Dietary Behaviour, Nutrition Knowledge
Conditions
Brief summary
To compare two added-sugar menu label--(1) red, icon-only, 150% of the menu text height and (2) black, icon-plus-text, 100% of the menu text height--to a no-label control on grams of added sugar ordered using two different added-sugar labeling thresholds: (1) ≥50% of Daily Value for added sugar (equivalent to ≥25g) and (2) ≥100% of Daily Value for added sugar (equivalent to ≥50g)
Detailed description
The main goal of this study is to compare two added-sugar menu labels--(1) red, icon-only, 150% of the menu text height and (2) black, icon-plus-text, 100% of the menu text height--to a no-label control on grams of added sugar ordered using two different added-sugar labeling thresholds: (1) ≥50% of Daily Value for added sugar (equivalent to ≥25g) and (2) ≥100% of Daily Value for added sugar (equivalent to ≥50g). This results in 5 conditions: (1) icon-only at 50% threshold, (2) icon-plus-text at 50% threshold, (3) icon-only at 100% threshold, (4) icon-plus-text at 100% threshold, and (5) no-label control. The two primary outcomes are (1) grams of added sugar ordered averaged across a fast-food and full-service restaurant menus and (2) grams of added sugar ordered from a café menu. The secondary outcomes are (1) noticing a high added sugar nutrition label and (2) knowledge of items' added sugar content. For continuous outcomes (e.g., grams of added sugar, knowledge), linear regression models regressing the outcome on an indicator for experimental condition will be used. If the outcomes are not normally distributed, alternative modeling approaches or data transformations will be explored. For dichotomous outcomes (e.g., noticing the added-sugar label), the probability ratio will be modeled using Poisson regression with a robust error variance, regressing the outcome on an indicator for experimental condition. Exploration of effect modification of the labels on primary outcomes by type 2 diabetes status and sociodemographic variables important for health equity will be conducted using interaction terms and stratified models. Exploratory process outcomes include (1) selection of at least one item that contains ≥50% of the Daily Value of added sugar and (2) selection of at least one item that contains ≥100% of Daily Value of added sugar. Other exploratory outcomes include the perception that the labels grabbed attention and support for an added sugars warning label policy. Additionally, differences in the primary outcomes between each of the 5 unique conditions will be examined. If there is evidence of interactions, the modeling approach will be modified.
Interventions
OTHERMenu label
Participants will select food items from three restaurant menus, displayed with labels as specified by their assigned group
Sponsors
University of California, Davis
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
PREVENTION
Masking
SINGLE (Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 99 Years
Healthy volunteers
Yes
Inclusion criteria
* Equal or greater than 18 years of age * English-speaking * U.S. residents * Have eaten restaurant food at least once in the last month * Participants will reflect the U.S. Census Bureau's American Community Survey 5-year estimates for sex, race/ethnicity, educational attainment, and age
Exclusion criteria
* Failing the attention check question * Completing the survey in less than 33% of the median completion time
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Grams of added sugar ordered averaged across fast-food and full-service menus | Within approximately 2 minutes of intervention exposure | Continuous variable. Average grams of added sugar in foods and beverages selected, averaged across fast-food and full-service menus, analyzed using linear regression to examine differences between factor levels |
| Grams of added sugar ordered from a cafe menu | Within approximately 2 minutes of intervention exposure | Continuous variable. Total grams of added sugar in menu items selected from a cafe menu, analyzed using linear regression to examine differences between factor levels |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Noticing and recall of added-sugar nutrient label - dichotomous variable Correct (Answered Yes to noticing, answered Added sugars to recall, and answered high for high low recall question) or Incorrect (otherwise) | Within approximately 10 minutes of intervention exposure | Noticing a nutrition label - Measured with Think back to the beginning of this survey when you imagined you were ordering dinner from restaurant menus. Did you notice any nutrition labels (other than the calories) next to any of the menu items? Response options are Yes, No, and Don't know. Recalling the label's meaning - \[If answered Yes\] Measured with What did the nutrition label tell you about? Response options are (displayed in survey in a random order) Sodium, Added sugars, Trans fats, Fiber, Calcium, Healthy items, Unhealthy items, Vegetarian, Organic, Gluten-free, Sustainable, None of these, Not sure. High/low - \[If answered Added sugars\] What did the label tell you about added sugars? Response options are High in added sugars, Low in added sugars, Something else, I don't know. There is no formal name for this measure/scale. |
| Knowledge of menu items high in added sugar | Within approximately 10 minutes of intervention exposure | Measured with (While viewing menu excerpt) Click on the menu items that you think have equal to or more than half \[or equal to or more than the total, if assigned 100% threshold\] the daily limit for added sugars. Continuous variable using the percent of 8 items correctly classified. Higher percentages of items correctly classified represent more knowledge. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Selection of at least one item that has ≥50% of the Daily Value of added sugar | Within approximately 10 minutes of intervention exposure | Dichotomous variable. Yes (ordered at least one that has ≥50% of the Daily Value of added sugar) or No (did not order any items high in added sugar), analyzed using Poisson regression. |
| Selection of at least one item that has ≥100% of Daily Value of added sugar | Within approximately 10 minutes of intervention exposure | Dichotomous variable. Yes (ordered at least one that has ≥100% of Daily Value of added sugar) or No (did not order any items high in added sugar), analyzed using Poisson regression. |
Countries
United States
Outcome results
None listed