Online Food and Beverage Labels and Vending Machine Selections

A Large-scale, Long-term, Randomized Trial of Nutrition Labeling Interventions

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT05432271

Acronym

VLO

Enrollment

8145

Registered

2022-06-27

Start date

2022-11-16

Completion date

2022-12-03

Last updated

2023-12-20

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Food Preferences, Obesity, Weight Gain

Keywords

food labeling, sugar-sweetened beverages, eating, drinking, choice behavior

Brief summary

The aim of this study is to compare the impact of 5 different types of front of package (FOP) food and beverage labels: 1) calorie labels \[control\], 2) green labels on healthy foods, 3) red/yellow/green labels on less healthy/moderately healthy/healthy foods, 4) physical activity calorie equivalent labels, and 5) High in nutrient warning labels) on consumers' beverage and snack selections.

Detailed description

This project involves an online randomized experiment. We are working with an external survey company that will recruit 8,000 participants to complete an online survey in which they will be randomized to one of the five different label conditions: 1) calorie labels (control condition); 2) single green traffic light labels (on healthy foods); 3) multiple traffic light labels (red traffic light labels applied to less healthy foods, yellow applied to moderately healthy foods, and green on healthy foods); 4) physical activity labels (calorie content displayed in terms of physical activity equivalents); 5) High in warnings (applied to all products exceeding thresholds for calories, saturated fat, sugar, or sodium content). Participants will be instructed to select products to purchase in a mock vending machine. After purchasing their products, they will be asked to answer questions about their perceptions of the different labels.

Interventions

BEHAVIORALExposure to calorie information

Calories for all beverages and foods

BEHAVIORALExposure to healthy labels only

Green labels only for beverages and foods scored as healthy

BEHAVIORALExposure to healthiness information

All beverages and foods labeled as either healthy (green), moderately healthy (yellow), or less healthy (red)

BEHAVIORALExposure to physical activity equivalents

All beverages and foods labeled with physical activity required to burn their calories

BEHAVIORALExposure to high in nutrient warning labels

Warning labels only for beverages and foods that exceed the thresholds for sugar, sodium, saturated fat, or calorie content

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

PREVENTION

Masking

NONE

Intervention model description

Participants will be randomly assigned to 1 of 5 front-of-package labeling arms with equal probability: Participants will complete two vending machine choice tasks with their assigned labels shown (one for beverages, one for snack foods, in random order). For each choice task, participants will be asked to select 1 item they most wish to purchase. We will incentivize truthful responding by instructing participants that they could be randomly selected to have their choice delivered to them. We will record participants' selections and match these to nutrition information.

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Yes

Inclusion criteria

* Participants will be US adults * Ages 18 or older * With an over-sample of adults with lower educational attainment (some college or less)

Exclusion criteria

* Younger than 18 * Non-US * Educational quota filled

Design outcomes

Primary

Measure	Time frame	Description
Number of Participants Purchasing Beverages With Calories	The survey will take up to 20 minutes.	Participants will select a beverage to purchase from the online vending machine. Outcome is binary: purchased a beverage with calories or not.
Calories Purchased From Beverages, if Beverage With Calories Chosen	The survey will take up to 20 minutes.	Participants will select a beverage to purchase from the online vending machine. Outcome is calories in beverage chosen to purchase - only for those participants who chose a beverage with calories.
Calories Purchased From Snacks	The survey will take up to 20 minutes.	Participants will select a snack to purchase from the online vending machine. Outcome is calories in snacks chosen to purchase.

