{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:05:22Z","timestamp":1760144722352,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:00:00Z","timestamp":1715990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health","award":["R01MD018022"],"award-info":[{"award-number":["R01MD018022"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>(1) Background: Independently owned restaurants (IORs) are prevalent in under-resourced racial and ethnic minority communities in the US and present a unique setting for public health nutrition interventions. (2) Methods: We conducted 14 in-depth interviews with IOR owners in Baltimore about their perceptions of healthy food, and customers\u2019 acceptance of healthier menus and cooking methods and concurrent observations of the availability of healthy options on their menus. Qualitative data were coded and analyzed using ATLAS.ti. Observations were analyzed with statistical analysis performed in R. (3) Results: Owners perceived non-fried options, lean proteins, and plant-based meals as healthy. While open to using healthier cooking fats, they had mixed feelings about reducing salt, adopting non-frying methods for cooking, and adding vegetables and whole grains to the menu, and were reluctant to reduce sugar in recipes and beverages. Only 17.5% of 1019 foods and 27.6% of 174 beverages in these IORs were healthy, with no significant differences in the healthfulness of restaurant offerings within low-healthy-food-access\/low-income neighborhoods and those outside. (4) Conclusion: Healthy options are generally scarce in Baltimore\u2019s IORs. Insights from owners inform future interventions to tailor healthy menu offerings that are well-received by customers and feasible for implementation.<\/jats:p>","DOI":"10.3390\/nu16101524","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T03:36:42Z","timestamp":1716176202000},"page":"1524","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Quality of Menu Offerings in Independently Owned Restaurants in Baltimore, Maryland: Results from Mixed-Methods Formative Research for the FRESH Trial"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9934-201X","authenticated-orcid":false,"given":"Shuxian","family":"Hua","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1433-3717","authenticated-orcid":false,"given":"Anna Claire","family":"Tucker","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1112-2153","authenticated-orcid":false,"given":"Sydney R.","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey E.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5101-4096","authenticated-orcid":false,"given":"Yeeli","family":"Mui","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronica","family":"Velez-Burgess","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Poirier","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0262-1030","authenticated-orcid":false,"given":"Lawrence J.","family":"Cheskin","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA"},{"name":"Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mika","family":"Matsuzaki","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacey","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0870-9722","authenticated-orcid":false,"given":"Uriyoan","family":"Colon-Ramos","sequence":"additional","affiliation":[{"name":"Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2761-3280","authenticated-orcid":false,"given":"Joel","family":"Gittelsohn","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,18]]},"reference":[{"key":"ref_1","unstructured":"Saksena, M.J., Okrent, A.M., Anekwe, T.D., Cho, C., Dicken, C., Effland, A., Elitzak, H., Guthrie, J., Hamrick, K.S., and Hyman, J. (2024, May 14). America\u2019s Eating Habits: Food Away from Home, Available online: https:\/\/www.ers.usda.gov\/webdocs\/publications\/90228\/eib-196.pdf?v=7152."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/j.jand.2021.01.012","article-title":"Association between Frequency of Eating Away-From-Home Meals and Risk of All-Cause and Cause-Specific Mortality","volume":"121","author":"Du","year":"2021","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s41043-022-00335-5","article-title":"Pooled prevalence of food away from home (FAFH) and associated non-communicable disease (NCD) markers: A systematic review and meta-analysis","volume":"41","author":"Godbharle","year":"2022","journal-title":"J. Health Popul. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"5511","DOI":"10.1080\/10408398.2021.1887075","article-title":"Contribution of foods prepared away from home to intakes of energy and nutrients of public health concern in adults: A systematic review","volume":"62","author":"Davies","year":"2022","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_5","unstructured":"(2024, January 27). U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020\u20132025, Available online: https:\/\/www.dietaryguidelines.gov."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Rinc\u00f3n-Gallardo Pati\u00f1o, S., Zhou, M., Da Silva Gomes, F., Lemaire, R., Hedrick, V., Serrano, E., and Kraak, V.I. (2020). Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research. Nutrients, 12.","DOI":"10.3390\/nu12061544"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"140455","DOI":"10.5888\/pcd12.140455","article-title":"Community-Based Restaurant Interventions to Promote Healthy Eating: A Systematic Review","volume":"12","author":"Guerrero","year":"2015","journal-title":"Prev. Chronic Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Price, J.H., Khubchandani, J., McKinney, M., and Braun, R. (2013). Racial\/ethnic disparities in chronic diseases of youths and access to health care in the United States. BioMed Res. Int., 2013.","DOI":"10.1155\/2013\/787616"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1097\/FCH.0000000000000183","article-title":"Examining the Impact of Structural Racism on Food Insecurity: Implications for Addressing Racial\/Ethnic Disparities","volume":"41","author":"Bruce","year":"2018","journal-title":"Fam. Community Health"},{"key":"ref_10","first-page":"A76","article-title":"The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines","volume":"3","author":"Baker","year":"2006","journal-title":"Prev. Chronic Dis."