Effect of Added-sugar Menu Labels

University of California (UC) Davis

Status: Completed

Conditions: Nutrition Knowledge; Dietary Behaviour

Treatments: Other: Menu label

Study type: Interventional

Funder types: Other

Identifiers

NCT06666725

1641776-8

Details and patient eligibility

About

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)

Full 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.

Enrollment: 11,275 patients

Sex: All

Ages: 18 to 99 years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Single Blind

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11,275 participants in 5 patient groups

Control

No Intervention group

Description:

Participant will order food and beverages from three menus. The menus will not contain any added sugar labels.

Large, red, icon-only label, 50% daily value

Experimental group

Description:

Participant will order food and beverages from three menus containing labels next to items that contain equal to or higher than half the daily value of added sugar (greater than or equal to 25 grams). The label will be on the right of the item, colored red, icon only design, and height that is 150% of size of the menu text height.

Treatment:

Other: Menu label

Large, red, icon-only label, 100% daily value

Experimental group

Description:

Participant will order food and beverages from three menus containing labels next to items that contain equal to or higher than the total daily value of added sugar (greater than or equal to 50 grams). The label will be on the right of the item, colored red, icon only design, and height that is 150% of size of the menu text height.

Treatment:

Other: Menu label

Small, black, icon-plus-text label, 50% daily value

Experimental group

Description:

Participant will order food and beverages from three menus containing labels next to items that contain equal to or higher than half the daily value of added sugar (greater than or equal to 25 grams). The label will be on the right of the item, colored black, icon plus text design, and height that is 100% of size of the menu text height.

Treatment:

Other: Menu label

Small, black, icon-plus-text label, 100% daily value

Experimental group

Description:

Participant will order food and beverages from three menus containing labels next to items that contain equal to or higher than the total daily value of added sugar (greater than or equal to 50 grams). The label will be on the right of the item, colored black, icon plus text design, and height that is 100% of size of the menu text height.

Treatment:

Other: Menu label