data for African American

youth, 61% had a disproportionately higher percentage of unique young African American visitors compared to all 2- to 17-year-olds visiting the site. Table 34 presents all websites with a composition index of 125 or higher, meaning that these websites received 25% or greater than expected African American youth visitors. DunkinAtHome.com, a site selling Dunkin Donuts products, had the highest African American composition index: African American youth visited this site 4.6 times more often than all youth. Not surprisingly, the percentage of African American youth visiting McDonalds ethnic-targeted 365Black.com was 3.5 times greater than the corresponding percentage of all 2- to 17-year-old visitors. Two smaller McDonalds websites (McState.com and AboutMcDonalds.com) followed. African American youth exposure was 2.5 times higher than all 2- to 17-year-olds on two Wendys websites, WendysHighSchoolHeisman.com, a scholarship website for kids, and WendysRealTime.com, an interactive gaming and instant messaging website. Ten of the twelve restaurants

Table 33. Average monthly exposure to main restaurant websites

Website PizzaHut.com Dominos.com McDonalds.com Starbucks.com SubwayFreshBuzz.com Subway.com BurgerKing.com DunkinDonuts.com Wendys.com KFC.com SonicDriveIn.com DairyQueen.com TacoBell.com Average unique visitors per month (000) 2-11 12-17 years years 195.3 242.4 175.6 256.8 98.1 160.4 33.9 54.5 17.7 34.2 27.2 53.7 41.8 55.8 25.6 32.1 34.4 52.0 34.9 50.5 43.4 37.4 27.9 20.4 16.0 51.1 Composition index 2-11 12-17 years years 59 64 59 75 60 86 34 48 29 50 30 53 72 85 45 50 50 66 33 42 87 66 85 55 28 79

Average time spent (min) 7.6 5.1 2.1 3.6 5.4 3.1 2.0 3.4 2.2 2.2 2.6 3.4 2.2

Source: comScore Media Metrix Key Measures Report (January-December 2009)

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Table 34. Websites with a disproportionate number of African American youth visitors
Website Type DunkinAtHome.com Product sales 365Black.com (McDonalds) Ethnic-targeted McState.com Store locator AboutMcDonalds.com Corporate responsibility WendysHighSchoolHeisman.com Scholarship (kids) WendysRealTime.com Social media SubwayKids.com Child-targeted KFC.com Main Wendys.com Main DunkinDonuts.com Main FeedTheBeat.com (Taco Bell) Promotion McDonalds.com Main BurgerKing.com Main DeeQs.com Child-targeted Subway.com Main BookItProgram.com (Pizza Hut) Learning (kids) ClubBK.com Child-targeted BlizzardFanClub.com Child-targeted Dominos.com Main TacoBell.com Main Average unique visitors per month (000) Composition index African Average African American All 2-17 time spent American 2-17 years years (min) 2-17 years 0.9 2.0 1.0 460 1.8 5.1 1.0 350 20.5 62.9 2.5 324 4.5 15.6 1.3 287 1.0 3.9 1.2 253 5.6 22.2 1.1 250 0.7 3.2 0.8 225 17.5 85.5 2.1 204 16.8 86.4 2.5 193 10.8 57.7 2.8 186 0.5 3.0 1.3 175 45.4 258.6 1.5 174 16.2 97.7 2.4 165 1.3 8.2 3.0 158 12.3 80.9 3.1 152 0.2 1.6 2.7 144 6.9 49.9 6.9 138 0.9 6.5 2.0 137 58.8 432.4 5.1 135 9.0 67.1 2.5 134

Source: comScore Media Metrix Key Measures Report (January-December 2009)

included in the analysis had at least one website with a disproportionate percentage of African American youth visitors, including the main websites for KFC, Wendys, Dunkin Donuts, McDonalds, Burger King, Subway, Dominos, Taco Bell and Pizza Hut. Four of the child-targeted fast food websites with available comScore data also exhibited a disproportionate African American youth composition. On SubwayKids.com, the percentage of African American youth visitors was 2.2 times higher than the percentage of all youth visitors. Visitor composition for DeeQs.com, BlizzardFanClub.com and ClubBK.com was 1.4 to 1.6 times more concentrated among African American youth as compared to youth overall. It is interesting to note that just McDonalds and KFC had websites explicitly targeting specific racial and ethnic groups. In addition to 365Black.com, McDonalds also had a website for Hispanic Americans, MeEncanta.com, and for Asian Americans, MyInspirasian.com. These websites emphasized the celebration of each culture and provided options to view pages in Spanish and Asian languages. KFC also had two websites targeted to African Americans (these sites could be accessed through the main KFC website): KFCHitmaker.com, a website celebrating African American heritage and music culture, as well as Pride360HBCU.KFC.com, which provided information about Historically Black Colleges and Universities.

With the exception of MeEncanta.com and 365Black.com, these targeted websites did not have enough visitors for comScore to provide exposure data.

Restaurant website overview

Fast food restaurant websites were visited frequently by children, adolescents and by African American youth. Childtargeted websites engaged children with the brand through fun and interactive features such as games and virtual worlds. While some child-targeted sites promoted nutrition, the sites most commonly visited by children did not. Instead they provided an opportunity for restaurants to immerse children in messages about their brands at a young age and encouraged product purchase such as by requiring codes found on kids meals to be entered on the sites. McDonalds and Burger Kings child-targeted websites: McWorld.com, HappyMeal.com, and ClubBK.com stood out as having both the highest youth exposure and the most engaging content. Notably, Dairy Queens child-targeted website DeeQs.com extensively advertised unhealthy foods, while SubwayKids. com and SonicZooTots.com emphasized health and nutrition. While less interactive, some main restaurant websites drew in more young visitors than did child-targeted websites. PizzaHut. com and Dominos.com for example had the highest youth

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exposure of all fast food restaurant websites. McDonalds. com and BurgerKing.com also had high youth exposure and were the main restaurant websites with the most engaging content. Main restaurant sites exposed children to marketing messages and promotions often for specific items on the restaurants regular menus. Although these sites contained fewer games and fun activities, entertainment features were still prominent. Based on the exposure data, their content had significant appeal for children and teens.

Banner advertising on third-party websites

Banner ad exposure Third-party websites Banner advertising Youth websites Definitions Websites on which advertising from other companies (i.e., the restaurants in our analysis) are present. Ads that appear on third-party websites as rich media (SWF files) and traditional image-based ads (JPEG and GIF files). They usually appear in a sidebar or banner at the top of a web page. Text, video, and html-based ads are not included. Third-party websites with a disproportionate number of youth visitors (2-17 years), including entertainment websites for youth (as defined by comScore), teen community websites (as defined by comScore), and websites with a percentage of youth visitors (2-17 years) that exceeds the percentage of youth visitors on the total internet.

Average unique viewers Average number of unique viewers exposed to a restaurants banner advertisements each month per month32 from June 2009 through March 2010. Average number of ads viewed per month33 Average number of banner advertisements viewed each month per unique viewer from June 2009 through March 2010.

Percentage of ads viewed Percentage of a restaurants banner advertisements that appeared on youth websites as a on youth websites34 proportion of all websites on which the ad appeared from June 2009 through March 2010. Total average ads viewed on youth websites per month35 The average total number of ads viewed on youth websites each month by all viewers from June 2009 through March 2010.

We obtained exposure data from comScore for banner ads from the twelve restaurants in our analysis for the period from June 2009 through March 2010. We also obtained copies of the ads. The initial sample included a total of 424 banner ads with the most frequent exposure during this period. After removing duplicates, we obtained a sample of 231 ads for content analysis. Ranking Table 10 presents exposure to banner ads by restaurant and product promoted, ranked by the average total number of ads viewed on youth websites per month. Banner ads for the twelve restaurants in our analysis averaged millions of unique viewers per month (see Table 35). Three of the five restaurants with child-targeted websites (McDonalds, Burger King, and Dairy Queen) used banner advertising on youth websites to drive children to their sites. However, the majority of banner ads from these restaurants advertised individual menu items. A substantial number of these menu item ads appeared on youth websites. The pizza restaurants used banner advertising the most. Dominos and Pizza Huts banner ads each were viewed approximately seven times per month by 70 million unique viewers. McDonalds also relied on banner advertising

Table 35. Banner advertising exposure by restaurant

Average unique viewers per Restaurant month (000) Domino's 70,937.1 Pizza Hut 69,617.5 McDonald's 49,027.2 Wendy's 30,744.2 Dunkin' Donuts 28,916.7 Subway 15,490.6 Starbucks Coffee 14,689.0 Burger King 14,570.5 Sonic 10,204.4 KFC 7,939.4 Dairy Queen 3,541.3+ Taco Bell 2,138.7 Twelve restaurants n/a Average number of ads viewed per month 7.0 7.6 5.5 4.4 4.2 10.1 2.9 3.4 3.2 4.9 n/a 4.9 n/a Ads viewed on youth websites 33% 26% 25% 20% 3% 2% 4% 28% 26% 16% 50% 10% 24%

Source: comScore Ad Metrix Advertiser Report (June 2009-March 2010)

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with 49 million individuals viewing 5.5 McDonalds banner ads per month. Dunkin Donuts and Wendys followed with approximately 30 million unique viewers per month each. Banner ads for Subway, Starbucks, Burger King, and Sonic were each viewed by 10 to 15 million individuals per month. On average, nearly one in four banner ads for these twelve restaurants appeared on a youth website. Therefore, children were exposed to banner ads for a wide range of fast food products, even those not specifically child-targeted. Figure 27. Product types featured in internet banner ads
Individual menu items Non-food promotion Value/combo menu Time of day Branding only Restaurant website Kids meal Healthy menu 0% 10% 20% 30% 40% 50%

Banner ad content analysis

Banner ad content analysis Child-targeted Main product type Selling point Engagement technique Definitions Ad withfeatures clearly intended to appeal to children such as promotions for kids meals; childtargeted websites, cartoons, and animation; or mentions of games or advergaming sites. Most important product or promotion featured in the ad. Quality of the product highlighted in the ad. Features that promote interaction with the banner ad.

Percent of ads

Source: Banner ad content analysis (June 2009-March 2010)

Figure 28. Selling points featured in internet banner ads*

Special offer Value/cheap New/ improved

Appendix C (Table C.3) presents the products promoted in each restaurants banner advertising. The restaurants differed significantly in the types of products they chose to promote most frequently. Most of the 231 unique banner ads that we coded conveyed a single, straightforward message about a specific menu item or special offer (non-food promotion) (see Figure 27). Two-thirds of ads promoted a food, beverage, menu or meal, and three-fourths of ads included an actual image of a food item. Banner ads most often highlighted three selling points: special offer (37%); value/cheap (29%); or new/improved (19%) (see Figure 28 and Appendix C, Table C.3). Notably, most ads that did not feature a food product promoted a limited-time promotion, such as Subways Scrabble and McDonalds Monopoly games. Internet banner ads are qualitatively different than other types of ads. Their content is limited by factors inherent to the medium. For example, human actors are rarely depicted because the ads do not contain sound or video. In addition, banner ads compete with a websites main content for the attention of the viewer. Therefore, the ads must grab the viewers attention. For this reason, nearly all banner ads incorporated one or more engagement techniques (see Figure 29).

Natural/ fresh/real Filling/ indulgent Comparison to other restaurant Weight loss 0% 10% 20% 30% 40% 50%

Percent of ads

* Excludes selling points that appeared in fewer than 1% of ads. Source: Banner ad content analysis (June 2009-March 2010)

Most banner ads (72% of our sample) included Flash animation. They also typically used bright colors, large text, and prominent depictions of food. Dominos and Pizza Hut, the two restaurants with the largest volume of third-party advertising, used a unique strategy to boost pizza sales via web ads: Their banner ads provided links to order food online. These ads generally contained a button that said Order Now. After just a few clicks, viewers who were tempted by one of the Hot Online Deals could have a pizza delivered without leaving their computer.

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Figure 29. Banner ads with specific engagement techniques*
Flash animation Game (in ad or link) Restaurant locator Link to order food Rollover Link to video Link to poll or quiz

A banner ad for Taco Bells half-pound burritos.

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* Excludes techniques that appeared in fewer than 1% of ads Source: Banner ad content analysis (June 2009-March 2010)

Many Dominos ads included a link to order food online. banner ad contained child-targeted features but mentioned that the information was intended for parents, we did not code it as a child-targeted ad. In addition, we identified banner ads that were placed disproportionately more often on youth websites and thus also appeared to be targeted to a youth audience. Child-targeted ads. A total of 10 unique ads (4.3%) in our content analysis were child-targeted. Just three restaurants (McDonalds, Burger King, and Dairy Queen) included childtargeted content in their banner ads; however, these ads were viewed by millions every month (see Table 36). They most commonly promoted child- and teen-targeted restaurant websites and appeared most frequently on youth websites. For instance, 97% of banner ads for Dairy Queens child-targeted website, DeeQs.com, were viewed on youth websites. Similarly, 83% of ClubBK.com banner ads appeared on youth websites. On average, more than 3.5 million viewers saw 2.9 banner ads every month for DeeQs.com and more than

Many other restaurants took advantage of another unique feature of banner advertising: Viewers could interact with the ad. For example, one Burger King ad allowed viewers with a webcam to snap a picture of themselves holding a dollar bill to promote its value menu. Many ads included restaurant locators, which enabled viewers to find locations closest to their home. Other ads included polls. For example, one Dominos ad asked, Whats Americas favorite pizza? By voting, viewers gained the chance to win a years worth of free pizza. The most common type of interaction involved simply clicking on the ad to learn more about the product.

Youth-targeted banner advertising

We distinguished between banner ads with child-targeted content and those that could appeal to all audiences. If a

Table 36. Exposure to child-targeted banner ads

Average unique Average number viewers per of ads viewed Ads viewed on Restaurant Product advertised month (000) per month youth websites Dairy Queen DeeQs.com 3,541.3 2.9 97% Burger King ClubBK.com 3,019.3 4.3 83% McDonald's LineRider.com 1,650.9 4.9 62% McDonald's Happy Meal 5,741.3 3.6 57% Source: comScore Ad Metrix Advertiser Report (June 2009-March 2010) Total average ads viewed on youth websites per month (000) 11,199.5 13,463.7 5,166.1 11,696.8

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This Dairy Queen ad encouraged children to visit DeeQs. com, a child-targeted advergaming site.

This Happy Meal ad promoted the free Penguins of Madagascar toys that come with the meal.

Ad instructed viewer to Draw a Star!

Viewer used mouse to draw a star on the ad.

3 million viewers saw 4.3 ads each per month for ClubBK. com. In addition, 62% of McDonalds banner ads promoting LineRider.com, a gaming website, and 57% of its Happy Meal banner ads were viewed on youth websites. In contrast, only 12% of SubwayKids.com banner ads appeared on youth websites; these ads contained content aimed at parents, not children, such as promotions for programs that provide money to childrens schools. As with McDonalds and Burger Kings child-targeted TV ads, child-targeted banner ads did feature the restaurants better-for-you products. For example, the Burger King and McDonalds ads depicted apple slices and milk instead of their less nutritious kids meal side and beverage options. However, these banner ads generally did not focus on the food. One prototypical McDonalds ad promoted the free Penguins of Madagascar toys included in a Happy Meal. The ad pictured a Happy Meal, but the main focus was the toys with a mission included in the meal. McDonalds also produced several ads with other promotional tie-ins, including partnerships with Ice Age: Dawn of the Dinosaurs, Alvin and the Chipmunks: The Squeakquel (six toys that talk!), Star Wars (may the toys be with you!), and Tys Teenie Beanie Babies. Dairy Queens child-targeted banner ads did not clearly depict any food products. These child-targeted ads primarily encouraged children to visit the restaurants child-targeted websites. Dairy Queen promoted DeeQs.com in many banner ads with a message such as Unlock sweet deals at DeeQs.com. Get new gear, cool downloads, & bonus points. The food in Dairy Queen ads was barely noticeable. It is likely that many children would not have understood that the ad was produced by a restaurant. If they were intrigued by the game and clicked on

Viewers drawing burst into dozens of colored shapes, providing the backdrop for the image of a kids meal.

Stars continued to shoot across the screen until a promotion for the Nickelodeon Kids Choice Awards was displayed.

Viewers were invited to Play Now! with a link to clubBK. com.

Kids who clicked the ad arrived at ClubBK.com.

the ad, they would have ended up at DeeQs.com, where they would be invited to play games in an animated world filled with cheeseburgers and ice cream. Burger King produced one of the most engaging child-targeted ads that we analyzed: The ad invited children to draw a star on the ad with their mouse, which then burst into an image of a BK kids meal followed by a promotion for Nickelodeon Kids Choice Awards and an invitation to visit ClubBK.com.

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Table 37. Banner ads with a high proportion of ads viewed on youth websites
Average unique Average number viewers per of ads viewed Ads viewed on Restaurant Product promoted month (000) per month youth websites KFC Unthink (grilled chicken) 6,291.6 2.2 67% Taco Bell Fruitista Freeze 108.3 4.3 39% Taco Bell Volcano Menu 454.4 5.4 36% Domino's All ads 70,937.1 7.0 33% McDonald's McCafe beverages 10,333.4 3.7 27% Sonic All ads 10,204.4 3.2 26% Pizza Hut All ads 69,617.5 7.6 26% Taco Bell Value Menu 84.3 6.9 21% Wendy's Hamburgers/Sandwiches 30,309.1 4.4 20% Source: comScore Ad Metrix Advertiser Report (June 2009-March 2010) Total average ads viewed on youth websites per month (000) 11,360.0 111.6 692.6 181,115.6 10,759.2 8,067.0 141,634.3 97.3 27,285.3

Versions of this ad were viewed approximately 23 million times, according to comScore. Banner ads on youth websites. While the banner ads with the highest proportion of youth website placements tended to contain child-targeted content, the majority of ads viewed on youth websites contained content with broad audience appeal. Table 37 provides exposure data for all general audience banner ad products for which 20% or more of ads appeared on youth websites. Dominos had the highest presence on youth websites, averaging 181 million ad views on youth websites every month. However, none of its banner ads contained specific child-targeted content. Similarly, Pizza Hut banner ads averaged 142 million ad views on youth websites every month. Although the exposure to its ads was much lower, Taco

This McDonalds McCafe ad featured Disney actress Demi Lovato on youth websites.

Bell placed 21% to 39% of banner ads for its Fruitista Freeze, Volcano Menu, and Value Menu items on youth websites. In addition, Sonic placed more than one in four general audience banner ads on youth websites; Wendys and Dairy Queen each placed nearly one in five. Of note, KFC placed two-thirds of banner ads on youth websites for its Unthink campaign promoting grilled chicken. McDonalds also placed 27% of its McCafe beverage banner ads and 16% of its Dollar Menu banner ads on youth websites. The McCafe ads often featured Disney actors such as Demi Lovato.

Racial- and ethnic-targeted banner ads

Just McDonalds and KFC appeared to target specific racial and ethnic minority groups with banner ads. These ads directed viewers to their ethnic-targeted websites (see Table 38). KFC had one such ad, while McDonalds had thirteen. These ads generally were similar to the restaurants other banner ads. They frequently used Flash animation, and most promoted a single product, usually a food item or special offer. They differed in a few ways. Sometimes the ads featured promotions that would be most appealing to a particular group (for example, a chance to win a trip to the Latin Grammys), and often the text was in Spanish or Asian languages. About one-third of Taco Bells Volcano Menu ads were viewed on youth websites.

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Table 38. Exposure to racial- and ethnic-targeted banner ads
Restaurant Product promoted McDonald's 365Black.com McDonald's MeEncanta.com McDonald's MyInspirAsian.com KFC Pride 360 Average unique viewers per month (000) 191.6 2,022.0 204.5 554.2 Average number of ads viewed per month 2.1 5.8 4.0 4.6 Ads viewed on youth websites 12% 3% 1% 0%

Source: comScore Ad Metrix Advertiser Report (June 2009-March 2010)

This ethnic-targeted McDonalds ad began with origami animals made from dollar bills.

The origami transformed into food items from the dollar menu.

Four food items were eventually revealed.

A link to MyInspirasian.com was displayed at the end of the ad.

Banner advertising overview

Banner advertising was used extensively by all twelve fast food restaurants in this analysis. Notably, McDonalds, Burger King and Dairy Queen strategically placed banner ads for their child-targeted gaming sites on third-party youth websites. These ads contained engaging content, such as games and activities embedded in the ads to entice children to visit fast food gaming sites. The ads focused less on food and more on fun; although when food was shown, it tended to be the restaurants healthier options.

Banner ads placed on youth websites, however, were not limited to ads promoting child-targeted websites. In fact, the majority of banner ads placed on youth websites promoted menu items with broad audience appeal. Most commonly, individual menu items were pushed in these ads, with an emphasis on special offers and value. Dominos and Pizza Hut stood out, as their banner ads had the largest presence on youth websites. Overall, all twelve fast food restaurants in this analysis maintained a strong presence on youth websites, placing one in four banner ads for a wide variety of products on these sites.

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Social media marketing
Social media marketing Definitions Facebook Facebook fan Profile picture Wall post Twitter YouTube The largest social networking site with more than 500 million users worldwide. Members have their own pages on which they present information about themselves, share links to other sites, upload photos and videos, and post messages. Members connect with other members by becoming friends and incorporating them in their network. A typical restaurant Facebook page contains multiple tabs with different content (e.g. notes, messages, polls, photos, videos, applications). Facebook users can become fans of a restaurant by clicking a like button on the restaurants page. A thumbnail photo of that individual is then visible on the restaurant page in the people who like this section. Any time the restaurant modifies its page (e.g., by adding a feature, posting a comment) that activity shows up in the individuals news feed, or personalized Facebook home page. Similarly, any time the individual interacts with the restaurants page, this action shows up in the news feeds of his or her Facebook friends. The restaurant also shows up on the individuals Facebook page as something that he or she likes. Every Facebook restaurant profile has a profile picture. This picture is selected by the restaurant and is visible at the top left-hand corner of the page. It is also used in thumbnail form to identify the restaurant in wall posts and comments. A message that the restaurant or other owner of a Facebook page posts to its wall tabs. These messages can be straightforward text, or they can incorporate images, videos, links to other pages within Facebook, links to other websites, or polls. Twitter is a micro blogging service that has more than 145 million registered users worldwide. Twitter users publish 140-character messages called tweets that are posted on their own profile pages. Users can follow each other by subscribing to another authors tweets. These followed tweets are then published on the Twitter home pages of all of the authors followers. Twitter users may also follow the tweets of authors through their mobile phones, either using SMS, third-party Twitter applications, or Twitters own mobile platform. YouTube is a website that enables restaurants to upload and share videos for the public to view. The fast food restaurants in our analysis have customized channels on YouTube with playlists of videos available for viewing. Anyone can watch the videos without registering, but registered users can subscribe to a channel and receive alerts whenever the restaurant posts a new video. YouTube accounted for nearly 40% of the 33.2 billion videos watched online during December 2009.

We examined fast food restaurants presence on three of the most popular social media sites with teens: Facebook, Twitter and YouTube. We compiled data on the popularity of these sites during the first half of 2010 and examined the content of marketing messages on the sites.

Facebook
Eleven of the fast food restaurants in our analysis sponsored at least one Facebook account between December 2009 and July 2010. Wendys and Dairy Queen each created additional profiles to support individual menu items. Subway had two pages on Facebook. The Subway365 page predated the Subway page and was run by one franchise owner in upstate New York. We included it in our analysis because of its popularity. Only Burger King did not have a presence on Facebook during this time. Table 39 shows the number of Facebook page fans and the growth in popularity of these pages.

The McDonalds and Starbucks pages led in number of fans, Starbucks is one of the most popular accounts on Facebook.36 Starbucks, Taco Bell, and Subway had the greatest increase in popularity from December 2009 to July 2010. Each more than doubled its number of fans. Subway launched its Subway page in December, and it grew more than 400 percent in the seven-month period. Fast food restaurants differed in the level of activity on their Facebook pages. Subways Subway365 page, Dairy Queens Dairy Queen page, and Taco Bell had the most active profiles measured by frequency of updates (see Figure 30). Subway365 posted new messages to its wall on average 5.8 times per week, and Dairy Queen and Taco Bell both posted new messages on average 5.4 times per week. The restaurants with the most tabs on their pages were McDonalds, Subways Subway page, and Starbucks, with an average of 12.9, 11.0, and 10.8 tabs, respectively.

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Table 39. Facebook pages and fans
Restaurant Starbucks McDonald's Subway Dunkin Donuts Taco Bell KFC Pizza Hut Dairy Queen Subway Wendy's Domino's Wendy's Dairy Queen Sonic Facebook page Starbucks McDonalds Subway365 Dunkin Donuts Taco Bell KFC Kentucky Fried Chicken Pizza Hut Dairy Queen Subway Frosty Dominos Pizza Wendys Blizzard Fan Club Sonic Drive-In Number of fans (000) 12/22/2009 7/30/2010 5,341.4 11,353.4 1,487.3 2,636.8 1,296.0 1,920.5 968.6 1,820.2 687.5 1,770.8 1,154.5 1,653.2 1,057.2 1,414.8 730.6 1,239.1 215 1,167.6 470.5 593.1 327 538.5 268.8 385.3 219.2 380.6 246 297 % growth 113% 77% 48% 88% 158% 43% 34% 70% 443% 26% 65% 43% 74% 21%

Source: Facebook weekly tracking

Engagement devices on Facebook. The profile picture, shown on the upper left-hand corner of a Facebook wall, is perhaps the most attention-grabbing feature of a Facebook page. During our tracking period, Dairy Queens Dairy Queen page, Dunkin Donuts, McDonalds, Subways Subway page, and Wendys Wendys page moved beyond a simple depiction of their logos to a more creative use of their de-facto faces.

Restaurants also used their profile pictures to promote specific menu items and special offers. McDonalds Big Mac and Wendys Bacon & Blue burgers made up 50% of their respective profile pictures, while Dunkin Donuts Iced Coffee and Subways $5 Footlongs comprised 30%. In an even more creative use of the profile picture space, Dunkin Donuts launched a fan of the week sweepstakes: The site incorporated the winners

Figure 30. Frequency of posts and number of tabs on restaurant Facebook pages
14 12 10 8 6 4 2 0

Avg. number of posts/week Avg. number of tabs

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Figure 31. Facebook wall posts with outbound links to other internet pages
Dairy Queen Pizza Hut McDonalds Taco Bell

Examples of the chains Facebook profile pictures. photo (holding a Dunkin Donuts beverage) into the restaurants profile picture for the duration of a week. Restaurant Facebook pages encouraged fans to engage with the restaurant beyond Facebook. For example, Dominos, both Dairy Queen pages, KFC, and Pizza Hut suggested that fans register with the restaurant via SMS or email to have exclusive deals delivered directly to your inbox! Dunkin Donuts promoted enrollment in Dunkin Perks, an online loyalty program, whose members regularly receive emails with product news, store locations, and special offers. The restaurant promised coupons for free drinks as a reward for enrolling. Dairy Queen even had a separate tab entitled Join us on the Dairy Queen Facebook page. People who signed up for the Dairy Queen Blizzard Fan Club received a free treat coupon. The Blizzard Fan Club Facebook page encouraged people to join its club with a separate Buy-OneGet-One (BOGO) tab, offering six free treats per year with the purchase of products. Facebook pages also provided outbound links to encourage fans to interact with the brand outside of Facebook (see Figure 31). Dairy Queen (Dairy Queen page), Pizza Hut, McDonalds, Taco Bell, Starbucks, Dominos, KFC, and Sonic were particularly active in redirecting their fans from Facebook to external web sites. More than 50% of these restaurants wall posts contained outbound links. Dairy Queen most frequently linked to the Dairy Queen Blog; Pizza Hut sent readers to download the restaurants iPhone application and to visit the Pizza Hut website; McDonalds linked to Olympic-themed pages on the restaurants own website; and Taco Bell directed fans to its DriveThruDiet.com and TacoBell.com websites. In addition, all restaurant Facebook pages, with the exception of Dairy Queens Blizzard Fan Club and Wendys Frosty page, promoted the restaurants Twitter pages. Pizza Hut was also the only restaurant in our analysis to offer customers the opportunity to order from Pizza Hut without ever leaving Facebook! Users were encouraged to add the Pizza Hut application to their own Facebook page to place their orders for delivery or take-out directly. Dunkin Donuts, Sonic, and Starbucks actively promoted their rewards cards on their Facebook pages. These restaurants

Starbucks Dominos KFC Sonic Dunkin Donuts Wendys Subway Subway365 Wendys Frosty Dairy Queen Blizzard Fan Club 0% 20% 40% 60% 80% 100%

Source: Facebook content analysis (January through March 2010)

Pizza Huts Facebook application allowed users to order food via the site.

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Starbucks and Dunkin Donuts used Facebook posts to promote rewards cards.

encouraged fans to register their cards online and receive free birthday drink and rewards (Starbucks) or get a $2 bonus (Dunkin Donuts). Dunkin Donuts and Starbucks also promoted customized card designs, Dunkin Donuts even allowed individuals to upload photos to create personalized cards that pictured their own likenesses. The site encouraged fans to virally market these rewards cards to their friends by either sending greeting cards (Dunkin Donuts) or purchasing a rewards card as a gift for a friend. Facebook pages frequently used polls to introduce new products, seek product evaluation, and obtain information about customer preferences. Dominos, Dunkin Donuts, Pizza Hut, Sonic, Starbucks, Subways Subway365 page, and both Wendys pages contained polls. Restaurants typically asked questions about favorite products, best pizza toppings, preferred side dishes, and ways to customize and improve menu items. Polls appear to be an efficient marketing tool for restaurants. By the end of the first quarter of 2010, Starbucks posted seven polls and received as many as 479,000

responses and more than 4,000 comments. Pizza Hut had five polls on its polls tab, receiving up to 58,000 responses and 270 comments. Dominos had only one poll, but accrued more than 70,000 responses. Restaurant Facebook pages contained separate tabs with regularly updated photo albums and videos. Videos could be uploaded by either the restaurant or fans (see Figure 32). Starbucks led in the average number of videos available in the first quarter of 2009. KFC and Subways Subway page led in the average number of photo albums. The majority of videos uploaded by restaurants introduced new menu items, promoted existing items, or highlighted restaurant events. Dominos created a special commercial just for Facebook to call out a competitor and launched the Stop the Puffery program. Dominos described Papa Johns slogan "better ingredients, better pizza" as "puffery," and asked users to report on their friends use of puffery (i.e., making unsubstantiated boasts about themselves) by reposting these claims on Facebook or Twitter with #PUFFERY included.

Figure 32. Average number of videos and photo albums on Facebook pages
20 18 16 14 12 10 8 6 4 2

Videos Photo albums

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Figure 33. Wall posts that mentioned specific products

Taco Bell Wendys Frosty Subway

Dominos ran a Facebook campaign that targeted one of its rivals. Products featured on Facebook pages. Restaurants frequently mentioned specific products in their Facebook wall posts in the form of general product discussions, sweepstakes announcements, and images (see Figure 33). During our tracking period, approximately 85% of Taco Bells wall posts mentioned a specific product, with over 60% of those messages being value-driven promotions of special pricing or coupons. Wendys Frosty page, unsurprisingly, touted the tastiness of its Frosty ice cream treat in 70% of wall posts. Subways Subway page included products in wall posts 58% of the time. The $5 Footlong accounted for 39% of product mentions.

Pizza Hut Dairy Queen Blizzard Fan Club Starbucks Wendys Subway365 Sonic Dunkin Donuts McDonalds Dairy Queen Dominos KFC 0% 20% 40% 60% 80% 100%

Twitter
With the notable exception of Burger King, the restaurants in our analysis maintained active Twitter accounts throughout 2009 and several (McDonalds, Starbucks, Taco Bell and Wendys) maintained more than one (see Table 40). From December 2009 through July 2010 only Wendys @UrBaconMeCrazy Twitter account did not accumulate followers. By the end of July, the main Starbucks account, @Starbucks, approached Table 40. Restaurant Twitter accounts and followers
Restaurant Starbucks Dunkin Donuts McDonald's Pizza Hut Taco Bell Subway KFC Domino's Starbucks Taco Bell Wendy's Dairy Queen Sonic McDonald's Starbucks Wendy's Source: Twitter weekly tracking Twitter account @Starbucks @DunkinDonuts @McDonalds @PizzaHut @TacoBell @SubwayFreshBuzz @KFC_Colonel @Dominos @MyStarbucksIdea @TacoBellTruck @Wendys_Restaurant @DairyQueen @Sonic_DriveIn @McCafeYourDay @StarbucksLive @UrBaconMeCrazy

Product mentions Value + product mentions

Source: Facebook content analysis (January through March 2010)

Number of followers (000) 12/22/09 7/30/10 622.1 972.6 40.3 55.1 8.8 37.5 23.3 31.3 10.4 26.1 8.2 22.8 10.5 15.1 7.3 14.4 10.1 14.4 7.7 9.1 6.6 8.1 4.9 7.8 3.4 7.2 1.6 2.1 1.1 2.1 2.1 2.1

% growth 56% 37% 326% 34% 151% 177% 44% 96% 42% 17% 24% 59% 108% 27% 88% 0%

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one million followers, more followers than all other restaurants combined. In our content analysis of 2009 tweets, fast food restaurants often used Twitter as a customer service vehicle. They responded directly to customers who tweeted about poor service or an inferior menu item, answered questions about store hours, and replied to requests for nutrition information. McDonalds offered gift cards to some customers who appeared to dislike the restaurants new McCafe coffee. Other restaurants, such as KFC, similarly offered coupons to displeased customers. Figure 34 provides examples of customer service-oriented tweets. The three most active customer service tweeters, @Starbucks, @Dominos, and @ DairyQueen, devoted 37%, 21%, and 19% of all tweets, respectively, to customer service in 2009. Figure 34. Examples of customer service-oriented tweets
From @McCafeYourDay, 05/19/09 @xxxxxxx Sorry to hear that! I'd like to send you a card for a FREE McCafe if you'd like to give it another shot - send me a DM From @KFC_Colonel, 04/19/09 @xxxxxxxSorry about the small thigh. Some pieces look small because of no breading on Grilled. DM me your address. I'll send free chik. From @Dominos, 12/21/09 @xxxxxxxx Hmm, hard to tell. The store refused the coupon? Was the store you tried listed on the coupon?

Figure 36. Examples of Twitter contests

From @TacoBellTruck, 09/29/09 Which Why Pay More Menu taco has the most syllables? First to @ reply the correct answer & tag it #TacoBellTriviaTue wins Taco Bell Bucks! From @Sonic_DriveIn, 09/29/09 GIVEAWAY: Free Limeade for Learning vote codes to the first 10 people to respond with their favorite Sonic menu item. GO! From @KFC_Colonel, 07/29/09 Use bucketized face as Twitter photo, and contact @kfc_colonel. $100 in free KFC for the 1 we like best! http://bit.ly/URzqg

The most complex Twitter contest was The Hunt for the Biggest Bacon Lover on Wendys @UrBaconMeCrazy Twitter page. For twelve days in November 2009, the restaurant awarded prizes of $200 and $50 twice daily. One grand prize of $2,000 was awarded at the contests completion. Contest participants earned points for completing new challenges every day and garnered additional points for more difficult challenges. A leaderboard posted on Facebook kept track of participants accumulated points. The individual with the most points won the grand prize. The tweets excerpted in Figure 37 show some of the challenges issued during the contest. Figure 37. Challenges issued in Wendys Hunt for the Biggest Bacon Lover contest
From @UrBaconMeCrazy, 11/10/09 [125 pts] To the first 10 people who get THEIR "#bacon" tweet on Wendysrealtime.com, screen grab the evidence & reply to me with it. From @UrBaconMeCrazy, 11/11/09 [50 pts] To the first 10 of yall that can tell me how many thick luxurious strips of Applewood smoked #bacon come on the new Bacon Deluxe. From @UrBaconMeCrazy, 11/14/09 [500 pts] If you're already having #bacon for brunch or lunch, twitpic me some #bacon eyebrows by 4pm EST for BIG #BACON POINTS! From @UrBaconMeCrazy, 11/18/09 [600 pts] Face it, you're addicted to #BACON. And it's time you admit it to the world. You have til 8pm ET to Twitvid your #BaconConfession From @UrBaconMeCrazy, 11/20/09 [1000 pts] If you build a respectable #bacon themed diorama (beach scene preferred) or hanging mobile by 8pm EST.

Restaurants also used Twitter to share links with followers. Links frequently directed consumers to restaurants Facebook pages, websites, videos, photos and blogs. They also linked to third-party articles, blog entries, photos and videos that put the restaurant in a positive light (see Figure 35). Figure 35. Examples of restaurant tweets with outbound links
From @TacoBell, 11/04/09 I posted 3 photos on Facebook in the album "Taco Bell Pics" http:// bit.ly/1PeuLu From @SubwayFreshBuzz, 08/18/09 Thanks! Check out our article in BrandWeek. RT @GrowMarketing We're digging the Scrabble at Subway promotion - http://bit.ly/C9x5J From @McDonalds, 10/02/09 Awesome! RT @xxxxxxxx: got a happy meal & the toy was this barbie notepad! I love it & can make so many lists now! http://twitpic. com/xxxxxxxx

In all types of messages, tweets frequently mentioned specific menu items. Table 41 lists the top 3 menu items mentioned more than twice in each Twitter account and the proportion of all tweets that mentioned the item.

Additional messages found on restaurants Twitter accounts included highlighting corporate social responsibility or charitable activities, and hosting giveaways and contests. Contests designed specifically for Twitter followers were commonly used. Eight restaurant Twitter accounts hosted contests on their pages in 2009: @Dominos, @KFC_Colonel, @McCafeYourDay, @McDonalds, @PizzaHut, @Sonic_DriveIn, @TacoBellTruck, and @UrBaconMeCrazy. The contests included restaurant trivia contests, rewards for the fastest response, and mechanisms to encourage sharing and other viral activities (see Figure 36).

YouTube
Eleven of the twelve fast food restaurants maintained at least one YouTube channel during the period we analyzed. Dairy Queen and Pizza Hut maintained two channels. Subway was the only restaurant that did not have a YouTube channel (see Table 42). As with Facebook fans and Twitter followers, the number of viewers on most restaurant YouTube channels grew significantly during the first half of 2010.

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Table 41. Specific menu items mentioned in Twitter accounts
Restaurant Dairy Queen Domino's KFC McDonalds Pizza Hut Sonic Starbucks Subway Taco Bell Wendy's Twitter Account Product @DairyQueen Tagalong Blizzard @DairyQueen Thin Mint Blizzard @DairyQueen DQ cakes @DairyQueen Pumpkin Pie Blizzard @Dominos Lava cakes @Dominos American Legends pizza @Dominos Bread Bowl pasta @KFC_Colonel Grilled chicken @KFC_Colonel Famous bowls @KFC_Colonel Original Recipe chicken @McCafeYourDay Iced coffee @McCafeYourDay Iced mocha @McCafeYourDay Mocha @McDonalds Big Mac @McDonalds McCafe Coffee @McDonalds Angus Burger @PizzaHut Edge pizza @PizzaHut Stuffed crust @PizzaHut Wings @SonicDrive_In Cherry Limeade @SonicDrive_In Tots @SonicDrive_In Breakfast burrito @MyStarbucksIdea VIA Instant Coffee @MyStarbucksIdea Loose Leaf Tea @Starbucks VIA Instant Coffee @Starbucks Hot chocolate @Starbucks Christmas Blend @StarbucksLive VIA Instant Coffee @SubwayFreshBuzz Cookie @SubwayFreshBuzz Buffalo chicken @SubwayFreshBuzz Tuna sub @TacoBell Black Jack taco @TacoBell Cheesy Gordita Crunch @TacoBell Drive-thru diet @TacoBellTruck Volcano tacos @TacoBellTruck Crunchy taco @TacoBellTruck Why Pay More menu @UrBaconMeCrazy Bacon Deluxe @UrBaconMeCrazy Applewood smoked bacon @UrBaconMeCrazy Baconator # of Mentions 25 22 14 14 39 38 27 204 22 14 84 65 48 63 20 16 46 30 26 19 7 6 31 3 113 12 10 20 16 13 5 86 25 20 22 10 7 10 5 5 Calories 570-1,190 530-1,050 290-820 n/a 357 565-1,120 672-740 80-480 700 120-680 60-280 270-310 280-400 540 40-400 750-790 640-900 660-960 155-408 140-460 130-330 440-480 0 0 0 140-530 5 0 200-220 420-940 530-1,300 210 500 150-340 240 170 200-350 640 n/a 600 NPI Score 36-48 46-54 36-48 n/a 22 34-64 50-66 46-68 66 38-70 40-58 66-68 66-68 48 40-72 42-46 32-62 34-50 28-42 66 50-52 34-40 70 70 70 66-70 70 70 18-24 64-68 50-68 52 50 64-74 50 68 38-72 44 n/a 40

Source: Twitter content analysis (January through December 2009)

Starbucks was by far the most active YouTube marketer in the number of videos and views during 2009. The coffee restaurant uploaded 61 videos compared to an average of thirteen videos for all restaurants. Starbucks YouTube videos from 2009 were viewed more than 2 million times. A single ad, a music video featuring hip-hop artist MC Yogi, generated half those views.37 The ad launched in January 2009 and promised a free coffee to any customer who committed to five hours of community service.

