Clinical trial NCT06909019: MENU Study: Online Experiment
Official title: The Menu Labels for Environmental Impact and Nutrition Study (MENU Study): Online Experiment
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Food Selection
Keywords: food labeling
climate labeling
choice behavior
Lead sponsor: Johns Hopkins Bloomberg School of Public Health
Sponsor class: OTHER
Collaborators: name: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
name: University of California, Davis
name: Harvard School of Public Health (HSPH)
name: University of Pennsylvania
First posted: 2025-04-03
Enrollment: 6294
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
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 climate impact label on all low impact items (3) a high climate impact label on high impact items; (4) traffic light labels on all items by level of impact; and (5) climate grade labels on all items by level of impact. 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 greenhouse gas emissions set a priori in kilograms of CO2 equivalent per kilogram of food. Participants will be instructed to select a hypothetical lunch meal order. 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

Brief summary: The primary objective of this study is to test the relative effects of climate-impact 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 examining total greenhouse gas emissions per meal order, energy and nutrient content of meals ordered, prices of meals ordered, and, through a post-order survey, noticeability, and perceptions, and knowledge and understanding of labels between the conditions.

Detailed description: This online randomized trial will test the relative effects of climate impact menu label designs on the healthfulness of consumers' fast-food meal choices and perceptions of menu items. The survey research firm National Opinion Research Center (NORC) will recruit a nationally representative sample of 6,000 adults aged 18 years and older who speak English and reside in the United States from the Center's AmeriSpeak 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 climate impact label on all low impact items (3) a high climate impact label on high impact items; (4) traffic light labels on all items by level of impact; and (5) climate grade labels on all items by level of impact. 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 greenhouse gas emissions set a priori in kilograms of carbon dioxide (CO2) equivalent per kilogram of food. 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 the whether the participant noticed the correct label for the participant's condition, whether the participant used the label when making meal selections, perceptions of the labeled menu items and the labeling condition which the participants were randomized to view, knowledge of the relative climate impact of food items and consumer behaviors, and support of governmental and policies and practices regarding food and nutrition. Additionally, participants will be asked about level of food security, use of GLP-1 agonists, personal values, dietary patterns, and other demographic information. Participation in the study will last approximately 10 minutes.

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 be total greenhouse gas emissions per meal ordered, total calories ordered, whether a sugar-sweetened beverage was ordered, and perceived message effectiveness of the climate-impact labels.

Analyses will be conducted overall (summing the meal selections across both restaurants) and stratified by restaurant.

Eligibility criteria: Inclusion Criteria:

* 18 years of age or older
* Member of the NORC AmeriSpeak 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)

Primary outcomes:
measure: Modified Nutrient Profile Index score
timeFrame: During online survey ordering task, up to 10 minutes
Secondary outcomes:
measure: Nutrient Profile Index score
timeFrame: During online survey ordering task, up to 10 minutes
measure: Total greenhouse gas emissions
timeFrame: During online survey ordering task, up to 10 minutes
measure: Frequency of red meat selected
timeFrame: During online survey ordering task, up to 10 minutes
measure: Total energy selected (number of calories)
timeFrame: During online survey ordering task, up to 10 minutes
measure: Total amount of saturated fat (grams) selected
timeFrame: During online survey ordering task, up to 10 minutes
measure: Total amount of sugar (grams) selected
timeFrame: During online survey ordering task, up to 10 minutes
measure: Total amount of protein (grams) selected
timeFrame: During online survey ordering task, up to 10 minutes
measure: Total amount of fiber (grams) selected
timeFrame: During online survey ordering task, up to 10 minutes
measure: Total amount of sodium (milligrams) selected
timeFrame: During online survey ordering task, up to 10 minutes
measure: Frequency of sugar-sweetened beverage selected
timeFrame: During online survey ordering task, up to 10 minutes
measure: Percentage of participants with knowledge of the climate impact of foods
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Percentage of participants with knowledge of the climate impact of menu items
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Frequency of participants with attention to labels
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Frequency of participants who recall labels that also correctly identify purpose of labels
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Perceived message effectiveness (PME) as assessed by the University of North Carolina (UNC) PME scale
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Total price of meal order
timeFrame: During online survey ordering task, up to 10 minutes
measure: Perceived level of appeal of food items
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Perceived level of healthfulness of food items
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Perceived level of climate impact of food items
timeFrame: During online survey post-ordering task, up to 10 minutes
Other outcomes:
measure: Participant's knowledge of the climate impact of consumer behaviors as assessed by survey
timeFrame: During online survey post-ordering task, up to 10 minutes
measure: Participant's level of support for food and nutrition policies as assessed by survey
timeFrame: During online survey post-ordering task, up to 10 minutes
Locations:
city: Baltimore
country: United States
facility: Johns Hopkins Bloomberg School of Public Health
state: Maryland
Study officials:
affiliation: Johns Hopkins Bloomberg School of Public Health
name: Julia A Wolfson, PhD MPP
role: PRINCIPAL_INVESTIGATOR
References: