HEAL Paper Classics: Children’s Menus, Neighbourhoods, and Food Environments

• Post by: Anastasia Soukhov
• 8:09AM Apr 15, 2026
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HEAL Paper Classics is a monthly series highlighting influential research that has shaped conversations around youth health, equity, and the environments where young people live, learn, and grow. Each post revisits a key paper from the HEAL or closely aligned work and reflects on why it matters today.

DuBreck CM, Sadler RC, Arku G, Seabrook J, Gilliland JA (2019). A comparative analysis of the restaurant consumer food environment in Rochester (NY, USA) and London (ON, Canada): Assessing children’s menus by neighbourhood socio‑economic characteristics. Public Health Nutrition

Overview: Children’s food environments play an important role in shaping diet, health, and long‑term wellbeing. While much food‑environment research has focused on grocery stores, this study shifts attention to restaurants, specifically to what children are offered when they eat out. This paper explores how neighbourhood socioeconomic characteristics intersect with the nutritional quality of children’s restaurant menus, and how these relationships differ across national contexts.

What this cross‑sectional study does: Examines children’s menus in London, Ontario and Rochester, New York, two geographically close cities in Canada and the United States. Specifically, authors:

• Assessed over 370 restaurant children’s menus using the Children’s Menu Assessment (CMA) tool
• Examined menu features such as healthier entrées and sides, beverages, desserts, nutritional information, toys, and marketing
• Created a novel measure (the Neighbourhood Restaurant Quality Index for Children (NRQI‑C)) to capture neighbourhood‑level access to healthier restaurant options for children
• Analyzed how neighbourhood factors (e.g., income, proportion of visible minority residents, family structure) related to children’s menu quality in each city

Key findings:

• Children’s menu quality varied widely across both cities.
• Rochester had a higher average nutritional quality score for children’s menus compared to London but also showed clear socioeconomic inequities.
• In Rochester, neighbourhoods with a higher proportion of visible minority residents had poorer access to higher quality children’s menus.
• In London, the pattern was reversed: neighbourhoods with higher proportions of visible minority residents tended to have better access to higher‑quality children’s menus.
• These contrasting patterns highlight how urban planning, policy context, and food systems differ between countries, shaping children’s everyday food environments in meaningful ways.

Why is it a “Classic”? This paper was among the first to:

• Focus explicitly on children’s menus as a component of the consumer food environment
• Introduce a neighbourhood‑level index that centres children’s food access
• Use a cross‑border comparison to reveal how social and policy contexts influence health equity

Its findings continue to inform research, policy discussions, and interventions aimed at improving food environments for children. Especially in ways that address structural inequities rather than individual choice alone.