Dominos produced multiple food-focused videos with substantial viewership. Its most popular video38 had more than 1.2 million views and featured Dave Brandon, the companys chief executive officer.39 In the fifteen-second video, Brandon claimed his restaurants oven-baked sandwiches were preferred over Subways toasted subs in a taste test. Two other videos promoted Dominos Pizza Turnaround in which the restaurant attempted to improve its recipe in response to customer feedback. These two videos had a combined viewership of nearly one million.

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Table 42. Restaurant YouTube channels, viewers, and videos posted in 2009
Channel Starbucks DominosVids TacoBell DunkinDonuts KFCColonelSanders Kingon Defense Academy DairyQueen* DQVideos McDonaldsRestaurant Wendy's SonicDriveIn PizzaHut MorePizzaHut * First tracked on 05/28/10 Source: YouTube weekly tracking 12/22/2009 2,758,497 2,364,174 805,942 879,563 331,098 182,768 54,318 68,538 33,410 47,211 8,289 8,132 178 Viewers 7/30/2010 5,293,553 3,805,940 2,073,772 1,144,645 980,412 195,589 130,589 113,220 115,628 110,607 62,502 16,529 242 % growth 92% 61% 157% 30% 196% 7% 140% 65% 246% 134% 654% 103% 36% Videos posted in 2009 61 14 4 6 3 9 14 14 11 3 4 10 10

Figure 38. Main products and messages in 2009 YouTube videos

Main products*
Non-food promotion Specic product Branding only Other Healthy menu Value menu 0% 10% 20% 30% 40% Humor

Messages

Cool/hip Special effects General nutrition info 0% 20% 40% 60% 80%

*Two ads were coded as having two main products. Source: YouTube content analysis, (January through December 2009)

Taco Bells most successful video was an expanded version of its Its all about the Roosevelts TV advertisement.40 This twominute music video promoted tacos and nachos costing 79 to 99 cents and was viewed more than 100,000 times. Dunkin Donuts most popular video was titled Dunkins Next Donut Winner and had approximately 50,000 views.41 This video featured Jeff Hager, the Alabama customer who won a contest to invent the recipe for Dunkins newest donut. Much of the video centered on Mr. Hagers life at home, including playing soccer with his children, viewing photo albums, and sharing a box of a dozen donuts. He proclaimed that eating donuts is valuable because it brings the whole family together. Our YouTube video content analysis included 50 videos added by the fast food restaurants in 2009 with at least 5,000 views. Figure 38 presents the main products and message of these videos. In 20 of the 50 videos, either a specific menu item or a

special menu was the main point. Food was depicted in 56% of the videos, and it was shown being eaten in 38%. Humor, the most common message strategy, appeared in 62% of the videos, followed by cool or hip in 12%. Interestingly, some popular videos were apparently identical to previously aired TV advertisements. For example, a Sonic commercial called Cheap Date was viewed more than 25,000 times on YouTube.42 Other videos were too long for TV ads. Not surprisingly, these videos tended to promote the products concurrently appearing in other media. For example, Taco Bell created a three-minute faux-infomercial about the Drive-Thru Diet43 which it began promoting in 2009. We did not identify any YouTube videos that appeared to specifically target a child audience (i.e., under 12 years old) or a particular minority group; 74% of the videos featured white actors exclusively.

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Mobile marketing
Mobile marketing Mobile website banner ads Definitions Advertisements that appear at the top or bottom of third-party mobile website pages. Similar to internet banner ads, mobile banner ads are graphic display ads (commonly accepted file types are GIF, Animated GIF, JPEG, and PNG) that click through to a website page designated by the advertiser.

Mobile banner Indicates relative share of presence of the advertisement, established by comparing the frequency ad index with which a particular advertisement on a given mobile website appeared compared to all other advertisements on that same website. The ad index therefore acts as a benchmark: any number above 100 indicates a greater observed presence than expected, while a number below 100 indicates the converse. Smartphone applications Text message advertising Operating system-specific (e.g. iPhone, Android) applications that may be downloaded to mobile phones. They act as stand-alone programs and may perform several different functions, including games, store locators, and ordering platforms. The short message service (SMS) enables companies to send brief text messages (160 characters or fewer) between mobile phones and other SMS-enabled devices. While the technology is primarily used to transmit messages between private parties, it can also be used to make payments, make inquiries from a service provider such as Google or Fandango, and to place orders with a restaurant

We first examine restaurants placement of banner ads on third-party mobile websites and the content of those ads. We then describe smartphone applications sponsored by fast food restaurants and examples of text message advertising.

increased in popularity throughout the year. In January, only KFC ran mobile banner ads. By the end of the year, six of the restaurants posted ads in the month of December (all restaurants did not post ads every month) (see Figure 39). These eight restaurants placed banner ads on 125 of the 200 mobile websites that comScore tracks. News, entertainment, sports, and video sites were most frequently selected for banner ad placements (see Figure 40 and Table 43). Burger King and Dominos placed ads on 50 and 66 mobile websites, respectively. In contrast, the other restaurants with

Mobile website banner ads

Eight of the twelve restaurants in our analysis ran banner ads on mobile websites at some point 2009: Burger King, Dominos, Dunkin Donuts, KFC, McDonalds, Starbucks, Subway, and Wendys. Usage of mobile website banner ads

Figure 39. Restaurants with banner advertising on mobile websites by month in 2009
7 6 5 4 3 2 1 0

Number of restaurants

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Source: comScore AdMetrix Mobile

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Figure 40. Types of mobile websites on which restaurant banner ads appeared in 2009 Technology & science 4% Social networking 3% Search 3% News 27% Games 3% Music 4% Table 43. Ten mobile websites with the most frequent placement of restaurant banner ads
Mobile website # of months with ad placements ESPN Mobile 12 Weather Bug Mobile 6 Yahoo! Mobile (sports pages) 5 VH1 Mobile 5 MLB.com Mobile 5 AT&T Media Net (sports pages) 5 WhitePages Mobile 4 photobucket Mobile 4 Comedy Central Mobile 4 CBS Sports Mobile 4 Source: comScore AdMetrix Mobile (January through December 2009)

Weather 5%

Automotive 2% Sports 16% Business & finance 1% City guides Entertainment & maps 3% 18%

Videos 11%

The top monthly ad placements for each restaurant, as measured by ad index, are reported in Table 45. Burger King and Dominos placed banner ads on mobile websites covering the widest range of topics, including ads on numerous games, news, video, sports, and social networking sites. Dunkin Donuts placed mobile banner ads on just one local news site for one month, but was the prominent advertiser on that site. KFC and Wendys both advertised heavily on sports sites, but also placed ads on music and video websites. KFC, in particular, appeared to target a male audience by placing ads on sports sites and the site for the mens magazine, FHM. McDonalds advertised on more general interest mobile sites, such as those providing weather reports, entertainment, and local news. Starbucks advertised exclusively on two news sites: Slate and The Washington Post Mobile. Subway placed banner ads exclusively on mobile websites devoted to sports (CBS Sports Mobile, Yahoo! Mobile sports pages, and AT&T Media Net sports pages). Given its focus on video (Comedy Central) and music (VH1) mobile sites, Wendys was the only restaurant to demonstrate potential teen targeting of mobile website ad placements. As compared to the total mobile internet population, teens access relatively more social networking, music, games, videos and technology mobile websites.

Mobile website banner ad content analysis

We identified 443 individual mobile banner ads placed by the restaurants in our analysis during 2009, but found only 48 unique ads for the content analysis. Three-fourths of these ads featured food (either an individual menu item or the value menu) as the main products (see Figure 41). The restaurants relied primarily on two selling points: value and novelty. KFC and Subway also advertised a promotion with a link to win prizes. Given that mobile banner ads must be small and are generally static images, it is not surprising that the ads lacked the complexity found in internet banner ads. Two-thirds of mobile banner ads did not even picture a food item. None of the mobile ads were child-targeted, and just one (a Spanishlanguage McDonalds ad) was targeted to a particular racial or ethnic group. In contrast to internet banner ads, just 17% of mobile banner ads contained techniques to engage viewers. Two companies

mobile banner ads each placed them on fewer than ten sites (see Table 44). However, most restaurants that advertised on fewer websites gained a higher share of presence on those sites (based on higher median ad index numbers). Only McDonalds advertised on relatively few mobile websites and had relatively low ad index numbers. Table 44. Mobile banner ad placements by restaurant
Restaurant Burger King Domino's Dunkin' Donuts KFC McDonald's Starbucks Subway Wendys # of months 7 1 1 6 9 2 7 4

# of sites 50 66 1 3 8 2 3 5

Ad index range 1 - 231 1 - 62 n/a 17 - 580 2 - 492 84 - 807 88 - 725 1 - 488

Ad index median 15 14 3,312 166 12 490 200 144

Source: comScore AdMetrix Mobile (January through December 2009)

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Table 45. Top five monthly ad placements as measured by ad index for each restaurant
Restaurant Mobile website Month Burger King Mapquest Mobile Dec GameTrailers.com Mobile Dec Comedy Central Mobile Dec ESPN Mobile Nov Discovery Mobile Oct Domino's LA Times Mobile Dec Boston.com Mobile Dec CBS iMobile Dec Mobicious Mobile Dec kiwibox Mobile Dec Dunkin' Donuts courant.com Mobile Dec KFC NFL.com Mobile Feb FHM Mobile Sep FHM Mobile Jul NFL.com Mobile Jan ESPN Mobile Feb McDonald's OrlandoSentinel.com Mobile May The Weather Channel Mobile Sep The Weather Channel Mobile Oct Us Mobile Sep ESPN Mobile Mar Starbucks Slate Mobile Nov Slate Mobile Oct Washington Post Mobile Nov Subway Yahoo! Mobile Sports Sep Yahoo! Mobile Sports Aug AT&T Media Net Sports Nov Yahoo! Mobile Sports Oct Yahoo! Mobile Sports Nov Wendys VH1 Mobile Nov VH1 Mobile Oct ESPN Mobile Sep Comedy Central Mobile Dec ESPN Mobile Oct Source: comScore AdMetrix Mobile (January through December 2009) Ad Index 231 188 127 102 100 62 58 53 46 43 3,312 580 354 309 252 79 492 371 321 96 66 807 490 84 725 705 287 278 238 488 214 168 158 148

KFC and Subway promoted prize giveaways with mobile website banner ads.

Many mobile banner ads advertised food without picturing the food.

McDonalds was the only restaurant to produce an ethnictargeted mobile banner ad.

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Figure 41. Selling points and main products on mobile banner ads
Value/ cheap

Selling points

New/ improved Special offer Individual menu item(s) Value menu Non-food promotion 0% 10% 20% 30% 40% 50%

Main products

Source: Mobile banner ad content analysis (January through December 2009)

This Dominos ad encouraged viewers to order food online using their smartphone.

harnessed the interactive potential of mobile ads by encouraging viewers to order food (Dominos) and locate a restaurant (Wendys) online. A few restaurants placed ads crafted for viewers of a particular mobile site. For example, KFC promoted itself as the official wing sponsor of the NFL (two of KFCs top three ad index scores were for NFL.com). Burger King, which advertised heavily on the Comedy Central mobile site, sponsored an ad for a Comedy Central program called Tosh.0.

Smartphone applications
A Wendys mobile ad with a link to a restaurant locator. During 2009, eight fast food restaurants introduced smartphone applications available for download by iPhone users. Table 46 identifies key functions available in each of these applications. Most applications featured restaurant locators. These allow a user to simply click a button to submit the current location of the phone and the application returns the nearest locations. Alternatively, a zip code may be entered manually. Although ordering applications were not yet widely available for smartphones, Pizza Huts iPhone ordering application

KFC ran many ads on the NFL.com mobile site.

The Pizza Hut iPhone application allowed users to place customized orders for pizza, wings, and pasta.

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Table 46. Smartphone application functions
Restaurant Use as locator in-store Special Restaurant Application name Launched (uses GPS) Game Ordering payment offers Starbucks myStarbucks Sep x x Starbucks Starbucks Card Mobile Sep x Pizza Hut Pizza Hut Jul x x  x  x Taco Bell Taco Bell Locator Jul x Taco Bell Why Pay More! Shaker May x Dunkin' Donuts Dunkin' Run Jun x Burger King Burger King Now Apr x X (Queens, NY only) x Subway Subway Feb x x Dairy Queen Where's DQ? Dec x KFC KFC Grillz Apr x Source: iPhone application analysis (September 2010) Nutrition info x

reportedly generated more than $1 million in sales and approached one million downloads in the first three months after its launch.44 After nearly a year on the market, according to Pizza Hut, it had generated more than $7 million in sales and had been downloaded more than two million times.45 Because of this success, the restaurant plans to develop ordering applications for Android smartphones and for iPads. Pizza Hut anticipates that the mobile channel eventually will account for more than 50% of all orders.46 Many of the smartphone applications were creative and engaging. Users of Pizza Huts iPhone application could fully customize their pizzas by adding toppings to a virtual pizza on the phone screen. When pasta was selected from the menu, a white-gloved waiter bearing a tray of pasta appeared. If wings were desired, the user added the sauce and chicken to a virtual bowl and shook the phone until the wings were fully coated. Favorite orders could be saved to a list for future reference. The Dunkin Donuts application, called Dunkin Run, was the only socially-based fast food application. A user could coordinate with friends who also had the application installed on their phones. Each person could make his or her own selections using the fully customizable menu in the application. All requests would then be aggregated into one shopping list for one user to make a Dunkin Run. The restaurant cashier could view the screen to complete the order. KFC launched this application to help promote its new grilled chicken. KFCs Grillz application promoted the launch of grilled chicken to the restaurants menu. Users could customize their own grill on an animated mouth by selecting one of sixteen combinations of grills and mouths and entering their own words or message on top. The custom grill could then be held in front of the users mouth and spoken into and it would appear to talk.

The Dunkin Run application allowed users to collect coffee orders from friends before making a coffee run.

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Table 47. iPhone application demographic profile
Application Name Burger King Now Dunkin' Run KFC Grillz myStarbucks Pizza Hut Starbucks Card Mobile Taco Bell Locator Taco Bell Why Pay More! Shaker Users 12+ years 6,505 737 1,658 306,533 210,145 43,323 1,253 18,441 12-17 years 2,697 n/a n/a 37,779 33,311 1,535 1,133 1,269 % 12-17 years 41% n/a n/a 12% 16% 4% 90% 7%

Source: comScore iTunes Application Tracking (August 2010)

Not surprisingly, many teens have downloaded these fast food restaurant applications (see Table 47). The data indicate the projected number of individuals with these applications installed on their iPhone or iPod Touch as of August 2010. The number does not include individuals who have downloaded the application and later deleted it.

Text message advertising

Although we registered our phone with the seven restaurants with options to receive promotional messages via SMS (Dominos, Dunkin Donuts, McDonalds, Sonic, Starbucks, Subway, and Taco Bell), we received texts from just two: Dominos and Sonic. Both restaurants sent us notifications about special offers. Dominos sent codes redeemable for discounts when ordering online approximately two to three times per month. Sonic alerted us to special promotions available in-store. Some companies have also enabled ordering via text message. Those reported to offer this service currently are: Burger King (Queens, NY only)47, Pizza Hut, and Subway (NYC and Southern California locations only).48 49

Social networking sites are extremely popular among teenagers: 73% of teens are members of a social media site, including 55% of 12- to 13-year-olds (even though 12-yearolds are technically prohibited from joining these sites) and 82% of 14- to 17-year-olds.50 Among teens with a profile on a social network, 71% maintain pages on Facebook.51 In addition, 86% of teens on social networking sites have posted comments on a friends page; 83% have commented on a friends picture;52 and 29% have added at least one brand to their selective group of Facebook friends.53 Similarly, a recent study from Edison Research and Arbitron indicates that approximately 18% of the 17 million Americans who use Twitter are between the ages of 12 and 17 years. Twitter also is well-poised to continue to attract advertisers. The percentage of Twitter users who follow corporate brands is three times higher than other social media users.54 It is significant to note that African Americans disproportionately use Twitter. They represent 24% of Twitter users, approximately double their proportion in the U.S. population.55 Approximately 17% of Twitter users are Hispanic. Teens are also active viewers of online videos. According to Nielsen, 12 million American teens, or about two-thirds of those who use the internet, watched video online during May 2009.56 The average teenager watched somewhat more than three hours of online video during the month. This age group (12-17 years) accounted for about 15% of all online video watching. In addition, children (2-11 years) watched about two hours on average during the month and accounted for 8% of all online video viewership. Teens watched a large proportion of online videos that fell into Nielsen's Entertainment--Videos/Moviescategory, and YouTube is the most significant contributor.57 In 2010, 75% of 12- to 17-year-olds owned cell phones, an increase from 45% in 2004.58 Teens use mobile websites frequently: 37% of teen mobile subscribers accessed the internet on their phones in the first quarter of 2009.59 Their mobile website usage increased by 45% from 2008 levels. This growth outpaced all mobile website users, which grew by 34%.60 Teens also avidly use text messages: 72% of all teens send text messages and 50% of those teens send at least 1,500 texts a month.61 However, the proportion of teens who receive SMS ads through their cell phones does not differ

Example from Dominos, received 5/8/2010: Any 3 or More Med 2-Top Pizzas or 10-Piece Chicken for $5.99 each. Use code M2M online or @ http://bit.ly/cd432p Reply STOP to opt out Example from Sonic, received 3/9/2010: Sonic.SonicDriveIn.mobi FREE Tots w/purchase of any SuperSONIC cheezburger: 2x meat, 2x cheez :-9 Manage alerts via SONIC account

Teen use of social , viral , and mobile media

At the time of this report, the advertising industry did not have reliable measurement methods to track users of social, viral and mobile media. Therefore, we cannot definitively confirm that these restaurant marketing efforts are viewed by children, adolescents, or different ethnic groups. However, numerous market research reports confirm that teens use these media disproportionately more than the general population.

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from the proportion of the total population.62 As our research suggests, restaurants did not appear to use text messaging aggressively. The percentage of teens who reported receiving SMS ads from either restaurants or other food companies fluctuated between 2% and 5% per month from May 2009 to May 2010.63 Overall, it is highly likely that a large proportion of teens frequently engage with the social, viral and mobile marketing techniques used by the restaurants in our analysis. In addition, given restaurants increasing use of these techniques and teens increasing adoption of these media, their exposure is likely to increase dramatically over time. Pizza Hut led the way in convenience, with applications that made it possible to order food using numerous media platforms on customers computers and mobile phones. In addition to its Facebook ordering application, the restaurant encouraged mobile phone orders through its iPhone application, by text message, or the mobile web. As indicated by Burger Kings and Subways tests of mobile ordering platforms, it appears that other fast food restaurants will soon establish their own means to order food from any location. Although exposure data were not available to reliably track users of social and mobile media by demographic group, Wendys may have targeted teens by placing mobile banner ads on the types of sites that are most popular among this group and Taco Bell may have targeted teens through its Taco Bell Locator iPhone application. In addition, all restaurants experienced significant gains in popularity during the 29-week period that we tracked. This remarkable growth indicates that the restaurants customers have embraced these new forms of marketing. As a result, we anticipate that social media and mobile marketing, although still in their nascent stages, will become increasingly widespread.

Social media and mobile marketing overview

Across all social media, Starbucks popularity eclipsed that of the other eleven restaurants in our analysis, as measured by number of fans, followers, and subscribers. Starbucks also had the most popular iPhone application.

Figure 42. Social media footprint

Combined social media presence

The size of each circle correlates with sum of the restaurant's Facebook fans, Twitter followers, and YouTube upload views (January 2010 to July 2010).

Sales revenue (2009)

Scale
1 million combined Facebook, Twitter, and YouTube users

Social media presence

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Marketing inside restaurants
Restaurant signs audit Definitions Menu item signs Featured menu items Menu type signs Promote specific menu items or meals, including items on restaurants kids menus, dollar/value menus, and healthy menus, and other lunch/dinner items, snack items, coffee drinks and breakfast items. The menu items presented on menu item signs. More than one menu item may be featured on the same sign. Mention the availability of breakfast or late-night menus, or promote value-priced options, but do not reference specific menu items.

Sign locations Indicate where signs were located at the restaurant, including ordering/counter for signs in direct view of customers standing in line; other indoor for additional signs inside the restaurant; drive thru signs located anywhere in the drive-thru lane; and other outdoor for signs located outside the restaurant, including those posted in the restaurant windows facing outside. Sign messages Indicate specific selling messages that appeared on menu item signs, including value when signs referenced dollar/value menus, combo meals, the word value, or lower price; kids for signs promoting menu items as part of a kids meal, toy, or included other mentions of kids or children; and health for signs that referenced words such as healthy, low-fat, diet, or low-calorie, as well as mentions of a healthy menu. Price promotions Indicate whether the sign referenced a price promotion, with a special price or free food giveaway for the featured menu item, or other promotions, including non-food giveaways, sweepstakes, celebrity endorsements, licensed characters, movie/TV tie-ins, and contests.

Restaurant signs audit

Across the twelve restaurant chains, each restaurant averaged 14.8 featured menu items on signs and an additional 1.0 menu type signs. More than one-third of featured menu items appeared on signs at the counter area (5.4 per restaurant) (see Figure 43). Approximately one-quarter appeared in both other outdoor (3.7) and other in-store locations (3.6). Menu item signs appeared least often in the drive-thru area, averaging 2.0 featured menu items per restaurant location. Although less prevalent than signs promoting specific menu items, menu type signs appeared most often in other outdoor locations (45% of menu type signs), followed by the counter area (28%). Figure 43. Location of signs at restaurants
Featured menu items

Table 48 details the average number of menu items featured on signs in different locations at the restaurants. Wendys had the most menu item signs, averaging 21.4 featured menu items per restaurant, followed closely by Dairy Queen at 21.3. McDonalds and Burger King also posted a significant number of menu item signs, averaging 19.5 and 18.8 featured items, respectively. Subway, Starbucks, and Dominos had the fewest menu items featured on signs, averaging 8.7 or fewer per store. With the exception of Pizza Hut and Sonic, at least one-third of restaurants featured menu items appeared on signs at the counter area where customers could view them while waiting in line and placing orders. Matching the total number of featured menu items per restaurant, Wendys and Dairy Queen

Menu type signs

Other outdoor signs 25% Drive-thru signs 14%

Counter signs 37%

Other outdoor 46%

Counter 28%

Other in-store 13% Drive-thru 13%

Other in-store signs 24%

Source: Restaurant signs audit (June 2010)

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Table 48. Average number of featured menu items per restaurant by location
Restaurant Wendys Dairy Queen McDonalds Burger King Dunkin Donuts Taco Bell Sonic Pizza Hut KFC Subway Starbucks Dominos Twelve restaurants Counter 8.3 7.9 6.9 7.1 6.0 5.7 2.2 1.4 5.5 5.3 3.3 4.3 5.4 Other in-store 5.5 7.0 4.5 3.0 3.3 4.1 0.1 9.7 0.8 1.5 1.9 0.8 3.6 Drive-thru 3.4 2.3 2.9 3.3 2.2 3.4 3.5 0.1 1.9 0.0 0.7 0.0 2.0 Other outdoor 4.2 4.1 5.3 5.4 4.9 4.2 9.4 2.1 3.3 1.9 0.9 1.2 3.8 Total 21.4 21.3 19.5 18.8 16.4 15.7 15.2 13.2 11.5 8.7 6.9 6.2 14.6

Source: Restaurant signs audit (June 2010)

had the most items featured at counter locations (8.3 and 7.9 per restaurant, respectively), followed by Burger King and McDonalds (approximately 7). Subway and Wendys had the largest concentration of menu items featured on signs at the counter; approximately two-thirds were placed at this location. Pizza Hut and Sonic had the lowest proportion located at the counter, each with less than 15% of featured menu items there. Menu items featured on signs at other in-store locations are placed for customers to see while they eat. Pizza Hut advertised most frequently on indoor signs located beyond the counter area. The restaurant averaged almost ten featured menu items on signs in other in-store locations, comprising 73% of its total. Dairy Queen followed with seven items per store placed in other in-store locations, accounting for one-third of total featured items. Menu items featured on signs at other in-store locations at Starbucks and Wendys represented 28% and 26% of the total for those restaurants. Sonic and KFC placed fewer than 10% of their menu items on signs in other in-store locations. As with signs located at the counter, signs at the drive-thru lane are viewed by customers waiting to place their orders. Taco Bell, Wendys, Burger King, and Sonic frequently placed menu item signs at the drive-thru, averaging more than three featured menu items per store in this location. Pizza Hut, Subway, Starbucks, and Dominos had few drive-thru locations and, therefore, signs rarely appeared at these restaurants. All other restaurants averaged two to three featured menu items on drive-thru signs per restaurant. Signs at the final type of location, other outdoor areas, encourage visits by potential customers passing the restaurant. Burger King and McDonalds placed extensive signs outside their restaurants, averaging more than five featured menu items on other outdoor signs per restaurant which accounted for more than one-quarter of their signs. Not surprisingly, given that Sonic typically serves customers in their cars, signs placed outside of the restaurant appeared to be Sonics primary strategy (comprising approximately 60% of featured menu items). Starbucks and Pizza Hut had the lowest proportion of signs outside the restaurant (less than 16%). The

other restaurants averaged three to five menu items on outdoor signs per restaurant. Restaurants use of signs to promote types of menus, but not specific menu items, varied widely (see Table 49). Four restaurants averaged 1.5 or more menu item signs per restaurant (Subway, Burger King, Taco Bell, and Wendys); whereas four restaurants rarely used this strategy (Pizza Hut, Sonic, KFC, and Dominos). The types of menus promoted most frequently were Subways breakfast menu (1.9 signs per store) and Taco Bells dollar/value menu (1.4 signs per store). Five restaurants featured a dollar/value menu sign in more than half of restaurants (Burger King, Subway, Dairy Queen, Wendys, and Pizza Hut). Signs mentioning late-night offerings and hours appeared infrequently, almost 75% of them outside the restaurant. Wendys promoted its late-night menu the most, averaging 0.6 signs per restaurant. The highest percentage of breakfast and dollar/value menu type signs (36% and 44%, respectively) were also located outside of the restaurant, suggesting that placement of menu type signs are commonly used to encourage visits to the restaurants.

Different formats of outdoor signs.

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Table 49. Number of menu type signs per restaurant
Restaurant Subway Burger King Taco Bell Wendys McDonalds Dunkin Donuts Dairy Queen Pizza Hut Sonic KFC Dominos Starbucks Twelve restaurants Breakfast 1.9 0.7 0.0 0.4 0.4 0.4 0.0 0.0 0.3 0.0 0.0 0.0 0.4 Late-night 0.0 0.3 0.3 0.6 0.2 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 Value 0.7 0.8 1.4 0.5 0.3 0.3 0.6 0.5 0.1 0.2 0.2 0.0 0.5 Total 2.6 1.8 1.7 1.5 0.9 0.7 0.6 0.5 0.4 0.3 0.2 0.0 1.0

Source: Restaurant signs audit (June 2010)

Figure 44. Messages and promotions on menu item signs

Value

Messages

Kids

Health

Price
Promotions

Other 0% 10% 20% Source: Restaurant signs audit (June 2010) 30% 40%

Messages and promotions on menu item signs

Figure 44 presents the proportion of menu item signs that featured messages about health, kids or value, and price or other promotions. Approximately one in five featured menu items on restaurant signs promoted value and/or included a price promotion to encourage sales or specific menu items. Health and kids messages were rare, appearing on 2% of signs. Other types of promotions also appeared infrequently. Table 50 presents the proportion of signs by restaurant that featured promotions and value, health, or kids messages. Dominos relied heavily on value and pricing to promote its menu items inside the restaurant; more than 40% of menu items on signs featured a value message and/or price promotion. Burger King, Taco Bell, and Subway also used this strategy frequently; value messages appeared on 24% or more of

their menu item signs. In addition, more than 20% of Burger King, Taco Bell, and Dunkin Donuts signs contained price promotions. In contrast, Dairy Queen and Starbucks featured value messages and/or price promotions in fewer than 10% of signs. Wendys promoted these messages in 10% to 12% of its signs, relatively few compared to McDonalds and Burger King, the other large burger restaurants. In contrast, health and kids messages appeared in 2% of all menu item signs and were not present at all in four of the twelve restaurants. Taco Bell had the most featured menu items with health messages, with 7% of the total, followed by Subway with 5%. McDonalds and KFC featured kids messages on 5% of signs, followed by 4% of Wendys signs, and 3% of Burger King and Sonic signs. Burger King, McDonalds, and Wendys featured other promotions on 5% or more of menu item signs. The most common types of other promotions included toy giveaways with kids meals (e.g., Shrek Forever After at

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Table 50. The percentage of menu item signs with theme and promotion messages
Restaurant Burger King Dairy Queen Dominos Dunkin Donuts KFC McDonalds Pizza Hut Sonic Starbucks Subway Taco Bell Wendys Twelve restaurants Source: Restaurant signs audit (June 2010) Value 33% 7% 44% 22% 21% 22% 16% 17% 5% 24% 27% 12% 20% Messages Health 2% n/a n/a 1% 1% 1% n/a n/a 3% 5% 7% n/a 2% Kids 3% n/a n/a n/a 5% 5% n/a 3% n/a 2% 2% 4% 2% Promotions Price Other 25% 10% 5% 2% 42% 3% 21% 4% 20% 2% 18% 7% 16% n/a 16% n/a 4% 3% 18% 3% 23% 2% 10% 5% 17% 4%

McDonalds, Marmaduke at Burger King, and Car Karaoke CDs at Wendys), other games (e.g., World Cup Soccer game at McDonalds), charity tie-ins (e.g., Dave Thomas Adoption Foundation at Wendys), and coupons for entertainment venues (e.g., Hersheypark, Sesame Place, and Knotts Berry Farm).

Special menus and food categories promoted

We categorized all menu items that appeared on signs by menu type and food category. We first identified signs that featured any menu items (kids, dollar/value, and healthy menus, including when the sign did not specifically refer to Figure 45. Proportion of featured menu items on signs by special menu and food category Kids menu items Breakfast items 6% 7% Dollar/value menu items 7%

the special menu). We then assigned the remaining menu items to food categories (lunch/dinner, breakfast, snacks, and coffee drinks). Appendix D (Table D.1) provides the number of featured menu items on signs promoting each special menu and food category by restaurant. As shown in Figure 45, lunch and dinner items comprised nearly one-half of menu items featured on restaurant signs. Signs promoting snack items accounted for another quarter of total signs, and 14% of signs featured coffee drinks and breakfast items. Individual items from dollar/value, healthy, and kids menus appeared in 4% to 7% of menu item signs. Table 51 presents the percentage of signs that featured items from each special menu and food category by restaurant. Lunch and dinner items accounted for 40% or more of featured menu items on signs at most restaurants. The pizza restaurants

Coffee drinks 7% Snack items 23% Lunch/dinner items 46%

Healthy menu items 4%

Source: Restaurant signs audit (June 2010)

Wendys and Burger King signs for late-night hours, value menu and breakfast menu.

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Table 51. Percentage of featured menu items on signs for each special menu and food category by restaurant
Restaurant Burger King Dairy Queen Domino's Dunkin' Donuts KFC McDonald's Pizza Hut Sonic Starbucks Subway Taco Bell Wendy's Twelve restaurants Kids' menu items 12% 2% n/a n/a 15% 11% n/a 3% n/a 16% 3% 7% 6% Dollar/value menu items 6% 3% 4% n/a 23% 7% 15% 2% n/a 5% 14% n/a 7% Lunch/dinner items 54% 30% 81% 7% 54% 40% 72% 66% 8% 47% 42% 62% 46% Healthy menu items n/a n/a 2% 11% 5% n/a 1% 7% 8% 12% 10% n/a 4% Snack items 13% 65% 14% 5% 2% 31% 12% 15% 63% 3% 30% 30% 23% Coffee drinks n/a n/a n/a 56% n/a 7% n/a 2% 16% n/a n/a n/a 8% Breakfast items 17% n/a n/a 21% n/a 4% n/a 5% 5% 18% n/a 1% 7%

Source: Restaurant signs audit (June 2010)

Table 52. Special menu and food category items featured on signs in different store locations
Other Drive- Other Counter in-store thru outdoor Total Lunch/dinner items 44% 45% 53% 44% 46% Snack items 22% 33% 19% 17% 23% Coffee drinks 6% 7% 7% 11% 8% Value menu items 6% 4% 6% 11% 7% Breakfast items 8% 5% 4% 8% 7% Kids' menu items 8% 4% 6% 5% 6% Healthy menu items 6% 2% 4% 3% 4% Source: Restaurant signs audit (June 2010)

featured the most lunch/dinner items, including 80% of Dominos and 72% of Pizza Huts signs. Only Dairy Queen, Dunkin Donuts, and Starbucks had a higher percentage of signs for a different food category. Dairy Queen and Starbucks advertised their snack items on more than 60% of signs; and 56% of Dunkin Donuts signs featured coffee beverages. Taco Bell, Wendys, and McDonalds featured snack items second most often; they promoted snacks on approximately one-third of signs, averaging 4.3 to 6.0 snack signs per restaurant. For Dunkin Donuts, Subway, and Burger King, breakfast items came in second in appearance on menu item signs, with about 3.5 breakfast item signs (about one in five) per restaurant. More than 15% of Subway and KFC signs promoted their kids meal items, averaging 1.4 and 1.7 items per store, respectively. McDonalds averaged 2.2 kids menu signs per restaurant, but promoted them in less than half of stores. Compared to the other restaurants, KFC also had the largest proportion of signs featuring dollar/value menu items (23%), followed by Pizza Hut and Taco Bell (14% to 15%). Meanwhile, healthy items appeared on 4% of menu item signs. Among the twelve restaurants, just Taco Bell, Subway, and Dunkin Donuts promoted items from their healthy menus on 10% or more of signs.

Table 52 shows the percentage of featured menu items from each special menu and food category present on signs in different locations across the twelve restaurants. Lunch/dinner items appeared most frequently on signs in all locations of the restaurant, but they represented a somewhat higher proportion of signs in the drive-thru area. Notably, snack items were featured on one-third of signs located in other in-store areas, a comparatively high percentage as they represented just 23% of all menu items. It appears that restaurants may use these signs to encourage additional purchases of snack or dessert items to customers who eat a meal inside the restaurant. Similarly, while dollar/value menu items and coffee beverages comprised just 7% to 8% of all menu item signs, they represented 11% of signs located in other outdoor locations, suggesting that these items may be used to encourage visits to the restaurants.

Outdoor sign for McDonalds coffee beverages.

Nutritional quality of menu items appearing on restaurant signs

Table 53 summarizes the nutritional quality of menu items that appeared on signs at each of the twelve restaurants. Results include the percentage of menu items with a healthy NPI score of 64 or higher for foods and 70 or higher for

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Table 53. NPI score, and weighted average calories and sodium content of menu items featured in signs at each restaurant
Restaurant Subway KFC McDonald's Taco Bell Starbucks Dunkin' Donuts Wendy's Pizza Hut Burger King Sonic Domino's Dairy Queen Twelve restaurants Healthy NPI score 65% 39% 36% 35% 32% 30% 29% 17% 16% 13% 10% 4% 25% Total calories 355 411 349 331 247 249 455 512 435 397 574 566 412 Weighted average of featured menu items Calories from sugar Calories from sat fat Sodium (mg) 47 37 963 60 53 956 124 58 413 147 23 556 115 26 238 131 22 262 105 71 909 38 80 1,297 53 75 821 112 62 625 51 103 1,237 204 103 512 108 62 699

Source: Restaurant signs audit (June 2010) and menu composition analysis (January 2010)

beverages. Average calories and sodium per menu item (weighted by number of menu items) are also presented. Nutrient information was not available on restaurant websites for 157 menu items (17% of items) that appeared 1,916 times (12% of signs). Signs at Subway restaurants featured the most nutritious menu items. Two-thirds met the cut-offs for healthy NPI scores. Subway items were also among the lowest in average calories across restaurants, but had higher than average sodium levels. In contrast, approximately one-third of menu items featured on signs at KFC, McDonalds, Taco Bell, Starbucks, and Dunkin Donuts had healthy NPI scores; and menu items featured on signs at these restaurants averaged 247 (Starbucks) to 454 (Wendys) calories per item. Saturated fat content of KFC, McDonalds and Wendys items was high, ranging from 6 to 9 grams (54 to 81 calories). Dominos and Dairy Queen featured the least healthy menu items on their signs: 10% or fewer had healthy NPI scores and menu items featured at these restaurants averaged more than 560 calories each. In addition, approximately one-half of the calories in menu items on signs at Sonic and Dairy Queen consisted of sugar and saturated fat. Table 54 presents the three menu items that appeared most frequently on signs at each restaurant, including calorie and NPI scores. The following items appeared on signs at 70% or more of restaurants: Frapp (McDonalds), BK Breakfast Bowl (Burger King), Boneless Wings and Frosty (Wendys), Fruitista Freeze (Taco Bell), Wings (Pizza Hut), Coolatta (Dunkin Donuts), Family Meal and Crispy Double Down sandwich (KFC), and Blizzard (Dairy Queen). None of these menu items had healthy NPI scores and some items, including large-sized Dairy Queen Blizzards and Dunkin Donuts Coolatas, had as many as 900 calories or more.

Table 55 presents the nutritional quality of menu items featured on restaurant signs by sign location, message, and promotions. Signs that appeared inside the restaurant in locations other than the counter area were least likely to have healthy NPI scores (20%) as compared to signs that appeared in other areas of the restaurant (24% to 29%), primarily due to higher levels of sugar averaging 32 grams (128 kcal) per sign. Menu items promoted in signs outside the restaurant had higher than average total calories and sodium. Signs with a kids or health message appeared in few restaurants, but the promoted items generally were more nutritious. Approximately half the items on signs with a kids message had a healthy NPI score and these items averaged fewer than 200 calories. McDonalds, Subway, and Burger King commonly promoted kids meal apple sides in their signs with a kids message; and McDonalds, Burger King, and Wendys promoted plain milk. Kids main dishes promoted at individual restaurants included chicken nuggets (at McDonalds and Wendys), Subways kid-sized Fresh Fit sandwiches, Burger Kings hamburger, KFCs grilled drumstick, and Taco Bells cheese roll-up and bean burrito. Wendys also featured its kids meal cheeseburger and flavored milk in these signs. Few restaurants featured health messages on menu item signs, but these menu items had the highest NPI scores: three-quarters met healthy cut-off scores and they averaged 241 calories. Individual menu items promoted with a health message and featured on 5% or more of signs in individual restaurants included apples and macaroni and cheese (Burger King); Fresco soft taco, chicken burrito supreme, and steak burrito supreme (Taco Bell); and grilled chicken drumstick (KFC). Table 56 presents menu items that appeared on signs with price promotions at 20% or more of restaurants. NPI scores

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Table 54. The three menu items featured most frequently on signs at each restaurant
Percent of restaurants Restaurant Item with sign McDonald's Frapp 81% Coffee 60% McFlurry 57% Subway 6" Fresh Fit sandwich 30% Coffee 34% 12" Fresh Fit sandwich 32% Burger King BK Breakfast Bowl 78% Firegrilled Ribs 42% Icees 60% Starbucks Frappuccino Light Blended Coffee 41% Frappuccino Coffee Drink 34% Frappuccino Blended Coffee 25% Wendy's Boneless Wings 96% Frosty 72% Twisted Frosty 62% Taco Bell Fruitista Freeze 87% Limeade Sparkler 49% $2 Meal Deal 39% Bacon Ranch Tortada 68% Pizza Hut Wings -10 pc 70% Hershey's Chocolate Dunkers 16% Hand Tossed Pizza 9% Dunkin' Donuts Coolatta 84% Iced Coffee 61% Latte - Iced 64% KFC Family Meal 100% Double Down - Crispy 70% Fountain soft drink 28% Sonic Fountain soft drink 20% Mozzarella Sticks 14% Tots 28% Domino's Chocolate Lava Crunch Cake 44% Soft drink (in a bottle) 26% Sandwich - Italian Sausage and Peppers 26% Dairy Queen Blizzard 84% DQ Cakes 68% Frozen Lemonade 34% *Per restaurant that had a sign for the menu item Source: Restaurant signs audit (June 2010) Average number of signs per store* Calories 4.0 450-680 1.8 40-400 1.6 550-620 2.1 230-480 1.5 5 1.5 460-1080 1.9 540 2.9 220-590 1.9 n/a 2.1 90-220 2.1 180-490 2.8 180-490 2.2 520-580 2.8 150-520 2.4 440-560 3.4 230-250 3.7 150-230 3.0 various 1.7 n/a 2.6 320-408 6.3 280 10.3 580-880 4.2 473-946 3.1 10-120 2.4 70-450 1.5 various 1.8 540 3.3 200-880 8.0 278-929 10.3 440 4.9 130-330 1.6 357 1.5 0-165 1.3 879 4.9 440-1,530 3.6 290-820 3.2 200-430 NPI score 40-72 54-58 50-76 70 50-76 48 26-28 68-70 64-68 64-68 42-44 60 44-58 66 66

28-42 38 36-64 60-66 70 68-70 46 66 66 38 50-52 22 66-70 46 40-60 36-48 66

and total calories for menu items featured on these signs did not differ significantly from menu items featured most often on other signs in the restaurants. As with all signs, few menu items met healthy NPI score cut-offs.

