LAUSR

OBJECTIVE Determine the association between socioeconomic status and self-reported noticing and using calorie menu labels in 2 states with high poverty and obesity. DESIGN Cross-sectional study of responses to the 2016 Behavioral Risk Factor Surveillance System Menu Labeling Module. PARTICIPANTS Representative sample of noninstitutionalized adults aged ≥ 18 years in West Virginia and Mississippi (n = 9,469). MAIN OUTCOME MEASURES The outcomes were reported noticing and using menu labels to make decisions at fast-food restaurants. Independent variables were highest attained education and federal poverty level (% FPL). ANALYSIS Generalized linear models estimated prevalence ratios for noticing and using menu labels. Models mutually adjusted for education, % FPL, age, sex, race/ethnicity, and body mass index. RESULTS Eighty-six percent of respondents reported noticing, and 56% reported using menu labels. Compared with individuals with less than high school education, college graduates were 11% more likely to report noticing (95% confidence interval, 1.06-1.18; P < 0.001) and 18% more likely to report using (95% confidence interval, 1.06-1.30; P < 0.01) menu labels. Patterns were similar for % FPL. CONCLUSIONS AND IMPLICATIONS These data support further investigation of menu labels among subgroups and a larger geographic scope. Limitations of the menu labeling module question and the cross-sectional nature of the existing literature warrant additional research.