},{"key":"ref_11","unstructured":"United States Census Bureau (2024, January 27). QuickFacts: Baltimore City, Maryland, Available online: https:\/\/www.census.gov\/quickfacts\/fact\/table\/baltimorecitycountymaryland\/HSG445222."},{"key":"ref_12","unstructured":"Department of Population Health, NYU Langone Health (2024, January 27). City Health Dashboard. Available online: https:\/\/www.cityhealthdashboard.com\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1080\/03670244.2010.524102","article-title":"Characteristics of Prepared Food Sources in Low-Income Neighborhoods of Baltimore City","volume":"49","author":"Lee","year":"2010","journal-title":"Ecol. Food Nutr."},{"key":"ref_14","unstructured":"Misiaszek, C., Buzogany, S., and Freishtat, H. (2018). Baltimore City\u2019s Food Environment: 2018 Report, Johns Hopkins Center for a Livable Future. Available online: https:\/\/clf.jhsph.edu\/sites\/default\/files\/2019-01\/baltimore-city-food-environment-2018-report.pdf."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"357","DOI":"10.4278\/ajhp.130805-QUAN-408","article-title":"Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting","volume":"29","author":"Bleich","year":"2015","journal-title":"Am. J. Health Promot"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1186\/s13063-018-2663-y","article-title":"Exposure to a multi-level multi-component childhood obesity prevention community-randomized controlled trial: Patterns, determinants, and implications","volume":"19","author":"Trude","year":"2018","journal-title":"Trials"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cantu-Jungles, T., McCormack, L., Slaven, J., Slebodnik, M., and Eicher-Miller, H. (2017). A Meta-Analysis to Determine the Impact of Restaurant Menu Labeling on Calories and Nutrients (Ordered or Consumed) in U.S. Adults. Nutrients, 9.","DOI":"10.3390\/nu9101088"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Fuster, M., Handley, M.A., Alam, T., Fullington, L.A., Elbel, B., Ray, K., and Huang, T.T.-K. (2021). Facilitating Healthier Eating at Restaurants: A Multidisciplinary Scoping Review Comparing Strategies, Barriers, Motivators, and Outcomes by Restaurant Type and Initiator. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18041479"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1002\/oby.21940","article-title":"A Systematic Review of Calorie Labeling and Modified Calorie Labeling Interventions: Impact on Consumer and Restaurant Behavior","volume":"25","author":"Bleich","year":"2017","journal-title":"Obesity"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sisnowski, J., Street, J.M., and Merlin, T. (2017). Improving food environments and tackling obesity: A realist systematic review of the policy success of regulatory interventions targeting population nutrition. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0182581"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s11606-021-07104-w","article-title":"Understanding the Influence and Impact of Stakeholder Engagement in Patient-centered Outcomes Research: A Qualitative Study","volume":"37","author":"Maurer","year":"2022","journal-title":"J. Gen. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"130310","DOI":"10.5888\/pcd11.130310","article-title":"Restaurant Owners\u2019 Perspectives on a Voluntary Program to Recognize Restaurants for Offering Reduced-Size Portions, Los Angeles County, 2012","volume":"11","author":"Gase","year":"2014","journal-title":"Prev. Chronic Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Fuster, M., Abreu-Runkle, R., Handley, M.A., Rose, D., Rodriguez, M.A., Dimond, E.G., Elbel, B., and Huang, T.T.K. (2022). Promoting healthy eating in Latin American restaurants: A qualitative survey of views held by owners and staff. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13294-7"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"101716","DOI":"10.1016\/j.evalprogplan.2019.101716","article-title":"Using formative research to tailor a community intervention focused on the prevention of chronic disease","volume":"78","author":"Pleasant","year":"2020","journal-title":"Eval. Program Plan."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.amepre.2006.12.022","article-title":"Nutrition Environment Measures Study in Restaurants (NEMS-R)Development and Evaluation","volume":"32","author":"Saelens","year":"2007","journal-title":"Am. J. Prev. Med."},{"key":"ref_26","unstructured":"Cohen, D., Bhatia, R., Story, M.T., Sugarman, S.D., Wootan, M., Economos, C.D., Van Horn, L., Whitsel, L.P., Roberts, S., and Powell, L.M. (2013). Performance Standards for Restaurants: A New Approach to Addressing the Obesity Epidemic, RAND Corporation. Available online: https:\/\/www.jstor.org\/stable\/10.7249\/j.ctt6wq7t8.1."},{"key":"ref_27","unstructured":"ESRI (2024, January 27). Healthy Food Priority Areas 2018. Available online: https:\/\/www.esri.com\/en-us\/arcgis\/products\/index."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1002\/nur.4770180211","article-title":"Sample size in qualitative research","volume":"18","author":"Sandelowski","year":"1995","journal-title":"Res. Nurs. Health"},{"key":"ref_29","unstructured":"Mihas, P. (2023). International Encyclopedia of Education, Elsevier. [4th ed.]."