Restaurant signs overview

Promoting specific menu items on signs inside the restaurant and outside is a marketing technique used extensively by all restaurants in our analysis. The burger restaurants, including Wendys, Dairy Queen, McDonalds, and Burger King, used

this strategy the most, averaging nineteen or more signs per restaurant. Signs appeared most frequently at the counter area inside the restaurant where they could influence specific menu items ordered, and outside the restaurant to encourage restaurant visits. Some restaurants also used signs outside the restaurant to advertise availability of different types of menus or other restaurant features such as Subways breakfast menu and Wendys late-night hours. As found in the analysis of TV advertising, restaurants rarely used signs to promote sales of their healthier menu items.

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Table 55. NPI score and weighted average calories and sodium content of menu items featured on restaurant signs
Restaurant All signs Sign location Counter Other in-store Drive-thru Other outdoor Message Value Health Kids Promotions Price Other Calories Healthy NPI Sat Sodium score Total Sugar fat (mg) 25% 412 108 62 699 29% 20% 25% 24% 27% 77% 51% 26% 34% 403 418 393 431 417 241 191 429 403 98 128 101 107 82 31 48 82 116 60 63 57 66 61 26 20 63 62 700 651 670 754 809 698 334 848 654

Source: Restaurant signs audit (June 2010) and menu composition analysis (January 2010)

Although items on restaurants dollar/value, healthy, and kids menus tended to receive higher NPI scores and to be lower in calories, these items were featured on 7% or fewer of restaurant signs. Similarly, although signs with health and kids messages promoted more nutritious menu items, these signs appeared just 2% of the time. In our analysis, just Subway and Taco Bell promoted health messages in 5% or more of their menu item signs. Four restaurants that did not advertise their kids meals on TV or the internet (KFC, Sonic, Taco Bell, and Wendys) promoted them on a small number of restaurant signs. As in TV ads, signs with a kids message usually featured the healthier side and beverage offered with the kids meal options. However, they were featured on restaurant signs less than 5% of the time.

Price promotions at Burger King, Taco Bell, and Wendys

Menu item signs at restaurants most frequently promoted lunch/dinner main dishes, which was also the case in general audience TV ads. In addition, many restaurants prominently

Table 56. Menu items that appeared on signs with price promotions*
Percent of restaurants Restaurant Item with sign McDonald's Sweet Tea 24% Burger King Firegrilled Ribs 23% Icees 26% BK Breakfast Bowl 21% Wendy's BBQ Bacon Jr. Cheeseburger Deluxe 24% BBQ Bacon Crispy Chicken Deluxe 23% Taco Bell $2 Meal Deal 29% Pizza Hut Any Pizza $10 37% Wings - 10 pc 38% Any Pasta $10 22% Dunkin' Donuts Coolata 24% Donut 25% KFC Family Meal 71% Crispy Strips 25% *Items that appeared in 20% or more of restaurants Source: Restaurant signs audit (June 2010) Average number of signs per store Calories 1.5 150 2.3 220-590 1.5 n/a 1.4 540 1.1 430 1.1 450 2.9 various 1.4 various 1.2 155-408 1.1 510-640 2.9 473-946 1.4 40-470 1.3 various 1.1 250-380 NPI score 68 26-28 48 38 40

28-42 62-66 60-66 14-50 48-50

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featured sweet snacks, especially at other in-store locations, placed to encourage impulse purchases after a meal. Restaurants frequently used value messages and short-term price promotions to promote sales of their high calorie and poor nutritional quality items. Although no restaurants prominently featured their more healthful items in TV advertising, Subway menu items featured on store signs were relatively nutritious. Approximately two-thirds had healthy NPI scores and these items averaged just 355 calories. It appears that Subway promoted its $5 footlong sandwiches to encourage customers to visit the restaurant but, at the point-of-sale, they encouraged purchases of smaller, more healthful items. As in other types of advertising, Pizza Hut, Sonic, Dominos, and Dairy Queen promoted the least nutritious menu items on signs in restaurants; fewer than 20% had healthy NPI scores and at least one-third of calories were from sugar and saturated fat. Burger King also promoted primarily unhealthy menu items in its restaurant signs. a healthy NPI score 66 or higher, and except for Taco Bells salad, they were less than 700 calories. All restaurants also offered a chicken sandwich with an NPI score of 66 or higher and fewer than 450 calories. Some restaurants (Wendys, Taco Bell, Sonic, and Burger King) offered a red meat sandwich with a healthy NPI score. In addition, all restaurants offered healthy sides with NPI scores as high as 86 and fewer than 200 calories. At all restaurants in our pricing analysis, the salad with chicken was priced higher than any other main dish evaluated. On average, the salad cost $1.30 more than any sandwich examined; it even cost more than restaurants large, unhealthy red meat sandwiches that averaged 972 calories. In addition, a hamburger combo meal (including a main dish, side, and beverage) was priced just $.72 higher than the salad. Therefore, restaurant pricing does not encourage sales of these items. In contrast, within similar types of main dishes, healthier options tended to be less expensive. For instance, the healthier version of chicken sandwich cost the same or less than the least healthy version (on average, $.51 less). Similarly, the healthiest red meat sandwich, such as a regular hamburger, cost $2.18 less on average than the least healthy sandwich (e.g., McDonalds Angus Bacon and Cheese burger and Burger Kings Quad Stacker). However, the least healthy items tended to provide the most food for the price. For example, the least healthy chicken sandwiches contained on average 55% more calories than the healthiest versions but cost just 14% more. Compared to the healthiest red meat sandwiches, restaurants least healthy versions contained 128% more calories but cost 93% more. For side dishes, however, the healthiest and least healthy options tended to be priced similarly. Therefore, by simply switching side dishes, customers do have the option to increase the healthiness of a fast food meal at no cost. It is interesting to note that kids meals and combo meals were priced similarly among the restaurants. Subway was the only exception. The average price of McDonalds, Burger King, Wendys, and Taco Bells kids meals differed by only $.10, and prices for their combo meals ranged from $4.47 to $5.80. However, both Subways kids meals and combo meals cost approximately $1.00 more than the highest priced meal at other restaurants: $4.05 for the kids meal and $6.80 for the combo meal. Overall, it is possible to obtain a healthy meal at these restaurants for a relatively low price. However, the chicken salad tended to be the healthiest main dish option at most restaurants but also the most expensive. In contrast, the largest burgers available at these restaurants provided 800 or more calories for a relatively low price.

Pricing analysis
We priced eight individual menu items that varied in nutritional quality at eight restaurants (excluding the pizza and coffee restaurants), as well as kids meals and combo meals at McDonalds, Burger King, Wendys, Subway, and Taco Bell. Individual menu items evaluated for price included the healthiest chicken main dish salad available (as measured by NPI score), the healthiest and less healthy versions of chicken and red meat sandwiches, and the healthiest and least healthy sides available. Appendix D (Table D.2) presents the average price for each menu item in the analysis, as well as NPI score and calories per item. Table 57 summarizes these results. Healthy options were available on all restaurant menus examined. All offered a chicken salad (including dressing) with

Table 57. Average price, calories, and NPI scores for healthiest and less healthy options at restaurants
Type of item Kids meal Combo meal Chicken main dishes Salad with chicken Healthy sandwich Least healthy sandwich Red meat sandwiches Healthiest available Less healthy Least healthy Side dishes Healthiest Least healthy Average price $3.19 $5.57 $4.85 $3.73 $4.24 $2.35 $2.95 $4.53 $1.35 $1.37 Average NPI score Average calories

72 69 55 60 44 40 75 52

495 383 594 426 534 972 101 314

Source: Pricing analysis (June 2010)

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Sales practices audit
Sales practices audit Default item Definition Side dish and/or beverage that is automatically provided when ordering a kids meal or combo meal. Figure 46. How sides were offered in kids meal orders
100%

% of kids meal orders

We also conducted an audit of sales practices used by fast food restaurant employees when customers placed orders for kids meals and combo meals. Field personnel acting as customers were instructed to purchase any side or beverage provided with the meal automatically, or the first item offered if restaurant employees offered them a choice. The audits were conducted at 50 locations each of McDonalds, Burger King, Wendys, Taco Bell and Subway across the country.

80%

Offered 1+ healthy sides 62% Offered no healthy sides 90% Offered no choice

60%

Kids meals
Although all restaurants examined offered nutritious beverage options with their kids meals, and all, with the exception of Taco Bell, offered nutritious sides, restaurant employees nearly always automatically provided a soft drink and french fries (or other unhealthy side) with the meal. In more than 84% of kids meal orders placed at McDonalds, Burger King, Wendys, and Taco Bell, the restaurant employees did not ask the customer what side he or she wanted (see Figure 46). They suggested a healthy side just 6% to 8% of the time at McDonalds, Burger King, and Wendys. Subway was the only exception: Restaurant employees offered the customer a choice of side options 78% of the time, including fruit in 60% of orders and yogurt in 22%.

40%

86%

92%

84%

20%

22%
0%

ay

ng

ald

dy

W en

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Source: Sales practices audit (June 2010)

Kids meal bags at Burger King and McDonalds.

Bu

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Be

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Figure 47. Sides received with kids meals
100%

Figure 48. How beverages were offered in kids meal orders

100%

Yogurt
80% % of kids meal orders

6% 28% 26% 34% Offered 1+ healthy beverages 76% Offered no healthy beverages Offered no choice

Fresh fruit 56% 98% 94% 96% 98% Dessert item French fries/ chips
% of kids meal orders

80%

60%

60%

40%

40%

78% 54% 62% 32% 18%

20%

20%

24%
0% 0%

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Source: Sales practices audit (June 2010)

Source: Sales practices audit (June 2010)

% of kids meal orders

As a result, 94% or more of kids meals ordered at McDonalds, Wendys, Burger King, and Taco Bell included an unhealthy side (french fries at the burger restaurants, or cinnamon twists at Taco Bell). In comparison, 56% of kids meals ordered at Subway included fruit and 10% included yogurt, while 34% included chips or cookies (see Figure 47). Restaurant employees offered customers a choice of kids meal beverages somewhat more often than they offered a choice of sides. Nevertheless, they did not offer a choice approximately half of the time (see Figure 48). Taco Bell offered no choice of beverage with kids meals 78% of the time, and McDonalds and Burger King offered no choice 54% and 62% of the time. In contrast, Wendys and Subway employees were more likely to offer customers a choice of beverage, including 68% of orders placed at Wendys and 82% at Subway. At Subway, they offered plain milk and 100% juice in three-quarters of orders. However, at Wendys, even though customers were typically offered a choice of beverage, plain milk or 100% juice was suggested in just 34% of orders. Interestingly, Wendys poured soft drinks behind the counter more often than other restaurants; this occurred in 54% of Wendys orders. Wendys provided customers a cup to pour his or her own soft drink 18% of the time, whereas this occurred 52% of the time at the other four restaurants. Consequently, 72% to 96% of kids meals ordered at McDonalds, Burger King, Wendys, and Taco Bell came with a soft drink (see Figure 49). Plain milk or 100% juice was received in 16% of kids meal orders at Burger King, 12% at McDonalds, 8% at Wendys, and 4% at Taco Bell. Subways kids meals came with a healthy beverage more often: 28%

Figure 49. Beverages received with kids meal orders

100%

Bu

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Su

Be ll

ys

ay

in

in

Other
80%

100% juice Plain milk

60%

96%
40%

Flavored milk Soft drink

82%

80%

72%

20%

30%

0%

ng

bw a

W en dy

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Source: Sales practices audit (June 2010)

of orders included 100% juice and 18% included plain milk. Even so, customers still received a soft drink with Subways kids meals 30% of the time and flavored milk 24% of the time. Wendys also suggested flavored milk first in 18% of orders.

Bu rg

Ta c

Be

ld

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Figure 50. How sides were offered with combo meals
100%

Figure 51. Size of combo meals received*

100%

14%
80% % of kids meal orders

60%

100%
40%

96%

92%

Offered 1+ healthy sides Offered no healthy sides Offered no choice

80% % of kids meal orders

60%

90% 96% 84% 82% 86%

40%

Largest combo meal Mediumsized combo meal Smallest combo meal

54%
20% 20%

0%

0%

ys

ay

na ld

na ld

bw

W en d

W en d

er K

er K

bw

cD o

cD o

rg

Bu

Source: Sales practices audit (June 2010)

Combo meals
Similar to the kids meal-ordering scenarios, restaurant employees rarely offered a choice of sides with combo meals, and instead, they automatically included a default side with the meal. At McDonalds, Burger King, and Wendys, customers automatically received a side with their combo meal 92% to 100% of the time (see Figure 50). Subway provided customers with a choice of sides in approximately one-half of orders. However, they offered a healthy side in just 14% of orders at Subway and in 2% to 4% of orders at Wendys and Burger King. No healthy sides were offered at McDonalds. Across all restaurants, customers received a soft drink with 98% of combo meals and they received french fries or chips more than 90% of the time. During the majority of combo meal orders (69%), restaurant employees did not offer customers a choice of meal sizes. When they did, they usually mentioned all available sizes. At McDonalds, Burger King, Wendys and Subway, customers most commonly received the smallest sized combo meal available (a medium at McDonalds and a small at Burger King, Wendys and Subway) (see Figure 51). Employees asked customers if they wanted a larger sized combo meal in 4% of orders at McDonalds, 14% at Subway, 16% at Burger King and 18% at Wendys. Notably, Taco Bell nearly always suggested a larger-sized combo meal. With the exception of Subway, restaurants seldom asked customers if they wanted to modify their meal, such as by adding condiments or offering a choice of toppings or bread types. Adding cheese to a sandwich was the only modification commonly suggested by restaurant employees (see Figure

*McDonalds smallest combo meal was labeled medium, but was the same size as Burger King and Wendys small. Accordingly, we classified McDonalds medium combo meal as the smallest combo meal offered. Source: Sales practices audit (June 2010)

Figure 52. Cheese modifications in fast food orders

80%

Bu

rg

Kids meal Combo meal

60% % of kids meal orders

40%

20%

ay

rK in

ald

dy

W en

bw

on

Su

Source: Sales practices audit (June 2010)

52). They asked the customer about adding cheese more often when the order involved combo meals (34% of orders) than kids meals (12%). In contrast, Subway commonly asked customers about bread choice (48% of kids meal and 66%

Bu rg e

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Ta c

Be

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Su

Be ll

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ay

in

in

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of combo meal orders); cheese (more than 54% of kids and combo meal orders); and choice of other toppings (10% of kids meal and 20% of combo meal orders). King promoted their healthy kids meal options extensively in their external advertising, their employees offered customers a healthy side option in 8% of orders and a healthy beverage option in approximately one-quarter of orders. Restaurant personnel offered customers a healthy side or beverage option even less often with a combo meal. As a result, with the exception of Subway kids meals, nearly all kids and combo meals automatically came with a soft drink and french fries. With the exception of Taco Bell, restaurant employees did not regularly suggest a larger-sized combo meal. On average, this occurred in 30% of orders.

Sales practices audit overview

The overwhelming default at four of the five restaurants examined in the sales practice audit was to provide french fries and a soft drink with orders for both kids meals and combo meals. Subway alone offered healthy sides and beverages as the default in its kids meals. Although McDonalds and Burger

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Results Marketing outcomes

In this final section, we assess the outcomes of fast food restaurant marketing practices, including frequency and reasons for restaurant visits as reported in a survey of parents of 2- to 11-year-old children. In addition, we purchased market research data from The NPD Groups CREST service to evaluate fast food items purchased most often by teens and by parents for their children. month and 22% reported going at least once a week. In contrast, approximately 30% reported taking their children to Burger King, Wendys, or Subway more than once a month, and fewer than 10% reported going once a week or more to any of these restaurants. We found similar patterns of responses when we asked parents how often their child asks to go to the twelve fast food restaurants (see Figure 54). Again, with the exception of Dunkin Donuts and Starbucks, one-third or more of parents reported that their child had asked them to go to these restaurants at least once. The most frequently requested restaurant was McDonalds; 91% of parents said their child had asked to go there and 41% of parents said their child asked at least once a week. In fact, 15% of parents of 2- to 5-year-olds reported that their child asked to go to McDonalds every day, and 8% of parents of older children reported daily requests. One-half to two-thirds of all parents reported that their child had asked to go to each of the following restaurants: Burger King, Wendys, Subway, Pizza Hut, and Taco Bell. Between 12% and 16% of parents reported requests to go to Burger King, Wendys, and/or Subway at least once a week. Differences by race and ethnicity. We found some significant differences by race and ethnicity in reported visits to individual fast food restaurants (see Figure 55). African American parents visited McDonalds, Burger King, Wendys, KFC, and Pizza Hut with their children more often than did white parents. Hispanic parents also visited McDonalds, Burger King, KFC, and Pizza Hut more often than white parents. Hispanic parents were less likely to visit Wendys but almost as likely as African American parents to visit Burger King.

Restaurant visits
We conducted an online survey of 689 parents of children (2-11 years), including 310 white, 214 African American, and 159 Hispanic parents (respondents were asked both race and ethnicity). We oversampled African American and Hispanic parents to obtain enough responses to compare differences by race and ethnicity. Of these parents, 60% had children from 2 to 5 years (n = 412), and 71% had children from 6 to 11 years (n = 486). The frequency that parents reported visiting the twelve restaurants in our analysis varied widely (see Figure 53). With the exception of Dunkin Donuts and Starbucks, 50% or more of parents had taken their children to all the fast food restaurants in our analysis at least once. At least 75% had visited McDonalds, Burger King, Wendys, or Subway. Approximately 70% had visited Pizza Hut, Taco Bell, and KFC. About half had visited Dairy Queen, Dominos, and Sonic. Parents took their children to McDonalds significantly more often than they visited other fast food restaurants: 66% reported taking their children there at least a few times per

Figure 53. How often parents reported taking their children to the twelve fast food restaurants
% of parents who have taken their children to these restaurants 100%

96% 84% 80%

Once a month or less Few times a month 1-2 times per week 3+ times per week

80%

76%

71%

70%

69%

60%

54%

53%

50% 34% 26%

40%

20%

in g

ay

ut

Be ll

ni

ut

ald

KF

dy

ee

aH

bw

in o

rK

So

on

W en

on

Do m

Su

Pi zz

Ta c

rg e

Bu

Da

Source: Survey of parents of children 2-11 years (August/September 2010)

Du

nk

in

St a

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iry

rb u

Qu

ck

0%

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Figure 54. How often parents reported that their child asked to go to the twelve fast food restaurants
100%

91%

% of parents reporting any child requests

80%

Once a month or less Few times a month 1-2 times per week 3+ times per week

64%
60%

56%

54%

53%

49% 42% 40% 38% 37% 27% 17%

40%

20%

os

bw ay

KF C

Be ll

ee n

ut s on D nk in
ic sp an
Pizza Hut

ys

ut

W en d

aH

m in

er K

Ta co

on

Qu

So

Su

cD

iry

Do

rg

Pi

Bu

Da

Source: Survey of parents of children 2-11 years (August/September 2010)

Figure 55. Parents reporting visits to fast food restaurants a few times per month or more often: Restaurants with differences by race and ethnicity
100%

Few times a month 1-2 times per week 3+ times per week

80%

60%

40%

20%

0%

ic

ic

te

Du

te

ic

te

ic

te

ica

te

ica

ica

ica

an

an

sp

er

sp

er

W hi

sp

er

sp

er

Am

Am

Am

Am

an

an

an

an

ric

ric

ric

ric

Af

Af

Af

McDonalds

Burger King

Af

Wendys

KFC

Source: Survey of parents of children 2-11 years (August/September 2010)

Similarly, African American parents were more likely to report that their child asked to visit McDonalds, Burger King, Dominos, and KFC compared to white parents (see Figure 56). Hispanic parents were even more likely to report that

their child asked to visit Burger King, perhaps explaining their higher relative frequency of visits to this restaurant: 44% of Hispanic children asked to visit compared to one-quarter of white and one-third of African American children.

Af

ric

an

Am

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Hi

Hi

Hi

Hi

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ica

an

an

hi

hi

hi

hi

St

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zz

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0%

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ni

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Figure 56. Menu items that appeared on signs with price promotions
100%

% of parents reporting any child requests

80%

Few times a month 1-2 times per week 3+ times per week

60%

40%

20%

0%

te

te

te

er ica n

er ica n

er ica n

te

sp an i

sp an i

sp an i

Am

Am

Am

sp an i Hi
KFC

an

an

an

ric

ric

ric

Af

Af

Af

McDonalds

Burger King

Dominos

Source: Survey of parents of children 2-11 years (August/September 2010)

Parents visits to the top four fast food restaurants

Of the parents responding to our survey, 84% reported that they had purchased lunch or dinner for their children from any fast food restaurant in the past week and 79% (n = 546) had purchased lunch or dinner from one of the four restaurants we examined in detail (McDonalds, Burger King, Subway, and Wendys). In addition, 39% had visited more than one of these four restaurants in the past week. McDonalds was the most popular choice: Twothirds (66%) of parents had taken their children to McDonalds for lunch or dinner in the past week, compared to 25% each who had taken their children to Burger King or Subway and 23% who had gone to Wendys. Parents also reported that these results were not unusual. Three-quarters indicated that they had eaten at fast food restaurants in the past week the same as usual and 20% reported eating at fast food restaurants less often than usual in the past week. Just 6% reported eating at fast food restaurants more often than usual. Parents also provided detailed information about their most recent visit to one of these four restaurants: 66% had visited McDonalds most recently (n = 360); 12% each had visited Burger King or Subway (n = 65 and 64, respectively); and 10% had visited Wendys (n = 57). They also reported specific purchasing information for their youngest child during their most recent visit. The sample included 312 parents who reported purchases for their 2- to 5-year-old (57%) and 234 who reported on their 6- to 11-year-old (43%). It also included 240 white, 163 African American, and 130 Hispanic parents.

With the exception of those who had gone to Subway, the majority of parents ordered food at the drive-thru window: 63% at McDonalds, 60% at Burger King, and 75% at Wendys. Just 3% reported ordering from a Subway drivethru. As a result, fewer parents reported eating inside a McDonalds, Burger King, or Wendys restaurant (25%, 23%, and 19%, respectively), while 33% ate inside a Subway. The most common locations for consuming the food were at home or someone elses home, including 43% who purchased from McDonalds, 40% from Burger King, 54% from Wendys, and 39% from Subway. In addition, approximately one-quarter of parents who purchased food from McDonalds, Burger King, or Wendys consumed the food inside their car (26%, 31%, and 21%, respectively). Parents who visited all four restaurants reported that the main reason they chose the restaurant was because their child likes it there (39%), convenience (25%), and value (12%). Just 5% reported going to these restaurants because they provide healthy menu options. However, we found significant differences in parents reasons for choosing individual restaurants (see Figure 57). Nearly half of parents (47%) reported that the main reason they visited McDonalds was because their child likes it, compared to 31% who went to Burger King, and fewer than 20% who went to Subway or Wendys. More than one-third of parents reporting going to Wendys for convenience. In contrast, healthy menu options was the most common reason that parents chose Subway (31%), compared to less than 1% of parents who went to McDonalds and 3% to 4% of parents who went to Burger King or Wendys.

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Figure 57. Main reason that parents chose to go to fast food restaurants
Other Healthy food Value Convenience Child likes it
100%

of parents reported that their child wanted to go to Wendys or Subway for a free toy or giveaway.

Fast food restaurant visits by children and teens

NPD also provided information on fast food restaurant visits to major quick service (i.e., fast food) chains, including information reported by teens (13-17 years) and by parents of children (under 13 years).64 According to NPD, children under 13 accounted for 13% of all visits to quick-service chains, while teens accounted for 8%. Relative to each groups representation in the population, children were below-average users of fast food chains, while teens were average users. Young adults, ages 18-24, had the highest propensity to visit fast food chains. Among visitors of all ages, approximately one-third of occasions were for lunch, one-quarter for supper or morning meal, and 18% for a p.m. (i.e., afternoon or night-time) snack (see Figure 58). Compared to consumers of all ages, parents visiting with children were more likely to visit at supper and less likely at morning meal. In addition, teens and parents of older children were less likely to visit at lunch. Teens were above average users of the p.m. snack occasion: One-quarter of their fast food visits were for snacks, compared to 18% of occasions for all visitors and 21% of occasions for 18- to 24-year-olds (the next highest group). Fewer differences were found when comparing all youth (under 18 years) by race and ethnicity. White youth were somewhat more likely to visit at supper, and African American youth to visit at morning meal.

80%

60%

40%

20%

0%

McDonalds

Burger King

Wendys

Subway

Source: Survey of parents of children 2-11 years (August/September 2010)

When asked about the main reason their child wanted to go to these restaurants, the majority of parents reported that their child likes the food, including 83% who went to Subway, 65% who went to Wendys, 59% for McDonalds, and 48% for Burger King. The free toy or giveaway was the second most common reason parents reported that their child wanted to go to McDonalds (15%) and Burger King (19%). Fewer than 5%

Figure 58. All fast food restaurant visits by time of day for children and teens
100%

80%

PM snack Supper Lunch Morning

60%

40%

20%

ge s

ar s

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ar

ar

ic

ye

ye

Al la

ye

Hi sp

612

13 -1 7

Un d

er

Youth (under 18)

Source: The NPD Group/CREST/Year Ending December 2009

Af

ric

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Am

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ica

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0%

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Figure 59. Percentage of all fast food restaurant visits by place of consumption and ordering method for children and teens
100%

80%

Carry out/delivery Drive-thru On premises

60%

40%

20%

la ge s

ye ar s

ye ar s

ye ar s

te

Al

de r6

12

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6-

13

Youth (under 18)

Source: The NPD Group/CREST/Year Ending December 2009

As found in our survey of parents, approximately one-quarter of fast food restaurant meals were consumed at the restaurant (see Figure 59). NPD reports that approximately one-third of orders occurred at the drive-thru, and the rest of orders were carried out of the restaurant or delivered. When children were present, parents of young children were most likely to use the drive-thru and parents in general were less likely to use carry out or delivery. Conversely, teens were least likely to use the drive-thru, but more likely to consume food at the restaurants and to use carry out or delivery. African American youth were less likely to consume food at the restaurants.

Children appear to have a significant influence over fast food restaurant visits by parents. The most common main reason that parents chose McDonalds or Burger King was that their child likes it there, including nearly one-half of parents who went to McDonalds. Similarly, nearly all children had asked their parents to go to McDonalds, and 40% asked them to go at least once per week. The main reason that parents reported their child wanted to go to these restaurants was that they like the food more than twice the number who reported the main reason their child wanted to go was because of the toy or giveaway.

Restaurant visits overview

These results confirm that young people visit fast food restaurants frequently. Similar to previous research that showed that 59% of teens consumed fast food in the past two days,65 84% of parents reported taking their child to at least one fast food restaurant in the past week and 39% reported taking them more than once. Across the four restaurants examined in detail, one-third of parents reported that convenience and value were the main reasons they had visited. Similarly, two-thirds reported that they placed their order at the drivethru window and consumed the food in their car or at home. Subway was the only restaurant that parents reported going to for healthy menu options. According to NPD data, parents of children under 6 were also more likely to purchase food at the drive-thru. Approximately two-thirds of fast food restaurant visits by parents and teens were for lunch or dinner. Teens were more likely to have visited for an afternoon or evening snack when compared to other age groups.

Special menus and menu items purchased

We also surveyed parents about fast food purchases for their children, and purchased NPD CREST data on restaurant usage across all age groups.66 We report on the special menus ordered and the specific items purchased. Finally, we combine the NPD data with our menu composition analysis to provide estimates of the nutritional quality of food purchased by age and demographic groups for the twelve restaurants in our analysis.

Parents purchases by menu from the top 4 fast food restaurants

In our survey, we asked parents to indicate from what menus they ordered for their child. We combined the special menus into three categories: 1) Kids meals, including McDonalds Happy Meal and Mighty Kids Meal, and Burger Kings,

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Figure 60. Parents orders for their child by menu type, restaurant, and age of child*
120% % of parents ordering from each menu for their child

Other
100%

20% 27% 29% 39% 30% 21% 47% 82% 67% 69% 47% 58% 65% 27% 27%

Dollar/value menu Kids meal

80%

60%

40%

55%

20%

0%

2-5 years

6-11 years

2-5 years

6-11 years

2-5 years

6-11 years

2-5 years

6-11 years

McDonalds

Burger King

Wendys

Subway

*Percentages exceed 100% as some parents ordered from more than one menu for their child Source: Survey of parents of children 2-11 years (August/September 2010)

Subways, and Wendys kids meals; 2) dollar/value menu, including McDonalds Dollar Menu, Burger Kings Value Menu, Subways $5 Footlongs, and Wendys Super Value Menu; and 3) other, including combo and value meals and the regular menu. As expected, parents reported purchasing kids meals most often for their children (70% across all restaurants). However, this number varied widely by restaurant: 76% of parents purchased a kids meal at McDonalds, compared to 59% at Burger King, 56% at Wendys, and 47% at Subway. At McDonalds, 20% of kids meals ordered were the largersized Mighty Kids Meal that came with a 6-piece chicken nuggets or double cheeseburger. The dollar/value menu was also popular with parents. Among the four restaurants, 26% purchased food from this menu for their child. Again, this number varied by restaurant, ranging from 23% of parents at McDonalds to 36% at Subway. The type of menu from which parents ordered also varied by the age of the child (see Figure 60). Parents of younger children were significantly more likely to order a kids meal for their child while parents of older children were more likely to order from the dollar/value menu. The percentage of parents ordering a kids meal ranged from 82% of parents of 2- to 5-yearolds at McDonalds to just 27% of parents of 6- to 11-year-olds at Subway. The Mighty Kids Meal at McDonalds was more popular with older children, comprising 42% of McDonalds kids meal orders for older children. By comparison, just 7% of parents ordered it for younger children. In addition, 20% of parents of young children ordered food from the dollar/ value menu for their child at McDonalds. Forty-seven percent

of parents of older children ordered a $5 Footlong sandwich for their child at Subway (56% of these parents indicated that their child ate one-half or less of the sandwich during the meal). In addition, 21% of parents of children 6-11 years who went to Wendys and 33% who went to Subway ordered an adult-sized combo meal for their child. Parents also indicated the main reason they chose to order a kids meal or dollar/value menu item for their child. Not surprisingly, 60% of parents chose the dollar/value menu because it was a good value. However, an additional 20% indicated that the dollar/value menu had the food their child liked the most. Parents had more varied reasons for choosing the kids meal. Among the four restaurants, 32% chose the kids meal because it contained the food their child likes the most, followed by 20% who said it was a good value, 17% who indicated that they always buy it, and 12% who said their child wanted the toy. Just 7% ordered a kids meal because it contained healthy items. The reasons that parents ordered a kids meal varied by restaurant (see Figure 61). Parents were more likely to indicate that they bought a kids meal at McDonalds and Wendys because it contained the food that their child likes most. They were more likely to indicate that the kids meal was a good value for the money at Burger King and Wendys. In addition, 13% to 14% of parents responded that they bought the kids meal at McDonalds or Burger King because their child wanted the toy. In contrast, 43% of parents said they purchased the kids meal at Subway because it contained healthy items.

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Figure 61. Main reason parents reported choosing a kids meal for their child
50%

Child likes the food

40%

Good value Always buy it Healthy items Toy

30%

20%

of young children purchased a kids meal for their child and another 17% purchased items from the dollar/value menu or combo meals. Parents of older children were more likely to purchase items from the dollar/value menu or combo meals (27%) than kids meals (21%) for their children. Teens rarely purchased kids meals, but 39% said they purchased dollar/ value menu items or combo meals. African American youth were also more likely to purchase dollar/value menu items and combo meals compared to white and Hispanic youth. The incidence of purchasing from a special menu was higher at burger restaurants: 77% of parents reported ordering from a special menu for their child under 13 and 69% of teens reported ordering from one.

10%

0%

McDonalds

Burger King

Wendys

Subway

Kids menu items purchased by parents for their children

In our parent survey, we also asked about the specific menu items they purchased for their child from the kids meal menu. Chicken nuggets was the most popular main dish at Wendys, McDonalds, and Burger King: 81% of parents purchased them at Wendys; 38% at McDonalds; and 50% at Burger King. The hamburger or cheeseburger was also popular at Burger King, purchased by 45% of parents, compared to 31% at McDonalds and 13% at Wendys. Overall, 66% of parents also ordered french fries or chips. Soft drinks were the most popular beverages: 38% ordered them for their children. Juice and flavored milk were also popular, ordered by 28% and 24% of parents, respectively. One-third of parents reported that they ordered fruit as the side and just 8% ordered plain milk.

Source: Survey of parents of children 2-11 years (August/September 2010)

Special menus purchased by children and teens

NPD also reports that parents commonly order kids meals and value-priced menu items and meals for their children at all fast food restaurants (see Figure 62).67 For all eating occasions (including breakfast and snacks), 36% of parents

Figure 62. Purchases from special menus by youth at all fast food and burger restaurants
80%

Combo meal Dollar menu Kids meal

60%

40%

20%

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Youth (under 18)

Source: The NPD Group/CREST/Year Ending December 2009

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0%

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In our survey of parents who had visited the top 4 restaurants, specific sides and beverages ordered with kids meals varied by restaurant and age of the child (see Figures 63 and 64). Approximately two-thirds of parents ordered french fries for their child at McDonalds, Burger King, and Wendys. At Subway, however, just 20% of parents ordered chips (Subway does not offer french fries) and 73% ordered fruit or yogurt. Parents were somewhat more likely to order Burger Kings Apple Fries than McDonalds Apple Dippers or Wendys mandarin orange fruit sides. Parents were also less likely to order fruit for older children than for younger children. Parents beverage orders with kids meals varied even more by restaurant and age. Soft drinks were the most popular options at McDonalds and Burger King and juice was most popular at Subway. Flavored milk was most popular at Wendys and appeared to displace both soft drink and juice purchases. In addition, 6% of parents ordered a Frosty for their child from Wendys. Parents ordered more plain milk at Subway than at any other restaurant (23%), compared to just 6% to 8% of parents at the other three restaurants. More than half of parents of older children ordered a soft drink with their childs kids meal double the percentage who ordered a soft drink for their younger child. In contrast, almost twice as many parents of younger children ordered juice or plain milk as compared to parents of older children. About 27% of parents ordered flavored milk for their younger child, but only 19% ordered it for their older child. We also asked parents who reported visiting McDonalds at least once within the past month (n = 528) whether they had ever purchased one of the healthy side or beverage options with a McDonalds kids meal (i.e., apple dippers, 100% juice, and/or plain milk). The majority of parents reported that they had purchased apple dippers or juice for their child with a McDonalds kids meal in the past (69% and 71%, respectively); and 51% reported that they had purchased plain milk. However, these percentages were more than twice as high as the percentage of parents who reported purchasing these items during their last visit to McDonalds. Among parents who reported that they had never purchased these items, the majority (60% or more) responded that it was because their child preferred other options. Few parents indicated that their child would not eat the healthier options. Of all parents sampled, just 8% reported that their child would not eat apple dippers, 13% would not drink plain milk, and 4% would not drink 100% juice. When asked to evaluate the healthiness of different main dishes available with McDonalds kids meals, 13% to 14% of parents believed that the hamburger or cheeseburger was somewhat to very healthy; however, 30% believed that chicken nuggets was a healthy main dish option. Differences by race and ethnicity. In our sample of parents who had visited one of the top 4 restaurants in the past week, we found some differences in menu items purchased by white, African American, and Hispanic parents for their children. Approximately two-thirds of parents in all demographic groups

Figure 63. Side dishes ordered with kids meals by restaurant and age of child
100%

Figure 64. Beverages ordered with kids meals by restaurant and age of child
100%

Frosty Juice Plain milk Flavored milk

28%
80%

37%

31%

35%

26%

Other Yogurt Fruit French fries/chips

80%

60%

60%

Soft drinks

53%
40%

72%

63%

69%

63%

72%

40%

20%

20%

40%

47% 31% 13% 28%

54%

20%
0%

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0%

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Bu rg er

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Ki

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25

W en

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4 restaurants

Bu rg

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4 restaurants

Source: Survey of parents of children 2-11 years (August/September 2010)

Source: Survey of parents of children 2-11 years (August/September 2010)

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Figure 65. Beverages ordered with kids meals by race and ethnicity
100%

to order flavored milk. Among parents of all races and ethnicities, 35% to 41% ordered a soft drink with their childs kids meal.

Other
80%

Juice Plain milk Flavored milk Soft drinks

Sizes of beverages and french fries ordered

NPD reports the sizes ordered by respondents who purchased a beverage (at all fast food restaurants) or french fries (at burger restaurants) by age and race/ethnicity.68 Approximately one-third of all beverages ordered at fast food restaurants are medium-sized. However, this proportion varies by the age of consumer (see Figure 66). Two-thirds of beverages purchased for young children and 44% purchased for older children are small-sized (including kids meal and dollar menu sizes). In contrast, just 15% of teens ordered a small-sized beverage, whereas 25% ordered a large or extra-large size. African American youth were less likely to order a small-sized beverage compared to white and Hispanic youth and they were more likely to order a large or extra-large size. Sizes of french fries ordered showed a similar pattern to beverages (see Figure 67). Overall, approximately one-third of french fries ordered were medium-sized. However, 89% of parents of young children and 70% of parents of older children ordered kids, dollar, or small-sized french fries for their child. In contrast, just 36% of teens ordered these smaller sizes and one quarter ordered large or extra-large sizes of fries. African American and Hispanic youth were less likely to order the kids sizes and more likely to order dollar-sized and largersized fries compared to white youth.

60%

40%

20%

0%

White

African American

Hispanic

Source: Survey of parents of children 2-11 years (August/September 2010)

reported ordering kids meals for their child at their last visit. However, African American parents were more likely to order from the dollar/value menu (32%) compared to 22% of white parents. Two-thirds of African American, Hispanic, and white parents ordered french fries or chips for their child (see Figure 65). However, African American and Hispanic parents were more likely to order juice, whereas white parents were more likely

Figure 66. Percentage of beverages ordered by size at all fast food restaurants*
100%

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*These percentages are based on all beverages ordered, including those purchased in a can, bottle, or box/pouch Source: The NPD Group/CREST/2 Years Ending December 2009

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Figure 67. Percentage of french fries ordered by size at burger restaurants*
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Large or Extra large Medium Small Dollar Kids

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Types of food purchased by parents for children and by teens at all fast food restaurants
Menu items purchased Definitions Food type NPD classifications used to categorize individual menu items into similar types of foods. Menu importance The percentage of meals or snacks ordered by a specific demographic group that included a specific food type.

Table Appendix E (Table E.1) summarizes data from The NPD Group on menu importance by food type at all fast food restaurants, including data by age group and by race/ ethnicity.69 Across all age groups, individuals purchased an average of 2.4 menu items per visit, including 1.7 foods and 0.7 beverages. Figure 68 summarizes menu importance by age group for different food categories. All individuals purchased the most lunch/dinner main dishes (81% overall), followed by beverages (74%). Parents purchased somewhat more lunch/dinner main dishes (83% to 87%) and somewhat fewer beverages for their children (63% to 67%). Appetizers and sides were purchased by 42% of fast food patrons overall, but in almost one-half of orders placed by parents for their children. The most common side item ordered, french fries, was purchased 30% of the time for children. In contrast, young children received fruit in 7% of orders and older children received it in 3% of orders. In

addition, 15% of all fast food orders included breakfast-oriented foods and 26% included desserts, breads and sweet breads. Children were less likely to eat breakfast items (8% to 11% of orders), and teens were more likely to order desserts, breads and sweet breads than other age groups (31% of orders). Overall, hamburgers and cheeseburgers were the most common type of lunch/dinner main dish ordered. They were purchased in 23% of fast food restaurant orders. Children and teens purchased them somewhat less often than adults did (see Figure 69). Across all age groups, approximately three-quarters of burgers ordered were large-sized versions (e.g., McDonalds Quarter Pounder, Burger King Whopper) and three-quarters included cheese. Large-sized burgers comprised just 25% of burgers ordered for young children, but almost half of those ordered for older children. Chicken nuggets or strips were the most common lunch/dinner main dish ordered for children, including one-third of main dishes

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Figure 68. Menu importance of food and beverage categories by age group
100

Figure 69. Menu importance of main dish items by age group

30

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Menu importance

Under 6 years 6-12 years 13-17 years

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Lu m nch ain /d di inn sh er es Ap pe tiz sid ers De es / ss e sw rts ee /br t b ea re ds ad / s

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Menu importance

for young children and 20% for older children. By comparison, fewer than 10% of teens ordered chicken nuggets or strips. Children also received pizza more often than other age groups (13% to 15% of all main dish items purchased). In contrast, the main dishes that tend to be healthier at most restaurants were rarely purchased: a main dish salad was purchased in just 2% of restaurant visits and a grilled chicken sandwich or non-fried chicken in 3%. Individuals of all ages ordered sugar-sweetened beverages more often than any other beverage (26% of orders), and older children and teens ordered them one-third of the time (see Figure 70). Juice and flavored and plain milk was ordered most often by parents for their young children; parents of older children ordered these options half as often; and teens ordered them less than 5% of the time. In contrast, teens ordered coffee drinks in almost 10% of restaurant visits. Differences by race and ethnicity. African American youth (under 18 years) ordered more food items overall (average 1.9 per order) compared to white and Hispanic youth (1.7 per order) (see Table E.1). These included more breakfast items (purchased twice as often compared to white youth), lunch/ dinner main dishes, appetizers/sides, and desserts/breads/ sweet breads (see Figure 71). Beverages were the only food category that African American youth did not purchase more often than white youth. Among lunch/dinner main dishes, African American youth were more likely to order large-sized burgers (16% of orders compared to 10% of orders by white youth) and three times as likely to order fried chicken (6% of

Figure 70. Menu importance of beverages by age group

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orders compared to 2% of orders by white youth) (see Figure 72). However, they purchased similar numbers or fewer regularsized burgers, chicken nuggets/strips, pizza, and Mexican items. For beverages, African American youth were less likely

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Figure 71. Menu importance of food categories purchased by white, Hispanic and African American youth (under 18 years)
100

Figure 72. Menu importance of main dishes purchased by white, Hispanic, and African American youth (under 18 years)
20

80

White youth Hispanic youth African American youth

16

White youth Hispanic youth African American youth

Menu importance

Menu importance

60

12

40

20

gg st ets rip / s

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*Includes cheeseburgers Source: The NPD Group/CREST/2 Years Ending December 2009

to order sugar-sweetened carbonated beverages than white or Hispanic youth, but more likely to order juice or juice drinks (see Figure 73). They also ordered less plain and flavored milk.

