The primary objective of this study is to explore perceptions and understanding of different menu label designs related to ultra-processed foods (UPF). Participants will be randomized to view a fast-food online menu excerpt featuring one of sixteen labeling conditions and then will answer questions about the participant's reactions to and interpretations of the label, perceived label effectiveness, the intention to purchase a menu item with the label, as well as the participant's perceptions of fast-food menu items with and without the label.
This survey will explore the perceptions and understanding of different hypothetical UPF menu label designs. The survey research firm CloudResearch will recruit a sample of \~12,400 adults aged 18 years and older who reside in the United States. This exploratory study will use a factorial experiment to assess different UPF label designs. Participants will be randomized to view a fast-food menu excerpt with one of sixteen labeling schemes, varying by message ("Ultra-Processed" vs. "Contains Food Additives" vs. "Warning: Ultra-Processed" vs. "Warning: UPF"), background and text color (red background with white text vs. yellow background with black text), and type (icon-plus-text vs. text-only). All menus will consist of a selection of food and beverage items, and select items will have the UPF label. Participants will be shown the menu and the label in isolation and will then be asked about the participant's interpretations of the label, reactions to the label, perceived message effectiveness (PME) of the label, how helpful the participant finds the label to be, and the participant's intention to purchase a menu item with the label. The participants will also be shown two different individual fast-food items with the label to which the participant was randomized in random order and asked about the perceived appeal and healthfulness of the menu items. The primary outcome will be intention to purchase a hypothetical menu item with the label. Secondary outcomes include label interpretation, perceived label understandability, perceived label believability, perception that the label grabbed attention, perceived message effectiveness (PME) of the label, perceived helpfulness of the label. Other outcomes include perceived level of appeal of menu items, and perceived level of healthfulness of menu items.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Ultra-Processed, Red, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Contains Food Additives, Red, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, United States
Intention to purchase
Intention to purchase is measured with the survey question: "How likely would you be to purchase a menu item with this label?" Response options are a 5-point Likert scale: 1=Very unlikely, 2=Unlikely, 3=Somewhat unlikely, 4=Neither likely nor unlikely, 5=Somewhat likely, 6=Likely, 7=Very likely. A higher rating is better.
Time frame: Immediately after viewing the menu excerpt and label image
Label interpretation
Label interpretation is assessed with the survey question: "Imagine that you are in a fast-food restaurant (such as Dunkin') to order for yourself. Next, is a question about the label, as displayed on the menu example. If you saw this label next to an item on the menu, what would you think the label indicates about the item? \[check all that apply\]". Response options provided are a range of statements about the menu item, including 1="This menu item is unhealthy", 2="This menu item contains artificial ingredients", 3="This menu item used a lot of natural resources to produce", 4="This menu item will keep you full for a long time", 5="This menu item is bad for the environment, 6="This menu item costs more", 7="This menu item was made using industrial processing techniques", "This menu item is high in (8) sugar (9) sodium, (10) saturated fat, (11) calories". Also included are "I don't know" and an "Other" option with open-text entry.
Time frame: Immediately after viewing the menu excerpt and label
Perceived label understandability
After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statement: "This label is easy to understand". Response options are a unipolar 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
Time frame: Immediately after viewing the menu excerpt and label image
Perceived label believability
After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statement: "This label is believable to me". Response options are a unipolar 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
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Purpose
PREVENTION
Masking
NONE
Enrollment
14,720
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning Ultra-Processed, Red, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning UPF, Red, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Ultra-Processed, Yellow, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Contains Food Additives, Yellow, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning Ultra-Processed, Yellow, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning UPF, Yellow, Icon-plus-text labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Ultra-Processed, Red, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Contains Food Additives, Red, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning Ultra-Processed, Red, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning UPF, Red, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Ultra-Processed, Yellow, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Contains Food Additives, Yellow, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning Ultra-Processed, Yellow, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Participants will view a fast-food restaurant menu excerpt. Each menu item will be displayed with an image of the item, name, price, and total calories. The Warning UPF, Yellow, Text-only labels will be displayed next to items that are ultra-processed. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
Time frame: Immediately after viewing the menu excerpt and label image
Perception that label grabbed attention
After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statement: "This label grabs my attention". Response options are a unipolar 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
Time frame: Immediately after viewing the menu excerpt and label image
Perceived message effectiveness (PME) as assessed by the University of North Carolina (UNC)-PME scale
Perceived message effectiveness (PME) is measured using the unipolar 3-item University of North Carolina (UNC)-PME scale. Participants will be asked how much each label discourages consumption of or evokes concern of unpleasantness about consumption of foods with the label. After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statements: "This label discourages me from wanting to eat foods with this label", "This label makes foods with this label seem unpleasant", and "This label makes me concerned about the health effects of eating menu items with this label". Response options are a 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
Time frame: Immediately after viewing the menu excerpt and label image
Perceived label helpfulness
Perceived label helpfulness is measured with the survey question: "How helpful would you find this label when deciding what to order at a fast-food restaurant?" Response options are a 7-point Likert scale: 1=Very unhelpful, 2=Unhelpful, 3=Somewhat unhelpful, 4=Neither helpful nor unhelpful, 5=Somewhat helpful, 6=Helpful, 7=Very helpful. A higher ranking is better.
Time frame: Immediately after viewing the menu excerpt and label image