Relationship between community characteristics and impact of calorie labeling on fast-food purchases

Objective: The objective of this study was to evaluate potential sources of heterogeneity in the effect of calorie labeling on fast-food purchases among restaurants located in areas with different neighborhood characteristics. Methods: In a quasi-experimental design, using transaction data from 2329 Taco Bell restaurants across the United States between 2008 and 2014, we estimated the relationships of census tract-level income, racial and ethnic composition, and urbanicity with the impacts of calorie labeling on calories purchased per transaction. Results: Calorie labeling led to small, absolute reductions in calories purchased across all population subgroups, ranging between −9.3 calories (95% CI: −18.7 to 0.0) and −37.6 calories (95% CI: −41.6 to −33.7) 2 years after labeling implementation. We observed the largest difference in the effect of calorie labeling between restaurants located in rural compared with those located in high-density urban census tracts 2 years after implementation, with the effect of calorie labeling being three times larger in urban areas. Conclusions: Fast-food calorie labeling led to small reductions in calories purchased across all population subgroups except for rural census tracts, with some subgroups experiencing a greater benefit.