Testing Non-Nutrition Menu Labels on Food Selections

Purpose

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.

Condition

  • Food Selection

Eligibility

Eligible Ages
Over 18 Years
Eligible Sex
All
Accepts 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

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
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.
Primary Purpose
Prevention
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Placebo Comparator
Control (QR) Labels 		A black label featuring a QR code and white text that reads "SCAN HERE" will be placed beneath all main menu items on two restaurant menus. Explanatory text describing the label's meaning will be displayed at the top of the menu.
  • Behavioral: Control (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).
Experimental
Low Environmental Harm Labels 		A green icon-plus-text label that reads "LOW ENVIRONMENTAL HARM" in white text against a green background will be placed on two restaurant menus beneath main menu items that are less harmful to the environment compared to unlabeled main menu items, based on use of cropland, pastureland, and water. Labels will include a white globe icon directly preceding the label text. Explanatory text describing the label's meaning will be displayed at the top of the menu.
  • Behavioral: Low 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).
Experimental
High Environmental Harm Labels 		A red icon-plus-text label that reads "HIGH ENVIRONMENTAL HARM" in white text against a red background will be placed on two restaurant menus beneath main menu items that are more harmful to the environment compared to unlabeled main menu items, based on use of cropland, pastureland, and water. Labels will include a white globe icon directly preceding the label text. Explanatory text describing the label's meaning will be displayed at the top of the menu.
  • Behavioral: High 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).
Experimental
Environmental Harm Traffic Light Labels 		Traffic Light labels will be placed on two restaurant menus beneath all main menu items. Using estimated cropland, pastureland, and water use, each item will be assigned one of three icon-plus-text labels within this scheme: low-, medium-, or high-impact label. Each will read, "HIGH ENVIRONMENTAL HARM" within a red label, "MED. ENVIRONMENTAL HARM" in a yellow label, and "LOW ENVIRONMENTAL HARM" in a green label. Text for all labels will be written in white, and a white globe icon will precede the text. Explanatory text describing the meaning of the labels will be displayed at the top of the menu.
  • Behavioral: Environmental 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).
Experimental
Environmental Grade Labels 		Environmental Grade labels will be placed on two restaurant menus beneath all main menu items, using estimated cropland, pastureland, and water use to assign one of five icon-plus-text labels which indicate a specific environmental grade (A, B, C, D, and F). All labels are solid black with a white globe icon followed by white text which reads "ENVIRONMENTAL GRADE". On the left side of each label, a grade is displayed, capitalized and in a white font within a solid-colored box. The color of the box corresponds with each letter grade: A = dark green, B = light green, C = yellow, D = orange, F = red. Beneath the letter grade, a gradient of all possible grades is displayed horizontally in smaller font, each grade atop a small solid box in the respective grade color. Explanatory text describing the meaning of the labels will be displayed at the top of the menu.
  • Behavioral: Environmental 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).

Recruiting Locations

Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland 21205

More Details

Status
Recruiting
Sponsor
Johns Hopkins Bloomberg School of Public Health

Study Contact

Nina M Carr, MPH, MBA
2404052823
ncarr6@jhu.edu

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.