Food Selection
Conditions
Keywords
food labeling, ecolabeling, choice behavior
Brief summary
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.
Detailed description
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.
Interventions
BEHAVIORALControl (QR) Labels
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).
BEHAVIORALLow Environmental Harm Labels
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).
BEHAVIORALHigh Environmental Harm Labels
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).
BEHAVIORALEnvironmental Harm Traffic Light Labels
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).
BEHAVIORALEnvironmental Grade Labels
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).
Sponsors
Johns Hopkins Bloomberg School of Public Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Participants will be randomized to view two fast-food menus presented in random 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. 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 environmental harm that factor estimated cropland, pastureland, and water used in the production of the item. Participants will be instructed to select a hypothetical lunch meal order from each menu. The investigators will record participant meal selections and, using publicly available nutritional information for each item selected, calculate a score of overall meal healthfulness.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* 18 years of age or older * Member of the Verasight Panel * Residing in the United States
Exclusion criteria
* \<18 years of age * Not residing in the United States * Completed the survey in less than one-third of the median completion duration of all participants * Respondents with high refusal rates (skipped or refused more than 50% of questions) * Respondents who 'straight-line' all question grids with 6 or more items, where responses are not internally consistent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Modified Nutrient Profile Index score | Immediately upon viewing the menus | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Nutrient Profile Index score | Immediately upon viewing the menus | 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 |
| Number of Participants who Notice labels (Attention to label) | Immediately after viewing the menus | 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". |
| Number of Participants who Recall Label Purpose | Immediately after viewing the menus | 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". |
| Number of Participants Who Use of label | Immediately after viewing the menus | 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". |
| Participant's Perceived label believability | Immediately after viewing the menu excerpt and label image | 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. |
| Perception that label grabbed attention | Immediately after viewing the menu excerpt and label image | 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. |
| Perceived message effectiveness (PME) as assessed by the University of North Carolina (UNC) PME scale | Immediately after viewing the menu excerpt and label image | 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. |
| Total price of meal order | Immediately upon viewing the menus | Measured by the cumulative total price (USD) of participants' hypothetical meal orders per restaurant, based on the prices displayed on the survey menus. |
| Beef item selected | Immediately upon viewing the menus | Measured as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include an item containing beef. |
| Total energy selected | Immediately upon viewing the menus | 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. |
| Total saturated fat selected | Immediately upon viewing the menus | 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. |
| Total sugar selected | Immediately upon viewing the menus | 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. |
| Total protein selected | Immediately upon viewing the menus | 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. |
| Total fiber selected | Immediately upon viewing the menus | 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. |
| Total sodium selected | Immediately upon viewing the menus | 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. |
| Sugar-sweetened beverage selected | Immediately upon viewing the menus | Measured as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include a sugar-sweetened beverage. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORJulia Wolfson, PhD MPP
Johns Hopkins Bloomberg School of Public Health
Outcome results
None listed