key: cord-0905432-0apdgut5
authors: Cohen, Juliana F.W.; Posluszny, Hannah; Falbe, Jennifer; Mueller, Megan P.; Gearhardt, Ashley N.; Leung, Cindy W.; Wolfson, Julia A.
title: Restaurant dining during the COVID-19 pandemic among adults with low-income in the United States
date: 2022-03-01
journal: Appetite
DOI: 10.1016/j.appet.2022.105976
sha: 00c37a03f0a40eeb076b5b7c51955e890331c1c3
doc_id: 905432
cord_uid: 0apdgut5

The COVID-19 pandemic caused widespread non-essential business closures in the U.S., which may have disproportionately impacted food consumption in lower-income communities, in part due to reduced access to healthy and affordable foods, as well as occupations that may have required working outside the home. The aims of this study were to examine restaurant dining behaviors (including drive-through, takeout, and delivery) at fast-food and non-fast-food (i.e., fast casual and full-service [‘other’]) restaurants and the impact on diet quality among racially/ethnically diverse low-income adults during the early months of the pandemic. Participants completed an online survey using CloudResearch regarding restaurant dining behaviors in the past week (during June 2020) and during a typical week prior to the pandemic. Diet quality was measured using the Prime Diet Quality Score (PDQS). Surveys from 1,756 low-income adults (incomes <250% of the Federal Poverty Level) were analyzed using chi-squared tests to examine differences in demographic characteristics among those dining at restaurants during the pandemic, as well as to examine differences in dining frequency compared with prior to COVID-19. Negative binomial regressions were used to examine the mean frequency of eating food from fast-food and other restaurants, adjusted for socio-demographic characteristics. This study found reductions in fast-food and other restaurant dining compared with prior to COVID-19, although overall restaurant consumption remained high with over half of participants reporting fast-food consumption in the week prior (average consumption of twice per week). Greater fast-food consumption was associated with poorer diet quality. In conclusion, while fast-food consumption was slightly lower during the pandemic, the overall high levels observed among socioeconomically disadvantaged adults remains concerning, highlighting the continued need for initiatives and policies to encourage greater access to and consumption of affordable and healthier foods.

In the United States, household food expenditures on food away from home (FAFH), 3 including full-service and fast-food restaurants, have been steadily rising over the past several 4 decades (Todd, 2017). Prior to the COVID-19 pandemic, roughly a third of adults consumed 5 fast-foods on any given day, and FAFH accounted for 55% of all food expenditures (Fryar, during the early stages of the pandemic, which was associated with higher fruit and vegetable 34 intake (Cummings, Wolfson, & Gearhardt, 2022) . Additionally, while indoor dining in restaurants 35 J o u r n a l P r e -p r o o f became restricted, other options such as drive-thru, takeout, and delivery from restaurants 36 remained with some restaurants pivoting to more limited menus with the more popular and high-37 performing options. Some research has found reductions in frequent fast-food consumption 38 (defined as 3 or more times per week) (Chen et al., 2021) . However, little is known about 39 socioeconomically disadvantaged adults, particularly from racial/ethnic minority groups. These 40 populations may have been differentially impacted by the pandemic, due to more limited access 41 to affordable, healthy foods in grocery stores and/or occupations as "essential workers" (i.e., 42 jobs critical to public health and safety, such as grocery retail and transportation). These 

We designed a web-based survey using Qualtrics software. The survey was fielded 57 using CloudResearch (formerly TurkPrime), an online crowdsourcing platform designed to be 58 used for academic research across multiple disciplines (Litman, Robinson, & Abberbock, 2017).

The objective of the survey was to measure potential impacts of COVID-19, and included 60 measures related to participant demographics, food behaviors, food security, and diet quality 61 (as well as other measures outside the scope of the present study). After providing consent, 62 study participants first completed a demographics module, followed by questions about food 63 security, then diet quality, and finally questions about food behaviors. We fielded the survey 

The frequency of consuming fast-food in the past 7 days compared to a typical week 184 prior to COVID-19 is presented in Figure 1 . Among adults who reported that they did not eat (Fryar et al., 2018) . It is possible that this may have been due to differential 240 impacts of the pandemic by income, with those with the fewest resources more likely to have to 241 work outside the home at the beginning of the pandemic and therefore more likely to get fast-242 food takeout for meals (Wolfson & Leung, 2020) .

244 Surprisingly, this study found no association when examining more frequent other 245 restaurant consumption and diet quality in general. Conversely, prior research has found that 246 consumption of food away from home is associated with poorer diet quality (Binkley, 2008;  247 Todd, 2017). It is possible that these results are directly associated with other restaurant dining 248 (e.g., if there was a shift to more limited but relatively healthier dining options during the 249 pandemic), or potentially due to residual confounding if fast casual/full-service restaurant 250 consumption (which is typically more expensive than fast-food dining) was associated with 251 having greater resources more broadly.

This study also found differences by race/ethnicity with the greatest fast-food English. In addition, the participants were limited to adults with lower-incomes, and this is a 275 population that may have be particularly impacted by the pandemic, especially with regards to 276 access to healthier food choices. Future studies should also examine the impact of the 277 pandemic on dining behavior among adults more broadly, as well as among children.

In conclusion, this study found that while the COVID-19 pandemic was associated with 

Data availability statement:

The data presented in this study are available on request from the corresponding author. The Difference from reference category significant at *p<0.05, **p<0.01, ***p<0.001

Figure 1. Self-reported difference in frequency of eating out before vs. during the COVID-19 pandemic.

Note: Based on cross tabulation between frequency of eating in fast food or other restaurants during a typical week prior to the COVID-19 pandemic and the within-person difference in eating out pre-covid vs during covid and frequency of eating out pre-covid. Less often during pandemic than before The same during pandemic than before More often during pandemic than before Note: Linear regression models adjusted for age, sex, race, marital status, presence of children <18 years old in the home, household income, education, employment status, and food security status. ** Model is mutually adjusted for fast-food and restaurant frequency. Covariates from the adjusted model are also included.

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Not applicable.

J o u r n a l P r e -p r o o f

Limited to participants who reported any dining at fast-food or other restaurants in the past 7 days Note: Negative binomial regression model adjusted for age, sex, race, marital status, presence of children <18 years old in the home, household income, education, employment status, and food security status. Fast-food outcome is also adjusted for restaurant frequency and restaurant outcome is adjusted for fast-food frequency. Results in the table are number of predicted visit based on post estimation margins. Difference from reference category significant at *p<0.05, **p<0.01, ***p<0.001