Figure 73. Menu importance of beverages purchased by white, Hispanic and African American youth (under 18 years)
35 30 25 Menu importance 20 15 10 5 0

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en

Nutritional quality of menu items purchased at fast food restaurants

To assess the nutritional quality of menu items purchased at fast food restaurants, we combined the information from NPD on menu importance by age and race/ethnicity70 and information from NPD on the menu items included in each of their food types with the nutrient information for individual menu items from our menu composition analysis. This analysis enabled us to estimate calories and sodium for all items purchased per visit to each of the twelve restaurants in our analysis (see Appendix E, Table E.2). The NPD data do not include sizes for menu items that can be purchased in more than one size (e.g., beverages, chicken nuggets, and french fries). Therefore, we used the conservative assumption that food types purchased for children would all be a child-sized menu item if one were offered. For all other food types and those purchased by teens, we used the median calories, milligrams of sodium, grams of sugar, and grams of saturated fat to calculate the nutrient content of menu items purchased per order. Starbucks, Dunkin Donuts, and Taco Bell were the only restaurants for which the estimated total calories consumed per visit did not exceed the maximum recommended calories for a lunch or dinner meal for younger and older children (410

White youth Hispanic youth African American youth

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and 650 calories, respectively). Starbucks and Dunkin Donuts also did not exceed the 700 calories recommended for a meal or main dish consumed by the average moderately active teen. However, purchases at the coffee restaurants were also more likely to be for a snack and not a meal. For eight other restaurants in our survey, excess calories per order for children ranged from 38 (Sonic) to 198 (Dairy Queen) (see Figure 74). Excess calories purchased at the pizza restaurants were even higher, although it is possible that younger children consumed less than the portion sizes we had estimated in the menu composition analysis. In spite of the higher caloric requirements for teens, excess calories per order were even higher for this age group. Excess calories ordered ranged from 197 at Subway to 700 at Pizza Hut. Total calories from saturated fat alone for menu items purchased from Dominos exceeded 160 (or 17.5 grams) (see Table E.2). At the remaining ten restaurants, the percentage of calories from sugar and fat exceeded 30%. Purchases of menu items at Dairy Queen also had the most calories from sugar, totaling more than 250 calories for children (63 grams) and 350 for teens (88 grams). At all restaurants except Starbucks and Dunkin Donuts, total sodium in menu items purchased was high, exceeding recommended limits for lunch or dinner meals by more than 1,000 mg for children at four restaurants (Subway, Pizza Hut, KFC, and Dominos) and for teens at seven restaurants (the same four plus Burger King, Wendys, and Taco Bell) (see Figure 75). In most cases, estimated calories and sodium in menu items purchased per visit by African American youth exceeded those purchased by white and Hispanic youth (see Figures 76 and 77). However, Hispanic youth purchased menu items with higher total calories from Dairy Queen and KFC.

Special menus and menu items purchased overview

Results of both our parent survey and NPD data on fast food purchases paint a disturbing picture of the foods purchased for children and by teens at fast food restaurants. As a result, children and teens are purchasing (and likely consuming) far more calories and sodium than should be consumed in one meal. In addition, 30% or more of fast food calories come from sugar and saturated fat, empty calories that comprise nearly 40% of young peoples energy intake and far exceeded recommended discretionary calorie allowances of 8% to 20% of total calories.71 Although most kids meals are a more appropriate portion size for older children, the majority of parents of preschoolage children buy them for their younger children. For older children, parents are more likely to buy a combo meal or menu item from the dollar/value menu, items that are more appropriately sized for moderately active teens and adults. We did find that parents were more likely to buy kids meals for their older children at McDonalds as compared to other restaurants. However, they tended to buy the larger-sized Mighty Kids Meal for these children. As a result, most meals purchased for children at fast food restaurants exceeded recommended calories for a lunch or dinner meal.

Figure 74. Excess calories in menu items purchased per visit by restaurant and age group
1,400 1,200 Estimated total calories per visit 1,000 800 600 400 200 0

Excess calories: Preschoolers Excess calories: Children Excess calories: Teens Recommended calories

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Although McDonalds and Burger King market their kids meal toy giveaways extensively, the most common reason parents gave for purchasing kids meals was that their child likes the food. Few parents reported that they purchased kids meals because their child wanted the toy. In addition, although most parents reported that they have purchased fruit, plain milk, and juice with McDonald's Happy Meals in the past and that their child will eat those items, few parents purchased them for their child at the last visit. Parents were also more likely to purchase these healthier items for their younger children than for older children. These findings suggest that restaurants could increase sales of these items if they promoted them more inside the restaurant, where parents and children place their order. For example, they could place signs for them at

Figure 75. Excess sodium in menu items purchased per visit by restaurant and age group
2,500

Excess sodium: Preschoolers Excess sodium: Children Excess sodium: Teens Recommended sodium

Estimated total sodium per visit

2,000

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Figure 76. Excess calories in menu items purchased per visit by restaurant and race/ethnicity
1,400 1,200 Estimated total calories per visit 1,000 800 600 400 200 0

Excess calories: White youth Excess calories: Hispanic youth Excess calories: African American youth Recommended calories (12-17 years)

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Figure 77. Excess sodium in menu items purchased per visit by restaurant and age/ethnicity
2,500

Excess sodium: White youth Excess sodium: Hispanic youth Excess sodium: African American youth Recommended sodium (12-17 years)

Estimated total sodium per visit

2,000

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the counter or offer them as the default option in place of french fries and soft drinks. These practices rarely occur now inside the restaurant (according to our audit of marketing inside restaurants). There also appears to be a misconception among parents that McDonalds Chicken McNuggets are a healthy option for their children; 30% rated them as healthy, even though they receive a fairly low NPI score of 42 to 48 (depending on the sauce) for overall nutrient quality. The foods purchased at fast food restaurants by teens and African American youth may be even more troublesome. With the exception of Starbucks and Dunkin Donuts, teens purchased on average from 800 to 1,400 calories for their meal; up to double the 700 calories recommended for lunch

or dinner for the average moderately active teen. Teens were more likely to order large-sized beverages and french fries, and more desserts, breads and sweet breads compared to all restaurant patrons. In addition, African American youth ordered as much as 10% more calories at some restaurants compared to white youth. They tended to order more breakfast items (i.e., some of the least healthy items on fast food menus, according to our menu composition analysis), more large sized burgers, and more food items per order overall. Average saturated fat for African American youth was 10% higher than for whites (121 grams versus 110 grams average visit), and total sodium contained in menu items ordered by African American youth was also dangerously high.

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Conclusions
The restaurant industry, including quickserve or fast food restaurants, has said it wants to be part of the solution to the childhood obesity crisis.1
Two of the largest fast food advertisers, McDonalds and Burger King, have joined the Childrens Food and Beverage Advertising Initiative (CFBAI) and pledged to advertise only better-for-you choices to children.2 The majority of restaurants have introduced more nutritious options to their menus for both children and adults.3 Most fast food restaurants also post detailed nutrition information about menu items on their websites. According to the National Restaurant Association, these efforts are part of an industry initiative to address consumers interest in more healthful food options.4 But one critical question remains: Will these industry promises reverse the unhealthy defaults in the current fast food marketing environment that make it too easy for people to consume the least healthy options? The data in this report about what young people order at fast food restaurants and what parents order for their children demonstrate that restaurants have a long way to go before a visit to a fast food restaurant ceases to harm young peoples health. Children consumed up to 200 excess calories (above recommended calorie limits for lunch and dinner meals) during the average visit to nine of the twelve restaurant chains in our analysis. Teens consumed between 100 and 700 excess calories at ten restaurants. In addition, 30% or more of all fast food calories came from sugar and saturated fat, two nutrients that young people already consume in excess.5 Sodium consumed at fast food restaurants also exceeded maximum recommended intake for a lunch or dinner meal: by 1,000 mg at Subway, Pizza Hut, KFC, and Dominos for children and teens, and at Burger King, Wendys, and Taco Bell for teens. Excess calories and sodium consumed by African American youth were generally higher than those consumed by white youth at most fast food restaurants. If visiting fast food restaurants was an occasional occurrence or reserved for a special treat, this picture of what young people consume at fast food restaurants would not be problematic. However, research demonstrates that fast food has become a staple of young peoples diet. Every day, one-third of young people (2-17 years) consume fast food.6 In 2003-2004, 59% of adolescents consumed fast food in the past two days and fast food contributed 16% to 17% of adolescents total caloric intake.7 external advertising, and marketing inside the restaurants, to substantially reduce the unhealthy impact of fast food on young peoples diet and health.

Menu composition
Of the almost 2,900 different items on the regular menus of the twelve restaurants in our analysis, just 17% qualified as healthful choices (i.e., received good NPI scores for overall nutritional quality) and did not exceed recommended calories and sodium for the average moderately active teen. However, the menu items that met these three nutrition criteria were predominantly beverages. In contrast, 12% of lunch/dinner sides qualified as healthy, and 5% or less of lunch/dinner main dishes, snacks, and breakfast items met the criteria. Of 3,000 possible kids meal combinations examined (including main dishes, sides, and beverages), 15 (0.5%) met the three nutrition criteria for elementary school-age children and 12 met the criteria for preschool-age children. Just two restaurants, Subway and Burger King, offered a main dish kids meal option with an NPI score that qualifies as healthy and would be allowed to be shown on childrens television in the United Kingdom. Overall, 91% of kids meal combinations at the twelve restaurants exceeded the recommended maximum calories for lunch or dinner for a preschool-age child. Although the majority of items on restaurants regular and kids menus did not qualify as nutritious choices, most restaurants offered some healthy options. For example, at most restaurants, customers could order a chicken salad or grilled chicken sandwich, each with 700 or fewer calories and healthy NPI scores. Eight restaurants promoted on their websites a healthy menu with an average of two dozen lowercalorie items. These items were also more likely to meet healthful NPI scores compared to items on the restaurants regular menus. In addition, most restaurants (except KFC, Taco Bell, and Dairy Queen) offered a fruit or vegetable side and plain milk and/or 100% juice with their kids meals. Some restaurants also appear to have responded to concerns that have been raised by the public health community about pricing that favors unhealthy foods, serving sizes, and healthy food availability.8 For example, lower-priced healthy items were available on many restaurant menus. Items on most value-priced dollar menus had smaller average serving sizes and fewer calories when compared to other items on restaurants menus. Several restaurants offered side salads, low-fat chicken sandwiches, and fruit for about $1. In addition, pricing for healthier and less healthy versions of sandwiches was often similar (e.g., grilled and fried chicken sandwiches, egg white and regular egg breakfast sandwiches). However, most restaurants continued to offer large and extralarge sizes of burgers, soft drinks, and french fries. According to NPD, these three categories were the most common menu items ordered at fast food restaurants. Five restaurants sold an extra-large burger with at least 800 calories for less than $4.50

Fast food marketing

While all this consumption is good for fast food companies bottom line, it is terrible for young peoples health. If the restaurants are sincere about wanting to do what they can to prevent obesity, they must transform their marketing practices with substantial improvements to all components of their marketing plans, including menu composition,

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(McDonalds, Burger King, Taco Bell, Sonic, and Dairy Queen), and Wendys sold a 1,300-calorie burger for $7.00. Compared to 2006, McDonalds remained the only restaurant to have eliminated its extra-large (i.e., supersized) soft drinks and fries.9 Five restaurants (Subway, Burger King, Taco Bell, KFC, and Sonic) sold fountain drinks in sizes of 40 oz. or more, the equivalent of five servings. Burger King, Wendys, and Dairy Queen sold french fries in a serving of more than 180 grams, totaling 500 calories or more. The names that restaurants assign to portion sizes also make it difficult for consumers to know how much food they are consuming. For example, Burger King and Wendys renamed their small french fries to a value size that was the same size as McDonalds small. Their new small became the same size as the medium at McDonalds, Wendys, and Sonic. The medium-sized french fries packages at McDonalds and Burger King looked nearly identical, but Burger Kings contained 25 additional grams of food. Wendys was the only restaurant to provide nutrition information about their beverages with ice. As a result, they sold a medium soft drink in a 32 oz. cup, but only reported calories and other nutrients for a 20 oz. serving. party) websites, including on many sites visited primarily by children and teens. Banner ads from these restaurants reached up to 70 million unique viewers every month. The use of social and viral media by fast food restaurants has also expanded exponentially. As of July 2010, nine fast food restaurants each had more than one million fans on their Facebook pages, most restaurants had thousands of Twitter followers, and four restaurants accrued more than one million viewers of their videos on YouTube. The use of mobile marketing by fast food restaurants is in its early stages, but most restaurants placed banner ads on third-party mobile websites, eight have introduced downloadable iPhone applications, and a few have begun to conduct text message advertising to customers who opt-in to this feature. Fast food marketing is becoming ever more ubiquitous and strategically targeted. Fast food advertising is highly concentrated among just a few restaurants. McDonalds alone spent $900 million in media in 2009, an increase of $100 million from 2008. YUM! Brands restaurants combined (KFC, Taco Bell, and Pizza Hut) spent more than $700 million in 2009; and Subway, Burger King, and Wendys each spent more than $280 million. Together, these seven restaurants accounted for more than 60% of fast food media spending and three-quarters of fast food TV ads viewed by children and teens. These restaurants also purchased more than two-thirds of fast food radio and outdoor media. McDonalds and Burger King dominated marketing on the internet as well with twelve of the forty websites visited most often by young people. More than 659,000 unique children and teens visited McDonalds websites every month. Several restaurants with relatively small marketing budgets also had a substantial presence on the internet. For example, Dominos. com and PizzaHut.com had more young visitors than the other fast food websites in our study. These two restaurants also placed the most banner ads on third-party websites. KFC. com and Starbucks.com also appeared in the top 10 most frequently visited fast food websites in our study. In spite of its low $29 million advertising budget, Starbucks dominated fast food social media across all platforms. With 11 million fans in 2010, Starbucks reportedly had more fans on Facebook than any other marketer.10 In spite of the vast amounts spent by fast food marketers, we found surprisingly little variation in their marketing messages and the products they promoted. Restaurants appeared to compete primarily by introducing new menu items and promoting the value of their foods. A few restaurants (notably Subway and Wendys) promoted the quality of their food. Messages about good value or cheap food were used in almost one-half of TV ads targeting a general audience, followed by new or improved (36%) and quality food (30%). Similarly, 30% of ads viewed by children and 44% of those viewed by teens promoted individual lunch and dinner menu items, and 15% to 22% promoted restaurants dollar/value menus and/or combo meals. Banner advertising and social media marketing also predominantly emphasized special

The marketing is relentless

Fast food advertisers spend a staggering amount on media to draw customers into their restaurants to consume this primarily unhealthy fare: more than $4.2 billion in the United States in 2009. The majority of the money (86% or $3.6 billion) supported TV advertising, although restaurants also spent more than $200 million on radio advertising and more than $150 million on outdoor advertising (e.g., billboards, transit signs). As a result, young people viewed enormous amounts of fast food advertising. Every day, the average preschooler saw 2.8 fast food ads on television, the average child saw 3.5, and the average teen saw 4.7. Teens listened to approximately one radio ad per day. Children were exposed to more than 1,200 traditional fast food ads per year while teens saw and heard more than 2,000. Although it is difficult to measure exposure to signs placed outside restaurants, fast food restaurants used this strategy extensively to encourage visits by potential customers passing by. The average fast food restaurant had 3.8 outdoor signs per location, and seven restaurants averaged four or more outdoor signs per location. Increasingly, fast food restaurants have expanded into newer forms of marketing that are relatively inexpensive and more difficult to quantify. We identified 55 different websites sponsored by the twelve restaurants in our analysis, including main restaurant sites, child-targeted sites, and special interest sites (e.g., charity and scholarship, entertainment, racial or ethnic sites). Several websites had as many as 200,000 unique child and teen visitors every month. Young people spent seven minutes or more per month interacting with some of the most engaging sites. The twelve restaurants in our analysis also placed banner ads with special promotions, ads for menu items, and links to their own websites on other company (i.e., third-

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offers, and value/cheap and new/improved messages; and promoted new menu item introductions, dollar/value menus, and combo meals. In contrast, just 5% of general audience TV ads promoted foods as low-fat or low-calorie. Healthy menu items comprised 3% to 4% of TV ads viewed by children and teens. Main restaurant websites were the only form of marketing with any noticeable messages about health and nutrition; these appeared on 32% of main restaurant website pages. In addition to significant amounts of marketing designed to reach a broad audience (including children and teens), we also identified a number of marketing practices used more selectively by some restaurants to reach a specific target market. We used the following three criteria to identify marketing that was targeted to children, teens, and African American and Hispanic youth:11 1) It was placed to reach one demographic group disproportionately more than another (i.e., children and teens compared to adults, African American compared to white youth). 2) Creative executions featured main character actors of the same age, race, and/or ethnicity as one of the targeted groups, addressed the groups directly (e.g., messages to kids to ask their parents or Spanishlanguage advertising), or promoted products specifically for these groups (e.g., kids meals). 3) It used techniques that appealed disproportionately to one of these targeted groups (e.g., licensed characters for children, social media for teens). targeted ads on TV (McDonalds, Burger King, and Subway); and three used banner ads with child-targeted content on third-party websites (McDonalds, Burger King, and Dairy Queen). Among the four restaurants with child-targeted marketing, the two CFBAI participants (McDonalds and Burger King) had by far the most advertising targeted to children. Children viewed approximately one child-targeted ad per day for these two restaurants (in addition to ads for other products not exclusively targeted to children). Since 2007, McDonalds and Burger King have increased their TV advertising to children (6-11 years) by 26% and 10%, respectively. In addition, two McDonalds child-targeted websites were among the most frequently visited advergaming sites on the internet. Every month, 100,000 to 200,000 different children visited these two McDonalds sites. Children spent on average eleven minutes per month on HappyMeal.com. McDonalds also sponsored a website targeted to preschoolers with games to teach them numbers and letters (Ronald.com). All child-targeted websites contained numerous engaging and interactive devices to entertain children and keep them on the website. They included virtual worlds, advergames, videos, points accumulation to purchase virtual items, and tie-ins with movies, TV shows, and other promotions. McDonalds and Burger King also prominently featured their child-targeted website URLs on kids meal packages to encourage further website visits. Dairy Queen was the only restaurant on its child-targeted websites to blatantly promote unhealthy foods, including burgers, french fries, and Dilly and Blizzard ice cream treats. McDonalds, Burger King and Subway featured their healthy sides and beverages and their healthiest main dish options in all forms of child-targeted marketing. However, perhaps most surprising about McDonalds and Burger Kings child-

Marketing targeted to children

Although eight restaurants offered kids meals designed for children, just four used marketing to address children directly outside the restaurant: McDonalds, Burger King, Subway, and Dairy Queen (see Table 58). The four restaurants had websites designed specifically for children; three had child-

Table 58. Restaurants with child-targeted marketing in 2009*

TV ads viewed in 2009 CFBAI Preschoolers Children participant (2-5 years) (2-11 years) McDonalds X 230 262 Happymeal.com McWorld.com Ronald.com Burger King X 102 125 ClubBK.com Subway 25 32 SubwayKids.com Dairy Queen DeeQs.com BlizzardFanClub.com Source: The Nielsen Company; comScore Inc. Websites: Banner ads: Average unique Average views visitors per month per month Children Placed on (2-11 years) youth websites (000) (000) 16,366 189.3 100.9 35.2 1.4 3.4 4.4 11,200 13,464

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targeted marketing was how frequently they did not picture or mention specific foods in their child-targeted marketing. The McDonalds Happy Meal box (with its smiling golden arch) was prominent in all forms of child-targeted marketing. However, when McDonalds better-for-you foods such as apple dippers and milk appeared, they were usually presented briefly and/ or in the background. One-quarter of childrens exposure to child-targeted McDonalds ads promoted the brand only and did not feature any food products, including Happy Meals. This approach contrasted with general audience ads, one-quarter of which prominently featured food onscreen more than half the time. Child-targeted Burger King ads did not focus on the food either. Instead, approximately half featured a kids meal tie-in with movies, TV shows and video games. Nearly all used humor and/or a fun/cool message that appealed to childrens emotions. Using licensed characters to promote unhealthy foods has been shown to increase how much preschoolers like the taste of those foods.12 It is not surprising then that children reported liking foods presented in a McDonalds wrapper more than the same foods in a plain wrapper.13 These child-targeted ads are also likely to influence parents directly and increase their likelihood to take their children to fast food restaurants. Research by Grier and colleagues demonstrated that higher exposure to fast food advertising by parents was associated with increased frequency of taking their children to these restaurants because the advertising influenced their beliefs about how often other parents took their children.14 The fact that restaurants now market healthier options for children also likely helps to alleviate parents concerns about the nutritional quality of fast food. Children were also exposed to significant amounts of advertising not targeted to them specifically. In fact, just one-third of the fast food ads that children viewed on TV were for kids meals and promotions. They also viewed every day at least two fast food ads that promoted unhealthy menu items and used the value/cheap and new/improved messages designed to reach a broader general audience. Children were also frequent visitors to many restaurants main websites including PizzaHut.com (195,000 unique under-12 viewers per month), Dominos.com (176,000 unique child viewers), BurgerKing.com (42,000 child viewers), and KFC.com, Starbucks.com, and Wendys.com (34,000-35,000 child viewers each). social media extensively, a venue that most teens frequent. It can be argued, therefore, that the majority of fast food advertising is targeted to teens. However, we did find several instances of restaurants and products that were advertised considerably more often to teens than to adults and had content designed specifically to appeal to this age group. Teens viewed more TV ads for Taco Bell and Burger King overall than adults viewed, and teens were also exposed to more Taco Bell radio ads. In addition, compared to adults, teens were exposed to more TV ads that promoted snack items from Dairy Queen, Sonic, and Dominos, and lunch/dinner items from Sonic and Subway. Content analyses of these ads highlighted frequent use of juvenile humor and movie and other entertainment tie-ins. Taco Bell, Sonic, and Burger King also promoted their latenight snack menus in several ads; and Dominos pushed its online ordering application. On the internet, teens visited Dominos.com, PizzaHut.com, and McDonalds.com most frequently; each site averaged 160,000 or more unique teen visitors every month. In addition, banner ads for Dominos, Sonic, and Pizza Hut; as well as Taco Bells Fruitista Freeze, Volcano menu and value menu; KFC grilled chicken (Unthink campaign); McDonalds McCafe beverages; and Wendys hamburgers/sandwiches were placed disproportionately on youth websites. Social media also commonly promoted snack items (e.g., Wendys Frosty and Dairy Queen Blizzard) and pricing and other food promotions.

Targeting African American and Hispanic youth

African American children and teens viewed approximately 50% more television compared to white children and teens; therefore, they were also exposed to approximately 50% more fast food ads on television. On average, African American children saw 4.1 fast food TV ads every day in 2009 and African American teens saw 5.2. In addition, African American children appeared to watch relatively more general audience television (versus childrens television) than white children. Consequently, they viewed twice as many ads targeted to a general audience for nearly twenty different restaurant product categories. Hispanic children and teens were exposed to approximately one ad per day on Spanish-language television in addition to ads they viewed on English-language television. With the exception of four McDonalds child-targeted ads, the Spanish-language ads were targeted to a general audience. McDonalds and KFC advertised disproportionately more often to African American teens who viewed 75% more advertising for both restaurants compared to white teens. Ads with higher than expected numbers of young African American viewers included ads for McDonalds lunch/dinner items, branding only, value/combo meals and breakfast, and KFC healthy options. Content analysis of general audience TV

Targeting teens
With few exceptions, adolescents viewed the same number of or more fast food ads that adults viewed. On television and the internet, many fast food ads used humor, celebrities, entertainment tie-ins, and other techniques that appeal specifically to this age group. Lower fast food prices are related to higher BMI for adolescents, but not adults.15 Therefore, the value and special pricing messages that commonly appear are also likely to negatively affect young people more than adults. In addition, most restaurants used

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ads confirmed that McDonalds used African American main characters in the highest proportion of its ads (23%) compared to other restaurants. KFC also used black characters to promote its under-400 calorie meal. In addition, Dairy Queen used African American characters in 19% of TV ads promoting its Blizzard ice cream treat and ice cream cake, and Subway featured African Americans in 10% of ads, including two with celebrity athletes. While we recognize the value of advertising that reflects a multicultural society, the poor nutritional quality of products sold at fast food restaurants may be even more dangerous for African American youth who face higher risk for obesity and obesity-related diseases compared to white youth.16 Nine fast food restaurants advertised on Spanish-language TV, but McDonalds was the most frequent advertiser, accounting for one-quarter of youth exposure to Spanishlanguage fast food ads. Products that were advertised relatively more frequently on Spanish-language TV compared to English-language TV included lunch/dinner items from Dominos, Burger King, McDonalds, and Sonic; value/combo meals and coffee drinks from McDonalds; and snack items from Sonic. We found few differences in the overall messages used to promote these products in Spanish, although several restaurants were more likely to use physical activity, low-fat/ low-calorie, and helping the community messages in their Spanish-language ads. As with TV advertising, African American youth were also exposed to disproportionately more fast food advertising on the internet that was not targeted to them directly. McDonalds was the only restaurant with websites specifically targeted to African American (McDonalds 365Black.com) and Hispanic (MeEncanta.com) consumers. KFC.com also featured two African American-targeted subsites, accessible through its main website, including one devoted to its Pride 360 campaign to support Historic Black Colleges and Universities (HBCU) and KFCHitmaker.com, a website that celebrated African American heritage and music. We also found 20 websites (out of 39 with data available on African American youth visitors) that were visited relatively more often by African American youth than by all youth. They included four childtargeted sites (SubwayKids.com, DeeQs.com, ClubBK. com, and BlizzardFanClub.com) and four McDonalds and three Wendys sites. Although restaurants also target African American communities with advertising through local event sponsorships and charitable donations (e.g., see events listed on McDonalds www.365Black.com website), we do not have data to quantify these locally-targeted efforts.17 child to McDonalds for lunch or dinner during the past week. According to parents, fast food restaurants fill a need for convenient and low-cost options to feed their children. More than half their fast food orders were placed at a drive-thru window and consumed in the car or at home. Less than 5% of parents who visited McDonalds, Burger King, and Wendys reported that the main reason was the restaurants healthy options. In contrast, one-third of parents visited Subway because of its healthy food. Children also played a major role in parents decision to visit these fast food restaurants: More than half of parents reported that their child had asked them to go to McDonalds, Burger King, Wendys, Subway, and Pizza Hut, and 39% reported that the main reason they chose the restaurant was because their child likes it there. McDonalds marketing targeted specifically to children as young as 2 years old has captured the loyalty of millions of young children: 47% of parents reported that the main reason they took their child to McDonalds was because their child likes it there. This rate was 50% higher than the percentage who took their child to Burger King primarily because their child likes it and three times higher than the rate for parents who took their child to Subway or Wendys. In addition, 41% of parents reported that their child asked them to go to McDonalds at least once a week; and 15% of parents of preschoolers reported that their child asked them to go to McDonalds every day. When children view one ad for McDonalds every day, it is not surprising that many children ask their parents to take them there at least once per week. It also helps explain why they ask to go to McDonalds much more often than to other fast food restaurants. Burger King, the second most frequent advertiser to children, came in far behind McDonalds in number of requests by children to visit, but ahead of the restaurants that did not market to children directly. Although 15% to 19% of parents who went to McDonalds and Burger King reported that their child wanted the restaurants toy, approximately half indicated that their childs main motivation was that he or she likes the food. As African American youth were exposed to significantly more fast food marketing than white youth, it is also not surprising that African American parents were more likely than white parents to report that their child asked to visit McDonalds, Burger King, Dominos, and KFC. African American parents also were more likely to take their children to McDonalds, Burger King, KFC, Wendys, and Pizza Hut. We found few significant differences in number of visits by Hispanic parents and youth compared to their white peers.

Fast food marketing works

According to our survey of parents of 2- to 11-year-olds, 84% reported taking their child to at least one fast food restaurant in the past week and 39% took them to more than one. An astonishing 66% of parents reported taking their

Unhealthy defaults in the restaurants

Once fast food restaurants have succeeded in drawing young people in, marketing inside the restaurants could be used to encourage customers to purchase the more nutritious options

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on restaurant menus: Signs could promote their healthy menus and lower calorie options. Price promotions and special offers could encourage trial and repeat purchase of healthier items. Restaurant employees could suggest healthier options when customers place their orders. In our audit of more than 1,000 restaurants across the country, we found almost no evidence that restaurants engage in any marketing practices to improve the nutritional quality of the menu items that customers select. Restaurants used signs extensively inside the restaurants to promote individual menu items and special deals. They averaged 14.6 signs per restaurant and placed more than one-third of signs at the counter so customers could view them as they waited in line. In addition, one in five of these signs featured price and other promotions to encourage sales of specific menu items. However, restaurants rarely used signs to encourage the purchase of healthier menu items. Items on restaurants healthy menus appeared on just 4% of signs, and messages about health and nutrition appeared on 2%. Although signs about kids meals tended to promote healthier side and beverage options, these signs appeared in fewer than 5% of restaurants. Just Subway and Taco Bell promoted health and nutrition messages in more than 5% of their menu item signs. Restaurants also frequently used value messages and short-term price promotions to encourage sales of highcalorie, poor quality foods. Many restaurants also prominently featured signs for sweet snacks in the dining areas, the ideal place to promote impulse purchases after the meal. The results of our examination of sales practices at five restaurants demonstrated that the overwhelming default at nearly all restaurants examined was to provide french fries and a soft drink automatically whenever a kids meal or combo meal was ordered. Subway was the only restaurant to offer healthy sides and beverages as the default in its kids meals. Although McDonalds and Burger King pictured their healthy kids meal options in child-targeted marketing, their employees mentioned the healthy side options in 8% of orders and the healthy beverage options in approximately onequarter. They offered customers a healthy side or beverage with combo meals even less often. In addition, in 90% of combo meal orders at Taco Bell and in 30% of orders at all five restaurants, employees suggested a larger-sized meal. At most fast food restaurants that we analyzed, it was possible to purchase a more nutritious meal for a reasonable price. As mentioned, many dollar/value menu items are smallersized than other menu items and most restaurants include a few nutritious options on these menus. In addition, healthier versions of sandwiches tended to be the same or even lowerpriced than the least healthy versions (as most were also smaller-sized). However, at all the restaurants in our pricing analysis, the chicken salad tended to be the most expensive main dish item examined, priced even higher than the mega burgers offered at many restaurants. In addition, restaurants rarely promoted the value of their lower-calorie, more nutritious items in any form of marketing. Therefore, at most of the restaurants in our analysis, it was possible to obtain a meal consisting of healthful items that did not exceed recommended calories for most teens and adults, and a kids meal with a healthy side and beverage that did not exceed recommended calories for most elementary schoolage children. Unfortunately, the marketing that occurred inside the restaurants did little to encourage purchases of these more nutritious options. Only the most determined parents and other customers who have studied the restaurants menus and nutrition facts before visiting are likely to have the information and fortitude needed to purchase these options when they arrive at the restaurant.

Nutritional quality of food purchased at fast food restaurants

Not surprisingly then, young people and their parents overwhelmingly purchased the high-calorie, poor nutritional quality items at fast food restaurants. At three of the restaurants included in our survey (McDonalds, Burger King, and Wendys), approximately two-thirds of parents who ordered a kids meal for their child ordered french fries instead of the fruit side option. One-third to one-half ordered a soft drink. Parents of younger children were somewhat more likely to order the healthy sides and beverages. However, across all fast food restaurants, parents of young children ordered french fries 4.5 times more often than they ordered fruit.18 In contrast, two-thirds of parents in our survey who took their child to Subway ordered fruit or yogurt and 100% ordered juice or plain milk when purchasing a kids meal. The most popular kids meal main dish choice for children was chicken nuggets. Interestingly, 30% of parents in our survey believed that McDonalds chicken nuggets were somewhat to very healthy, more than twice as many who believed the hamburger to be healthy. However, both menu items receive low NPI scores (48-50) and have similar calorie, fat and sodium content. The number of calories in the average kids meal (616) is appropriate for elementary-school children, but too high for most preschoolers. However, in three of four restaurants in our parent survey, parents of preschoolers were more likely to order a kids meal for their child than were parents of elementary school-age children. Across all fast food restaurant visits, approximately one-third of parents ordered a kids meal for their child under 6, and 21% ordered one for their 6- to 12-year-old.19 Parents were more likely to order combo meals and items from the dollar/value menus for their elementary school-age child, including in 84% of visits to Subway. Across all restaurants, parents ordered these value-priced items for their older children (6-12 years) in 27% of visits.20 Almost one-half of burgers ordered for older children were larger sized options such as McDonalds Quarter Pounder or Burger Kings Whopper.21 Pizza was also more likely to be ordered by parents for their children than by older patrons. In addition, teens often ordered many of the highest-calorie, nutrient-poor items available at fast food restaurants.22 For

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example, teens ordered a large or extra-large size of french fries and soft drinks one-quarter of the time. More than 75% of burgers ordered by teens were larger sized options. Teens also purchased breads and sweets (including desserts and sweet breads) during 20% of visits, more often than any other age group, and coffee drinks (including iced and frozen coffees) at 9% of visits. Similarly, 26% of teen visits to fast food restaurants were for an afternoon or evening snack, compared to 21% of young adult and 17% of adult visits. Teens were also frequent patrons of dollar/value menus and combo meals, ordering these value-priced options during 39% of all fast food restaurant visits and two-thirds of visits to burger restaurants. In contrast, teens ordered healthier options, including grilled chicken sandwiches and main dish salads, in less than 5% of visits to fast food restaurants. Compared to white and Hispanic youth, African American youth ordered more food items when they visited fast food restaurants, including more of the least healthy items on restaurant menus, such as breakfast items, desserts, breads and sweet breads, large-sized burgers, and fried chicken.23 They were somewhat less likely to order sugar-sweetened carbonated beverages, but more likely to order juice and other sugar-sweetened beverages. African American parents were more likely to purchase dollar/value menu items for their children in place of kids meals, and African American youth were more likely to purchase combo meals and large or extralarge beverages and french fries. African American youth consumed at least 10% more calories at McDonalds and Burger King, and at least 15% more sodium at McDonalds, Burger King, and Wendys. Unthink grilled chicken campaign, we found no evidence that fast food restaurants have made any attempt to promote their healthier options to teens. The differences found in sales practices at some restaurants also demonstrate how much restaurants can do to influence consumers choices of healthy, lower-calorie options. For example, Subway offered or automatically provided healthy side and beverage options to customers who ordered a kids meal. Seventy-three percent of parents in our survey reported ordering a healthy side for their child at Subway, and twothirds ordered plain milk or juice. In contrast, employees at McDonalds and Burger King rarely offered a healthy kids meal side or beverage. Accordingly, just 28% of parents who went to McDonalds and 37% of those who went to Burger King ordered the healthy side for their childs kids meal; and 35% ordered juice or plain milk for their child at McDonalds and 40% at Burger King. Wendys provided another interesting point of comparison to McDonalds and Burger King. Wendys employees offered customers a choice of beverage two-thirds of the time, and suggested flavored milk first in 18% of orders. Wendys also featured flavored milk on some restaurant signs. As a result, 41% of parents who took their child to Wendys reported choosing flavored milk with their kids meals, compared to 25% at McDonalds and 13% at Burger King. Most parents in our survey also reported that their child would consume the healthy options but just preferred the french fries and soft drinks. This finding indicates that if healthy options were the default choice, most parents would buy them.

Recommendations
Young people must consume less of the calorie-dense nutrient-poor foods served at fast food restaurants. Parents and schools can do more to teach children how to make healthy choices and consume fewer calories, and why it is important to do so. Parents can research fast food menus online. They can use the information on our website (www. fastfoodmarketing.org) to learn about healthy calorie and sodium consumption for their children and to find the best options available at restaurants. But such education will be for naught unless fast food restaurants also drastically change their current marketing practices. Children and teens should not receive continuous reminders every day about the great tasting food served by these restaurants that severely damages their health. In addition, when young people visit, the restaurants should do much more to encourage the purchase of more healthful options.

The role of marketing in young peoples product choices

Fast food restaurants must take some responsibility for the influence of marketing on the products that young people and their parents choose to purchase. For example, childrens second-hand exposure to advertising designed to reach a broad audience of consumers likely has a significant influence on what children want to eat and expect to eat at fast food restaurants. The predominance of messages about dollar/value menus and combo meals could help explain why older children are more likely to order these items at some restaurants. Similarly, when the majority of ads that children see are for less healthy menu items, it is not surprising that they prefer french fries and soft drinks over apples and plain milk. The sheer volume of fast food advertising designed to encourage customers to visit these restaurants is also likely to affect how frequently children want to consume fast food. It is important to note that many fast food restaurants advertised their snack items to teens and that this age group purchased more afternoon and evening snacks at restaurants than other age groups. Unfortunately, snack items are among the least healthy and highest calorie options available at most fast food restaurants. With the exception of KFCs online

Fast food restaurants must establish meaningful standards for child-targeted marketing

These standards should apply to all fast food restaurants, not just the two restaurants who have volunteered to participate in the CFBAI.

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The nutrition criteria for foods presented in child-targeted marketing must apply to kids meals served, not just the items pictured in marketing. Child-targeted marketing must do more to persuade children to want the healthy options available, not just to encourage them to ask their parents to visit the restaurants. Restaurants must redefine child-targeted marketing to include TV ads and other forms of marketing viewed by large numbers of children, but not exclusively targeted to them. Restaurants must expand the definition of advertising to include all forms of marketing viewed by children. McDonalds must stop marketing directly to preschoolers.

Fast food restaurants must do more to push their lower-calorie and more nutritious menu items inside the restaurants when young people and parents make their final purchase decisions

Healthier sides and beverages must be the default option when ordering kids meals. Parents can request the french fries and soft drink if they want, but they (not the restaurant) must make that decision. A McDonalds Hamburger Happy Meal with apple dippers (no caramel sauce) and plain milk or 100% juice contains 385 calories; the same meal with french fries and a sugar-sweetened beverage contains 600. McDonalds reports that it sells millions of Happy Meals every year.24 This one change would reduce childrens consumption by billions of calories every year. The smallest size and most healthy version should be the default option provided for all menu items. Portions of menu items that come in different sizes (e.g., small, medium, and large) should be consistent across restaurants. The current situation confuses customers and is potentially misleading. Restaurants must promote their more nutritious items on signs inside the restaurant, and use price and other promotions to encourage customers to purchase them.

Fast food restaurants must do more to develop and promote lower-calorie and more nutritious menu items

The focus in all forms of marketing must be reversed to emphasize the healthier options instead of the high-calorie poor quality items now promoted most extensively. Marketing that reaches a high proportion of teens must meet even higher nutritional standards than other forms of marketing. Restaurants must increase the relative number of lowercalorie, more nutritious items on their menus. Popular items should be reformulated to decrease the saturated fat, sodium, and calories in the average entre. Kids meal options must be developed to meet the needs of both the preschoolers and older children who consume them. Lower-calorie kids meal options appropriate for preschoolers are needed at most restaurants. Subway and Burger King provide healthy kids meal main dishes, but these items may not have enough calories for older children. Subway, for example, could offer a kids meal with a 6-inch turkey and/or veggie sandwich, apples or yogurt, and plain milk or 100% juice to encourage more parents to purchase these healthy options for their older children.

All those responsible must take action to ensure that young people visit fast food restaurants less often and, when they do visit, that they consume less of the primarily calorie-dense nutrient-poor foods typically purchased. The restaurant industry can rightly claim that parents should make decisions about what to feed their children and that teens must learn how to make healthy choices. But it is disingenuous for the industry to imply that it is only responsible for making more healthful food options available for consumers who are interested in them.25 According to the data in this report, fast food restaurants spend billions of dollars in marketing every year to increase the number of times that customers visit their restaurants, encourage visits for new eating occasions and purchases of specific menu items (rarely the healthy options), and create lifelong, loyal customers. By creating more healthful items and marketing them more effectively, fast food restaurants could attract lifelong customers who will also live longer, healthier lives.

