The primary objective of this study is to test the relative effects of climate-impact menu label designs on the healthfulness of consumers' fast-food meal choices. Participants will complete a hypothetical online meal ordering task using a survey which emulates the online menu of a burger restaurant chain. Participants will be randomized for exposure to menus featuring one of five labeling conditions. Secondary objectives include examining total greenhouse gas emissions per meal order and, through a post-order survey, perception of labels between the conditions.
This online randomized trial will test the relative effects of climate impact menu label designs on the healthfulness of consumers' fast-food meal choices and perceptions of menu items. The survey research firm CloudResearch will recruit a sample of 6,250 adults aged 18 years and older who speak English and reside in the United States. Participants will complete a between-subjects online experiment in which the participants will be randomized to view a fast-food online ordering menu with one of five labeling schemes applied: (1) a QR code on all items (control); (2) a high climate impact warning label on high impact items; (3) traffic light labels on all items by level of impact; (4) climate grade labels on all items by level of impact; and (5) numeric carbon footprint labels on all items. All fast-food menus will include main items, sides, desserts, and drinks. Labels will only appear alongside main menu items and will be assigned using thresholds for greenhouse gas emissions set a priori in kilograms of carbon dioxide (CO2) equivalent per kilogram of food. Participants will be instructed to select up to 4 menu items for a hypothetical meal order. After completing the meal ordering task, participants will be prompted to answer questions about the perception of the labeling condition which the participants were randomized to view, perception of the relative effectiveness of all labels in this experiment, and personal values, dietary patterns, and other demographic information. The primary outcome will be the healthfulness of meal orders selected from the online menu, indicated by a modified Nutrient Profile Index meal score for all food items ordered. Secondary outcomes will be total greenhouse gas emissions per meal ordered, total calories ordered, whether a sugar-sweetened beverage was ordered, and perceived message effectiveness of the climate-impact labels.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Participants will view a fast-food restaurant menu including main, side, dessert, and drink items. Each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Control (QR) labels will be displayed beneath each item. Participants will be instructed to select up to 4 menu items for a hypothetical meal order.
Participants will view a fast-food restaurant menu including main, side, dessert, and drink items. Each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Warning High Climate Impact labels will be displayed beneath select items. Participants will be instructed to select up to 4 menu items for a hypothetical meal order.
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Modified Nutrient Profile Index Score
The primary outcome measure will be the healthfulness of the fast-food meal selections, measured with a modified Nutrient Profile Index (NPI) score. NPI scores are based on the United Kingdom (UK) Ofcom Nutrient Profiling Model, which is used to score individual foods in the UK to determine which ones can be marketed to children. The NPI is a 0 to 100-point score for foods; scores \>=64 are considered healthy. NPI awards points from nutrients to encourage (e.g., fiber, protein) and nutrients of concern (e.g., sodium, sugar) per 100 grams. The investigators will generate a modified NPI score to evaluate the healthfulness of full meals comprised of multiple food items. This measure will be determined by calculating the weighted mean NPI score of all food items selected per meal, with each item's NPI score weighted by its proportionate contribution of mass in grams to the total mass of the meal.
Time frame: approximately 1 minute
Total Greenhouse Gas Emissions as Assessed by Cumulative Total Kilograms of Carbon Equivalent (kgCO2e) Per Kilogram
Cumulative total kilograms of carbon equivalent (kgCO2e) per kilogram of food for all meal items.
Time frame: approximately 1 minute
Perceived Message Effectiveness (PME) as Assessed by the University of North Carolina (UNC) PME Scale
The 3-item University of North Carolina (UNC)-PME scale measures how much the label placed beneath high climate impact menu items, discouraged consumption or evoked concern or unpleasantness about consumption of high climate impact foods. Responses to all questions will be measured on a 5-point unipolar Likert scale from 1=Not at all to 5= A great deal. Preceding the questions, participants will view the assigned label demonstrating high climate impact and the following prompt: "Considering this label, how much do you agree or disagree with the following statements." The exact text for each question is: "This label discourages me from wanting to eat foods with a high climate impact." " This label makes eating foods with a high climate impact seem unpleasant." " This label makes me concerned about eating foods with a high climate impact." The mean likert scale choice is reported. The scale choice range is between 1 and 5, with higher scores interpreted as better.
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Purpose
PREVENTION
Masking
NONE
Enrollment
6,622
Participants will view a fast-food restaurant menu including main, side, dessert, and drink items. Each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Traffic Light labels will be displayed beneath each item. Participants will be instructed to select up to 4 menu items for a hypothetical meal order.
Participants will view a fast-food restaurant menu including main, side, dessert, and drink items. Each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Climate Grade labels will be displayed beneath each item. Participants will be instructed to select up to 4 menu items for a hypothetical meal order.
Participants will view a fast-food restaurant menu including main, side, dessert, and drink items. Each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Numeric Carbon Footprint labels will be displayed beneath each item. Participants will be instructed to select up to 4 menu items for a hypothetical meal order.
Time frame: approximately 1 minute
Total Energy (Calories) Selected
The total number of calories in participants' hypothetical meal orders, calculated as the sum of calories across all menu items selected. Higher values indicate more calories selected.
Time frame: approximately 1 minute
Number of Participants Who Selected Sugar-sweetened Beverage
Measured as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include a sugar-sweetened beverage.
Time frame: approximately 1 minute