Table 4.

Implementation and enforcement characteristics of healthy kids’ meal laws enacted in the United States from January 2010 through August 2020 (N=20)

Variable	Laws, N (%)
Monitoring & enforcement agency
State Health Dept	3 (15)
Local Health Dept	11 (55)
City Manager	2 (10)
City Attorney	1 (5)
City Health Initiative	1 (5)
City Administrative Services Dept	1 (5)
City Dept of Licenses & Inspections	1 (5)
Enforcement method
Inspections	12 (60)
Self-certification	6 (30)
Self-reporting, customer-reporting	1 (5)
Pending rulemaking	1 (5)
Maximum violation fines
No fine	2 (10)
$50	1 (5)
$100	2 (10)
$200	2 (10)
$250	1 (5)
$500	8 (40)
$1,000	3 (15)
Pending rulemaking	1 (5)
Restaurants and community must be notified of policy adoptiona	10 (50)
Education or technical assistance must be provided to restaurants and community	3 (15)
Only applies to unincorporated regions of a jurisdictionb	2 (10)
Healthy default beverage and nutritional standards provisions (N=18)
Kids’ meal is defined as a
Combination of food and beverage that is prepared by and offered for purchase at a food service establishment as a unit at a single price intended to be consumed by children	3 (17)
Combination of food and beverage primarily intended for consumption by children sold at a single unit price	15 (83)
Kids’ meals exclude foods pre-packaged elsewhere	2 (11)
Kids’ meals must be listed on the menu or menu board	1 (6)
Default beverages are defined as any beverage	14 (78)
Automatically included or offered as part of a kids’ meal, absent a specific request by the purchaser of the children’s meal for an alternative beverage	12 (67)
Automatically included as part of a kids’ meal, absent a specific request by the purchaser of the children’s meal for an alternative beverage	2 (11)
Only default beverages can be offered on the menu or menu board	5 (28)
Only default beverages can be offered on advertisements of kids’ meals	1 (6)
Only default beverages can be offered on online menus or ordering platforms	0 (0)
Substitute beverage can be requested at no cost	16 (89)
Toy restriction provision (N=2)
Meal is defined as a combination of single food items and/or beverages offered together for a single price	2 (100)
Incentives include food incentives	1 (50)
Mandates a restaurant can give away a “free” incentive if the kids’ meal meets minimum nutrition standards	1 (50)

^aDecision-making body or monitoring/enforcement agency is listed as responsible for notifying the community and restaurant of the policy adoption such as posting the policy in a distinct number of conspicuous places for the public.

^bAn unincorporated region is a geographic area with a common social identity that is not governed by a local municipal corporation.