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Endnotes Executive Summary

1. Bowman, S.A., Gortmaker, S.L., Ebbeling, C.B., Pereira, M.A. & Ludwig, D.S. (2004). Effects of fast food consumption on energy intake and diet quality among children in a national household survey. Pediatrics, 113(1), 112-118. 2. French, S.A., Story, M., Neumark-Sztainer, D., Fulkerson, J.A. & Hannan, P. (2001). Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. International Journal of Obesity, 25, 1823-1833. 3. Nielsen, S.J., Siega-Riz, A.M. & Popkin, B.M. (2002). Trends in food locations and sources among adolescents and young adults. Preventive Medicine, 35(2), 107-113. 4. Sebastian, R.S., Enns, C.W. & Goldman, M.A. (2009). US adolescents and MyPyramid: Associations between fast food consumption and lower likelihood of meeting recommendations. Journal of the American Dietetic Association, 109(2), 226-235. 5. Bowman et al. (2004). 6. Sebastian, Enns, & Goldman (2009). 7. Federal Trade Commission [FTC] (2008). Marketing food to children and adolescents: A review of industry expenditures, activities, and self-regulation. A report to Congress. Retrieved from www.ftc.gov. 8. Powell, L.M., Szczpka, G. & Chaloupka, F.J. (2010). Trends in exposure to television food advertisements among children and adolescents in the United States. Archives of Pediatric and Adolescent Medicine, 164(9), E1-E9. 9. Connor, S.M. (2006). Food-related advertising on preschool television: Building brand recognition in young viewers. Pediatrics, 118, 1478-1485. 10. Powell, Szczpka & Chaloupka (2010) 11. White House Task Force on Childhood Obesity (2010). Solving the problem of childhood obesity within a generation. Retrieved from www.letsmove.gov/tfco_fullreport_may2010.pdf. 12. National Restaurant Association (2010, September 13). Press release. National Restaurant Association welcomes First Lady Michelle Obama to speak about Lets Move Initiative. Retrieved from www.restaurant.org/pressroom/pressrelease/?ID=2003 13. Peeler, C.L., Kolish, E.D. & Enright, M. (2009). The Childrens Food and Beverage Advertising Initiative in action: A report on compliance and implementation during 2008. Retrieved from www.bbb.org/us/storage/0/Shared%20Documents/finalbbbs.pdf. 14. National Restaurant Association (2010). 15. American Dietetic Association. Smart Snacking for Adults and Teens. Eat Right: Food, Nutrition, and Health Tips from the American Dietetic Association. Retrieved from www.eatright.org. policy debate over the effects of food advertising to children. International Journal of Advertising, 24(3), 273-296. 5. Peeler, C. L., Kolish, E. D., & Enright, M. (2009). The Children's Food & Beverage Advertising Initiative in action: A report on compliance and implementation during 2008. Retrieved from http://www.bbb.org/us/storage/0/Shared%20Documents/ finalbbbs.pdf. 6. National Restaurant Association (2008). Restaurant Industry Facts. Retrieved from www.restaurant.org. 7. Public Law 111-148 (2010). H.R. 3590 The Patient Protection and Affordable Care Act. Retrieved from frwebgate.access.gpo.gov. 8. Brownell, K. D., Schwartz, M. B., Puhl, R. M., Henderson, K. E., & Harris, J. L. (2009). The need for bold action to prevent adolescent obesity. Journal of Adolescent Health, 45, S8-S17. 9. Bowman, S. A., Gortmaker, S. L., Ebbeling, C. B., Pereira, M. A., & Ludwig, D. S. (2004). Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics, 113(1), 112-118. 10. Nielsen, S. J., Siega-Riz, A. M., & Popkin, B. M. (2002). Trends in food locations and sources among adolescents and young adults. Preventive Medicine, 35(2), 107-113. 11. Federal Trade Commission [FTC] (2008). Marketing Food to Children and Adolescents. A Review of Industry Expenditures, Activities, and Self-Regulation. A report to Congress Retrieved from www.ftc.gov. 12. Guthrie, J. F., Lin, B. H., & Frazao, E. (2002). Role of food prepared away from home in the American diet, 1977-78 versus 1994-96: changes and consequences. Journal of Nutrition Education and Behavior, 34(3), 140-150. 13. Nielsen, Siega-Riz, & Popkin (2002). 14. Guthrie, Lin, & Frazao (2002). 15. Bowman et al. (2004). 16. Young, L. R., & Nestle, M. (2003). Expanding portion sizes in the US marketplace: implications for nutrition counseling. Journal of the American Dietetic Association, 103, 231-234. 17. Sabastian, R. S., Enns, C. W., & Goldman, M. A. (2009). US adolescents and MyPyramid: Associations between fast food consumption and lower likelihood of meeting recommendations. Journal of the American Dietetic Association, 109(2), 226-235. 18. Mancino, L., Todd, J. E., Guthrie, J. F., & Lin, B. H. (2010). How food away from home affects childrens diet quality. USDA Economic Research Service. Retrieved from http://www.ers. usda.gov/Publications/ERR104/. 19. O'Donnell, S. I., Hoerr, S. L., Mendoza, J. A., & Goh, E. T. (2008). Nutrient quality of fast food kids meals. American Journal of Clinical Nutrition, 88, 1388-1395. 20. Saelens, B. E., Glanz, K., Sallis, J. F., & Frank, L. D. (2008). Nutrition environment measures study in restaurants (NEMS-R). American Journal of Preventive Medicine, 32(4), 273-281. 21. Young & Nestle (2003). 22. Sabastian, Enns, & Goldman (2009). 23. French, S. A., Story, M., Neumark-Sztainer, D., Fulkerson, J. A., & Hannan, P. (2001). Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. International Journal of Obesity, 25, 1823-1833. 24. Bowman et al. (2004). 25. French et al. (2001). 26. Nielsen, Siega-Riz, & Popkin (2002).

Introduction
1. White House Task Force on Childhood Obesity (2010). Solving the problem of childhood obesity within a generation. Retrieved from www.letsmove.gov/tfco_fullreport_may2010.pdf. 2. Institute of Medicine [IOM] (2006). National Academy of Sciences, Committee on Food Marketing and the Diets of Children and Youth. Food marketing to children and youth: Threat or opportunity? 3. World Health Organization [WHO] (2006). Marketing of food and non-alcoholic beverages to children. Oslo, Norway, 2-5 May 2006. 4. Livingstone, S. (2005). Assessing the research base for the

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Endnotes
27. Li, F., Harmer, P., Cardinal, B. J., & Vongjaturapat, N. (2009). Built environment and changes in blood pressure in middle aged and older adults. Preventive Medicine, 48(3). 28. Nielsen, Siega-Riz, & Popkin (2002). 29. Bowman et al. (2004). 30. FTC (2008). 31. Nestle, M. (2007). Politics. How the Food Industry Influences Nutrition and Health. Berkeley: University of California Press. 32. FTC (2008). 33. Powell, L. M., Szczpka, G., & Chaloupka, F. J. (2010). Trends in exposure to television food advertisements among children and adolescents in the United States. Archives of Pediatric and Adolescent Medicine, 164(9), E1-E9. 34. Connor, S. M. (2006). Food-related advertising on preschool television: Building brand recognition in young viewers. Pediatrics, 118, 1478-1485. 35. FTC (2008). 36. Chester, J., & Montgomery, K. (2008). Interactive food & beverage marketing: Targeting children and youth in the digital age. An update. Memo prepared for NPLAN/BMSG meeting on digital media and marketing to children. Retrieved from www. digitalads.org. 37. FTC (2008). 38. Kumanyika, S. K., & Grier, S. A. (2006). Targeting interventions for ethnic minority and low-income populations. The Future of Children, 16.1, 187-207. 39. Powell, Szczpka, & Chaloupka (2010). 40. Roberts, D. F., Foehr, U. G., & Rideout, V. J. (2005). Generation M: Media in the lives of 818 year-olds: Kaiser Family Foundation. Retrieved from www.kff.org. 41. Henderson, V. R., & Kelly, B. (2005). Food advertising in the age of obesity: content analysis of food advertising on general market and African American television. Journal of Nutrition Education and Behavior, 37, 191-196. 42. Bell, R. A., Cassady, D., Culp, J., & Alcaly, R. (2009). Frequency and types of foods advertised on Saturday morning and weekday afternoon in English- and Spanish-Language American television programs. Journal of Nutrition Education and Behavior, 41(6), 406-413. 43. Yancey, A.K., Cole, B.L., Brown, R., Williams, J.D., Hillier, A., Kline, R.S., Ashe, M., Grier, S.A., Backman, D. & McCarthy, W.J. (2009). A cross-sectional prevalence study of ethnically targeted and general audience outdoor obesity-related advertising. The Millbank Quarterly, 87, 155-184. 44. Lewis, L. B., Sloane, D. C., Nascimento, L. C., Diamont, A. L., Guinyard, J. J., Yancey, A. K., et al. (2005). African Americans' access to healthy food options in South Los Angeles restaurants. American Journal of Public Health, 95, 668-673. 45. White House Task Force on Childhood Obesity (2010). 46. National Restaurant Association (2010, September 13). National Restaurant Association Welcomes First Lady Michelle Obama To Speak About Lets Move Initiative. Retrieved from www. restaurantnews.com. 47. New York Times (2010). Ad Rules Stall, Keeping Cereal a Cartoon Staple. Retrieved July 23, 2010 from www.nytimes. com. 48. Peeler, Kolish & Enright (2009). 49. Ibid. 50. Powell, Szczpka, & Chaloupka (2010). 51. Ibid. 52. Ibid. 53. French et al. (2001). 54. Sabastian, Enns & Goldman (2009). 55. Center for Science in the Public Interest [CSPI] (2010). CSPI to sue McDonalds if it continues using toys to market junk food to children. Retrieved June 22, 2010, from www.cspinet.org/ new/201006221.html. 56. The NPD Group/CREST/2 Years Ending December 2009. 57. NPD Group (2009). NPD finds todays kids taking a different approach to restaurant meals. Retrieved from www.npd.com/ press/releases/press_090527.html. 58. Grier & Kumanyika (2008). 59. Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999-2004. JAMA, 295, 15491555.

Methods
1. QSR Magazine (2009). QSR 50 by 2009 QSR 50 Rank. Retrieved from www.qsrmagazine.com/reports/qsr50/2009/charts/09rank. html. 2. Peeler, C. L., Kolish, E. D., & Enright, M. (2009). The Children's Food & Beverage Advertising Initiative in action: A report on compliance and implementation during 2008. Retrieved from www.bbb.org/us/storage/0/Shared%20Documents/finalbbbs.pdf. 3. Food Standards Agency (2007). Nutrient profiling. Retrieved from http://www.food.gov.uk/healthiereating/advertisingtochildren/ nutlab/. 4. Institute of Medicine [IOM] (2010). School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press. See p. 117. 5. OFCOM (2007). Television advertising of food and drink products to children. Final statement. Retrieved from www.ofcom.org.uk/ consult/condocs/foodads_new/statement/statement.pdf. 6. Food Standards Australia New Zealand (2008). Retrived from www.foodstandards.gov.au/foodmatters/ healthnutritionandrelatedclaims/. 7. Scarborough, P., Rayner, M., Stockley, L. & Black, A. (2007). Nutrition professionals perception of the healthiness of individual foods, Public Health Nutrition, 10, 346-353. 8. Harris, J.L., Schwartz, M.B., Brownell, K.D. et al. (2009). About Nutrition Scores. Cereal FACTS: Evaluating the nutritional quality and marketing of children's cereals. Retrieved from www. cerealfacts.org/about_nutrition_scores.aspx. 9. OFCOM (2007). 10. IOM (2010). See pp. 71, 117. 11. The NPD Group/CREST/2 Years Ending December 2009. 12. IOM (2010). See Table 7-1, p. 117 for maximum calories and sodium by age group. 13. U.S. Department of Agriculture [USDA] (2005). MyPyramid Food Intake Pattern Calorie Levels. Retrieved from www.mypyramid. gov/professionals/index.html. 14. Institute of Medicine [IOM] (2004). Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, DC: The National Academies Press.

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Endnotes
15. USDA/FNS (2007). School Nutrition Dietary Assessment StudyIII. Retrieved from www.fns.usda.gov/oane/MENU/Published/ CNP/cnp.htm. 16. The NPD Group/CREST/2 Years Ending December 2009. 17. USDA (2005). 18. IOM (2010). See pp. 86-87. 19. USDA/FNS (2007). 20. Piernas, C. & Popkin, B. M. (2010). Trends in snacking among US children. Health Affairs, 29(3), 398-404. 21. Interagency Working Group on Food Marketed to Children (2009, December 15). Tentative Proposed Nutrition Standards. Retrieved from ftc.gov/bcp/workshops/sizingup/SNAC_PAC.pdf. 22. The Nielsen Company (2010). Nielsen Monitor Plus AdViews. www.nielsenmedia.com 23. Federal Trade Commission [FTC] (2007). Children's Exposure to TV Advertising in 1977 and 2004. Bureau of Economics Staff Report. Retrieved from www.ftc.gov. 24. Kantar Media (2010). Adscope. Retrieved from www. kantarmediana.com/intelligence/products/adscope. 25. Harris, J.L., Schwartz, M.B., Brownell, K.D. et al. (2009). Cereal FACTS: Evaluating the nutritional quality and marketing of children's cereals. Retrieved from www.cerealfacts.org. 26. Hayes, A., & Krippendorff, K. (2007). Answering the call for a standard reliability measure for coding data. Communication Methods and Measures, 1(1), 77-89. 27. Arbitron (2010). Arbitron company profile. Retrieved from www. reuters.com/finance/stocks/companyProfile?rpc=66&symbol=AR B. 28. Radio Advertising Bureau [RAB] (2010). Radio Revenue Trends. Retrieved from http://www.rab.com/public/pr/yearly.cfm. RAB estimates that in 2009, local spot radio accounted for 74% of all on-air radio advertising dollars. 29. Calculation made using Metro Survey Area Populations for Persons 12+ from Arbitrons Fall 2009 Market Survey Schedule & Population Rankings. 30. comScore (2010). Media Metrix Core Reports. Retrieved from comscore.com/Products_Services/Product_Index/Media_Metrix_ Suite/Media_Metrix_Core_Reports. 31. comScore (2009). U.S. Client Newsletter. Retrieved from www. comscore.com/Newsletter/2009/August/US_Client_Newsletter. 32. comScore (2010). Media Metrix: Methodology Overview. Retrieved from mymetrix.comscore.com/app/HelpGuideWindow. aspx?activeTab=helpIndexTab. 33. The data used for average visits per month is comScore Media Metrix Key Measures Reports data for the measure: Average Visits per Visitor. 34. The data used for average time spent per visit is comScore Media Metrix Key Measures Reports data for the measure: Average Minutes per Visit. 35. Moore, E. S. (2006). It's Child's Play: Advergaming and the Online Marketing of Food to Children. Kaiser Family Foundation. Retrieved from www.kff.org/entmedia/upload/7536.pdf. 36. Lingas, E. O., Dorfman, L., & Bukofzer, E. (2009). Nutrition content of food and beverage products on websites popular with children. American Journal of Public Health, 99, S587-S592. 37. Chester, J., & Montgomery, K. (2007). Interactive food and beverage marketing: Targeting children and youth in the digital age. A report from Berkeley Media Studies Group. Retrieved from www.digitalads.org. 38. Lee, M., Choi, Y., Quilliam, E. T., & Cole, R. T. (2009). Playing with food: Content analysis of food advergames. The Journal of Consumer Affairs, 43(1), 129-154. 39. Moore, E. S., & Rideout, V. J. (2007). The online marketing of food to children: Is it just fun and games? Journal of Public Policy and Marketing, 26(2), 202-220. 40. Harris, Schwartz, Brownell et al. (2009). 41. comScore (2010). Ad Metrix. Retrieved from comscore.net/ Products_Services/Product_Index/Ad_Metrix. 42. The data used for monthly unique viewers is comScore Ad Metrix Advertiser Reports data for the measure: Advertising Exposed Unique Visitors. 43. Kaplan, A. M., & Haenlein, M. (2010). Users of the world, unite! The challenges and opportunities of social media. Business Horizons, 53(1), 59-68. 44. Zuckerberg, M. (2010). 500 million stories. The facebook blog. Retrieved from blog.facebook.com/blog. php?post=409753352130. 45. Williams, E. (2010). The evolving ecosystem. Twitter blog. Retrieved from blog.twitter.com/2010/09/evolving-ecosystem. html. 46. comScore (2010). U.S. online video market continues ascent as Americans watch 33 billion videos in December. Retrieved from www.comscore.com/Press_Events/Press_Releases/2010/2. 47. Survey Sampling International (2010). Retrieved from www. surveysampling.com. 48. Wright, K. B. (2005). Researching Internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. Journal of Computer-Mediated Communication, 10(3), article 11. 49. NPD (2010). NPD Group. CREST Overview. 50. Ibid. 51. Ibid. 52. Ibid. 53. Ibid. 54. Ibid. 55. Ibid. 56. Ibid.

Results
1. QSR Magazine (2009). Top 50 by 2009 QSR 50. Retrieved from www.qsrmagazine.com/reports/qsr50/2009/charts/09rank.phtml. 2. QSR Magazine (2010). Top 50 by 2010 QSR 50. Retrieved from www.qsrmagazine.com/reports/qsr50/2010/chart_rank.phtml. 3. Ibid. 4. QSR Magazine (2009). 5. This kids meal is not included in our menu analysis as it was introduced after January 15, 2010. 6. Institute of Medicine [IOM] (2010). School Meals: Building Blocks for Healthy Children. Washington, DC: The National Academies Press. 7. Ibid. 8. The NPD Group/CREST/2 Years Ending December 2009.

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Endnotes
9. Young, L.R. & Nestle, M. (2007). Portion sizes and obesity: Responses of fast-food companies. Journal of Public Health Policy, 28, 238-248. 10. Ibid. 11. Ibid. 12. Statistical analysis was conducted using a Mann-Whitney nonparametric test to compare the sum of ranks. 13. IOM (2010). 14. IOM (2010). 15. These kids meals included a small or value sized 16 oz. soft drink that was also available on the regular menu. 16. The Nielsen Company (2010). 17. Powell, L.M., Szczpka, G. & Chaloupka, F.J. (2010). Trends in exposure to television food advertisements among children and adolescents in the United States. Archives of Pediatric and Adolescent Medicine, 164(9), E1-E9. 18. Ibid. 19. Ibid. 20. Peeler, C.L., Kolish, E.D., & Enright, M. (2009). The Childrens Food and Beverage Advertising Initiative in action: A report on compliance and implementation during 2008. Retrieved from www.bbb.org/us/storage/0/Shared%20Documents/finalbbbs.pdf. 21. Ibid. 22. Grier, S.A. & Kumanyika, S. (2010). Targeted marketing and public health. Annual Review of Public Health, 41, 349-369. 23. The Nielsen Company (2010). 24. Ibid. 25. Ibid. 26. Radio Advertising Bureau [RAB] (2010, February 19). 09 YearEnd Results Confirm Positive Signs for Radio. Retrieved from www.rab.com/dailypress/RevenueReportQ42009Final.pdf. 27. The data used for average visits per month is comScore Media Metrix Key Measures Reports data for the measure: Average Visits per Visitor. 28. The data used for average pages per month is comScore Media Metrix Key Measures Reports data for the measure: Average Pages per Visitor. 29. The data used for average time spent per visit is comScore Media Metrix Key Measures Reports data for the measure: Average Minutes per Visit. 30. The data reported for composition indices is not a measure from comScore, but instead was defined by researchers (detailed definition in Methods). 31. Data retrieved from comScore Media Metrix Audience Duplication Report (July through December 2009). The list of websites used to run this report included the following McDonalds websites: 365Black.com, AboutMcDonalds.com, HappyMeal.com, McDonalds.com, McDonaldsAllAmerican. com, McdonaldsMcCafeYourday.com, McState.com, McWorld. com, MeEncanta.com, MyInspirasian.com, Passport2Play.com, RMHC.org, and Ronald.com. 32. The data used for Average unique viewers per month is comScore Ad Metrix Advertiser Reports data for the measure: Advertising Exposed Unique Visitors. 33. The data used for average number of ads viewed per month is comScore Ad Metrix Advertiser Reports data for the measure: Average Frequency. 34. Percentage of ads viewed on youth websites and total average ads viewed on youth websites per month were not defined by comScore, but by the researchers (detailed definitions in Methods). 35. The data used for total average ads viewed on youth websites per month is comScore Ad Metrix Advertiser Reports data for the measure: Total Display Ad Views. 36. Inside Facebook (2010). As of September 24, 2010, Starbucks was the 8th-most popular page with a vanity URL on Facebook (behind Texas Holdem Poker, Michael Jackson, Facebook, Lady Gaga, Family Guy, Vin Diesel, and The Twilight Saga). http:// pagedata.insidefacebook.com/. 37. See http://www.youtube.com/watch?v=fom57XAEYWI. 38. See http://www.youtube.com/watch?v=6_V_r6RCjNs. 39. See http://www.youtube.com/watch?v=6_V_r6RCjNs. 40. Video is no longer available on YouTube. 41. See http://www.youtube.com/watch?v=PAWzOqQuq9M. 42. See http://www.youtube.com/watch?v=C5a5kQlu8ZY. 43. See http://www.youtube.com/watch?v=hGA_8f3tpcY. 44. Butcher, D. (2009, October 30). Pizza Hut iPhone app generates $1M in sales. Mobile Marketer. Retrieved from www. mobilemarketer.com/cms/news/commerce/4533.html. 45. Panchuk, K. (2010, August 13). Pizza Hut sees $7M in sales from iPhone app. Dallas Business Journal, Retrieved from www.bizjournals.com/dallas/stories/2 010/08/16/story3. html?b=1281931200^3792111. 46. Kats, R. (2010, August 18). Pizza Hut exec: Mobile to account for 50 percent of future orders. Mobile Marketer. Retrieved from www.mobilecommercedaily.com/pizza-hut-exec-claims-mobileaccounts-for-50-percent-of-orders. 47. Hillmantel, R, (2009 March). GoMobo Brings an EZ Pass Lane to Quick-Serves. QSR, Retrieved from www.qsrmagazine.com/ articles/exclusives/0309/GoMobo-1.phtml. 48. Walters, C. (2009, January 29). Subway Launches Text Message Ordering in NYC. The Consumerist. Retrieved from consumerist. com/2009/01/subway-launches-text-message-ordering-in-nyc. html. 49. Koeppel, D. (2010, January 20). Subway Customers Can Now Order By Text Message. Slash Food, Retrieved from www. slashfood.com/2010/01/20/subway-text-messaging. 50. Pew Internet (2010, February 3). Social Media & Mobile Internet Use Among Teens and Young Adults. Retrieved from www. pewinternet.org/Reports/2010/Social-Media-and-Young-Adults. aspx 51. Ibid. 52. Ibid. 53. Fuse and the University of Massachusetts (2009, May). Fuses Teen Advertising Study: Spring 2009. Retrieved from http://www. fusemarketing.com/pdfs/Fuse_UMASS_Teen_Advertising_Study. pdf. 54. Ibid. 55. Ibid. 56. The Nielsen Company (2009, June). How teens use media: A Nielsen report on the myths and realities of teen media trends. Retrieved from http://blog.nielsen.com/nielsenwire/reports/ nielsen_howteensusemedia_june09.pdf. 57. Ibid.

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Endnotes
58. Pew Internet & American Life Project (2010, April 20). Teens and Mobile Phones. Retrieved from http://www.pewinternet.org/~/ media//Files/Reports/2010/PIP-Teens-and-Mobile-2010-withtopline.pdf. 59. Ibid. 60. The Nielsen Company (2009, September 30). Women, Teens, and Seniors Help Fuel 34% Mobile Web Spike. Retrieved from blog.nielsen.com/nielsenwire/online_mobile/mobile-web-up-34percent-july-09. 61. Pew Internet & American Life Project (2010). 62. Data retrieved from comScore MobiLens. 63. Ibid. 64. The NPD Group/CREST/Year Ending December 2009 65. Sebastian, R.S., Enns, C.W., & Goldman, M.A. (2009). U.S. adolescents and MyPyramid: Associations between fast food consumption and lower likelihood of meeting recommendations. Journal of the American Dietetic Association, 109(2), 226-235. 66. The NPD Group/CREST/Year and 2 Years Ending December 2009. 67. Ibid. 68. Ibid. 69. Ibid. 70. Ibid. 71. Reedy, J. & Krebs-Smith, S.M. (2010). Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. Journal of the American Dietetic Association, 110(10), 1477-1484. 7. Sebastian, R.S., Enns, C.W., & Goldman, M.A. (2009). US adolescents and MyPyramid: Associations between fast food consumption and lower likelihood of meeting recommendations. Journal of the American Dietetic Association, 109(2), 226-235. 8. Lewin, A., Lindstrom, L. & Nestle, M. (2006). Food industry promises to address childhood obesity: Preliminary evaluation. Journal of Public Health Policy, 27, 327-348. 9. Young, L.R. & Nestle, M. (2007). Expanding portion sizes in the US marketplace: Implications for nutrition counseling. Journal of the American Dietetic Association, 103, 231-234. 10. Inside Facebook (2010). As of September 24, 2010, Starbucks was the 8th most popular page with a vanity URL on Facebook (behind Texas Holdem Poker, Michael Jackson, Facebook, Lady Gaga, Family Guy, Vin Diesel, and the Twilight Saga). Retrieved from pagedata.insidefacebook.com. 11. Grier, S.E. & Kumanyika, S. (2010). Targeted marketing and public health. Annual Review of Public Health, 31, 349-369. 12. Roberto, C.A., Baik, J., Harris, J.L. & Brownell, K.D. (2010). Influence of licensed characters on childrens taste and snack preferences. Pediatrics, 126, 88-93. 13. Robinson, T.N., Borzekowski, D.L., Matheson, D.M., & Kraemer, H.C. (2007). Effects of fast food branding on young childrens taste preferences. Archives of Pediatric and Adolescent Medicine, 161, 792-797. 14. Grier, S.A., Mensinger, J., Huang, S.H., Kumanyika, S.K., & Stettler, N. (2007). Fast-food marketing and childrens fast food consumption: Exploring parents influences on an ethnically diverse sample. Journal of Public Policy and Marketing, 26, 221235. 15. Powell, Lisa M. (2009). Fast food costs and adolescent body mass index: Evidence from panel data. Journal of Health Economics, 28, 963970. 16. Flegal, K.M., Carroll, M.D., Ogden, C.L., & Curtin, L.R. (2010). Prevalence and trends in obesity among US adults, 1999-2008. JAMA, 303, 235-241. 17. McDonalds 365Black Whats Happening? Retrieved from www.365black.com/365black/events.jsp. 18. The NPD Group/CREST/2 Years Ending December 2009. 19. Ibid. 20. Ibid. 21. Ibid. 22. Ibid. 23. Ibid. 24. MacArthur, K. (2010, September 10). McDonalds a charity cheapskate, says critic; but is chain pinching pennies? Crains Chicago Business. Retrieved from www.chicagobusiness.com/ article/20100922/NEWS07/100929958/mcdonalds-a-charitycheapskate-says-critic-but-is-chain-pinching-pennies. 25. National Restaurant Association (2010).

Conclusions
1. New York Times (2010). Ad Rules Stall, Keeping Cereal a Cartoon Staple. Retrieved from www.nytimes.com. 2. Peeler, C.L., Kolish, E.D. & Enright, M. (2009). The Childrens Food and Beverage Advertising Initiative in action: A report on compliance and implementation during 2008. Retrieved from www.bbb.org/us/storage/0/Shared%20Documents/finalbbbs.pdf. 3. National Restaurant Association (2010, September 13). National Restaurant Association welcomes First Lady Michelle Obama to speak about Lets Move Initiative. Retrieved from www. restaurant.org/pressroom/pressrelease/?ID=2003. 4. Ibid. 5. Reedy, J. & Krebs-Smith, S.M. (2010). Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. Journal of the American Dietetic Association, 110(10), 1477-1484. 6. Bowman, S.A., Gortmaker, S.L., Ebbeling, C.B., Pereira, M.A. & Ludwig, D.S. (2004). Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics, 113(1), 112-118.

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Ranking Table 1

Nutritional quality of food item categories

Ranking by percentage of items that met all three nutrition criteria and then by median NPI score
Ranking Restaurant Menu item category

Best

Total # of items
14 6 29 76 9 5 21 11 23 12 26 44 30 84 51 72 140 43 58 149 162 3 6 24 28 5 19 2 33 123 39 32 3 3

NPI score Calories Sodium % met all % met % met % met criteria Median Range criteria Median Range criteria Median Range criteria
43% 33% 28% 24% 22% 20% 14% 9% 9% 8% 8% 7% 7% 6% 6% 4% 3% 2% 2% 1% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 70 66 58 64 42 58 47 54 68 57 48 48 40 48 46 48 66 50 46 48 48 66 55 54 49 48 46 46 44 44 42 40 40 40 64-80 66-70 24-86 38-78 36-68 48-80 18-70 42-74 38-78 28-72 32-82 38-74 22-70 30-76 34-72 32-72 38-78 42-78 26-72 32-82 34-70 58-80 54-58 46-60 18-68 38-50 20-62 40-52 32-80 30-68 32-76 24-58 28-42 38-46 100% 100% 38% 57% 22% 40% 14% 18% 70% 25% 8% 27% 7% 30% 26% 25% 63% 19% 17% 1% 14% 67% 0% 0% 29% 0% 0% 0% 24% 7% 15% 0% 0% 0% 310 168 100 350 390 310 265 340 140 325 330 465 455 365 610 520 545 400 415 610 700 180 480 430 270 300 540 240 520 680 580 420 300 280 70-540 40-500 20-360 150-1,000 230-680 53-500 130-620 70-790 35-340 190-500 35-690 205-1,060 150-1,370 80-1,040 210-980 160-1,310 85-1,420 150-750 150-660 50-1,530 249-1,120 130-270 440-560 150-1,110 150-520 218-325 35-1,360 170-310 230-1,330 400-1,590 200-1,640 240-680 300-320 260-360 64% 67% 97% 92% 100% 60% 9% 55% 100% 92% 58% 86% 60% 96% 78% 68% 66% 74% 78% 23% 51% 100% 0% 29% 89% 100% 73% 100% 76% 60% 67% 69% 100% 67% 340 310 280 855 1,090 640 185 670 810 595 675 1,160 1,095 1,000 1,200 1,195 1,570 1,400 990 260 1,600 720 230 180 315 573 1,420 255 1,250 1,440 1,025 210 250 15-1,695 35-375 0-1,060 330-2180 560-1,390 230-1,040 55-830 35-1,190 0-990 105-1,140 0-1,410 490-2,320 180-2,335 230-3,120 440-2,310 340-2,310 410-5,520 440-1,650 340-3,790 10-970 660-2,720 410-840 180-320 55-440 90-990 268-960 150-3,030 200-310 500-3,150 450-3,690 260-2,350 210-300 210-281 50% 50% 59% 34% 22% 20% 67% 18% 35% 25% 15% 18% 13% 29% 12% 21% 3% 5% 2% 65% 1% 0% 100% 88% 57% 20% 16% 100% 18% 0% 15% 3% 100% 100%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

Wendys McDonalds KFC Taco Bell Dunkin Donuts Dairy Queen McDonalds Burger King Subway Starbucks Sonic McDonalds McDonalds KFC Sonic Burger King Subway Subway Dunkin Donuts Dairy Queen Dominos Taco Bell Wendys Sonic KFC Dominos Dairy Queen Taco Bell Wendys Pizza Hut Dairy Queen Burger King Burger King Pizza Hut

Lunch/dinner sides Lunch/dinner sides Lunch/dinner sides Lunch/dinner main dishes Lunch/dinner main dishes Lunch/dinner sides Snack foods Lunch/dinner sides Lunch/dinner sides Breakfast Lunch/dinner sides Lunch/dinner main dishes Breakfast Lunch/dinner main dishes Lunch/dinner main dishes Lunch/dinner main dishes Lunch/dinner main dishes Breakfast Breakfast Snack foods Lunch/dinner main dishes Lunch/dinner sides Snack foods Snack foods Snack foods Lunch/dinner sides Breakfast Snack foods Lunch/dinner main dishes Lunch/dinner main dishes Lunch/dinner main dishes Breakfast Snack foods Snack foods

1,733 1,067-4,090

continued Fast Food FACTS

144

Ranking Table 1
Ranking Restaurant Menu item category

Total # of items
64 13 31 2 63 7 9

NPI score Calories Sodium % met all % met % met % met criteria Median Range criteria Median Range criteria Median Range criteria
0% 0% 0% 0% 0% 0% 0% 38 38 36 35 31 30 22 28-62 24-50 20-38 22-48 14-50 24-60 18-38 0% 0% 0% 0% 0% 0% 0% 318 530 370 328 320 470 220 155-790 330-690 140-490 299-357 40-660 340-680 200-250 84% 38% 42% 50% 67% 57% 100% 985 1,380 330 170 330 1,230 160 410-2,080 490-1,770 75-580 170-170 60-860 920-1,770 100-290 0% 0% 55% 100% 67% 0% 100%

Worst

35 36 37 38 39 40 41

Pizza Hut Sonic Starbucks Dominos Dunkin Donuts Wendys Subway

Lunch/dinner sides Breakfast Snack foods Snack foods Snack foods Breakfast Snack foods

Restaurant rankings Ranking Restaurant Menu item category

Total # of items
81 60 101 141 114 118 215 43 130 169 212 190

NPI score Calories Sodium % met all % met % met % met criteria Median Range criteria Median Range criteria Median Range criteria
22% 10% 10% 9% 4% 3% 3% 2% 2% 1% 1% 0% 64 52 46 49 48 46 64 36 40 48 46 42 38-80 24-80 18-74 18-86 24-82 24-74 18-78 20-72 14-72 22-70 20-82 28-78 56% 37% 23% 31% 13% 17% 52% 7% 9% 14% 5% 5% 340 445 410 285 490 450 460 360 350 693 580 583 0-550 70-1,330 40-1,370 20-1,040 35-1,110 70-1,310 35-1,420 140-500 40-680 218-1,120 35-1,640 155-1,590 93% 63% 78% 95% 59% 68% 73% 56% 74% 52% 34% 68% 840 845 850 665 935 1,050 1,390 370 555 1,577 350 1,480 10-525 15-3,150 35-2,335 0-3,120 0-2,310 35-2,350 0-5,520 75-1,140 60-3,790 170-2,720 10-3,690 210-4,090 35% 32% 29% 40% 27% 18% 11% 47% 32% 3% 50% 2%

Best

Worst

1 2 3 4 5 6 7 8 9 10 11 12

Taco Bell Wendys McDonalds KFC Sonic Burger King Subway Starbucks Dunkin Donuts Dominos Dairy Queen Pizza Hut

All food items All food items All food items All food items All food items All food items All food items All food items All food items All food items All food items All food items

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145

Ranking Table 2

Nutritional quality of beverage categories

Ranking by percentage of items that met all three nutrition criteria and then by median NPI score
Ranking Restaurant Menu item category

Best

Total # of items
12 23 132 29 90 51 66 112 10 33 113 70 98 34 12 40 18 1 59 9 12 138 24 2 19

NPI score Calories Sodium % met all % met % met % met criteria Median Range criteria Median Range criteria Median Range criteria
75% 74% 62% 59% 48% 47% 47% 45% 40% 39% 34% 30% 27% 26% 25% 10% 0% 0% 0% 0% 0% 0% 0% 0% 0% 74 70 70 70 68 68 69 67 66 68 68 66 66 68 66 66 62 68 60 64 60 60 61 66 60 64-74 58-70 64-74 68-76 60-72 66-76 66-70 66-76 66-70 64-78 40-72 66-72 66-70 66-72 66-70 66-70 54-58 68-68 56-66 60-66 60-62 56-66 58-68 66-66 44-62 75% 74% 64% 59% 48% 47% 50% 45% 40% 39% 34% 30% 30% 27% 25% 10% 0% 0% 0% 0% 0% 0% 0% 0% 0% 270 15 180 100 170 184 190 150 140 160 180 135 220 185 248 280 550 340 750 430 660 490 460 240 410 250-540 0-480 5-550 0-390 0-650 0-586 0-530 0-480 0-275 0-460 40-400 0-310 0-880 0-360 0-440 0-550 110-960 340-340 240-1,390 220-860 420-1,160 190-1,040 250-780 230-250 150-540 83% 96% 89% 90% 88% 78% 88% 88% 100% 91% 99% 100% 68% 94% 75% 58% 28% 89% 3% 33% 0% 26% 46% 100% 21% 125 5 120 25 95 83 88 25 67 20 105 18 102 50 70 95 410 310 350 75 240 150 230 33 190 115-410 0-640 0-430 0-150 0-220 0-400 0-210 0-200 40-187.5 0-250 40-220 0-160 15-840 0-150 40-140 40-525 10-780 310-310 0-770 35-340 130-510 30-550 90-440 10-55 70-310 92% 91% 98% 100% 100% 98% 100% 100% 100% 100% 100% 100% 92% 100% 100% 95% 39% 100% 49% 100% 9% 93% 83% 100% 100%

Worst

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Starbucks Dunkin Donuts Starbucks Burger King Dunkin Donuts Subway Starbucks Sonic Dominos McDonalds McDonalds Wendys KFC Dairy Queen Pizza Hut Taco Bell Burger King Burger King Dairy Queen Dunkin Donuts McDonalds Sonic Sonic Taco Bell Wendys

Snack beverages Side beverages Coffee beverages Side beverages Coffee beverages Side beverages Side beverages Side beverages Side beverages Side beverages Coffee beverages Side beverages Side beverages Side beverages Side beverages Side beverages Snack beverages Coffee beverages Snack beverages Snack beverages Snack beverages Snack beverages Coffee beverages Snack beverages Snack beverages

continued Fast Food FACTS

146

Ranking Table 2
Restaurant rankings Ranking Restaurant Menu item category NPI score Calories Sodium % met all % met % met % met criteria Median Range criteria Median Range criteria Median Range criteria
58% 49% 47% 40% 35% 32% 27% 25% 24% 16% 10% 10% 70 68 68 66 68 68 66 66 66 66 62 66 64-74 58-72 66-76 66-70 54-76 40-78 66-70 66-70 44-72 56-76 56-72 66-70 61% 49% 47% 40% 35% 32% 30% 25% 24% 18% 10% 10% 190 80 184 140 190 180 220 248 240 290 500 265 0-550 0-860 0-586 0-275 0-960 0-1,160 0-880 0-440 0-540 0-1,040 0-1,390 0-550 88% 85% 78% 100% 67% 90% 68% 75% 83% 53% 37% 60% 115 25 83 67 38 105 102 70 120 65 220 95 0-430 0-640 0-400 40-1,875 0-780 0-510 15-840 40-140 0-310 0-550 0-770 10-525 98% 98% 98% 100% 77% 98% 92% 100% 100% 95% 68% 95%

Total # of items
210 122 51 10 48 158 98 12 89 274 93 42

Best

Worst

1 2 3 4 5 6 7 8 9 10 11 12

Starbucks Dunkin Donuts Subway Dominos Burger King McDonalds KFC Pizza Hut Wendys Sonic Dairy Queen Taco Bell

All beverages All beverages All beverages All beverages All beverages All beverages All beverages All beverages All beverages All beverages All beverages All beverages

Fast Food FACTS

147

Ranking Table 3

Nutritional quality of kids Meals

Ranking of best possible kids meal combinations by NPI score of food items. All Best kids meals were determined by selecting the items with the highest NPI score and lowest calorie content among the menu options at each restaurant. Calorie content was used to rank the final items. All beverages on the Best list are free of artificial sweeteners. Inclusion on the Best list does not necessarily indicate that the meal is healthy, only that it is the relative best choice from that restaurant.
Best kids meal combinations NPI score Calories Snack Total from Calories or calories Sodium Main Side Snack or saturated from Ranking Restaurant Main dish Side dish Beverage dessert (Kcal)* (mg) dish item Beverage dessert fat sugar

Best

Meet all nutrition criteria for preschool-age and elementary school-age children

Veggie Delite sandwich 1 Subway (wheat bread, no cheese) Roast beef sandwich 2 Subway (wheat bread, no cheese) Veggie Delite sandwich 3 Subway (wheat bread, no cheese) Veggie Delite sandwich 4 Subway (wheat bread, no cheese) Veggie Delite sandwich 5 Subway (wheat bread, no cheese) 6 Burger King Macaroni and cheese 7 Burger King Macaroni and cheese Veggie Delite sandwich 8 Subway bread, American cheese) 9 Burger King Macaroni and cheese 10 Burger King Macaroni and cheese 11 Burger King Macaroni and cheese 12 Burger King Macaroni and cheese

Apple slices Apple slices Apple slices Yogurt Yogurt Apple fries (without caramel sauce) Apple fries (without caramel sauce) Apple slices Apple fries with caramel sauce Apple fries with caramel sauce Apple fries (without caramel sauce) Apple fries with caramel sauce

