The primary objective of this study is to test the relative effects of environmental harm menu label designs on the healthfulness of consumers' fast-food meal choices. Participants will complete hypothetical online meal ordering tasks using a survey which emulates the online menus of two types of fast-food chain restaurants: a burger restaurant and a sandwich restaurant. Participants will be randomized the view both menus, presented in random order, with one of five labeling conditions applied. Secondary objectives include energy and nutrient content of meals ordered, prices of meals ordered, and, through a post-order survey, noticeability of the labels and perceptions of labels between the conditions.
This online randomized trial will test the relative effects of environmental harm menu label designs on the healthfulness of consumers' fast-food meal choices and perceptions of menu items. The survey research firm Verasight will recruit a nationally representative sample of 7,000 adults aged 18 years and older who speak English and reside in the United States from their survey panel. Participants will complete a between-subjects online experiment in which the participants will be randomized to view two fast-food online ordering menus (in randomized order) with one of five labeling schemes applied: (1) a QR code on all items (control); (2) a low environmental harm label on all low harm items (3) a high environmental harm label on high harm items; (4) traffic light labels on all items by level of environmental harm; and (5) environmental grade labels on all items by level of environmental harm. Each restaurant menu will be presented across 2 pages; page 1 will display all main items, and page 2 will display categories for side, dessert, and drink items. Labels will only appear alongside main menu items and will be assigned using thresholds for environmental harm set a priori which factor in estimated cropland, pastureland, and water usage associated with each food item. Each hypothetical order must include between 1 and 4 items. Participants will be required to select 1 main item and, optionally, up to 3 additional items (drinks, sides, desserts). After completing the meal ordering task, participants will be prompted to answer questions about whether they noticed the correct label for their condition, whether they used the label when making their meal selections, perceptions of the labeled menu items and the labeling condition which the participants were randomized to view. Additionally, participants will be asked about their level of food security, participation in the Supplemental Nutrition Assistance Program (SNAP), support of governmental policies and practices regarding food and nutrition, use of GLP-1 agonists, 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 include total calories ordered, whether a sugar-sweetened beverage was ordered, and perceived message effectiveness of the environmental harm labels. Analyses will be conducted overall (summing the meal selections across both restaurants) and stratified by restaurant.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
7,000
Participants will view two fast-food restaurant menus presented in a random order. Each menu will include main, side, dessert, and drink items, and 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 at least 1 and up to 4 menu items for a hypothetical meal order. Participants will be required to select a main item and, optionally, up to 3 additional items (drinks, sides, desserts).
Participants will view two fast-food restaurant menus presented in a random order. Each menu will include main, side, dessert, and drink items, and each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Low Environmental Harm labels will be displayed beneath a subset of items. Participants will be instructed to select at least 1 and up to 4 menu items for a hypothetical meal order. Participants will be required to select a main item and, optionally, up to 3 additional items (drinks, sides, desserts).
Participants will view two fast-food restaurant menus presented in a random order. Each menu will include main, side, dessert, and drink items, and each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Environmental Harm labels will be displayed beneath select items. Participants will be instructed to select at least 1 and up to 4 menu items for a hypothetical meal order. Participants will be required to select a main item and, optionally, up to 3 additional items (drinks, sides, desserts).
Participants will view two fast-food restaurant menus presented in a random order. Each menu will include main, side, dessert, and drink items, and each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Environmental Harm Traffic Light labels will be displayed beneath each item. Participants will be instructed to select at least 1 and up to 4 menu items for a hypothetical meal order. Participants will be required to select a main item and, optionally, up to 3 additional items (drinks, sides, desserts).
Participants will view two fast-food restaurant menus presented in a random order. Each menu will include main, side, dessert, and drink items, and each menu item will be displayed with an image of the item, name, price, and total calories. For main items only, Environmental Grade labels will be displayed beneath each item. Participants will be instructed to select at least 1 and up to 4 menu items for a hypothetical meal order. Participants will be required to select a main item and, optionally, up to 3 additional items (drinks, sides, desserts).
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; a score of \>=64 is considered healthy. Higher score is better.
Time frame: Immediately upon viewing the menus
Nutrient Profile Index score
The healthfulness of the fast-food main item selections, measured with a 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; a score of \>=64 is considered healthy. Higher score is better
Time frame: Immediately upon viewing the menus
Number of Participants who Notice labels (Attention to label)
Measured by whether participants noticed labels on the menus, in addition to calorie labels. The exact question is, "On the menus you saw, did you notice any labels (other than calories) next to or below the menu items?" Response options are "Yes", "No", and "Don't Know".
Time frame: Immediately after viewing the menus
Number of Participants who Recall Label Purpose
Measured by whether participants who noticed labels in addition to calorie labels correctly, identify the purpose of the labels. Response options are "Sugar", "Sodium", "QR code", "Environmental Harm", "Organic", "Healthy", "Unhealthy", "None of these", and "I don't know/ I can't remember".
Time frame: Immediately after viewing the menus
Number of Participants Who Use of label
Measured by whether participants who noticed labels in addition to calorie labels, used the labels in selecting a hypothetical meal order. The exact question is, "Did you use these labels you saw when deciding what to order?". Response options are "Yes" and "No".
Time frame: Immediately after viewing the menus
Participant's Perceived label believability
After viewing images of a labeled menu excerpt and a zoomed in 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.
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
This modified 4-item UNC-PME scale measures how much the label placed beneath high environmental impact menu items discouraged consumption, or evoked concern or unpleasantness about consumption, of high environmental impact foods. Responses measured on a 5-point Likert scale from 1=Not at all to 5= A great deal, with higher scores interpreted as better. Preceding the questions, participants will view a menu excerpt with the assigned label applied and a prompt, and likert scale.
Time frame: Immediately after viewing the menu excerpt and label image
Total price of meal order
Measured by the cumulative total price (USD) of participants' hypothetical meal orders per restaurant, based on the prices displayed on the survey menus.
Time frame: Immediately upon viewing the menus
Beef item selected
Measured as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include an item containing beef.
Time frame: Immediately upon viewing the menus
Total energy 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: Immediately upon viewing the menus
Total saturated fat selected
The total amount of saturated fat in participants' hypothetical meal orders, calculated as the sum of saturated fat (grams) across all menu items selected. Higher values indicate more saturated fat selected.
Time frame: Immediately upon viewing the menus
Total sugar selected
The total amount of sugar in participants' hypothetical meal orders, calculated as the sum of sugar (grams) across all menu items selected. Higher values indicate more sugar selected.
Time frame: Immediately upon viewing the menus
Total protein selected
The total amount of protein in participants' hypothetical meal orders, calculated as the sum of protein (grams) across all menu items selected. Higher values indicate more protein selected.
Time frame: Immediately upon viewing the menus
Total fiber selected
The total amount of fiber in participants' hypothetical meal orders, calculated as the sum of fiber (grams) across all menu items selected. Higher values indicate more fiber selected.
Time frame: Immediately upon viewing the menus
Total sodium selected
The total amount of sodium in participants' hypothetical meal orders, calculated as the sum of sodium (milligrams) across all menu items selected. Higher values indicate more sodium selected.
Time frame: Immediately upon viewing the menus
Sugar-sweetened beverage selected
Measured as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include a sugar-sweetened beverage.
Time frame: Immediately upon viewing the menus
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