Secondary

Measure	Time frame	Description
Likelihood of Selecting a Healthy Snack	The survey will take up to 20 minutes.	Participants will select a snack to purchase in the virtual store. Outcome is percentage of people selecting a healthy snack (green labeled in the traffic light condition)
Likelihood of Selecting a Moderately Healthy Snack	The survey will take up to 20 minutes.	Participants will select a snack to purchase in the virtual store. Outcome is percentage of people selecting a moderately healthy snack (yellow labeled in the traffic light condition)
Likelihood of Selecting a Less Healthy Snack	The survey will take up to 20 minutes.	Participants will select a snack to purchase in the virtual store. Outcome is percentage of people selecting a less healthy snack (red labeled in the traffic light condition)
Saturated Fat Purchased From Beverages	The survey will take up to 20 minutes.	Participants will select a beverage to purchase from the online vending machine. Outcome is saturated fat in beverage chosen to purchase.
Sodium Purchased From Beverages	The survey will take up to 20 minutes.	Participants will select a beverage to purchase from the online vending machine. Outcome is sodium in beverage chosen to purchase.
Total Sugar Purchased From Beverages	The survey will take up to 20 minutes.	Participants will select a beverage to purchase from the online vending machine. Outcome is total sugar in beverage chosen to purchase.
Saturated Fat Purchased From Snacks	The survey will take up to 20 minutes.	Participants will select a snack to purchase from the online vending machine. Outcome is saturated fat in snack chosen to purchase.
Sodium Purchased From Snacks	The survey will take up to 20 minutes.	Participants will select a snack to purchase from the online vending machine. Outcome is sodium in snack chosen to purchase.
Total Sugar Purchased From Snacks	The survey will take up to 20 minutes.	Participants will select a snack to purchase from the online vending machine. Outcome is total sugar in snack chosen to purchase.
Perceived Healthiness of a Healthy Beverage	The survey will take up to 20 minutes.	This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy.
Perceived Healthiness of a Moderately Healthy Beverage	The survey will take up to 20 minutes.	This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy.
Perceived Healthiness of a Less Healthy Beverage	The survey will take up to 20 minutes.	This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy.
Perceived Healthiness of a Healthy Snack	The survey will take up to 20 minutes.	This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy.
Perceived Healthiness of a Moderately Healthy Snack	The survey will take up to 20 minutes.	This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy.
Perceived Healthiness of a Less Healthy Snack	The survey will take up to 20 minutes.	This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy.
Likelihood of Selecting a Healthy Beverage	The survey will take up to 20 minutes.	Participants will select a beverage to purchase in the virtual store. Outcome is percentage of people selecting a healthy beverage (green labeled in the traffic light condition)
Degree of Perceived Label Influence on Beverage Selection	The survey will take up to 20 minutes.	Participants will respond on a 5-point scale ranging from Not at all to A great deal to the item: How much did you use this label to help you decide what beverage to buy?
Degree of Perceived Label Influence on Snack Selection	The survey will take up to 20 minutes.	Participants will respond on a 5-point scale ranging from Not at all to A great deal to the item: How much did you use this label to help you decide what snack to buy?
Trust in Labels	The survey will take up to 20 minutes.	Item: How much do you trust or distrust the information on this label?. Responses will be measured on a 5-point Likert scale from completely distrust to completely trust.
Reactance to Labels	The survey will take up to 20 minutes.	We will examine the average reactance to the label (said the label is trying to manipulate me, or annoys me). Each reactance item will be scored on a 5-pt likert scale from not at all to a great deal.
Attention to Labels	The survey will take up to 20 minutes.	Item: How much does this label grab your attention?. Responses will be measured on a 5-point Likert scale from not at all to a great deal.
Learned From Labels	The survey will take up to 20 minutes.	Item: To what extent did you learn something new from this label?. Responses will be measured on a 5-point Likert scale from not at all to a great deal.
Thinking About Health Effects	The survey will take up to 20 minutes.	Item: How much does this label make you think about the health effects of food and beverages?. Responses will be measured on a 5-point Likert scale from not at all to a great deal
Perceived Discouragement	The survey will take up to 20 minutes.	We will examine if they said the label discourages them from choosing unhealthy products. This item will be scored on a 5-pt likert scale from not at all to a great deal
Perceived Encouragement	The survey will take up to 20 minutes.	We will examine if they said the label encourages them to choose healthy products. This item will be scored on a 5-pt likert scale from not at all to a great deal
Negative Emotional Reactions	The survey will take up to 20 minutes.	We will examine the average negative emotional response to the label (said the label made them feel worried, scared, guilty, ashamed, or sad). Each emotion will be scored on a 5-pt likert scale from not at all to a great deal.
Perceived Control in Response to Labels	The survey will take up to 20 minutes.	Participants will respond to the item Overall does this label make you feel… with one of 3 responses: less in control of making healthy eating decisions, more in control of healthy eating decisions, or neither less nor more in control of making healthy eating decisions
Perceived Personal Stigmatization	The survey will take up to 20 minutes.	Participants will respond to the item How personally stigmatized does this label make you feel? on a 5-pt likert scale from not at all to a great deal.
Perceived Obesity Stigma	The survey will take up to 20 minutes.	We will examine the average stigma response to the label (the label stigmatizes people with obesity, the label increases blame toward people for being overweight). Each stigma item will be scored on a 5-pt likert scale from not at all to a great deal.
Disgust Toward People With Obesity	The survey will take up to 20 minutes.	Participants will respond to the item How disgusted do people with obesity make you feel? on a 5-pt likert scale from not at all to a great deal.
Noticing Trial Labels	The survey will take up to 20 minutes.	Participants will respond yes, no, or not sure to the item: When you were selecting a beverage and a snack, did you notice any other nutrition labels on or next to the products?
Likelihood of Selecting a Moderately Healthy Beverage	The survey will take up to 20 minutes.	Participants will select a beverage to purchase in the virtual store. Outcome is percentage of people selecting a moderately healthy beverage (yellow labeled in the traffic light condition)
Likelihood of Selecting a Less Healthy Beverage	The survey will take up to 20 minutes.	Participants will select a beverage to purchase in the virtual store. Outcome is percentage of people selecting a less healthy beverage (red labeled in the traffic light condition)