100% juice 100% juice Low-fat milk 100% juice Low-fat milk Fat-free milk Apple juice 100% juice Fat-free milk Apple juice Low-fat chocolate milk Low-fat chocolate milk

285 335 345 330 390 285 285 315 330 330 365 410

295 515 460 375 540 490 355 485 525 390 480 515

78 78 78 78 78 66 66 70 66 66 66 66

72 72 72 70 70 80 80 72 74 74 80 74

76 76 72 76 72 72 76 76 72 76 70 70

0 9 23 0 23 14 14 18 14 14 27 27

124 128 108 140 124 92 124 128 112 144 156 176

continued Fast Food FACTS

148

Ranking Table 3
Best kids meal combinations NPI score Calories Snack Total from Calories or calories Sodium Main Side Snack or saturated from Ranking Restaurant Main dish Side dish Beverage dessert (Kcal)* (mg) dish item Beverage dessert fat sugar Meet all nutrition criteria for elementary school-age children only

13 14 15

Subway Subway Subway

Roast Beef sandwich (wheat bread, no cheese) Turkey breast sandwich (wheat Bread, no cheese)

Yogurt Apple slices

100% juice 100% juice 100% juice

380 325 360

595 625 565

78 76 70

70 72 70

76 76 76

9 5 18

144 128 144

Veggie Delite sandwich (white Bread, American cheese) Yogurt

Meet maximum calorie criteria for elementary school-age children only

16 KFC Grilled chicken drumstick Roast beef sandwich 17 Subway (wheat bread, no cheese) 18 KFC Grilled chicken drumstick Turkey breast sandwich 19 Subway (wheat bread, no cheese) 20 Sonic Jr. Burger 21 Sonic Jr. Burger Chicken strips (2) with 22 Sonic honey mustard sauce 23 Sonic Corn dog 24 KFC Original chicken drumstick 25 Burger King Hamburger 26 Wendys Crispy chicken sandwich 27 Wendys Crispy chicken sandwich Chicken tenders (4) 28 Burger King with sweet and sour sauce 29 Sonic Corn dog 30 McDonalds Hamburger

Corn on the cob Apple slices Cole slaw Apple slices Apple slices Apple slices Banana Banana Cole slaw Apple fries (without caramel sauce)

Unsweetened tea Low-fat milk Unsweetened tea Low-fat milk Unsweetened tea Low-fat milk Low-fat milk Unsweetened tea Unsweetened tea Fat-free milk

String cheese String cheese String cheese

270 395 310 385 350 455 510 325 350 385 520 650 350 355 385

545 680 700 790 620 740 790 540 790 670 815 990 515 660 645

60 78 60 76 48 48 44 44 48 50 62 62 48 44 50

86 72 72 72 82 82 78 78 72 80 76 68 80 82 78

70 72 70 72 72 72 72 70 70 72 72 72 72 72 72

36 36 36

23 32 36 27 45 59 41 32 41 36 41 59 18 45 45

20 112 56 112 56 104 128 76 56 92 132 64 112 92 96

Mandarin orange cup Low-fat milk French fries Apple fries (without caramel sauce) Apple slices Low-fat milk Fat-free milk Low-fat milk

Apple dippers (without low-fat caramel dip) Low-fat milk

continued Fast Food FACTS

149

Ranking Table 3
Best kids meal combinations NPI score Calories Snack Total from Calories or calories Sodium Main Side Snack or saturated from Ranking Restaurant Main dish Side dish Beverage dessert (Kcal)* (mg) dish item Beverage dessert fat sugar Meet maximum calorie criteria for elementary school-age children only

31 Wendys 32 Burger King 33^ 34 35 36

Dairy Queen McDonalds Burger King McDonalds

Hamburger Double hamburger Chicken strips with ketchup Hamburger Chicken tenders (6) with sweet and sour sauce Chicken McNuggets (4) with barbeque sauce

Mandarin orange cup Low-fat milk Apple fries (without caramel sauce) Applesauce Apple dippers with low-fat caramel dip Apple fries (without caramel sauce) Fat-free milk Sugar- sweetened soft drink (Sprite) Low-fat milk Fat-free milk

Vanilla cone

400 495

635 700

48 46

76 80

72 72

41 72

136 92

628 455 485 375

1000 680 720 785

46 50 48 48

78 66 80 78

68 72 72 72

58 45

32 132 27 32

268

152 112

Apple dippers (without low-fat caramel dip) Low-fat milk

Bold numbers indicate that the item does not meet minimum health NPI score and/or maximum recommended calories or sodium * Kids meals with fewer than 400 calories may not provide adequate nutrition for some elementary school-aged children. ^ This meal contains excessive sugar (67 grams) and sodium (1000 mg), however, this is the healthiest kids meal available at Dairy Queen

continued

Fast Food FACTS

150

Ranking Table 3
The worst list includes the worst three combinations from each restaurant, excluding Subway. Each of these combinations exceed multiple nutrition recommendations for children and are never a healthful choice. The following meals are the options with the most extreme calorie, sodium, saturated fat and sugar content.
Worst kids meal combinations NPI score Calories Snack Total from Calories or calories Sodium Main Side Snack or saturated from Restaurant Main dish Side dish Beverage dessert (Kcal)* (mg) dish item Beverage dessert fat sugar
Taco Bell Taco Bell Wendys Wendys Burger King Burger King McDonalds KFC Sonic Sonic McDonalds Chicken soft taco Cheese roll-up Chicken nuggets (4) with sweet and sour sauce Cheeseburger Cheeseburger Chicken tenders (4) with ranch dipping sauce Cheeseburger Extra crispy chicken drumstick Grilled cheese sandwich Chicken strips (2) with ranch sauce Chicken McNuggets (6) with barbeque sauce Cinnamon twists Cinnamon twists French fries French fries French fries French fries French fries Potato wedges Tots French fries French fries Sugar- sweetened soft drink (Mountain Dew Baja Blast) Sugar- sweetened soft drink (Mountain Dew Baja Blast) Vanilla Frosty Jr. Vanilla Frosty Jr. Sugar- sweetened soft drink (Dr. Pepper) Sugar- sweetened soft drink (Dr. Pepper) Sugar- sweetened soft drink (Hi-C Orange Lavaburst)

590

900

48

40

66

27

276

590 610 630

790 760 960

38 42 42

40 68 68

66 60 60

45 68 86

276 132 108

635

1,106

40

52

68

86

140

645

906

42

52

68

63

120

650

910

40

66

66

68

152

Sugar- sweetened soft drink String (Mountain Dew) cheese Cherry slush Green apple slush Sugar- sweetened soft drink (Hi-C Orange Lavaburst)

680 680 708

1,330 1,305 1,012

46 28 40

50 50 60

66 64 64

36

54 86 51

232 208 184

720

1,025

44

66

66

41

216

continued Fast Food FACTS

151

Ranking Table 3
Worst kids meal combinations NPI score Calories Snack Total from Calories or calories Sodium Main Side Snack or saturated from Restaurant Main dish Side dish Beverage dessert (Kcal)* (mg) dish item Beverage dessert fat sugar
Wendys Taco Bell Sonic KFC Burger King Dairy Queen McDonalds KFC Dairy Queen Dairy Queen Chicken nuggets (4) with ranch dipping sauce Bean burrito Grilled cheese sandwich Popcorn chicken Double cheeseburger Hot dog Double cheeseburger Popcorn chicken Grilled cheese sandwich Original cheeseburger French fries Cinnamon twists French fries Potato wedges French fries French fries French fries Biscuit French fries French fries Vanilla Frosty Jr. Sugar- sweetened soft drink (Mountain Dew Baja Blast) Green Apple slush 720 860 38 68 60 90 92

760 760

1,530 1,310

68 28

40 60

66 64

32 86

284 208

Sugar- sweetened soft drink String (Mountain Dew) cheese Sugar- sweetened soft drink (Dr. Pepper)

820

1,820

38

50

66

36

68

232

820

1,365

38

52

68

140

180

Sugar- sweetened Chocolate soft drink Dilly (Mountain Dew) Bar Sugar- sweetened soft drink (Hi-C Orange Lavaburst)

823

1,300

40

58

66

36

135

248

830

1,315

40

66

66

113

204

Sugar- sweetened soft drink String (Mountain Dew) cheese Sugar- sweetened Chocolate soft drink Dilly (Mountain Dew) Bar Sugar- sweetened Chocolate soft drink Dilly (Mountain Dew) Bar

840

1,610

38

24

66

36

99

240

893

1,550

32

58

66

36

162

240

973

1,450

40

58

66

36

171

268

Bold numbers indicate that the item does not meet minimum health NPI score and/or maximum recommended calories or sodium

Fast Food FACTS

152

Advertising spending
Ranking by total advertising spending* Includes total spending in all measured media for fast food restaurants in 2009.
Rank Restaurant

Ranking Table 4

2009 spending by selected media Total spending: 2008

$797,797 $410,865 $274,825 $271,004 $279,792 $256,523 $264,300 $165,538 $133,227 $140,710 $110,130 $124,477 $122,992 $104,174 $77,520 $36,235 $86,969 $19,943 $26,196 $13,673

Most

Total spending: 2009

$898,077 $424,641 $282,552 $281,614 $268,866 $243,431 $221,842 $185,067 $180,768 $129,562 $120,877 $119,204 $113,475 $95,675 $77,636 $53,575 $52,849 $28,929 $26,174 $15,902

% change vs. 2008

13% 3% 3% 4% -4% -5% -16% 12% 36% -8% 10% -4% -8% -8% 0% 48% -39% 45% 0% 16%

TV advertising
$697,934 $374,249 $244,438 $242,646 $250,299 $225,825 $212,165 $152,269 $159,429 $120,900 $96,806 $112,698 $108,456 $89,913 $75,152 $52,754 $48,155 $7,472 $19,553 $5,939

Radio Outdoor
$64,920 $24,697 $21,914 $18,117 $3,670 $12,262 $657 $5,314 $3,164 $2,020 $11,744 $1,965 $3,218 $1,329 $950 $0 $236 $675 $480 $6,931 $73,567 $8,274 $6,983 $10,647 $2,204 $2,967 $792 $1,179 $866 $2,013 $4,140 $297 $1,201 $3,733 $1,161 $595 $965 $2,801 $5,749 $2,339

Spanish-language TV
$73,869 $20,282 $18,508 $25,540 $9,849 $13 $9,880 $18,944 $23,471 $0 $0 $546 $1,216 $0 $0 $15,213 $0 $0 $0 $0

Least

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

McDonalds Subway Wendys Burger King KFC Taco Bell Pizza Hut Sonic Dominos Arbys Dunkin Donuts Papa Johns Jack in the Box Hardees Dairy Queen Popeyes Quiznos Starbucks Chick-fil-A Panera Bread

*Includes spending in 18 different media including television, magazines, radio, newspapers, free standing insert coupons, internet, and outdoor advertising The Nielsen Company

Fast Food FACTS

153

Ranking Table 5

Television advertising exposure to children by product category

Ranking by ads viewed for children (ages 6-11 years) Includes average number of advertisements viewed by children in 2009 on national (network, cable and syndicated) television.
Advertising exposure: Advertising exposure: Rank Restaurant Product type Preschoolers 2-5 years Children 6-11 years

Most

Targeted ratio: Preschoolers to adults*

4.73 4.09 2.58 0.35 0.35 0.34 0.38 0.35 0.36 5.60 0.48 0.35 0.47 0.36 0.44 0.34 0.36 0.38 0.33 0.39 0.33 0.41 0.27 0.38 0.37 0.37 0.37 0.40 0.51 0.36

Targeted ratio: Children to adults*

5.40 5.00 2.99 0.43 0.49 0.44 0.51 0.45 0.46 7.23 0.64 0.48 0.64 0.50 0.63 0.46 0.44 0.50 0.45 0.53 0.43 0.50 0.35 0.53 0.52 0.58 0.48 0.50 0.68 0.52

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

McDonalds Burger King McDonalds Pizza Hut Taco Bell KFC Dominos Burger King Wendys Subway McDonalds Subway Subway Sonic Dairy Queen McDonalds McDonalds Subway KFC Pizza Hut Burger King Wendys Dunkin Donuts Subway Sonic Burger King Dairy Queen McDonalds Dominos Sonic

Kids meals Kids meals Branding only Lunch/dinner items Lunch/dinner items Value/combo meals Lunch/dinner items Lunch/dinner items Lunch/dinner items Kids meals Lunch/dinner items Value/combo meals Healthy options Value/combo meals Snacks Coffee drinks Value/combo meals Lunch/dinner items Lunch/dinner items Value/combo meals Value/combo meals Value/combo meals Snacks Promotion only Snacks Promotion only Value/combo meals Promotion only Snacks Lunch/dinner Items

169 102 61 39 36 38 36 34 33 25 23 23 19 15 11 11 12 11 11 8 7 7 6 6 5 5 5 6 5 4

192 125 70 49 49 48 47 43 42 32 31 30 26 20 15 15 15 15 14 11 8 8 8 8 8 7 7 7 6 5

continued

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154

Ranking Table 5
Advertising exposure: Advertising exposure: Rank Restaurant Product type Preschoolers 2-5 years Children 6-11 years

Targeted ratio: Preschoolers to adults

0.36 0.34 0.43 0.42 0.39 0.35 0.27 0.38 0.29 0.34 1.82 0.25 0.47 0.50 0.25 0.40

Targeted ratio: Children to adults

0.50 0.41 0.49 0.63 0.45 0.48 0.35 0.48 0.38 0.45 2.17 0.32 0.71 0.69 0.27 0.62

Least

31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

Taco Bell Wendys KFC Taco Bell McDonalds Burger King Dunkin Donuts McDonalds Dunkin Donuts Burger King McDonalds Dunkin Donuts Dairy Queen Subway Starbucks Taco Bell

Value/combo meals Snacks Healthy options Snacks Breakfast Snacks Coffee drinks Snacks Breakfast Breakfast Healthy options Healthy options Lunch/dinner items Snacks Coffee drinks Healthy options

4 4 4 3 4 2 3 2 2 2 1 1 1 1 1 0

5 5 5 4 4 3 3 3 3 3 2 1 1 1 1 1

*Bold indicates higher than expected targeted ratios

continued Fast Food FACTS

155

Ranking Table 5
Restaurant rankings Advertising exposure: Advertising exposure: Rank Restaurant Preschoolers 2-5 years Children 6-11 years Targeted ratio: Preschoolers to adults
1.05 0.89 0.46 0.33 0.33 0.37 0.34 0.37 0.33 0.35 0.33 0.31 0.24 0.39 0.21 0.37 0.18 0.27 0.24 0.19 0.54 0.51 0.49

Targeted ratio: Children to adults

1.25 1.09 0.61 0.41 0.42 0.51 0.43 0.48 0.44 0.48 0.46 0.36 0.32 0.53 0.28 0.44 0.26 0.29 0.25 0.20 0.68 0.64 0.61

Most

Least

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

McDonalds Burger King Subway KFC Pizza Hut Taco Bell Wendys Dominos Sonic Dairy Queen Quiznos Papa Johns Arbys Popeyes Dunkin Donuts Jack in the Box Hardees Chick-fil-A Starbucks Panera Bread Twelve restaurants Top 20 restaurants All fast food restaurants

309 152 97 62 54 50 46 35 27 20 18 19 16 14 11 11 2 2 1 0 865 948 1,021

368 185 127 78 69 69 58 46 37 27 25 22 22 19 15 14 3 2 1 0 1,079 1,187 1,272

The Nielsen Company Bold indicates higher than expected targeted ratios

Fast Food FACTS

156

Ranking Table 6

Television advertising exposure to teens by product category

Ranking by ads viewed for teens (ages 12-17 years) Includes average number of advertisements viewed by all teens in 2009 on national (network, cable and syndicated) television.
Most
Rank Restaurant
Taco Bell Pizza Hut KFC Burger King Dominos McDonalds Wendys Burger King Subway McDonalds McDonalds Sonic Subway Subway KFC McDonalds Dairy Queen McDonalds Pizza Hut Burger King Dunkin Donuts Wendys Sonic Burger King Subway Dairy Queen Subway Taco Bell Sonic Taco Bell Dominos McDonalds

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

Product type Advertising exposure

Lunch/dinner items Lunch/dinner items Value/combo meals Lunch/dinner items Lunch/dinner items Kids meals Lunch/dinner items Kids meals Value/combo meals Lunch/dinner items Branding only Value/combo meals Healthy options Lunch/dinner items Lunch/dinner items Value/combo meals Snacks Coffee drinks Value/combo meals Value/combo meals Snacks Value/combo meals Snacks Promotion only Promotion only Value/combo meals Kids meals Value/combo meals Lunch/dinner Items Snacks Snacks Promotion only 111 95 95 91 88 87 84 59 57 43 39 39 38 31 30 29 27 26 19 18 17 16 15 15 14 14 14 11 10 10 10 10

Targeted ratio: Teens to adults*

1.10 0.83 0.86 0.94 0.94 2.44 0.92 2.34 0.90 0.88 1.66 0.95 0.95 1.03 0.93 0.86 1.11 0.79 0.92 0.94 0.77 0.98 1.05 1.22 0.97 0.96 3.16 1.15 1.02 1.44 1.05 0.69

continued

Fast Food FACTS

157

Ranking Table 6
Rank

Least

33 34 35 36 37 38 39 40 41 42 43 44 45 46

Restaurant
Wendys Dunkin Donuts KFC McDonalds Burger King Burger King Dunkin Donuts McDonalds Dunkin Donuts Dairy Queen Subway Starbucks Taco Bell McDonalds

Product type Advertising exposure

Snacks Coffee drinks Healthy options Breakfast Snacks Breakfast Breakfast Snacks Healthy options Lunch/dinner items Snacks Coffee drinks Healthy options Healthy options 9 8 8 7 7 6 6 5 3 2 1 1 1 1

Targeted ratio: Teens to adults*

0.77 0.84 0.80 0.76 0.96 0.91 0.71 0.70 0.72 1.05 1.09 0.52 1.21 1.46

Most

Least

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Restaurant rankings Rank Restaurant Advertising exposure Targeted ratio: Teens to adults*
McDonalds Burger King Subway KFC Pizza Hut Taco Bell Wendys Dominos Sonic Dairy Queen Quiznos Papa Johns Arbys Popeyes Dunkin Donuts Jack in the Box Hardees Chick-Fil-A Starbucks Panera Bread 284 189 177 146 125 140 113 85 68 48 46 40 41 35 28 25 5 3 1 1 0.96 1.11 0.84 0.77 0.76 1.04 0.82 0.88 0.81 0.85 0.85 0.65 0.60 0.95 0.52 0.80 0.39 0.42 0.47 0.31

The Nielsen Company *Bold indicates higher than expected targeted ratios

Fast Food FACTS

158

Ranking Table 7

Television advertising exposure: African American and Hispanic youth

Ranking by ads viewed for African American children (ages 2-11 years) Includes average number of advertisements viewed by children and teens in 2009 on national (network, cable and syndicated) television for African American youth and by Hispanic preschoolers, children and teens on Spanish-language televison.
Advertising Targeted exposure: ratios: Advertising exposure: African American African American Spanish-language youth to white* TV (Hispanic youth) Children Teens Children Teens Preschoolers Children Teens 2-11 12-17 2-11 12-17 2-5 6-11 12-17 Rank Restaurant Product years years years years years years years Targeted ratios: Spanishlanguage TV (Hispanics) to all other TV (all persons)* Preschoolers Children Teens 2-5 6-11 12-17 years years years
0.09 0.19 0.44 0.17 1.03 1.03 0.58 0.12 0.76 0.33 0.65 0.73 1.02 1.10 0.72 0.66 0.27 1.03 0.06 0.13 0.24 0.10 0.62 0.66 0.36 0.07 0.46 0.18 0.35 0.40 0.64 0.75 0.46 0.37 0.15 0.72 0.12 0.24 0.11 0.04 0.2 0.29 0.15 0.17 0.32 0.1 0.26 0.19 0.43 0.39 0.26 0.18 0.08 0.28

Most

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

McDonalds Burger King McDonalds Pizza Hut Taco Bell KFC Dominos Burger King Wendys Subway McDonalds Subway Subway Sonic Dairy Queen McDonalds McDonalds Subway KFC Pizza Hut Burger King Wendys Dunkin Donuts Subway Sonic Burger King Dairy Queen

Kids meals Kids meals Branding only Lunch/dinner items Lunch/dinner items Value/combo meals Lunch/dinner items Lunch/dinner items Lunch/dinner items Kids meals Lunch/dinner items Value/combo meals Healthy options Value/combo meals Snacks Coffee drinks Value/combo meals Lunch/dinner items Lunch/dinner items Value/combo meals Value/combo meals Value/combo meals Snacks Promotion only Snacks Promotion only Value/combo meals

204 125 81 70 77 84 70 69 64 33 47 44 34 31 22 25 29 22 26 14 13 13 10 12 12 11 11

133 82 39 128 150 157 133 125 118 14 43 78 53 57 37 44 29 31 30 25 25 26 18 22 23 21 20

1.14 1.12 1.28 1.71 2.04 2.29 2.02 2.01 1.95 1.24 1.94 1.75 1.62 1.96 1.84 2.10 2.51 1.89 2.50 1.68 2.10 1.93 1.59 1.91 2.18 2.30 1.87

1.70 1.57 1.66 1.45 1.46 1.89 1.79 1.45 1.56 3.16 0.88 1.43 1.46 1.59 1.41 1.92 0.86 1.03 0.93 1.43 1.45 1.76 1.14 1.57 1.67 1.42 1.48

15 12 17 6 37 35 19 3 18 7 12 11 11 13 8 7 2 7

11 9 12 5 29 28 15 2 14 6 9 8 10 11 7 5 2 6

11 9 11 4 26 27 13 2 14 6 8 7 11 11 8 5 1 5

1.62

0.87

0.39

continued Fast Food FACTS

159

Ranking Table 7
Advertising Targeted exposure: ratios: Advertising exposure: African American African American Spanish-language youth to white* TV (Hispanic youth) Children Teens Children Teens Preschoolers Children Teens 2-11 12-17 2-11 12-17 2-5 6-11 12-17 Rank Restaurant Product years years years years years years years

Targeted ratios: Spanishlanguage TV (Hispanics) to all other TV (all persons)* Preschoolers Children Teens 2-5 6-11 12-17 years years years
0.64 0.66 2.00 0.46 0.39 1.07 0.31 0.24 0.5

Least

28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

McDonalds Dominos Sonic Taco Bell Wendys KFC Taco Bell McDonalds Burger King Dunkin Donuts McDonalds Dunkin Donuts Burger King McDonalds Dunkin Donuts Dairy Queen Subway Starbucks Taco Bell

Promotion only Snacks Lunch/dinner Items Value/combo meals Snacks Healthy options Snacks Breakfast Snacks Coffee drinks Snacks Breakfast Breakfast Healthy options Healthy options Lunch/dinner items Snacks Coffee drinks Healthy options

11 9 8 7 7 8 7 7 5 4 5 4 4 2 2 1 1 1 1

16 15 14 14 12 14 13 13 9 9 7 6 7 2 3 2 2 2 2

1.87 1.95 2.13 2.03 1.75 2.09 2.38 1.96 2.00 1.76 1.69 1.48 1.74 1.46 1.46 1.80 1.60 1.50 1.93

1.88 1.77 1.72 1.42 1.37 2.30 1.45 2.05 1.31 1.16 1.81 1.14 1.40 1.99 1.10 1.57 1.33 1.68 1.48

4 3 7

3 2 6

3 2 5

2 3

1 2

1 2

0.37 0.78

0.22 0.52

0.14 0.31

0.80

0.53

0.38

Most

Restaurant rankings Children Teens Children Teens Preschoolers Children Teens Preschoolers 2-11 12-17 2-11 12-17 2-5 6-11 12-17 2-5 Rank Restaurant Product years years years years years years years years

Children 6-11 years

0.15 0.13 0.16 0.13 0.17 0.26 0.39 0.29

Teens 12-17 years

0.18 0.12 0.13 0.07 0.09 0.13 0.24 0.17

Least

1 2 3 4 5 6 7 8 9 10 11 12

McDonalds Burger King Subway KFC Taco Bell Pizza Hut Wendys Dominos Sonic Dairy Queen Dunkin Donuts Starbucks

414 219 147 119 95 85 84 70 49 34 12 1

420 254 216 223 181 154 156 133 90 58 23 2

1.33 1.40 1.53 2.16 2.03 1.76 1.87 1.76 1.94 1.65 2.12 1.84

1.75 1.46 1.40 1.76 1.37 1.43 1.59 1.46 1.44 1.16 1.46 1.22

68 41 38 17 26 25 25 20

46 29 24 11 16 18 17 13

47 29 25 11 14 16 15 12

0.20 0.19 0.24 0.20 0.27 0.36 0.51 0.42

*Bold targeted ratios indicate higher than expected exposure for this group The Nielsen Company

Fast Food FACTS

160

Ranking Table 8

Radio advertising exposure

Ranking by advertising exposure for teens*
Advertising exposure Number of markets Teens Young adults Adults Rank Restaurant with advertising* 12-17 years 18-24 years 25-49 years

Most

Targeted ratio Teens to adults

0.73 1.12 0.76 0.74 0.68 0.66 0.56 0.58 0.73 0.70 0.62 0.68

Least

1 2 3 4 5 6 7 8 9 10 11 12

McDonalds Taco Bell Burger King Wendys Subway Dunkin Donuts Dairy Queen Sonic KFC Dominos Pizza Hut Starbucks

39 34 38 39 39 23 5 20 23 29 14 13

108 30 29 28 25 24 10 8 8 3 2 2

159 40 42 40 38 33 15 14 11 5 3 3

147 27 38 38 37 37 18 13 10 5 4 3

*Markets with a minimum of 100 GRPs for at least one age group (maximum 39 markets) The Nielsen Company; Arbitron Inc.

Fast Food FACTS

161

Restaurant website exposure

Ranking by average total visits per month by 2- to 17-year-olds*
Average unique visitors per month 2-11 years 12-17 years Average visits Average time Average pages Rank Restaurant Website (000) (000) per month spent (min) per month

Ranking Table 8 9

Most

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33

Dominos Pizza Hut McDonalds McDonalds McDonalds Burger King KFC Starbucks Wendys Subway Sonic Taco Bell Subway McDonalds Burger King Dunkin Donuts Dairy Queen Sonic Wendys Starbucks McDonalds McDonalds Dairy Queen Wendys Dairy Queen KFC Burger King Dairy Queen McDonalds Wendys Subway McDonalds McDonalds

Dominos.com PizzaHut.com HappyMeal.com McDonalds.com McWorld.com BurgerKing.com KFC.com Starbucks.com Wendys.com Subway.com SonicDriveIn.com TacoBell.com SubwayFreshBuzz.com McState.com ClubBK.com DunkinDonuts.com DairyQueen.com LimeadesForLearning.com WendysRealTime.com StarbucksStore.com McdonaldsMcCafeYourDay.com AboutMcDonalds.com DQSlowJam.com WendysKids.com DeeQs.com KFCScholars.org SimpsonizeMe.com BlizzardFanClub.com RMHC.org WendysHighSchoolHeisman.com MySubwayCard.com 365Black.com MeEncanta.com

175.6 195.3 189.3 98.1 100.9 41.8 34.9 33.9 34.4 27.2 43.4 16.0 17.7 9.5 35.2 25.6 27.9 1.4 3.2 12.4 8.9 2.1 8.3 9.9 3.4 3.7 1.5 4.4 4.7 0.9 1.8 0.3 1.3

256.8 242.4 58.2 160.4 27.0 55.8 50.5 54.5 52.0 53.7 37.4 51.1 34.2 53.4 14.7 32.1 20.4 22.2 19.0 7.0 1.9 13.5 5.9 1.8 6.0 4.5 6.2 4.3 4.1 3.5 3.6 5.0 3.5

1.3 1.2 1.8 1.3 1.8 1.3 1.3 1.2 1.2 1.2 1.1 1.3 1.6 1.3 1.6 1.2 1.1 1.1 1.1 1.2 1.7 1.1 1.1 1.2 1.2 1.3 1.3 1.1 1.1 1.9 1.3 1.1 1.2

5.1 7.6 6.1 2.1 3.2 2.0 2.2 3.6 2.2 3.1 2.6 2.2 5.4 2.4 7.5 3.4 3.4 5.4 1.8 3.0 1.8 1.3 0.1 3.1 3.2 0.7 1.6 2.0 2.1 1.0 3.6 1.1 1.5

11.6 14.0 8.5 5.7 4.7 4.0 5.6 6.5 4.8 5.2 6.4 5.2 16.9 8.0 13.1 7.3 6.1 4.8 2.1 5.7 2.2 2.8 1.4 2.8 3.4 2.1 2.1 2.6 3.9 2.9 4.2 2.4 2.6

continued Fast Food FACTS

162

 Average unique visitors per month 2-11 years 12-17 years Average visits Average time Average pages Rank Restaurant Website (000) (000) per month spent (min) per month

Ranking Table 8 9

Least

34 35 36 37 38 39 40

Starbucks Subway Taco Bell Taco Bell Dunkin Donuts Pizza Hut Sonic

MyStarbucksVisit.com SubwayKids.com TacoBellFoundationForTeens.org FeedTheBeat.com DunkinAtHome.com BookItProgram.com SonicDriveInStore.com

2.5 1.4 2.5 0.7 1.1 0.5 n/a

1.0 2.3 1.0 2.6 1.5 1.4 1.2

1.2 1.2 1.2 1.1 1.1 1.3 1.1

7.0 0.9 1.6 1.3 1.0 3.2 1.9

23.4 2.1 1.4 2.1 1.9 5.5 2.5

*Data retrieved from comScore Media Metrix Key Measures Report (January-December 2009) Includes all websites with available data from comScore

Fast Food FACTS

163

Banner advertising exposure by product

Ranking by total average ads viewed on youth websites per month*
Rank Restaurant Product(s) advertised in ad Contains Average Average child-targeted Ads viewed unique number of content on youth viewers per ads viewed (Yes/No) websites month (000) per month
N Y Y N Y N Y N N N N N N N N N N N N N N N N N N N N 20% 83% 57% 67% 97% 27% 62% 16% 12% 4% 11% 19% 12% 36% 3% 5% 39% 21% 8% 12% 11% 12% 1% 1% 0% 0% 0% 30,309.1 3,019.3 5,741.3 6,291.6 3,541.3 10,333.4 1,650.9 9,286.0 12,621.2 10,711.9 5,271.0 1,560.1 2,401.5 454.4 2,022.0 1,053.3 108.3 84.3 614.7 191.6 229.6 131.4 314.1 204.5 554.2 178.9 1,642.9 4.4 4.3 3.6 2.2 2.9 3.7 4.9 3.2 2 5.4 2.1 2.2 4.7 5.4 5.8 14.7 4.3 6.9 1.4 2.1 2.5 1.7 4.5 4 4.6 4.5 3.8

Ranking Ranking Table Table 10 8

Most

Total average ads viewed on youth websites per month (000)

27,285.3 13,463.7 11,696.8 11,360.0 11,199.5 10,759.2 5,166.1 4,975.2 2,917.5 2,263.7 1,277.5 1,231.8 735.8 692.6 384.4 196.8 111.6 97.3 74.2 65.3 59.0 32.2 12.7 6.5 0.0 0.0 0.0

Least

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

Wendys Burger King McDonalds KFC Dairy Queen McDonalds McDonalds McDonalds Pizza Hut Subway Burger King Wendys McDonalds Taco Bell McDonalds McDonalds Taco Bell Taco Bell Dunkin Donuts McDonalds Taco Bell Subway Dunkin Donuts McDonalds KFC McDonalds Subway

Hamburgers/sandwiches ClubBK.com Happy Meal Unthink (grilled chicken) DeeQs.com McCafe beverages LineRider.com Dollar Menu WingStreet wings Subway Fresh Buzz Menu ($1 Whopper Jr.) Frosty Snack Wrap Volcano Menu MeEncanta.com Chicken McNuggets Fruitista Freeze Value Menu Contest 365Black.com Fourth Meal SubwayKids.com Dunkin Donuts Card MyInspirAsian.com Pride 360 Chicken biscuit Subway Card

continued

Fast Food FACTS

164

Most

Restaurant rankings Contains Average Average Total average child-targeted Ads viewed unique number of ads viewed content on youth viewers per ads viewed on youth websites Rank Restaurant Product(s) advertised in ad (Yes/No) websites month (000) per month per month (000)

Ranking Ranking Table Table 10 8

Least

1 2 3 4 5 6 7 8 9 10 11 12

Dominos Pizza Hut McDonalds Wendys Burger King Dairy Queen Sonic KFC Dunkin Donuts Subway Starbucks Taco Bell

All ads All ads All ads All ads All ads All ads All ads All ads All ads All ads All ads All ads

N N Y N Y Y N N N N N N

33% 26% 25% 20% 28% 50% 26% 16% 3% 2% 4% 10%

70,937.1 69,617.5 49,027.2 30,744.2 14,570.5 3,541.3+ 10,204.4 7,939.4 28,916.7 15,490.6 14,689.0 2,138.7

7.0 7.6 5.5 4.4 3.4 n/a 3.2 4.9 4.2 10.1 2.9 4.9

181,115.6 141,634.3 67,802.6 27,657.2 13,832.1 12,423.6 8,067.0 7,589.0 3,381.9 3,101.6 2,212.7 1,168.6

*Data retreived from comScore Ad Metrix Advertiser Report (June 2009-March 2010)

Fast Food FACTS

165

Social media exposure

Ranking by sum of Facebook fans, Twitter followers and YouTube upload views
Rank Restaurant

Ranking Table 8 11

Most

Facebook fans (000)

11,353.4 1,820.2 1,770.8 2,636.8 1,653.2 538.5 1,619.7 3,088.1 1,414.8 978.4 n/a 297.0

Twitter followers (000)

989.2 55.1 35.2 39.5 15.1 14.4 7.8 22.8 31.3 10.2 n/a 7.2

YouTube upload views (000)

5,293.6 1,144.6 2,073.8 115.6 980.4 3,805.9 243.8 0.0 16.8 110.6 195.6 62.5

Least

1 2 3 4 5 6 7 8 9 10 11 12

Starbucks Dunkin Donuts Taco Bell McDonalds KFC Dominos Dairy Queen Subway Pizza Hut Wendys Burger King Sonic

Data as of July 30, 2010

Fast Food FACTS

166

Restaurant signs and nutritional quality

Ranking by number of featured menu items on signs per store
Rank Restaurant Signs per store Weighted average per menu item % of featured menu items with healthy NPI score
29% 4% 36% 16% 30% 35% 13% 17% 39% 65% 32% 10%

Ranking Table 12 8

Total calories
455 566 349 435 249 331 397 512 411 355 247 574

Sugar calories
105 204 124 53 131 147 112 38 60 47 115 51

Sat fat calories

71 103 58 75 22 23 62 80 53 37 26 103

Sodium (mg)
909 512 413 821 262 556 625 1,297 956 963 238 1,237

Most

Least

1 2 3 4 5 6 7 8 9 10 11 12

Wendys Dairy Queen McDonalds Burger King Dunkin Donuts Taco Bell Sonic Pizza Hut KFC Subway Starbucks Dominos

21.4 21.3 19.5 18.8 16.4 15.7 15.2 13.2 11.5 8.7 6.9 6.2

Fast Food FACTS

167

Table A1. Adjustments to restaurant menus for menu standardization

McDonalds

For the ten-piece chicken nuggets and the six-piece chicken strips, we included two packets of sauce, as one packet is typically consumed with the smaller serving sizes.

We included one-half of a dressing packet for side salads and one packet for main dish salads.

Subway provided nutrition data for most of its sandwiches with 9-grain wheat bread, lettuce, tomatoes, onions, green peppers and cucumbers, but no condiments. We included two versions of each sandwich: The healthiest version of the sandwich as presented in Subways nutrition facts; and the least healthy version, which included parmesan oregano bread, American cheese, and mayonnaise. If the sandwich listed in the nutrition facts included cheese, we did not add the extra cheese.

Subway

Egg sandwiches were offered with regular eggs or egg whites. We included these two versions of all egg sandwiches.

Subway did not provide nutrition information for its fountain beverages. Subways website indicated that it offered Coca Cola fountain beverages. We obtained nutrition information from cocacola.com and minutemaid.com for Subways fountain beverages.

Burger King

For the six-piece and eight-piece chicken tenders, the twelve-piece chicken fries, and the medium and large size onion rings, we included two packets of sauce, as one packet is typically consumed with the smaller serving sizes.

We included one-half of a dressing packet for side salads and one packet for main dish salads.

KFC

KFC listed all of its pieces of chicken individually. As it is unlikely that individuals dining at KFC consumed just one piece of chicken, we combined pieces to create two-piece entrees. The specications for plated meals on KFCs website were used as a guide.

We included one-half of a dressing packet for side salads and one packet for main dish salads.

Taco Bell

We used the MPEDS database to assess the fruit, vegetable, and nut content of Taco Bells menu items. The database provided the amount, in cups, of tomatoes, legumes (beans), and other vegetables (for the majority of Taco Bell items, this was assumed to be shredded lettuce) in each item. We converted cups into grams using the USDA National Nutrient Database and summed these numbers to determine an overall fruit, vegetable, and nut weight. Dividing this number by the total gram weight of the item, we were able to determine the percentage of each item that was fruit, vegetables, or nuts.

Sonic

The Chicken Strip Dinner included four chicken strips, fries, an onion ring, toast, and gravy. This dinner differed from other combo meals, as these items were always sold and advertised together. Thus, nutrition information is presented for the entire dinner.

We calculated the nutrition prole for the 4 oz. jumbo popcorn chicken with one dipping sauce and the 6 oz. size with two packets of sauce.

Dairy Queens Chicken Strip Basket, Iron Grilled Quesadilla Basket and Popcorn Shrimp Basket were always advertised and sold together. Thus, nutrition information is presented for the entire basket meal.

Dairy Queen did not provide nutrition information for dipping sauces available with kids chicken strips; therefore, we included one packet of ketchup in the nutrition information.

Dairy Queen

Dairy Queen did not include its kids size (12 oz) beverages on its January menu pdf. Therefore, we added a kids 12 oz. beverage to its kids meals. Nutrition information was calculated by computing 75% of the 16 ounce version.

One-half of a dressing packet was included in the nutrition prole for side salads, and one packet for main dish salads.

Dominos nutrition calculator on its website provided nutrition information for one slice of pizza. As a typical individual consumes more than 1 slice of pizza per meal, we calculated nutrition information for pizzas based on the following assumptions: A small pizza serves two people, a medium serves three, a large serves three and a half, and an extra large serves four. Similarly, Dominos provided nutrition information for two-liter sodas based on an 8 oz. serving size. We assumed that a typical person consumes 12 oz. as a typical serving and used this in our nutrition analysis.

Dominos nutrition calculator was able to calculate nutrition information for thousands of pizza topping combinations. We calculated nutrition information for all promoted specialty pizza combinations, as well as for regular cheese and pepperoni with regular cheese pizzas. For each topping combination and size, we provided nutrition information for the healthiest and least healthy crusts. If two crusts had the same NPI score, we used calories to determine the healthiest and least healthy varieties.

Appendix A

Dominos

We assumed that any items intended for family consumption (e.g., a bucket of wings) provided four servings, and calculated the nutrition proles based on this assumption. When dipping sauce was appropriate to include with the item, one-fourth of a serving of sauce was included. The only exception to this rule was for salads. Dominos listed salad nutrition information for a half bowl. We calculated salad nutrition information for an entire bowl plus one dressing.

Fast Food FACTS

Nutrition information for non-pizza options was from the January 2010 menu. All pizza nutrition data was obtained from Dominos website in April 2010, except the Americas Favorite Feast pizzas, which were obtained in May 2010 and healthy menu Lighter Options pizzas, which were obtained in June 2010.

We retrieved nutrition information for Coca Cola products and Minute Maid Orangeade at cocacola.com and minutemaid.com respectively. Dominos online nutrition calculator was not working properly during the collection of beverage nutrition information. A Dominos customer service representative referred us to these beverage websites for accurate beverage nutrition information.

168

Adjustments to restaurant menus for menu standardization

Pizza Hut provided nutrition information for one slice of pizza. As a typical individual consumes more than one slice of pizza per meal, we calculated nutrition information for pizzas based on the following assumptions: a medium pizza provided three servings and a large pizza provided four servings.

We assumed that any items intended for family consumption (e.g., a bucket of wings) provided four servings, and calculated the nutrition proles based on this assumption.

Pizza Hut

Tuscani pastas were an exception to this rule. Pizza Hut indicated that a single pan serves two; therefore, we assumed that one serving size was one-half a pan of pasta.

We also assumed that one-half of a PZone was a single serving and one Pizza Roller was a single serving, based on gram weight serving sizes indicated by Pizza Hut.

We added dipping sauces shown with one item proportionally. For example, for one-half of a PZone, we added one-half of a dipping sauce; and for one pizza roller which usually comes in a pack of four, we added one-fourth of a side of dipping sauce.

We included one-half of a dressing packet in the nutrition prole for side salads and one packet for main dish salads.

Wendys

We included two sauce packets with the ten-piece chicken nuggets and one packet with the ve-piece chicken nuggets.

