Online Food and Beverage Labels and Vending Machine Selections

Study Overview
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Brief Summary
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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
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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.

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

Conditions
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Food Preferences, Obesity, Weight Gain

Intervention / Treatment
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* Behavioral: Exposure to calorie information
* Behavioral: Exposure to healthy labels only
* Behavioral: Exposure to healthiness information
* Behavioral: Exposure to physical activity equivalents
* Behavioral: Exposure to high in nutrient warning labels


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional 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.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Control<br>Calorie labels shown on front of product packaging | Behavioral: Exposure to calorie information<br>* Calories for all beverages and foods<br>|
| Experimental: Green labels<br>Green label added to front of product packaging for healthy products; no additional labels shown for less healthy products | Behavioral: Exposure to calorie information<br>* Calories for all beverages and foods<br>Behavioral: Exposure to healthy labels only<br>* Green labels only for beverages and foods scored as healthy<br>|
| Experimental: Traffic light labels<br>Red/yellow/green labels added to front of product packaging for less healthy/moderately healthy/healthy products, respectively | Behavioral: Exposure to calorie information<br>* Calories for all beverages and foods<br>Behavioral: Exposure to healthiness information<br>* All beverages and foods labeled as either healthy (green), moderately healthy (yellow), or less healthy (red)<br>|
| Experimental: Physical activity calorie equivalent labels<br>Labels added to front of product packaging that display products' calorie content in terms of physical activity required to burn those calories | Behavioral: Exposure to calorie information<br>* Calories for all beverages and foods<br>Behavioral: Exposure to physical activity equivalents<br>* All beverages and foods labeled with physical activity required to burn their calories<br>|
| Experimental: High in nutrient warning labels<br>Labels added to front of product packaging that signal when the product exceeds thresholds for sugar, sodium, saturated fat, or calorie content | Behavioral: Exposure to calorie information<br>* Calories for all beverages and foods<br>Behavioral: Exposure to high in nutrient warning labels<br>* Warning labels only for beverages and foods that exceed the thresholds for sugar, sodium, saturated fat, or calorie content<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Purchasing Beverages With Calories | Participants will select a beverage to purchase from the online vending machine. Outcome is binary: purchased a beverage with calories or not. | The survey will take up to 20 minutes. | 
| 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. | The survey will take up to 20 minutes. | 
| Calories Purchased From Snacks | Participants will select a snack to purchase from the online vending machine. Outcome is calories in snacks chosen to purchase. | The survey will take up to 20 minutes. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Likelihood of Selecting a Healthy Beverage | 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) | The survey will take up to 20 minutes. | 
| Likelihood of Selecting a Moderately Healthy Beverage | 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) | The survey will take up to 20 minutes. | 
| Likelihood of Selecting a Less Healthy Beverage | 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) | The survey will take up to 20 minutes. | 
| Likelihood of Selecting a Healthy Snack | 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) | The survey will take up to 20 minutes. | 
| Likelihood of Selecting a Moderately Healthy Snack | 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) | The survey will take up to 20 minutes. | 
| Likelihood of Selecting a Less Healthy Snack | 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) | The survey will take up to 20 minutes. | 
| Saturated Fat Purchased From Beverages | Participants will select a beverage to purchase from the online vending machine. Outcome is saturated fat in beverage chosen to purchase. | The survey will take up to 20 minutes. | 
| Sodium Purchased From Beverages | Participants will select a beverage to purchase from the online vending machine. Outcome is sodium in beverage chosen to purchase. | The survey will take up to 20 minutes. | 
| Total Sugar Purchased From Beverages | Participants will select a beverage to purchase from the online vending machine. Outcome is total sugar in beverage chosen to purchase. | The survey will take up to 20 minutes. | 
| Saturated Fat Purchased From Snacks | Participants will select a snack to purchase from the online vending machine. Outcome is saturated fat in snack chosen to purchase. | The survey will take up to 20 minutes. | 
| Sodium Purchased From Snacks | Participants will select a snack to purchase from the online vending machine. Outcome is sodium in snack chosen to purchase. | The survey will take up to 20 minutes. | 
| Total Sugar Purchased From Snacks | Participants will select a snack to purchase from the online vending machine. Outcome is total sugar in snack chosen to purchase. | The survey will take up to 20 minutes. | 
| Perceived Healthiness of a Healthy Beverage | This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy. | The survey will take up to 20 minutes. | 
| Perceived Healthiness of a Moderately Healthy Beverage | This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy. | The survey will take up to 20 minutes. | 
| Perceived Healthiness of a Less Healthy Beverage | This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy. | The survey will take up to 20 minutes. | 
| Perceived Healthiness of a Healthy Snack | This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy. | The survey will take up to 20 minutes. | 
| Perceived Healthiness of a Moderately Healthy Snack | This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy. | The survey will take up to 20 minutes. | 
| Perceived Healthiness of a Less Healthy Snack | This variable will be measured on a 5-point Likert scale ranging from very unhealthy to very healthy. | The survey will take up to 20 minutes. | 
| Noticing Trial Labels | 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? | The survey will take up to 20 minutes. | 
| Degree of Perceived Label Influence on Beverage Selection | 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? | The survey will take up to 20 minutes. | 
| Degree of Perceived Label Influence on Snack Selection | 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? | The survey will take up to 20 minutes. | 
| Trust in Labels | 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. | The survey will take up to 20 minutes. | 
| Reactance to Labels | 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. | The survey will take up to 20 minutes. | 
| Attention to Labels | 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. | The survey will take up to 20 minutes. | 
| Learned From Labels | 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. | The survey will take up to 20 minutes. | 
| Thinking About Health Effects | 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 | The survey will take up to 20 minutes. | 
| Perceived Discouragement | 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 | The survey will take up to 20 minutes. | 
| Perceived Encouragement | 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 | The survey will take up to 20 minutes. | 
| Negative Emotional Reactions | 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. | The survey will take up to 20 minutes. | 
| Perceived Control in Response to Labels | 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 | The survey will take up to 20 minutes. | 
| Perceived Personal Stigmatization | 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. | The survey will take up to 20 minutes. | 
| Perceived Obesity Stigma | 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. | The survey will take up to 20 minutes. | 
| Disgust Toward People With Obesity | 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. | The survey will take up to 20 minutes. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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food labeling, sugar-sweetened beverages, eating, drinking, choice behavior