Countries

United States

Participant flow

Participants by arm

Arm	Count
Control Calorie labels shown on front of product packaging Exposure to calorie information: Calories for all beverages and foods	1,593
Green Labels Green label added to front of product packaging for healthy products; no additional labels shown for less healthy products Exposure to calorie information: Calories for all beverages and foods Exposure to healthy labels only: Green labels only for beverages and foods scored as healthy	1,587
Traffic Light Labels Red/yellow/green labels added to front of product packaging for less healthy/moderately healthy/healthy products, respectively Exposure to calorie information: Calories for all beverages and foods Exposure to healthiness information: All beverages and foods labeled as either healthy (green), moderately healthy (yellow), or less healthy (red)	1,588
Physical Activity Calorie Equivalent Labels Labels added to front of product packaging that display products' calorie content in terms of physical activity required to burn those calories Exposure to calorie information: Calories for all beverages and foods Exposure to physical activity equivalents: All beverages and foods labeled with physical activity required to burn their calories	1,590
High in Nutrient Warning Labels Labels added to front of product packaging that signal when the product exceeds thresholds for sugar, sodium, saturated fat, or calorie content Exposure to calorie information: Calories for all beverages and foods Exposure to high in nutrient warning labels: Warning labels only for beverages and foods that exceed the thresholds for sugar, sodium, saturated fat, or calorie content	1,587
Total	7,945

Baseline characteristics

Characteristic	Green Labels	Traffic Light Labels	Physical Activity Calorie Equivalent Labels	Control	High in Nutrient Warning Labels	Total
Age, Customized Age in years 18-29	311 Participants	324 Participants	317 Participants	310 Participants	343 Participants	1605 Participants
Age, Customized Age in years 30-44	382 Participants	402 Participants	408 Participants	419 Participants	408 Participants	2019 Participants
Age, Customized Age in years 45-59	394 Participants	385 Participants	374 Participants	426 Participants	389 Participants	1968 Participants
Age, Customized Age in years >=60	500 Participants	477 Participants	491 Participants	438 Participants	447 Participants	2353 Participants
Education College graduate or associate degree	650 Participants	639 Participants	627 Participants	596 Participants	614 Participants	3126 Participants
Education Graduate degree	175 Participants	186 Participants	159 Participants	171 Participants	197 Participants	888 Participants
Education High school diploma or less	401 Participants	426 Participants	437 Participants	417 Participants	436 Participants	2117 Participants
Education Some college	361 Participants	337 Participants	367 Participants	409 Participants	340 Participants	1814 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	235 Participants	270 Participants	246 Participants	295 Participants	251 Participants	1297 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	1352 Participants	1318 Participants	1344 Participants	1298 Participants	1335 Participants	6647 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants	0 Participants	0 Participants	0 Participants	1 Participants	1 Participants
Race (NIH/OMB) American Indian or Alaska Native	27 Participants	25 Participants	24 Participants	26 Participants	17 Participants	119 Participants
Race (NIH/OMB) Asian	32 Participants	42 Participants	50 Participants	30 Participants	42 Participants	196 Participants
Race (NIH/OMB) Black or African American	206 Participants	196 Participants	186 Participants	193 Participants	183 Participants	964 Participants
Race (NIH/OMB) More than one race	64 Participants	55 Participants	53 Participants	66 Participants	66 Participants	304 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	6 Participants	7 Participants	5 Participants	9 Participants	9 Participants	36 Participants
Race (NIH/OMB) Unknown or Not Reported	52 Participants	51 Participants	49 Participants	60 Participants	47 Participants	259 Participants
Race (NIH/OMB) White	1200 Participants	1212 Participants	1223 Participants	1209 Participants	1223 Participants	6067 Participants
Sex/Gender, Customized Gender Female	799 Participants	825 Participants	844 Participants	814 Participants	796 Participants	4078 Participants
Sex/Gender, Customized Gender Male	773 Participants	746 Participants	729 Participants	757 Participants	774 Participants	3779 Participants
Sex/Gender, Customized Gender Nonbinary or another gender	15 Participants	17 Participants	17 Participants	22 Participants	17 Participants	88 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk	EG002 affected / at risk	EG003 affected / at risk	EG004 affected / at risk
deaths Total, all-cause mortality	0 / 1,627	0 / 1,639	0 / 1,623	0 / 1,633	0 / 1,623
other Total, other adverse events	0 / 1,627	0 / 1,639	0 / 1,623	0 / 1,633	0 / 1,623
serious Total, serious adverse events	0 / 1,627	0 / 1,639	0 / 1,623	0 / 1,633	0 / 1,623

Outcome results

Primary

Calories Purchased From Beverages, if Beverage With Calories Chosen

Participants will select a beverage to purchase from the online vending machine. Outcome is calories in beverage chosen to purchase - only for those participants who chose a beverage with calories.