No sauce was included with boneless wings.

Dunkin Donuts

Dunkin Donuts provided nutrition information per item (e.g., one donut); they did not provide serving sizes in grams. To calculate NPI scores, we purchased individual menu items from the local Dunkin Donuts and weighed them to obtain average serving sizes by weight.

All bagels are listed as two menu items: a plain bagel and a bagel with regular cream cheese.

Starbucks

Starbucks did not provide a pdf with nutrition information on its website. Researchers visited a local Starbucks to obtain brochures with nutrition information for beverages and foods available at Starbucks nationally.

Appendix A

Fast Food FACTS

169

Table A2. Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item Hamburger 100 114 92 92 68 89 71 236 236 200 355 355 355 355 355 355 355 29 165 123 123 89 71 236 236 200 473 Diet Coke Sprite Hi-C Orange Lavaburst 473 473 473 8 8 6.8 16 16 16 16 45 440 340 330 105 230 100 170 100 150 0 150 160 12 90 12 0 12 70 12 120 0.3 0.2 0.0 0.3 1.6 2.7 2.8 2.7 1.2 3.2 0.4 0.7 0.5 0.3 0.0 0.3 0.3 12 110 0.3 12 0 0.0 12 110 0.3 6.8 100 0.5 11% 8% 0% 8% 9% 5% 0% 6% 5% 11% 11% 8% 0% 8% 9% 8 170 0.7 11% 8 100 0.4 5% 2.5 3 0 0 0 0 0 0 0 0 1 23 19.5 17 0.5 11 2.5 3 0 0 0 0 0 230 3.2 11 105 1.2 0.5 0 1.5 1.5 1.5 0 0 0 0 0 0 0 0 0.5 11 3 3 0 1.5 1.5 1.5 0 0 0 0 0 35 0.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1.5 0 0 0 0 0 0 0 0 0 0 0 240 2.6 12 2 0 10 6 15 0 12 25 22 29 0 28 32 16 0 23 6 7 6 10 15 0 12 25 22 40 0 39 44 250 2.7 14.5 2 0 6 650 660 35 160 125 150 15 5 15 30 65 5 5 20 1,150 850 860 35 160 125 150 15 10 20 40 5 300 2.6 12 6 0.5 6 750 250 2.5 9 3.5 0.5 6 520 Cheeseburger Chicken McNuggets (4 piece) with hot mustard sauce Chicken McNuggets (4 piece) with barbeque sauce Apple dippers (without low fat caramel dip) Apple dippers with low fat caramel dip French fries- small 1% low fat milk jug 1% low fat chocolate milk jug Minute Maid apple juice box Coca-Cola Classic Diet Coke Sprite Hi-C Orange Lavaburst Powerade Moutain Blast Iced tea Sweet tea Kiddie coneb Double cheeseburger Chicken McNuggets (6 piece) with hot mustard sauce Chicken McNuggets (6 piece) with barbeque sauce Apple dippers with low fat caramel dip French fries- small 1% low fat milk jug 1% low fat chocolate milk jug Minute Maid apple juice box Coca-Cola Classic 2 2 2 0 0 0 3 0 1 0 0 0 0 0 0 0 0 0 2 2 0 0 3 0 1 0 0 0 0 0 Main Dish Main Dish Main Dish Main Dish Side Dish Side Dish Side Dish Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Dessert Main Dish Main Dish Main Dish Side Dish Side Dish Beverage Beverage Beverage Beverage Beverage Beverage Beverage

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 12 15 11 10 0 0 3 8 9 0 0 0 0 0 0 0 0 1 25 15 14 0 3 8 9 0 0 0 0 0 50 40 70 70 78 66 66 72 70 76 68 70 68 66 68 70 68 62 40 70 70 66 66 72 70 76 68 70 68 66

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Happy Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

Appendix A

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

Fast Food FACTS

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

170

Source: Menu composition analysis (January 2010)

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item Powerade Moutain Blast 473 473 473 29 101 150 1.5 1.5 0 0 3 45 1.6 1 0.5 0 6 16 120 0.3 6% 0 0 0 30 10 20 280 16 0 0.0 0% 0 0 0 0 10 16 100 0.2 4% 0 0 0 21 85 Iced tea Sweet tea Kiddie cone Kids' Veggie Delite sandwich (wheat bread, no cheese) 0 0 0 0 3 Beverage Beverage Beverage Dessert Main Dish

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 0 0 0 1 6 70 70 68 62 78

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

McDonald's

Mighty Kids Meal

Subway

Fresh Fit for Kids

Main Dish Main Dish Kids' turkey breast sandwich (wheat bread, no cheese) 138 190 1.4 2.5 Kids' roast beef sandwich (wheat bread, no cheese) 138 200 1.4 3

Subway 129 180 1.4 2.5

Fresh Fit for Kids Main Dish

Kids' black forest ham sandwich (wheat bread, no cheese) 0.5 1 0.5

0 0 0

4 4 4

670 500 610

3 4 3

10 15 12

72 78 76

Subway

Fresh Fit for Kids

Subway

Fresh Fit for Kids

Subway 107 180 1.7

Fresh Fit for Kids Main Dish

Kids' Veggie Delite sandwich (white bread, american cheese)

470

70

Subway 135 210

Fresh Fit for Kids Main Dish

Kids' black forest ham sandwich (white bread, american cheese) 1.6

2.5

860

12

64

Subway 144 230

Fresh Fit for Kids Main Dish

Kids' roast beef sandwich (white bread, american cheese)

1.6

6.5

690

17

68

Side Dish Side Dish Beverage Beverage Main Dish Main Dish Main Dish Main Dish Double hamburgerf Cheeseburgere Double cheeseburgerf Hamburgere Low fat milk 355 110 147 121 171 90 90 100% juice box 177 Yogurt Dannon light & t 170 6 12 Apple slices 71 -

Subway 144 -

Fresh Fit for Kids

Kids' turkey breast sandwich Main Dish (white bread, american cheese)

220 35 80 100 160 260 370 310 460 225 320

1.5 0.5 0.5 0.6 0.5 2.4 2.5 2.6 2.7 2.5 3.6

12% 5% -

6 0 0 0 3.5 11 19 15 27 11 26

2.5 0 0 0 2.5 4 8 7 13 2 4.5

0 0 0 0 2.5 0 1 0.5 1 0 0

5 7 11 21 17 5 5 6 6 10 1

800 80 15 180 520 550 740 990 365 540

1 2 0 0 0 1 1 1 1 0 0

14 0 5 0 12 14 23 16 27 9 10

66 72 70 76 72 50 46 40 38 48 42

Subway

Fresh Fit for Kids

Subway

Fresh Fit for Kids

Subway

Fresh Fit for Kids

Subway

Fresh Fit for Kids

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Appendix A

Burger King

BK Kids Meal

Fast Food FACTS

Chicken tenders (4 piece) with sweet and sour saucee Main Dish Chicken tenders (4 piece) with ranch saucee Main Dish

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Source: Menu composition analysis (January 2010)

171

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score

Burger King 149 360 2.4 16 3 0 20

BK Kids Meal

Chicken tenders (6 piece) with sweet and sour dipping sauce (2 packets)f Main Dish 570

14

48

Burger King Main Dish 113 53 71 74 235 235 196 355 471 355 471 355 471 355 471 92 103 135 88 88 71 142 244 251 Diet Coke Sprite 235 245 8 8 8 8 16 12 105 140 220 260 340 240 350 210 80 100 170 0 80 16 140 12 105 16 0 12 0 0.0 0.0 0.3 0.3 0.3 0.3 2.4 2.5 2.5 2.7 4.0 3.0 0.6 0.4 0.7 0.0 0.3 16 140 0.3 12 105 0.3 6.67 100 0.5 8 180 0.8 12% 11% 8% 8% 0% 0% 8% 8% 8% 8% 5% 11% 0% 8% 8 100 0.4 6% 0 2.5 0 0 0 0 0 0 0 0 0 8 11 15 13 30 10 0 2.5 2.5 0 0 220 3.0 11 70 1.0 0.5 25 0.5 0 0 0 2.5 0 1.5 0 0 0 0 0 0 0 0 0 3 5 3 3 5.5 2 0 1.5 1.5 0 0 160 1.4 5 1.5 Side Dish Side Dish Apple fries with caramel sauce Side Dish Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Main Dish Main Dish Main Dish Crispy chicken sandwich- kids' Chicken nuggets (4 piece) with sweet & sour nugget sauce Main Dish Chicken nuggets (4 piece) with Main Dish heartland ranch dipping sauce Side Dish Side Dish Beverage French fries- kids' Mandarin orange cup Nesquik low fat white milk Cheeseburger- kids' Hamburger- kids' Dr. Pepper Dr. Pepper Sprite Sprite Diet Coke Diet Coke Coca-Cola Classic Coca-Cola Classic Minute Maid apple juice Hershey's 1% low fat chocolate milk Hershey's fat free milk French fries- value Apple fries (without caramel sauce) Kraft macaroni and cheesee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.5 0 0 0 0 0 0 0 0 0

BK Kids Meal 149 550 3.7 31 8 0

Chicken tenders (6 piece) with ranch dipping sauce (2 packets)f Main Dish 2 5 5 10 0 13 29 21 29 39 0 0 29 39 29 39 5 5 4 11 1 0 17 12 28 0 20

920 340 35 340 150 140 15 11 15 23 30 26 35 500 700 680 500 600 190 15 120 160 10 20

0 1 1 1 2 0 1 0 0 0 0 0 0 0 0 0 1 1 2 0 0 3 1 0 1 0 0

16 7 0 0 2 9 9 0 0 0 0 0 0 0 0 0 12 15 15 9 9 3 1 8 8 0 0

40 66 80 74 52 72 70 76 68 68 70 70 68 68 68 68 48 42 62 42 38 68 76 72 68 70 68

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Burger King

BK Kids Meal

Wendy's

Kids' Meal

Wendy's

Kids' Meal

Wendy's

Kids' Meal

Wendy's

Kids' Meal

Wendy's

Kids' Meal

Appendix A

Wendy's

Kids' Meal

Wendy's

Kids' Meal

Beverage Beverage

Wendy's

Kids' Meal

Fast Food FACTS

Beverage Nesquik low fat chocolate milk

Wendy's

Kids' Meal

Wendy's

Kids' Meal

Wendy's

Kids' Meal

172

Source: Menu composition analysis (January 2010)

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item Coca-Cola Classic 245 236 246 247 247 245 235 234 324 113 113 64 78 99 99 198 35 473 473 473 473 473 473 473 473 473 473 53 59 42 85 Green beans Mashed potatoes with gravy Macaroni and cheese Potato wedges 98 153 137 102 16 16 16 16 16 16 16 0 200 220 200 160 200 220 120 150 80 290 25 130 180 260 16 200 16 200 16 220 170 4.9 0.5 0.4 0.4 0.0 0.4 0.5 0.4 0.3 0.4 0.5 2.3 2.5 1.9 3.4 0.3 0.8 1.3 2.5 370 1.9 210 2.1 200 2.0 170 2.2 12% 12% 11% 0% 11% 13% 11% 9% 11% 12% 200 3.1 6 160 1.4 19% 4 10 10 8 9 10 7 0 0 0 0 0 0 0 0 0 0 7 10 3.5 19 0 4.5 9 13 6 150 1.3 19% 4 8 60 0.2 5% 0 8 90 0.4 11% 0 0 0 2.5 2.5 5 3.5 3 4 3.5 0 0 0 0 0 0 0 0 0 0 0 1.5 2 1 3.5 0 1 3 2.5 8 0 0.0 0% 0 0 8 80 0.3 9% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 90 0.4 10% 0 0 0 8 90 0.4 10% 0 0 0 25 25 22 0 26 15 22 22 1 1 1 2 3 10 58 58 54 0 54 60 54 42 54 58 0 0 0 0 1 0 4 0 8 90 0.4 9% 0 0 0 22 8 0 0.0 0% 0 0 0 0 10 20 10 10 25 5 70 70 530 330 640 620 1,270 200 70 80 50 50 40 50 210 50 70 60 340 360 250 850 380 550 990 740 8 80 0.3 9% 0 0 0 22 Minute Maid light lemonade Hi-C Flashin Fruit Punch Barqs root beer Fanta orange Pibb Xtra Coke Zero Dr. Pepper Sweet tea Chocolate Frosty Jr. Vanilla Frosty Jr. Cheese roll-up Crunchy taco Chicken soft taco Soft taco - beef Bean burrito Cinnamon twists Mountain Dew Mug root beer Pepsi Diet Pepsi Sierra Mist Tropicana fruit punch Tropicana pink lemonade Lipton raspberry iced tea Dr. Pepper Mountain Dew Baja Blast Original recipe chicken drumstick 0 0 0 0 0 0 0 0 0 0 0 2 3 1 3 11 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 1 2 3 Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Main Dish Main Dish Main Dish Main Dish Main Dish Dessert Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kids' Meal Kid's Meal Kid's Meal Kid's Meal Kid's Meal Kid's Meal Kid's Meal Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Kid's Meal Beverages Main Dish

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 0 0 0 68 70 68 66 0 0 0 0 0 4 4 9 8 12 10 14 1 0 0 0 0 0 0 0 0 0 0 12 12 10 16 1 2 6 4 66 68 70 66 68 60 60 38 68 48 52 68 40 66 66 66 70 66 66 66 68 66 66 48 46 60 38 76 62 50 50

Wendy's

Wendy's

Wendy's

Wendy's

Wendy's

Wendy's

Wendy's

Wendy's

Wendy's

Wendy's

Wendy's

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

Taco Bell

KFC Kids Laptop Meal

KFC Kids Laptop Meal Main Dish Main Dish Side Dish Side Dish Side Dish Side Dish

Main Dish Extra crispy chicken drumstick Grilled chicken drumstick Popcorn chicken- kids'

Appendix A

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

Fast Food FACTS

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

173

Source: Menu composition analysis (January 2010)

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item 3" corn on the cob 71 146 130 128 130 54 21 177 473 473 473 473 473 473 473 473 473 473 473 473 473 473 473 473 473 473 473 473 473 Dr. Pepper Diet Dr. Pepper 7up 473 473 473 16 16 16 16 16 16 16 16 16 16 16 16 16 160 220 0 220 200 0 200 220 220 200 200 0 200 16 160 16 0 16 160 16 0 0.0 0.3 0.0 0.3 0.3 0.5 0.0 0.5 0.4 0.0 0.4 0.5 0.5 0.4 0.4 0.0 0.4 16 220 0.5 16 220 0.5 16 0 0.0 16 200 0.4 11% 0% 12% 12% 0% 9% 0% 9% 9% 12% 0% 13% 11% 0% 11% 13% 13% 11% 11% 0% 11% 16 200 0.4 12% 16 0 0.0 0% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16 200 0.4 11% 0 6 30 0.2 5% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 2.4 2.5 1.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 180 3.3 8 6 0 180 1.4 11 1.5 0 14 2 0 8 54 0 56 54 0 58 56 0 44 0 42 42 58 0 62 54 0 54 60 60 52 54 0 50 200 1.6 10 2 0 5 200 1.5 1.5 0 0 18 680 540 160 530 160 15 50 50 40 50 100 50 60 130 140 50 50 50 70 80 70 210 130 210 50 50 30 70 70 52 140 1.0 1 0 0 5 5 70 1.0 0.5 0 0 3 5.5" corn on the cob BBQ baked beans Potato salad Cole slaw Biscuit Sargento light string cheesec Capri Sun Roarin' Waters Tropical Fruit Pepsi Diet Pepsi Wild Cherry Pepsi Sierra Mist Diet Sierra Mist Mirinda strawberry Manzanita Sol Lipton Brisk tea Lipton Brisk lemon tea Lipton Brisk green with peach tea Lipton Brisk peach tea Lipton Brisk raspberry tea Mountain Dew Diet Mountain Dew Code Red Mountain Dew Tropicana lemonade 2 4 9 3 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Side Dish Side Dish Side Dish Side Dish Side Dish Side Dish Snack Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Tropicana sugar free lemonade Beverage Beverage Beverage Beverage Beverage Beverage Beverage Tropicana fruit punch Tropicana Twister orange Mug root beer Tropicana pink lemonade

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 2 5 8 2 1 4 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 86 86 78 62 72 24 36 68 66 70 66 66 70 66 66 70 66 70 68 68 66 70 66 66 70 66 66 66 66 66 70 66

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

KFC Kids Laptop Meal

Appendix A

KFC Kids Laptop Meal

KFC Kids Laptop Meal

Fast Food FACTS

KFC Kids Laptop Meal

KFC Kids Laptop Meal

Source: Menu composition analysis (January 2010)

174

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item Corn dog 74 117 98 98 110 120 96 71 44 68 244 244 278 267 273 275 279 282 Limeade 284 12 12 12 12 12 12 12 160 120 5 70 120 130 130 110 110 35 0.5 0.5 0.7 0.4 0.0 0.3 0.4 0.5 0.5 0.4 130 3.0 200 2.8 120 1.3 11% 0% 7% 11% 13% 10% 10% 110 0.9 0 0 8 8 0 2.5 2.5 0 0 0 0 0 0 0 380 3.5 20 8 0 0 1.5 1.5 0 1.5 1.5 0 0 0 0 0 0 0 328 3.3 24.8 4.2 0 0.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 290 3.0 18 3 0 5 0 6 15 23 0 0 7 12 25 31 1 19 29 35 27 29 310 2.6 15 5 0.5 7 610 660 712 1,010 60 270 270 130 210 10 5 60 15 15 20 25 210 2.8 11 3.5 0 4 530 Jr. burger Chicken strips (2 piece) with honey mustard sauce Chicken strips (2 piece) with ranch sauce Grilled cheese sandwich Fresh banana Apple slices with fat-free caramel dipping sauce French fries- small Tots- small Apple slices 1% milk 1% chocolate milk Hi-C fruit punch Minute Maid light lemonade Powerade Mountain Blast Minute Maid apple juice Minute Maid cranberry Minute Maid orange juice 2 3 1 1 2 3 2 2 1 2 0 0 0 0 0 0 0 0 0 Main Dish Main Dish Main Dish Main Dish Main Dish Side Dish Side Dish Side Dish Side Dish Side Dish Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 6 15 14 14 12 1 0 2 1 0 8 8 0 0 0 0 0 2 0 44 48 44 40 28 78 66 60 50 82 72 70 66 70 68 76 68 76 66

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Appendix A

Wacky Pack Kids' Meal Sonic

Fast Food FACTS

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Source: Menu composition analysis (January 2010)

175

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item Lo-cal diet lime limeade 273 290 277 286 284 344 345 342 336 335 335 335 335 335 336 335 335 336 Diet Coke 266 12 12 12 12 12 12 12 12 170 170 170 180 170 170 170 0 12 170 12 170 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.0 12 180 0.5 12 170 0.5 12 180 0.5 13% 13% 13% 14% 13% 13% 13% 13% 14% 13% 13% 14% 0% 12 170 0.5 13% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 120 0.4 11% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 140 0.5 12% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 10 0.0 0% 0 0 0 1 33 32 44 45 44 45 46 45 45 44 45 46 45 45 46 0 12 140 0.5 12% 0 0 0 36 30 10 30 25 25 30 25 30 25 30 30 25 30 30 30 25 45 10 12 5 0.0 0% 0 0 0 0 5 Cherry limeade Lo-cal diet cherry limeade Strawberry limeade 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Beverage Beverage Beverage Beverage Beverage Minute Maid cranberry limeade Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Bubble gum slush Minute Maid cranberry juice slush Powerade Mountain Blast slush Green apple slush Watermelon slush Blue coconut slush Orange slush Grape slush Cherry slush Strawberry real fruit slush Lime real fruit slush Lemon-berry real fruit slush Lemon real fruit slush

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70 66 70 66 66 66 66 66 66 64 66 66 66 66 64 66 66 64 70

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Appendix A

Wacky Pack Kids' Meal Sonic

Fast Food FACTS

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Source: Menu composition analysis (January 2010)

176

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item Diet Dr. Pepper 266 266 277 278 277 281 269 278 278 278 277 267 266 266 266 251 96 156 142 94 103 Applesauce 114 12 12 12 12 12 20 5 5 5 0 250 400 350 285 320 90 12 120 12 120 0.4 0.4 0.1 0.0 0.0 0.0 0.0 2.6 2.6 2.5 3.0 3.1 0.8 12 120 0.4 12 130 0.5 12 120 0.4 12% 13% 12% 12% 11% 2% 0% 0% 0% 0% 4% 6% 6% 15% 12 130 0.5 12% 0 0 0 0 0 0 0 0 0 0 0 14 18 14 10 13 0 12 110 0.4 11% 0 0 0 0 0 0 0 0 0 0 0 0 0 5 9 7 1 8 0 12 100 0.4 10% 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0.5 0.5 0 0 0 12 110 0.4 11% 0 0 0 30 29 29 34 33 35 33 32 30 5 0 0 0 0 4 9 8 2 2 17 10 25 5 10 10 15 15 5 770 920 680 880 1,020 30 12 5 0.0 0% 0 0 0 0 5 5 35 25 25 5 12 0 0.0 0% 0 0 0 0 55 Sprite Zero Coca-Cola Dr. Pepper Sprite Barq's root beer Fanta orange Minute Maid strawberry soda Mello Yello Ocean Water Sweet iced tea Cranberry tea Iced tea Raspberry iced tea Peach iced tea Diet green tea All-beef hot dog Original cheeseburger Original hamburger Chicken strips with ketchup Iron grilled cheese sandwich 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 2 1 3 Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Main Dish Main Dish Main Dish Main Dish Main Dish Side Dish

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 19 17 16 13 0 70 70 66 66 66 66 66 66 66 66 66 70 70 70 70 70 40 40 44 46 70 78

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Wacky Pack Kids' Meal Sonic

Dairy Queen

DQ Kids Meal

Appendix A

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Fast Food FACTS

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

177

Source: Menu composition analysis (January 2010)

Kids' meal menu items and their nutrient information

Healthy Artical NPI score sweetenersa Part of kids' meal Individual item French fries- kids' 71 360 353 353 365 364 353 365 361 360 365 93 93 93 86 86 87 87 87 88 87 85 210 210 190 220 240 240 150 1.7 2.8 2.8 2.5 2.4 2.4 2.2 140 1.6 190 2.0 190 2.0 190 2.0 19% 19% 19% 19% 17% 23% 23% 25% 23% 23% 21% 12 142.5 0.4 10% 0 8 9 9 4 4.5 15 15 13 12 11 5 12 120 0.3 9% 0 12 120 0.3 10% 0 12 135 0.4 10% 0 0 0 0 0 3.5 4.5 6 2.5 3 9 9 10 8 9 3 12 120 0.3 9% 0 0 0 0 0 0 0 0 1.5 0.5 0 0 0 0 0 0 0 0 12 112.5 0.3 9% 0 0 0 12 0 0.0 0% 0 0 0 0 32 32 36 35 32 38 18 18 18 16 15 20 20 22 20 20 18 12 0 0.0 0% 0 0 0 0 12 120 0.3 9% 0 0 0 33 30 8 23 30 30 30 49 41 60 65 65 65 60 70 70 70 95 80 105 135 12 120 0.3 9% 0 0 0 32 8 190 2.7 0% 8 1 0 0 400 Coca-Cola Classic Pepsi Diet Coca-Cola Diet Pepsi Sprite Sierra Mist Barqs root beer Mug root beer Dr. Pepper Mountain Dew 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 Side Dish Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage Beverage
d Dessert Chocolate dipped cone - kids'

Restaurant

Meal name

Energy density beverages Serving Serving Total calories Energy density NPI (% sugar by Total Saturated Trans Sugar Sodium Fiber Protein size (g) size (oz) (Kcal) (kcal/g) weight) fat (g) fat (g) fat (g) (g) (mg) (g) (g) Score 2 0 0 0 0 0 0 0 0 0 0 4 4 4 4 4 4 4 3 3 3 4 58 68 66 70 70 68 68 66 66 68 66 56 54 46 58 58 36 36 32 36 32 56

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen Dessert Dessert Dessert Dessert Dessert Dessert Dessert Dessert Dessert Dessert DQ sandwichd Butterscotch Dilly Bad Cherry Dilly Bard Heath Dilly Bard Chocolate Dilly Bard Chocolate mint Dilly Bard Chocolate coned- kids' Vanilla coned- kids' Cherry dipped coned- kids' Butterscotch dipped conedkids'

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Dairy Queen

DQ Kids Meal

Items with articial sweeteners were excluded from the analysis

McDonald's desserts are not included in the Kids' Meal

KFC Kid's Meals include a snack item

Dairy Queen Kids Meals include a dessert

Item comes with a 12 oz. soft drink

Item comes with a 16 oz. soft drink

Appendix A

Fast Food FACTS

Source: Menu composition analysis (January 2010)

178

Table B1. Exposure data by demographic group

GRPs by age group

GRPs: 2008 6-11 years 31,683 13,184 16,792 8 7,001 5,606 8,207 1,525 6,334 3,407 3,659 1,178 2,836 180 14 3,113 2,578 475 2,748 1,203 75 2,098 5,292 6,473 6,980 1,979 729 901 1,545 4,700 5,547 6,899 5,963 6,143 6,121 19 33 73 38 1,992 1,914 238 1,814 1,422 270 371 580 171 5,882 6,761 6,886 3,547 1,921 2,247 2,620 1,128 6,522 7,196 8,956 1,604 6,880 7,786 7,990 2,744 3,723 2,178 1,353 4,591 187 39 2,678 2,246 346 2,484 1,936 12,037 14,062 16,427 6,154 7,774 3,354 3,812 4,123 1,127 1,483 15,850 17,910 19,191 5,433 6,919 13,023 14,866 12,738 5,048 6,875 14,021 12,473 2,751 14,587 6,839 4,083 2,473 8,487 271 61 4,766 4,025 523 4,610 3,467 13,739 14,501 13,107 4,610 5,830 11,271 12 13 35 71 72 136 17,720 16,266 14,578 15,173 18,490 18,925 17,152 17,303 18,896 9,688 12,723 17,714 24,009 19,761 23,364 30,914 36,785 28,424 24,595 18,432 18,053 187 13,088 15,338 14,152 3,379 16,917 7,683 4,787 2,865 9,297 391 81 5,221 4,834 641 5,185 3,548 12-17 years 18-24 years 25-49 years 2-5 years 6-11 years 12-17 years 18-24 years GRPs: 2009 25-49 years 29,523 20,964 17,013 290 13,678 13,501 16,377 5,310 18,851 8,414 6,799 3,088 9,643 643 197 5,614 6,212 1,329 5,435 3,655

Restaurant 27,511 10,460 13,911 7 5,013 4,185 6,496 1,118 4,995 2,471 2,605 1,006 2,298 147 7 2,149 2,056 313 2,122 1,040

2-5 years

McDonald's

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin' Donuts

KFC

Sonic

Arby's

Jack in the Box

Domino's

Chick-Fil-A

Panera Bread

Dairy Queen

Papa John's

Hardee's

Quiznos

Popeyes

Twelve restaurants 89,909 97,881 120,833 169,578 181,972 111,729 155,148 164,050

80,613

99,694

135,620

139,183

143,456 173,087 197,943

86,502 94,831 102,138

107,944 118,714 127,163

140,395 159,908 172,281

146,343 168,675 184,085

159,179 186,536 209,521

Top 20 fast food restaurants

All fast food restaurants

Appendix B

Source: The Nielsen Company

Fast Food FACTS

179

GRPs by age group

Spanish-language GRPs: 2008 6-11 years 4,606 2,395 2,922 1,795 1 1,578 1,112 1,330 10 1,700 12 661 2,680 1,023 1,181 12 24 28 41 2,509 1,516 2,595 3,585 3,713 14 22 39 140 145 2,943 28 2,027 1,217 1,880 2,866 2,024 1,532 1,103 1,755 2,379 1,507 1,112 1,058 1,386 304 2,615 35 1,990 1,446 2,447 3,749 1,971 1,376 1,239 2 2 3 0 0 0 1,628 2,526 3,695 2,603 2,089 1,738 2,890 4,225 5,939 3,522 2,828 2,678 4,019 2,663 1 1,981 1,669 2,059 271 3,870 94 2,817 2,463 3,696 5,345 3,122 2,451 2,714 3,827 4,697 7,049 9,974 7,889 6,379 6,434 9,262 12-17 years 18-24 years 25-49 years 2-5 years 6-11 years 12-17 years 18-24 years Spanish-language GRPs: 2009 25-49 years 13,462 5,233 5,976 4,228 1 2,972 2,563 3,395 209 5,839 95 4,244

Restaurant 6,779 3,846 4,123 2,490 1 2,635 1,681 2,012 17 2,453 11 810

2-5 years

McDonald's

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin' Donuts

KFC

Sonic

Arby's

Jack in the Box

Domino's

Chick-Fil-A

Panera Bread

Dairy Queen

Papa John's

Hardee's

Quiznos

Popeyes

Twelve restaurants 26,859 26,859 18,122 19,666 27,244 18,122 19,666 27,244

26,020

17,439

16,962

26,174

37,534 38,782 38,782

26,351 29,042 29,042

20,710 22,911 22,911

19,862 22,191 22,191

29,352 32,534 32,534

43,670 48,218 48,218

Top 20 fast food restaurants

All fast food restaurants

Source: The Nielsen Company

Appendix B

Fast Food FACTS

180

GRPs by race
GRPs: 2008 12-17 years White 2,139 14,502 9,857 1,899 26,599 2,051 5,187 3,925 5,881 3,659 783 7 13 10 18 14 53 30 86 57 3,625 2,484 4,025 3,017 3,264 2,183 1,234 775 2,274 181 15,312 11,196 16,862 13,397 15,104 10,705 9,542 4,788 18,100 19,273 13,525 21,976 15,795 23,478 15,872 8,518 4,991 15,419 10,649 12,490 1,977 108 16,148 9,152 18,341 11,131 19,521 11,678 11,915 5,140 22,348 11,721 19,177 12,073 19,653 13,389 17,840 11,714 8,414 4,362 15,611 9,918 7,836 5,447 8,668 6,291 8,111 5,164 4,912 2,438 9,027 5,595 9,598 17,017 24,142 16,901 18,465 2,888 237 32,448 18,516 27,957 14,349 25,818 15,007 41,397 30,404 42,020 21,783 36,523 6,890 4,715 7,773 5,652 7,446 5,218 6,982 3,455 13,297 7,423 14,081 19,661 14,022 19,334 14,326 18,698 13,450 14,677 9,209 21,641 14,570 21,378 15,312 8,429 18,286 6,419 12,041 14,178 12,431 13,983 2,577 161 23,570 16,116 21,088 15,411 19,145 13,624 21,900 15,796 25,354 17,203 23,574 16,639 6,063 5,232 6,387 5,394 6,085 4,568 3,407 1,844 5,821 4,064 6,167 4,474 African American White White White White White White 5,829 21,529 20,884 14,287 34,576 9,521 17,092 25,259 19,194 16,451 3,238 320 African American African American African American African American African American African American 18-24 years 25-49 years 2-11 years 12-17 years 18-24 years 25-49 years White 4,057 15,311 15,045 8,689 19,762 5,877 11,649 14,464 13,373 11,506 2,722 224 GRPs: 2009

2-11 years

Restaurant

African American

Dairy Queen

3,524

Burger King

20,268

Subway

15,096

Domino's

3,346

McDonald's

35,412

Sonic

3,971

Wendy's

9,699

KFC

8,479

Pizza Hut

10,362

Taco Bell

7,413

Dunkin' Donuts

1,663

Starbucks

12

Twelve restaurants 83,261 87,677 197,776 135,665 205,425 146,840 203,197 139,061 149,945 189,186 127,691 193,616 136,405 187,413 126,831 144,864

119,245

76,488

170,016

112,488

172,082

118,164

164,563

109,214

132,984

83,259 88,985 92,525

191,092 212,781 220,070

117,500 131,096 137,007

190,971 214,008 222,840

124,929 140,767 147,963

188,179 211,605 222,659

122,679 138,127 146,639

Top 20 fast food restaurants

130,418

All fast food restaurants

136,742

Source: The Nielsen Company

Appendix B

Fast Food FACTS

181

Table B2. Content analysis of general audience TV ads

Selling points in general audience TV ads

Value/cheap 13% 49% 42% 0% 33% 42% 82% 60% 70% 61% 83% 25% 47% 2% 30% 19% 13% 0% 19% 81% 0% 0% 9% 35% 4% 17% 0% 1% 4% 9% 9% 9% 0% 2% 15% 23% 13% 0% 0% 12% 8% 0% 0% 3% 26% 21% 47% 5% 2% 7% 9% 28% 0% 2% 0% 8% 13% 0% 0% 0% 5% 0% 63% 43% 6% 0% 0% 0% 13% 25% 0% 0% 0% 0% 12% 27% 18% 0% 0% 4% 82% 8% 8% 0% 18% 3% 0% 50% 7% 2% 3% 0% 0% 4% 0% 31% 4% 0% 31% 3% 7% 1% 3% 5% Health/nutrition Quality food Comparison/ unique Filling/ lots of food Convenience Low-fat/Low-cal Helping the community Limited time special offers 19% 32% 25% 50% 7% 28% 29% 20% 23% 13% 39% 25% 23%

Restaurant 16% 36% 13% 38% 35% 61% 53% 20% 53% 41% 57% 38% 36%

Total # ads

New/improved

McDonald's

86

Subway

78

Burger King

67

Starbucks

Wendy's

54

Taco Bell

43

Pizza Hut

38

Dunkin' Donuts

25

KFC

47

Sonic

85

Domino's

23

Dairy Queen

16

Total ads

570

Source: Television advertising content analysis 2009

Product associations in general audience TV ads

Fun/cool 35% 23% 19% 13% 17% 21% 21% 4% 6% 6% 4% 0% 17% 94% 58% 83% 62% 53% 56% 26% 3% 0% 2% 0% 0% 13% 2% 61% 0% 72% 0% 50% 0% 84% 5% 40% 1% 0% 5% 0% 2% 0% 0% 4% 6% 0% 0% 13% 3% 46% 1% 7% Humor Adults as negative Family bonding

Restaurant 2% 19% 2% 0% 2% 5% 0% 4% 4% 0% 0% 0% 4%

Total # ads

Physical activity

McDonald's

86

Subway

78

Burger King

67

Starbucks

Wendy's

54

Taco Bell

43

Pizza Hut

38

Dunkin' Donuts

25

KFC

47

Sonic

85

Domino's

23

Appendix B

Dairy Queen

16

Total ads

570

Fast Food FACTS

Source: Television advertising content analysis 2009

182

Target audience in general audience TV ads

Male 26% 37% 45% 13% 54% 54% 24% 28% 23% 44% 44% 50% 38% 8% 34% 40% 8% 1% 0% 38% 25% 19% 0% 0% 39% 57% 0% 0% 11% 18% 59% 6% 0% 17% 47% 36% 6% 2% 2% 0% 0% 0% 1% 16% 28% 44% 8% 0% 0% 8% 53% 50% 5% 0% 0% 5% 16% 51% 2% 0% 0% 4% 32% 35% 2% 0% 0% 0% 38% 13% 0% 0% 0% 38% 50% 19% 29% 20% 40% 7% 26% 6% 28% 5% 28% 49% 0% 0% 3% 24% 5% 30% 24% 10% 0% 1% 36% 15% 50% 25% 23% 8% 2% 33% Female Both White Black Hispanic Asian Multi-ethnic

Restaurant

Total # ads

McDonald's

86

Subway

78

Burger King

67

Starbucks

Wendy's

54

Taco Bell

43

Pizza Hut

38

Dunkin' Donuts

25

KFC

47

Sonic

85

Domino's

23

Dairy Queen

16

Total ads

570

Source: Television advertising content analysis 2009

Featured third parties, brand characters, and spokespeople in general audience TV ads
Spokesperson 1% 6% 2% 0% 2% 2% 0% 0% 6% 1% 17% 0% 3% 6% 0% 0% 1% 0% 0% 88% 7% 0% 0% 4% 0% 0% 0% 5% 0% 2% 9% 7% 2% 0% 0% 4% 6% 0% 0% 6% 0% 0% 0% 10% 25% 21% 19% 0% 4% 7% 2% 5% Celebrities Brand characters Movie/TV/ video games Licensed characters 2% 0% 9% 0% 0% 0% 0% 0% 2% 0% 0% 0% 2% Charities 3% 0% 2% 25% 6% 2% 3% 0% 0% 2% 0% 31% 3% Other sports 0% 3% 3% 0% 0% 9% 0% 0% 6% 0% 0% 0% 2% Other entertainment 13% 13% 2% 0% 4% 5% 3% 4% 11% 9% 4% 0% 7% Other food brands 6% 12% 19% 0% 0% 9% 11% 4% 15% 12% 9% 6% 9%

Restaurant

Total # ads

McDonald's

86

Subway

78

Burger King

67

Starbucks

Wendy's

54

Taco Bell

43

Pizza Hut

38

Dunkin' Donuts

25

KFC

47

Sonic

85

Domino's

23

Appendix B

Dairy Queen

16

Total ads

570

Fast Food FACTS

Source: Television advertising content analysis 2009

183

Eating behaviors in general audience TV ads

Restaurant 17% 24% 15% 0% 17% 30% 34% 32% 32% 35% 13% 31% 25% 47% 5% 12% 1% 9% 21% 19% 13% 0% 0% 0% 6% 0% 2% 13% 4% 9% 0% 0% 4% 0% 58% 0% 1% 1% 54% 1% 2% 66% 4% 11% 0% 0% 51% 0% 0% 0% 4% 0% 1% 44% 0% 8% 0% 0% 40% 8% 0% 63% 13% 24% 0% 0% 29% 0% 0% 44% 0% 12% 0% 0% 30% 0% 2% 56% 9% 28% 0% 0% 19% 0% 2% 0% 0% 0% 0% 0% 6% 0% 0% 2% 13% 13% 0% 0% 0% 25% 0% 0% 0% 34% 2% 18% 0% 2% 18% 3% 0% 2% 18% 3% 5% 0% 3% 6% 0% 0% 4% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 69% 14% 15% 2% 5% 36% 3% 1% 1% 2%

Total # ads

Food as Family meals primary focus In restaurant In the car Breakfast Lunch Anytime Snack

Food is consumed

At the table (not in restaurant) Front of TV/ computer Consumed other place

Unclear time 51% 17% 34% 25% 50% 42% 55% 40% 53% 41% 13% 19% 39%

McDonald's

86

2%

Subway

78

0%

Burger King

67

2%

Starbucks

0%

Wendy's

54

2%

Taco Bell

43

0%

Pizza Hut

38

5%

Dunkin' Donuts

25

4%

KFC

47

9%

Sonic

85

1%

Domino's

23

0%

Dairy Queen

16

0%

Total ads

570

2%

Source: Television advertising content analysis 2009

Appendix B

Fast Food FACTS

184

Table B3. Content analysis of child-targeted TV ads

Selling points in child-targeted TV ads

Value/cheap 0% 0% 0% 0% 2% 14% 2% 0% 0% 2% 0% 22% 0% 0% 0% 0% 33% 100% 33% 0% 0% 0% 0% 0% 0% 0% 0% 3% 0% 0% 4% 2% Health/ nutrition Quality food Comparison/ unique Convenience Low-fat/Low-cal Filling/ lots of food Helping the community Limited time special offers 48% 33% 70% 54%

Restaurant 3% 0% 4% 4%

Total # ads

New/improved

McDonald's

31

Subway

Burger King

23

Total ads

57

Source: Television advertising content analysis 2009

Product associations in child-targeted TV ads

Fun/cool 69% 33% 57% 63% 56% 28% 5% 91% 65% 9% 33% 0% 0% 31% 3% 3% Humor Adults as negative Family bonding

Restaurant 0% 67% 4% 5%

Total # ads

Physical activity

McDonald's

31

Subway

Burger King

23

Total ads

57

Source: Television advertising content analysis 2009

Target audience in child-targeted TV ads

Male 39% 0% 9% 26% 19% 40% 53% 17% 74% 74% 33% 0% 33% 0% 0% 4% 21% 21% 36% 7% Female Both White Black Hispanic 0% 0% 0% 0% Asian 3% 0% 0% 2% Multi-ethnic 38% 0% 22% 28%

Restaurant

Total # ads

McDonald's

31

Subway

Burger King

23

Total ads

57

Source: Television advertising content analysis 2009

Featured third parties, brand characters and spokespeople in child-targeted TV ads

Celebrities Brand characters 0% 0% 0% 0% 0% 0% 4% 7% Movie/TV/ video games 38% 0% 44% 37% Licensed characters 28% 0% 44% 32% Charities 0% 0% 0% 0% Other sports 3% 0% 0% 2% Other entertainment 28% 67% 22% 26% Other food brands 3% 0% 70% 32%

Restaurant 0% 0% 0% 0%

Total # ads

Spokesperson

McDonald's

31

Appendix B

Subway

Burger King

23

Total ads

57

Fast Food FACTS

Source: Television advertising content analysis 2009

185

Eating behaviors in child-targeted TV ads

Total # ads 0% 0% 0% 0% 74% 11% 35% 4% 2% 21% 0% 0% 0% 0% 2% 83% 4% 48% 4% 4% 22% 0% 0% 0% 0% 4% 33% 33% 0% 0% 0% 0% 0% 0% 0% 0% 0% 72% 14% 31% 3% 0% 24% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Family meals Breakfast Lunch Dinner Late at night Anytime

