Consumption of restaurant food and beverage products high in fat, sugar and sodium contribute to obesity and non-communicable diseases. We evaluated restaurant-sector progress to promote healthy food environments for Americans. We conducted a desk review of seven electronic databases (January 2006–January 2017) to examine restaurant strategies used to promote healthful options in the United States (U.S.). Evidence selection (n = 84) was guided by the LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions) and verified by data and investigator triangulation. A marketing-mix and choice-architecture framework was used to examine eight voluntary strategies (i.e., place, profile, portion, pricing, promotion, healthy default picks, priming or prompting and proximity) to evaluate progress (i.e., no, limited, some or extensive) toward 12 performance metrics based on available published evidence. The U.S. restaurant sector has made limited progress to use pricing, profile (reformulation), healthy default picks (choices), promotion (responsible marketing) and priming and prompting (information and labeling); and some progress to reduce portions. No evidence was available to assess progress for place (ambience) and proximity (positioning) to promote healthy choices during the 10-year review period. Chain and non-chain restaurants can apply comprehensive marketing-mix and nudge strategies to promote healthy food environments for customers.

In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to promote fruit and vegetable sales and intake to moms and teens in two California and Virginia pilot markets. The FNV Campaign used a novel, creative approach to promote fruits and vegetables through integrated marketing communication (IMC) strategies. Findings from a mixed-methods process evaluation conducted between 2016 and 2017 were used to explore congruence between stakeholders' expectations of IMC strategy potential and FNV brand awareness and reach among target audiences. Awareness and recall of IMC strategies were assessed through a cross-sectional survey of target audience respondents (n = 1604) from the pilot markets. Qualitative data regarding IMC strategy potential and influential factors were gathered from stakeholder interviews (n = 22). Approximately 19.6% (n = 315) of respondents were aware of the FNV Campaign. Stakeholders' perspectives regarding IMC potential aligned with findings that the proportion of aware respondents was significantly (p = 0.008) higher among teens (22%) than moms (17%). Qualitative results also converged with higher proportions of survey respondents recalling brand exposure through social media (46%) and retail settings (30%) than community activities (18%), word of mouth (17.5%), and traditional media advertisements (9.5%). IMC recall did not differ between mom and teen respondents except for significantly (p = 0.02) higher word of mouth recall among teen respondents. Findings support using selected IMC strategies and future involvement of diverse stakeholders. Evaluation results can inform future research and practice to improve IMC strategy reach and influence as the FNV Campaign expands to new markets nationwide.

Clinical trials of novel therapeutics in the United States have not been adequately representative of diverse populations, particularly racial and ethnic minorities. The challenges and consequences of underrepresentation in clinical trial recruitment are exemplified by the case of belimumab, a biologic treatment for systemic lupus erythematosus (SLE), a disease that is more prevalent in patients of Black African ancestry and of Hispanic/Latino ethnicity than in other patient populations. Although belimumab was found to be effective in phase 2 and 3 clinical trials in the general population, post hoc analyses of efficacy data in patients of Black African ancestry showed inconsistent results. Consequently, a cautionary statement regarding belimumab use in this population was added to the product label. To alleviate concerns that belimumab may not be safe and effective for patients of Black African ancestry, the Efficacy and Safety of Belimumab in Black Race Patients with SLE (EMBRACE) study was conducted in a post‐marketing commitment to the Food and Drug Administration. The study recruited only patients who self‐identified as being of Black race; its findings led to the removal of the cautionary labeling of belimumab use in patients of Black African ancestry. Our manuscript highlights the critical lessons learned from the successes and failures of the EMBRACE study. It also provides suggestions for overcoming health disparities, highlighting strategies for conducting well‐designed clinical trials to overcome systematic barriers to diversity in recruitment, with a focus on enacting long‐term support to ensure equity in the process, products, and benefits from drug development and clinical trials.