Mapping the Relationship between Neighborhood-Level Factors and Nutrition Environments of Restaurants Offering Children’s Menus

This study examined the nutritional environments of restaurants offering children's menus and their association with neighborhood-level factors in a southern United States city with disproportionately high childhood obesity rates. On-site assessments were conducted to generate nutrition environment scores for restaurants offering children's menus in New Orleans, Louisiana (n = 191). Restaurants were geocoded and linked to neighborhood characteristics, including racial/ethnic composition and socioeconomic opportunity measured by the Social and Economic Child Opportunity Index (COI-SE). Multivariate linear regressions assessed associations between nutrition environment scores and neighborhood characteristics, adjusting for restaurant-specific attributes. Restaurants located in neighborhoods with COI-SEs above the median had significantly higher nutrition environment scores (+ 2.41 points; 95% CI 0.47, 4.35; p = 0.015). This relationship appears to be driven by the associations with the healthy options and facilitators to healthy eating sub-scores. Neighborhood racial/ethnic composition was not associated with nutrition environment scores. Restaurant characteristics were associated with nutrition environment quality: sit-down restaurants had lower scores than fast-food restaurants (- 2.35 points; 95% CI -4.45, -0.24; p = 0.029), while chain restaurants scored higher than independent establishments (+ 2.13 points; 95% CI 0.44, 3.82; p = 0.014). These findings suggest that neighborhood socioeconomic opportunity and restaurant characteristics shape children's exposure to healthier restaurant food environments. Health strategies that prioritize place-based policies and support healthier children's menu offerings, particularly in lower-opportunity neighborhoods, may help address inequities in food environments and reduce disparities in child health.