Food as primary focus Food is consumed In restaurant Consumed In the car other place

At the table (not in Front of TV/ restaurant) computer

Snack Unclear time 66% 0% 61% 60%

McDonald's

31

3%

Subway

0%

Burger King

23

13%

Total ads

57

7%

Source: Television advertising content analysis 2009

Appendix B

Fast Food FACTS

186

Table B4. Content analysis of Spanish-language TV ads

Selling points in Spanish-language TV ads

Value/cheap 11% 38% 50% 50% 100% 70% 100% 31% 91% 48% 1% 34% 5% 16% 1% 0% 9% 0% 23% 5% 0% 0% 0% 0% 0% 0% 0% 0% 14% 0% 0% 40% 10% 20% 0% 0% 14% 0% 0% 6% 0% 0% 0% 0% 0% 0% 0% 80% 20% 0% 0% 0% 0% 19% 13% 44% 0% 0% 6% 81% 0% 31% 0% 44% 13% 0% 0% 0% 0% 0% 0% 0% 5% 0% 43% 6% 3% 0% 0% 11% Health/nutrition Quality food Comparison/ unique Convenience Low-fat/Low-cal Filling/ lots of food Helping the community Limited time special offers 17% 6% 6% 10% 0% 20% 43% 8% 27% 16%

Restaurant 11% 50% 13% 40% 100% 60% 100% 23% 73% 40%

Total # ads

New/improved

McDonald's

35

Subway

16

Burger King

16

Wendy's

10

Taco Bell

Pizza Hut

10

KFC

Sonic

13

Domino's

22

Total ads

131

Source: Television advertising content analysis 2009

Product associations in Spanish-language TV ads

Fun/cool 34% 69% 44% 30% 0% 0% 57% 39% 14% 34% 40% 1% 59% 0% 0% 0% 29% 0% 20% 0% 100% 0% 50% 0% 0% 23% 9% 8% 70% 0% 0% 88% 6% 13% 38% 0% 6% 17% 0% 6% Humor Adults as negative Family bonding

Restaurant 6% 31% 6% 10% 0% 10% 0% 8% 14% 11%

Total # ads

Physical activity

McDonald's

35

Subway

16

Burger King

16

Wendy's

10

Taco Bell

Pizza Hut

10

KFC

Sonic

13

Domino's

22

Total ads

131

Source: Television advertising content analysis 2009

Appendix B

Fast Food FACTS

187

Target audience in Spanish-language TV ads

Male 23% 6% 69% 50% 100% 20% 14% 46% 23% 31% 14% 39% 1% 0% 80% 1% 5% 46% 0% 0% 64% 0% 8% 46% 0% 0% 100% 0% 29% 57% 0% 0% 100% 0% 0% 30% 10% 0% 40% 0% 0% 0% 0% 0% 100% 0% 0% 0% 0% 0% 9% 2% 10% 10% 0% 0% 6% 10% 0% 13% 13% 0% 0% 94% 0% 0% 0% 63% 0% 0% 69% 0% 0% 31% 43% 0% 0% 94% 0% 3% Female Both White Black Hispanic Asian Multi-ethinic

Restaurant

Total # ads

McDonald's

35

Subway

16

Burger King

16

Wendy's

10

Taco Bell

Pizza Hut

10

KFC

Sonic

13

Domino's

22

Total ads

131

Source: Television advertising content analysis 2009

Featured third parties, brand characters and spokespeople in Spanish-language TV ads

Spokesperson 0% 0% 13% 0% 0% 0% 0% 0% 0% 2% 0% 2% 4% 0% 0% 9% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 0% 0% 6% 6% 6% 0% 0% 0% 0% 0% 6% 6% 0% Celebrities Brand characters Movie/TV/ video games Licensed characters Charities 0% 13% 0% 0% 0% 0% 0% 0% 0% 2% Other sports 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Other entertainment 17% 0% 0% 0% 0% 0% 0% 0% 0% 5% Other food brands 6% 25% 0% 0% 0% 0% 0% 0% 5% 5%

Total # ads

McDonald's

35

Subway

16

Burger King

16

Wendy's

10

Taco Bell

Pizza Hut

10

KFC

Sonic

13

Domino's

22

Total ads

131

Source: Television advertising content analysis 2009

Appendix B

Fast Food FACTS

188

Eating behaviors in Spanish-language TV ads

Total # ads 29% 50% 13% 30% 0% 70% 14% 0% 18% 27% 43% 11% 9% 2% 1% 24% 2% 0% 1% 27% 0% 14% 5% 0% 18% 0% 0% 5% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 57% 0% 14% 0% 14% 29% 0% 0% 0% 0% 40% 0% 0% 10% 0% 30% 0% 0% 0% 0% 100% 0% 0% 0% 0% 100% 0% 0% 0% 0% 50% 0% 40% 0% 0% 10% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 19% 0% 6% 0% 0% 13% 0% 0% 0% 0% 0% 63% 63% 0% 0% 0% 19% 0% 0% 0% 0% 0% 63% 11% 9% 3% 0% 43% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Family meals Breakfast Lunch Dinner Late at night Anytime

Food as primary focus Food is consumed In restaurant Consumed In the car other place

At the table (not in Front of TV/ restaurant) computer

Snack Unclear time 51% 56% 13% 50% 100% 40% 14% 0% 9% 33%

McDonald's

35

3%

Subway

16

6%

Burger King

16

6%

Wendy's

10

0%

Taco Bell

0%

Pizza Hut

10

0%

KFC

14%

Sonic

13

0%

Domino's

22

5%

Total ads

131

4%

Source: Television advertising content analysis 2009

Appendix B

Fast Food FACTS

189

Table B5. Nutritional quality of TV ads by age and race or ethnicity

Nutritional quality of TV ads: By age

Preschoolers ( 2-5 years) Calories per ad 459 1,310 407 488 725 796 636 570 745 780 251 582 1,111 40% 481 49% 643 100% 953 59% 1,373 82% 1,523 78% 1,704 95% 1,835 94% 22% 23% 28% 17% 40% 53% 36% 37% 1,390 14% 21% 608 19% 37% 2,039 37% 65% 804 20% 38% Sodium per ad % unhealthy products % of calories from sugar and saturated fat Calories viewed per day 281 188 155 102 93 78 76 66 46 34 5 1,124

Restaurant

McDonald's

KFC

Burger King

Subway

Pizza Hut

Domino's

Wendy's

Taco Bell

Sonic

Dairy Queen

Dunkin' Donuts

Total ads

Children (6-11 years) Calories per ad 457 1,242 407 493 728 799 631 566 763 777 249 582 1,518 1,367 978 623 472 1,122 1,707 1,843 1,399 607 2,008 800 Sodium per ad % unhealthy products 23% 38% 19% 14% 94% 95% 79% 83% 58% 100% 50% 42% % of calories from sugar and saturated fat 38% 62% 37% 21% 22% 23% 28% 17% 40% 54% 36% 36% Calories viewed per day 330 227 192 137 119 103 95 92 65 47 6 1,414

Restaurant

McDonald's

KFC

Burger King

Subway

Pizza Hut

Domino's

Wendy's

Taco Bell

Sonic

Dairy Queen

Dunkin' Donuts

Appendix B

Total ads

Fast Food FACTS

Source: The Nielsen Company; Menu composition analysis (January 2010)

190

Nutritional quality of TV ads: By age

Teens (12-17 years) Calories per ad 1,196 454 635 730 570 439 789 626 752 775 241 657 1,336 61% 453 48% 632 100% 959 61% 1,491 79% 1,691 95% 23% 27% 41% 53% 36% 34% 742 43% 30% 1,374 83% 17% 1,847 94% 22% 1,854 19% 20% 821 52% 35% 1,967 40% 61% Sodium per ad % unhealthy products % of calories from sugar and saturated fat Calories viewed per day 431 248 239 226 208 191 190 187 124 87 13 2,144

Restaurant

KFC

McDonald's

Subway

Pizza Hut

Taco Bell

Burger King

Domino's

Wendy's

Sonic

Dairy Queen

Dunkin' Donuts

Total ads

Source: The Nielsen Company; Menu composition analysis (January 2010)

Appendix B

Fast Food FACTS

191

Nutritional quality of TV ads: By age and race

Black children (2-11 years) Calories per ad 1,253 457 417 533 731 796 641 566 760 792 242 617 1,197 48% 460 48% 665 100% 968 59% 1,365 83% 1,536 79% 27% 17% 41% 53% 36% 37% 1,693 95% 23% 1,846 93% 22% 1,531 16% 21% 646 26% 35% 809 32% 37% 2,001 38% 63% Sodium per ad % unhealthy products % of calories from sugar and saturated fat Calories viewed per day 401 400 227 192 168 151 147 143 101 72 7 2,009

Restaurant

KFC

McDonald's

Burger King

Subway

Pizza Hut

Domino's

Wendy's

Taco Bell

Sonic

Dairy Queen

Dunkin' Donuts

Total ads

White children (2-11 years) Calories per ad 458 1,304 405 491 723 636 798 567 752 776 258 575 968 624 501 1,099 1,367 1,712 1,525 1,833 1,394 601 2,050 798 Sodium per ad % unhealthy products 20% 36% 18% 13% 94% 78% 95% 83% 57% 100% 49% 39% % of calories from sugar and saturated fat 38% 64% 37% 21% 22% 28% 23% 17% 40% 54% 35% 37% Calories viewed per day 293 180 165 112 97 75 75 70 49 38 5 1,160

Restaurant

McDonald's

KFC

Burger King

Subway

Pizza Hut

Wendy's

Domino's

Taco Bell

Sonic

Dairy Queen

Dunkin' Donuts

Total ads

Appendix B

Fast Food FACTS

Source: The Nielsen Company; Menu composition analysis (January 2010)

192

Nutritional quality of TV ads: By age and race

Black teens (12-17 years) Calories per ad 1,202 456 628 733 788 567 630 437 761 787 234 666 1,099 61% 445 49% 675 100% 971 61% 735 42% 1,485 78% 27% 30% 41% 52% 36% 35% 1,364 82% 17% 1,679 95% 23% 1,849 93% 22% 1,833 20% 20% 831 56% 34% 1,960 39% 61% Sodium per ad % unhealthy products % of calories from sugar and saturated fat Calories viewed per day 723 417 326 305 286 277 268 261 185 122 14 3,184

Restaurant

KFC

McDonald's

Subway

Pizza Hut

Domino's

Taco Bell

Wendy's

Burger King

Sonic

Dairy Queen

Dunkin' Donuts

Total ads

White teens (12-17 years) Calories per ad 1,207 643 452 730 570 442 627 791 752 771 245 657 1,695 963 620 465 1,337 1,498 750 1,372 1,847 815 1,879 1,973 Sodium per ad % unhealthy products 40% 19% 52% 94% 83% 44% 78% 95% 60% 100% 48% 61% % of calories from sugar and saturated fat 61% 20% 35% 22% 17% 30% 27% 23% 40% 54% 36% 34% Calories viewed per day 380 226 216 210 192 178 169 160 113 83 12 1,939

Restaurant

KFC

Subway

McDonald's

Pizza Hut

Taco Bell

Burger King

Wendy's

Domino's

Sonic

Dairy Queen

Dunkin' Donuts

Total ads

Appendix B

Fast Food FACTS

Source: The Nielsen Company; Menu composition analysis (January 2010)

193

Nutritional quality of TV ads: Spanish-language TV ads by age

Spanish-language TV: Preschoolers (2-5 Years) Calories per ad 461 748 668 532 811 557 618 401 588 Spanish-language TV: Children (6-11 Years) Calories per ad 456 748 671 532 596 817 617 406 591 1,292 1,116 1,661 944 1,427 957 2,050 26% 53% 64% 64% 100% 74% 69% 1,683 96% 869 77% Sodium per ad % unhealthy products % of calories from sugar and saturated fat 32% 22% 20% 24% 24% 42% 23% 15% 26% Calories viewed per day 61 60 43 41 34 33 23 12 307 1,290 69% 1,106 74% 1,671 100% 23% 14% 26% 1,363 65% 23% 929 66% 42% 951 51% 24% 2,041 26% 20% 1,685 96% 22% 878 76% 32% Sodium per ad % unhealthy products % of calories from sugar and saturated fat Calories viewed per day 76 75 56 51 43 40 32 17 390

Restaurant

McDonald's

Domino's

Subway

Burger King

Sonic

Wendy's

Pizza Hut

KFC

Total ads

Restaurant

McDonald's

Domino's

Subway

Burger King

Wendy's

Sonic

Pizza Hut

KFC

Total ads

Spanish-language TV: Teens (12-17 Years) Calories per ad 449 751 672 525 814 590 622 392 584 Sodium per ad 844 1,689 2,049 945 942 1,434 1,673 1,081 1,287 % unhealthy products 78% 96% 27% 52% 68% 65% 100% 75% 69% % of calories from sugar and saturated fat 33% 22% 20% 25% 42% 24% 23% 15% 26% Calories viewed per day 60 53 48 39 30 28 20 11 289

Restaurant

McDonald's

Domino's

Subway

Appendix B

Burger King

Sonic

Wendy's

Fast Food FACTS

Pizza Hut

KFC

194

Total ads

Source: The Nielsen Company; Menu composition analysis (January 2010)

Table C1. Content analysis of child-targeted websites

Engagement techniques on child-targeted websites

Percentage of pages using engagement technique

Website 87% 84% 77% 47% 79% 60% 89% 20% 74% 45% 34% 26% 25% 21% 13% 27% 7% 7% 80% n/a 7% 89% 29% 29% 7% 7% 7% 60% 10% n/a n/a n/a 10% 30% 7% 20% 11% 10% 18% 16% n/a 14% 5% 5% 20% 15% 15% 69% 42% 3% 12% 63% 77% 77% n/a 49% 9% n/a 30% 44% 41% 40% 25% 39% 27% 1% n/a 51% n/a n/a n/a 33% 11% 84% 44% 14% 1% 4% 7% 2% n/a

Fun Flash animation

Music

Games

Advergames (branded games) Viral marketing Downloadable Customization content of page

Other advertising (TV Behavioral commercials, targeting Facebook)

Unbranded games 30% 3% n/a n/a 2% 10% n/a n/a 8%

Video n/a 2% n/a 16% 3% n/a n/a 40% 5%

McWorld.com

99%

HappyMeal.com

98%

Ronald.com

97%

SubwayKids.com

97%

ClubBK.com

67%

SonicZooTots.com

70%

DeeQs.com

100%

BlizzardFanClub.com

67%

All child-targeted websites

91%

*Other features that appeared on fewer than 5% of pages included: quizzes or polls, incentive for product purchases, chat features, the ability to create an avatar, photos, parental approval, and other cross-promotions such as famous actors.

Source: Website content analysis (March/April 2010)

Featured third parties on child-targeted websites

Percentage of pages featuring third parties

Website n/a 56% n/a 47% 95% 100% n/a n/a 19% 12% n/a n/a n/a n/a 11% n/a n/a 21% n/a 1% n/a n/a 100% n/a n/a 25% n/a n/a n/a 8% 29% 5% 12% 10% 7% 8%

Charity tie-ins

Other entertainment tie-ins (park, zoo, etc.) Movie/TV show/video game Spokescharacter Licensed character Other food brand n/a n/a n/a 7% 19% n/a 4% 100% 8%

Company spokesperson n/a n/a n/a 28% n/a n/a n/a n/a 5%

Other sports tie-ins n/a n/a n/a 4% 27% n/a n/a 7% 5%

McWorld.com

3%

HappyMeal.com

82%

Ronald.com

17%

SubwayKids.com

4%

ClubBK.com

13%

SonicZooTots.com

n/a

Appendix C

DeeQs.com

100%

BlizzardFanClub.com

n/a

All child-targeted websites

30%

Fast Food FACTS

Source: Website content analysis (March/April 2010)

195

Products and health messages promoted on child-targeted websites

Percentage of pages promoting product or health message Branding only Any food (branded or not) 93% 89% 100% 35% 70% 90% 89% n/a 75% 27% 21% 6% 5% 100% 93% n/a 100% 57% 57% n/a 11% 100% 90% n/a n/a 37% 30% 21% n/a 14% 90% n/a n/a 17% 43% 35% 8% 1% 61% 9% n/a n/a n/a n/a 2% 2% 3% 1% 1% 19% 2% 2% n/a 6% Branded food product Kids' meal Individual menu item Health and nutrition Physical activity 13% 8% 20% 30% n/a n/a 25% n/a 13%

Website

McWorld.com

HappyMeal.com

Ronald.com

SubwayKids.com

ClubBK.com

SonicZooTots.com

DeeQs.com

BlizzardFanClub.com

Avg: All child-targeted websites

*Other items that appeared on fewer than 5% of pages included: nutrition information as a static list, nutrition information as an individual customizable list, nutrition calculator, and combo meal.

Source: Website content analysis (March/April 2010)

Appendix C

Fast Food FACTS

196

Table C2. Content analysis of main restaurant websites

Most common products and selling points appearing on main restaurant websites
Percentage of pages with product or selling point

Website 32% 43% 44% 62% 43% 36% 30% 80% 46% 46% 32% 24% 15% 14% 12% 56% 20% 36% 16% 92% 28% 19% 27% 40% 10% 33% 3% 8% 8% 10% 11% 18% 71% 4% 50% 11% 4% 69% 26% 17% 17% 4% 6% 4% 70% 50% 2% 24% 11% 12% n/a 24% 35% 18% 6% 4% 3% 13% 7% 2% 11% 4% 5% 92% 9% 93% 39% 52% 29% 2% 20% 27% 2% 34% 26% 6% 16% 5% 20% 7% 5%

Any food mention Value Weight loss Fills you up

Individual menu items

Quality of food Health/ nutrition

Special offer/ limited time

New/ improved

Better than other restaurants 2% 2% 3% 9%

Online convenience/ ordering

Help your community 20% 5% 1% 15% n/a 75% 3% 64% 9% 7% n/a 10% n/a 9%

McDonalds.com

67%

SubwayFreshBuzz.com

94%

BurgerKing.com

59%

Starbucks.com

92%

Wendys.com

98%

PizzaHut.com

93%

KFC.com

83%

Dominos.com

96%

All main restaurant websites

85%

*Messages appearing on fewer than 5% of adult pages included time of day (snack, late night menu), family bonding, family meals, and safety.

Source: Website content analysis (March/April 2010)

Most common messages appearing on main restaurant websites

Percentage of pages with message Fun 15% 53% 8% n/a 17% 7% 11% 4% 17% 15% 15% n/a 4% 3% 11% n/a n/a 11% 7% n/a n/a 4% n/a 6% n/a 2% 5% 15% 1% 26% 2% 6% n/a n/a 8% n/a 8% 50% 85% 5% 25% 13% n/a 12% 10% Physical activity Motivation Humor Personal stories

Website

Cool/hip

McDonalds.com

7%

SubwayFreshBuzz.com

37%

BurgerKing.com

27%

Starbucks.com

6%

Wendys.com

n/a

PizzaHut.com

7%

KFC.com

32%

Dominos.com

92%

All main restaurant websites

22%

Appendix C

Fast Food FACTS

Source: Website content analysis (March/April 2010)

197

Engagement techniques on main restaurant websites

Percentage of pages using engagement technique Integrated advertising Viral marketing Music 14% 18% 34% 14% 9% 4% 32% n/a 20% 16% 12% 10% 12% n/a 8% n/a 6% 2% 21% 4% 7% n/a 2% n/a 8% 2% 6% 87% 83% 8% 14% 5% n/a 4% 11% 1% n/a 83% 25% n/a 1% n/a 4% n/a n/a 75% 3% 60% 8% n/a 11% 2% n/a 2% Mobile Video Newsletter 10% 86% 20% 100% 87% 4% 2% 88% 43% 40% 27% 20% n/a 84% 28% 3% n/a 16% n/a 36% 18% 11% 89% 9% 100% 12% 5% 55% 35% 47% 89% 5% 5% 5% 16% 14% Customization of page Downloadable content Purchase giftcards Online purchasing Behavioral targeting 2% 7% 4% 3% 4% 36% 8% 8% 6%

Website

Flash animation

McDonalds.com

41%

SubwayFreshBuzz.com

86%

BurgerKing.com

72%

Starbucks.com

9%

Wendys.com

39%

PizzaHut.com

57%

KFC.com

40%

Dominos.com

20%

All main restaurant websites

51%

Source: Website content analysis (March/April 2010)

Featured third parties on main restaurant websites

Percentage of pages featuring third parties

Website 2% 86% n/a n/a 100% n/a 100% n/a 33% 19% 18% 16% 92% n/a n/a n/a 5% 25% n/a 4% 4% 2% n/a 85% 96% n/a n/a n/a 9% n/a n/a 6% n/a 7% 13% 5% 23% 82% 89% 12% 5% 2% 3% 8% 11% 34% 9% 1% 97% 7% n/a n/a n/a 20%

Other foods

Company spokesperson Charity tie-in

Movie/TV show/video game Famous athlete Spokescharacter

Other entertainment tie-ins (zoo, park, etc.)

McDonalds.com

28%

SubwayFreshBuzz.com

33%

BurgerKing.com

15%

Starbucks.com

53%

Wendys.com

39%

PizzaHut.com

93%

KFC.com

43%

Dominos.com

96%

All main restaurant websites

37%

Source: Website content analysis (March/April 2010)

Appendix C

Fast Food FACTS

198

Products and nutrition promoted on main restaurant websites

Percentage of pages promoting product or nutrition Food present 67% 94% 59% 92% 98% 93% 83% 96% 79% 43% 24% 9% 80% 16% n/a 30% 14% n/a 36% 54% n/a 43% 31% 4% 11% 7% 5% 8% 8% 62% 26% 3% 18% 44% 13% 31% 2% 43% 22% 5% 4% 32% 35% 2% 12% Individual menu item Branding only Individual customizable feature Nutrition information: Static list Kids' meal 10% 2% 1% n/a 11% 0% 2% 0% 4%

Website

McDonalds.com

SubwayFreshBuzz.com

BurgerKing.com

Starbucks.com

Wendys.com

PizzaHut.com

KFC.com

Dominos.com

All main restaurant websites

*Other items that appeared on fewer than 5% of main company pages included combo meals, and nutrition calculators.

Source: Website content analysis (March/April 2010)

Appendix C

Fast Food FACTS

199

Table C3. Content analysis of banner ads on third-party websites

Banner ads by product type

Percentage of ads promoting product type Value/combo menu 23% n/a 28% n/a n/a 8% 34% 20% 57% 17% n/a 15% 19% 6% 6% 23% n/a n/a n/a n/a n/a 14% n/a 10% n/a n/a n/a n/a n/a n/a n/a n/a 15% 4% 12% 16% n/a n/a n/a n/a 7% n/a 7% 6% 22% 17% 6% n/a n/a 3% 8% 7% 3% 6% n/a n/a n/a n/a n/a 5% n/a 17% n/a n/a 3% Branding only Time of day Restaurant website Kids meal Healthy menu n/a n/a n/a n/a n/a 8% n/a n/a n/a n/a n/a n/a 1%

Restaurant 61 17 18 14 16 25 12 21 14 12 8 13 231 42% 30% 31% 15% 63% 38% 25% 25% 21% 43% 52% 19% 25% 33% 28% 24% 69% 13% 71% 57% 33% 17% 29% 59% 46% 31%

Number of ads Individual menu items Non-food promotion

McDonalds

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin Donuts

KFC

Sonic

Dominos

Dairy Queen

Twelve restaurants

Source: Banner ad content analysis (June 2009-March 2010)

Selling points on restaurant banner ads

Percentage of ads with selling point Special offer 31% 59% 17% 79% 19% 28% 42% 43% 36% 50% 75% 15% 37% 17% 38% 31% 29% 43% 33% 42% 12% 38% n/a 36% 50% 24% 25% 14% 21% 8% n/a n/a 19% 50% n/a 24% 12% 30% 21% Value/cheap New/Iimproved Quality food 10% 24% 28% 7% 44% n/a 8% n/a 14% 8% 13% n/a 12% Filling/indulgent 5% 6% 17% 14% 19% 16% 25% n/a n/a 8% n/a n/a 9% Better than other restaurants 10% n/a n/a n/a 6% n/a n/a 10% 7% n/a n/a 8% 5% Weight loss n/a n/a n/a n/a n/a 12% n/a n/a 7% n/a n/a n/a 2%

Restaurant 61 17 18 14 16 25 12 21 14 12 8 13 231

Number of ads

McDonalds

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin Donuts

KFC

Sonic

Appendix C

Dominos

Dairy Queen

Fast Food FACTS

Twelve restaurants

Excludes selling points that appeared in fewer than 1% of ads: health/nutrition, convenience , kids like it, help your community.

Source: Banner ad content analysis (June 2009-March 2010)

200

Table D1. Average number of featured items on signs by special menu and food category
Value menu/item 1.4 0.4 1.1 0.0 0.0 2.2 2.0 0.0 2.7 0.3 0.2 0.7 6.4 0.0 13.8 5.0 0.1 0.9 10.1 1.1 2.3 6.2 0.6 0.2 1.1 1.8 0.9 9.5 0.1 1.7 6.6 1.6 4.8 0.0 0.0 9.2 0.0 0.2 0.0 0.0 13.3 0.0 6.3 0.0 0.6 0.6 4.3 1.1 10.2 0.0 2.4 0.0 4.1 1.1 0.2 0.0 7.8 0.0 6.1 1.3 Lunch/dinner items Healthy items Snack items Coffee drinks Breakfast 0.8 1.5 3.3 0.3 0.3 0.0 0.0 3.5 0.0 0.8 0.0 0.0 2.2 1.4 1.8 0.0 1.5 0.5 0.0 0.0 1.7 0.4 0.0 0.4

Restaurant

Kids menu/item

McDonald's

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin' Donuts

KFC

Sonic

Domino's

Dairy Queen

Source: Restaurant signs audit (June 2010)

Appendix D

Fast Food FACTS

201

Table D2. Individual menu item pricing analysis

Average price of kids' and combo meals

Kids' meal Main dish in kids' meal Hamburger Roast beef sandwich Hamburger Hamburger Crunchy taco - beef Average $3.19 $2.91 $3.01 Quarter pound single hamburger Crunchy taco - beef Average $3.00 Whopper $4.05 Roast beef sandwich - 6" $2.97 Quarter Pounder Price Main dish in combo meal Combo meal Price $5.49 $6.80 $5.80 $5.31 $4.47 $5.57

Restaurant

McDonald's

Subway

Burger King

Wendy's

Taco Bell

All restaurants

Source: Pricing analysis (June 2010)

Appendix D

Fast Food FACTS

202

Average price, calories and NPI scores of healthy and unhealthy food items
Healthiest chicken sandwich Specic item $3.89 $3.62 $4.21 $4.07 $2.86 $3.70 $3.69 $3.78 $3.73 383 69 Average 370 66 Crispy chicken sandwich with cheese 400 68 Crispy chicken sandwich 350 70 Double Crunch crispy sandwich $4.47 $3.70 $3.79 $4.24 340 72 n/a n/a 350 70 Chicken club sandwich $4.89 435 67 Tendercrisp chicken sandwich $4.20 400 70 n/a n/a n/a 695 620 n/a 460 550 610 594 420 66 Premium crispy chicken club sandwich $4.37 630 Price Calories NPI score Specic item Price Calories Least healthy chicken sandwich NPI score 50 n/a 57 48 n/a 64 62 50 55

Restaurant

McDonald's

Premium grilled chicken classic sandwich

Subway Tendergrill chicken sandwich Ultimate chicken grill sandwich

Oven roasted chicken breast sandwich - 6"

Burger King

Wendy's

Taco Bell Tender Roast sandwich Grilled chicken sandwich Grilled chicken sandwich Average

Fresco burrito supreme - chicken

KFC

Sonic

Dairy Queen

All restaurants

Healthiest side Specic item $1.08 $1.18 $1.42 $1.41 $0.99 $1.68 $1.29 $1.71 $1.35 101 75 102 80 120 66 70 86 180 80 125 78 70 74 35 72 105 66 Price Calories NPI score

Least healthy side Specic item French fries - medium Doritos - 1 bag French fries - medium French fries - medium Nachos Biscuit - 1 Tots - medium French fries - medium Average Price $1.62 $1.03 $1.76 $1.81 $0.96 $0.58 $1.52 $1.73 $1.37 Calories 380 250 440 420 330 180 200 310 314 NPI score 66 46 54 66 52 24 52 58 52

Restaurant

McDonald's Apple slices Apple fries w/ caramel sauce Side salad Pintos 'n cheese Corn on the cob - 3"

Apple dippers w/ low fat caramel dipping sauce

Subway

Burger King

Wendy's

Taco Bell

KFC

Sonic Side salad Average

Apple slices w/ fat-free caramel dipping sauce

Dairy Queen

All restaurants

Salad with chicken Specic item $4.79 $5.02 $4.96 $5.08 $5.33 $3.96 $4.72 $4.95 $4.85 375 550 910 650 363 393 495 313 410 Price Calories NPI score 70 76 71 80 70 66 70 73 72

Restaurant

McDonald's

Premium caesar salad with grilled chicken

Subway Tendergrill chicken salad Mandarin chicken salad Chicken ranch taco salad Crispy chicken caesar salad Grilled chicken salad Grilled chicken salad Average

Oven roasted chicken breast salad

Burger King

Wendy's

Taco Bell

Appendix D

KFC

Sonic

Dairy Queen

Fast Food FACTS

All restaurants

Source: Pricing analysis (June 2010)

203

Average price, calories and NPI scores of healthy and unhealthy food items
Healthiest red meat sandwich Specic item Hamburger n/a Whopper - no cheese Single hamburger - no cheese Fresco soft taco - beef n/a SONIC burger Classic Grillburger Average $2.35 426 60 Average $3.14 470 50 Flame Thrower Grillburger - 1/2 lb. $2.75 590 65 SuperSONIC cheeseburger n/a n/a n/a n/a n/a $4.13 $4.46 $4.53 $1.00 180 64 Volcano burrito $3.03 $3.06 470 64 Triple Baconator $6.98 $3.24 595 66 BK Quad Stacker $4.50 n/a n/a n/a n/a n/a n/a 930 1330 800 n/a 923 1060 972 $0.93 250 50 Angus bacon and cheese burger $4.08 790 Price Calories NPI score Specic item Price Calories Least healthy red meat sandwich NPI score 42 n/a 32 32 48 n/a 45 38 40

Restaurant

McDonald's

Subway

Burger King

Wendy's

Taco Bell

KFC

Sonic

Dairy Queen

All restaurants

Moderately unhealthy red meat sandwich Specic item Big Mac Spicy italian sandwich - 6" Double cheeseburger Bacon Deluxe - single Soft taco - beef n/a Chili cheeseburger $3.51 $2.95 534 44 650 38 $3.87 660 46 n/a n/a n/a $1.07 210 52 $4.05 640 44 $1.27 460 38 $3.59 580 42 $3.31 540 48 Price Calories NPI score

Restaurant

McDonald's

Subway

Burger King

Wendy's

Taco Bell

KFC

Sonic

Dairy Queen Average

Bacon Cheddar Grillburger - 1/4 lb.

All restaurants

Source: Pricing analysis (June 2010)

Appendix D

Fast Food FACTS

204

Table E1. Menu importance for all quickserve restaurants

All youth (under 18 years) Total 100.0 244.0 166.8 167.3 173.9 168.3 166.6 167.1 165.3 173.0 233.7 243.4 247.6 242.4 245.6 237.1 246.9 100.0 100.0 100.0 100.0 100.0 100.0 100.0 < 6 yrs 6-12 yrs 13-17 yrs 18-24 yrs 25-49 yrs White Hispanic African American 100.0 264.2 191.0

Total trafc

Total foods and beverages

Total foods

All breakfast-oriented foods

14.9

8.4

8.5

11.2

11.4

16.9

8.4

9.8

15.0

All lunch/dinner main dishes 81.2 23.0 5.6 17.4 6.1 16.6 22.8 5.6 2.7 12.2 2.6 0.8 7.3 1.0 10.1 1.4 7.7 1.9 2.1 1.2 0.4 0.6 1.2 13.1 14.6 2.3 2.3 6.9 8.3 0.7 1.2 1.2 11.3 1.6 10.1 1.6 1.7 27.6 16.9 7.9 0.7 1.0 0.5 2.7 3.8 1.8 32.3 23.4 12.1 11.2 1.4 0.6 7.1 1.2 13.4 1.4 8.8 1.6 1.6 0.5 1.1 3.0 3.7 1.8 3.9 7.6 8.2 10.2 15.0 24.7 27.4 4.1 10.7 16.5 18.2 12.3 10.1 4.8 4.8 5.2 18.9 23.6 5.9 3.0 9.6 2.4 0.7 4.9 1.1 11.4 1.2 6.6 2.1 1.8 12.0 15.9 17.0 18.7 19.1 4.8 5.3 4.5 4.6 5.4 16.8 21.2 21.5 23.3 24.4 83.2 86.6 84.6 88.7 80.7

83.0 19.0 4.7 14.3 8.8 9.9 17.1 4.1 1.6 21.0 2.0 0.7 17.0 0.7 9.5 2.1 12.4 0.9 1.0

87.3 20.4 5.6 14.8 9.0 11.1 16.5 5.0 1.7 23.4 3.2 1.5 16.6 1.2 8.8 2.1 13.6 1.0 1.5

93.2 24.5 5.2 19.3 8.4 15.7 18.6 7.4 1.6 25.6 6.2 0.7 15.4 2.6 6.5 2.2 12.2 1.1 2.5

All burgers

All hamburgers

All cheeseburgers

Regular burgers/cheeseburgers

Large burgers/cheeseburgers

All other sandwiches (excluding burgers)

All breaded chicken sandwiches (except wraps)

All grilled/broiled/roasted chicken sandwiches (except wraps)

All chicken/turkey main dishes

Fried chicken

Non-fried chicken

Nuggets/strips

Chicken wings

Mexican (including nachos)

Pasta

Pizza

Main dish salads

All other main dishes/entrees

All appetizers and sides 28.6 4.2 20.8 1.6 1.1 1.1 0.7 2.4 29.7 6.6 0.5 1.4 0.9 36.0

42.0

51.1

49.4 36.6 3.0 29.5 2.8 0.6 1.4 0.4

38.7 26.6 5.2 20.0 1.4 0.8 0.6 0.6

38.4 26.2 5.3 19.7 1.1 0.8 0.7 0.8

42.3 29.5 4.2 20.8 1.1 1.1 1.0 0.7

45.0 32.2 3.6 25.6 3.5 0.6 1.0 0.6

46.6 32.6 3.8 26.1 3.3 0.7 1.3 0.7

50.8 36.6 3.8 28.8 3.2 0.9 1.7 0.8

All potatoes (including chips)

Chips, pretzels, crackers, etc.

Appendix E

All french fries (including sweet potatoes)

All fruit

All appetizer-sized green salads

Fast Food FACTS

All non-fried vegetables

Yogurt (non-frozen)

205

Source: The NPD Group/CREST/2 Years Ending December 2009

Menu importance for all quickserve restaurants

All youth (under 18 years) Total 16.0 2.7 1.4 4.8 4.3 4.9 5.7 4.3 4.5 5.0 2.7 2.8 1.7 1.9 1.1 2.4 2.4 4.5 2.8 3.3 1.9 1.7 2.5 2.2 3.1 13.2 14.9 17.2 15.2 15.7 14.9 14.8 < 6 yrs 6-12 yrs 13-17 yrs 18-24 yrs 25-49 yrs White Hispanic African American 16.5 5.1 1.9 5.1

All breads/sweet rolls

Biscuits

Breadsticks

Donuts and sweet rolls

All dessert-oriented and frozen sweets

10.3

9.5

13.2

14.0

10.4

9.0

12.1

12.4

13.4

All beverages (excluding tap water) 74.0 14.2 3.2 3.4 2.7 1.1 1.6 2.6 39.3 25.6 8.7 1.3 6.2 2.3 2.6 6.1 1.1 2.0 2.5 1.5 2.9 4.0 19.0 33.0 31.4 29.0 43.4 43.4 41.6 30.7 4.0 1.7 6.0 1.4 3.0 4.1 3.0 7.1 3.8 1.4 0.9 8.7 3.6 0.6 0.5 15.8 7.4 2.0 1.4 10.4 4.6 3.2 3.4 2.9 1.2 0.3 0.9 2.2 41.1 27.2 9.7 1.2 7.0 0.3 0.6 4.6 4.0 3.6 0.8 1.3 9.3 9.7 16.0 63.0 66.5 75.9 72.2 75.9

68.3 4.3 2.1 5.0 8.7 4.4 4.3 2.9 38.9 28.5 3.4 1.8 3.7

70.9 3.9 1.7 7.2 7.0 3.2 3.8 2.6 40.7 29.2 2.1 2.1 3.3

70.4 3.5 1.5 8.6 4.4 2.3 2.1 2.8 39.9 25.8 0.9 2.4 4.7

All coffee

Coffee, iced/frozen/slushes

Juice

All milk

Flavored milk

Plain milk

All shakes/malts/oats

All soft drinks (including non-carbonated)

Regular carbonated soft drinks

Diet carbonated soft drinks

Frozen soft drinks/slushes

Iced tea

Source: The NPD Group/CREST/2 Years Ending December 2009

Appendix E

Fast Food FACTS

206

Table E2. Average calories and sodium per visit

Average calories and sodium per visit: By age

Preschoolers (under 6 years) Total calories per Total calories from Total calories from visit sat fat sugar Total sodium (mg) Calories per item 270 363 279 276 269 253 493 267 190 292 552 430 688 1,043 848 731 477 1,141 540 722 96 59 169 69 97 88 179 122 436 42 756 98 754 82 717 81 156 176 146 210 114 116 170 119 150 172 90 251 627 683 647 453 602 505 1095 460 670 546 992 863 114 188 1,313 174 78 2,167 69 134 910 90 120 1,789 69 104 670 163 161 2,487 57 92 1,213 74 105 971 62 168 363 75 123 1,043 73 147 1,617 63 127 1,031 Children (6-12 years) Total calories per Total calories from Total calories from visit sat fat sugar Total sodium (mg) 1,168 1,856 1,247 321 1,224 1,241 2,600 678 1,879 1,126 2,247 1,037

Restaurant 243 325 255 319 236 254 488 255 187 258 567 411

Calories per item

McDonald's

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin' Donuts

KFC

Sonic

Domino's

Dairy Queen

Teens (13-17 years) Total calories per Total calories from Total calories from visit sat fat sugar Total sodium (mg) 985 897 1,226 372 1,089 910 1,403 651 833 981 1,201 1,199 181 208 130 94 98 151 245 281 113 369 207 219 95 234 146 203 33 180 164 204 2,009 308 1,866 1,936 3,248 1,035 1,869 1,473 2,618 1,394 89 204 2,231 115 197 1,561

Restaurant 352 408 430 230 383 329 501 282 239 399 546 542

Calories per item

McDonald's

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin' Donuts

KFC

Sonic

Domino's

Appendix E

Dairy Queen

Fast Food FACTS

Source: The NPD Group/CREST/2 Years Ending December 2009 and menu composition analysis (January 2010)

207

Average calories and sodium per visit: By race or ethnicity

White youth (under 18 years) Total calories per Total calories from Total calories from visit sat fat sugar Total sodium (mg) Calories per item 337 424 407 268 364 314 493 286 226 403 533 501 1,050 1,192 881 782 677 1,297 189 104 94 107 203 166 769 80 1,005 133 418 37 1,087 143 892 96 162 160 200 161 191 197 173 224 253 125 298 945 105 179 837 838 981 383 917 736 1,162 535 820 871 1,048 1,067 154 310 1,313 183 85 2,275 111 229 1,352 101 195 2,014 79 123 816 173 172 2,647 78 188 1,561 116 181 1,411 38 177 307 117 176 1,545 83 186 2,075 87 172 1,269 African American youth (under 18 years) Total calories per Total calories from Total calories from visit sat fat sugar Total sodium (mg) 1,468 2,238 1,816 357 1,691 1,640 3,049 1,032 1,801 1,223 2,600 1,326

Restaurant 318 394 367 247 341 316 495 269 222 376 562 509

Calories per item

McDonald's

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin' Donuts

KFC

Sonic

Domino's

Dairy Queen

Hispanic youth (under 18 years) Total calories per Total calories from Total calories from visit sat fat sugar Total sodium (mg) 862 900 1,024 442 928 697 1,226 560 885 858 1,105 1,217 162 191 104 200 104 338 105 234 86 143 177 209 74 179 118 169 1,479 1,509 2,758 829 2,055 1,393 2,390 1,591 44 203 347 121 173 1,649 87 198 2,213 92 174 1,326

Restaurant 319 388 371 265 352 312 496 265 220 371 550 514

Calories per item

McDonald's

Subway

Burger King

Starbucks

Wendy's

Taco Bell

Pizza Hut

Dunkin' Donuts

KFC

Sonic

Domino's

Dairy Queen

Appendix E

Fast Food FACTS

Source: The NPD Group/CREST/2 Years Ending December 2009 and menu composition analysis (January 2010)

208