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1016\/j.amepre.2020.01.012","article-title":"Trends in the Nutrition Profile of Menu Items at Large Burger Chain Restaurants","volume":"58","author":"Wolfson","year":"2020","journal-title":"Am. J. Prev. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.jneb.2020.12.002","article-title":"Understanding Restaurant Healthfulness in Food Deserts","volume":"53","author":"Lee","year":"2021","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_32","unstructured":"World Health Organization (2023). Red and Processed Meat in the Context of Health and the Environment: Many Shades of Red and Green: Information Brief, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240074828."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"503","DOI":"10.4162\/nrp.2023.17.3.503","article-title":"Comparison of participant and non-participant perceptions on healthy restaurant for sodium reduction: A qualitative study","volume":"17","author":"Pyo","year":"2023","journal-title":"Nutr Res Pr."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Du, W., Zhang, P., Zhang, J., Li, Y., He, F.J., Zhang, X., Su, C., Jia, X., Li, L., and Song, J. (2022). Sodium Reduction in Restaurant Food: A Randomized Controlled Trial in China. Nutrients, 14.","DOI":"10.3390\/nu14245313"},{"key":"ref_35","unstructured":"Son, M., and Lusk, J. (2023). An Analysis of U.S. Cooking Oil Demand, Purdue University. Available online: https:\/\/ag.purdue.edu\/cfdas\/wp-content\/uploads\/2023\/07\/An-Analysis-of-U.S.-Cooking-Oil-Demand_USB-approval_6-29-update.pdf."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2497","DOI":"10.1002\/oby.21684","article-title":"Reducing calories, fat, saturated fat, and sodium in restaurant menu items: Effects on consumer acceptance","volume":"24","author":"Patel","year":"2016","journal-title":"Obesity"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Seo, H.-S. (2020). Sensory Nudges: The Influences of Environmental Contexts on Consumers\u2019 Sensory Perception, Emotional Responses, and Behaviors toward Foods and Beverages. Foods, 9.","DOI":"10.3390\/foods9040509"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"106432","DOI":"10.1016\/j.appet.2022.106432","article-title":"Personal values, motives, and healthy and sustainable food choices: Examining differences between home meals and restaurant meals","volume":"182","author":"Claessens","year":"2023","journal-title":"Appetite"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"52","DOI":"10.5993\/AJHB.41.1.5","article-title":"Spice and Herb Use with Vegetables: Liking, Frequency, and Self-efficacy among US Adults","volume":"41","author":"Nikolaus","year":"2017","journal-title":"Am. J. Health Behav."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1186\/s12966-019-0830-5","article-title":"Effectiveness of a low-value financial-incentive program for increasing vegetable-rich restaurant meal selection and reducing socioeconomic inequality: A cluster crossover trial","volume":"16","author":"Nagatomo","year":"2019","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1001\/jama.2023.12618","article-title":"Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Liver Cancer and Chronic Liver Disease Mortality","volume":"330","author":"Zhao","year":"2023","journal-title":"JAMA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.amepre.2023.02.007","article-title":"Online RCT of Icon Added-Sugar Warning Labels for Restaurant Menus","volume":"65","author":"Falbe","year":"2023","journal-title":"Am. J. Prev. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"430","DOI":"10.3945\/ajcn.112.054833","article-title":"Caloric effect of a 16-ounce (473-mL) portion-size cap on sugar-sweetened beverages served in restaurants","volume":"98","author":"Wang","year":"2013","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Mitchell, W.F. (2009). African American Food Culture, Greenwood Press.","DOI":"10.5040\/9798400607677"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1177\/0890117121999184","article-title":"Eat Well El Paso!: Lessons Learned from a Community-Level Restaurant Initiative to Increase Availability of Healthy Options While Celebrating Local Cuisine","volume":"35","author":"Redelfs","year":"2021","journal-title":"Am. J. Health Promot."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/j.jneb.2017.09.027","article-title":"STRIVE, San Diego! Methodology of a Community-Based Participatory Intervention to Enhance Healthy Dining at Asian and Pacific Islander Restaurants","volume":"50","author":"Oropeza","year":"2018","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1161\/CIRCULATIONAHA.118.037401","article-title":"Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults","volume":"139","author":"Malik","year":"2019","journal-title":"Circulation"},{"key":"ref_48","unstructured":"American Heart Association (2021). Suggested Servings from Each Food Group, American Heart Association. Available online: https:\/\/www.heart.org\/en\/healthy-living\/healthy-eating\/eat-smart\/nutrition-basics\/suggested-servings-from-each-food-group."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1353\/cpr.2011.0035","article-title":"Partnering with REACH to Create a \u201cDiabetes-Friendly\u201d Restaurant: A Restaurant Owner\u2019s Experience","volume":"5","author":"Chen","year":"2011","journal-title":"Prog. Community Health Partnersh. Res. Educ. Action"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/10\/1524\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:44:25Z","timestamp":1760107465000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/10\/1524"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,18]]},"references-count":49,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["nu16101524"],"URL":"https:\/\/doi.org\/10.3390\/nu16101524","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2024,5,18]]}}}