Perceptions of and Reactions to Ultra-Processed Menu Label Designs

Johns Hopkins Bloomberg School of Public Health

Status: Completed

Conditions: Food Choices

Treatments: Behavioral: Contains Food Additives, Red, Text-only Labels; Behavioral: Warning Ultra-Processed, Red, Text-only Labels; Behavioral: Warning Ultra-Processed, Yellow, Text-only Labels; Behavioral: Contains Food Additives, Yellow, Text-only Labels; Behavioral: Ultra-Processed, Yellow, Text-only Labels; Behavioral: Warning Ultra-Processed, Red, Icon-plus-text Labels; Behavioral: Contains Food Additives, Yellow, Icon-plus-text Labels; Behavioral: Warning UPF, Red, Text-only Labels; Behavioral: Warning Ultra-Processed, Yellow, Icon-plus-text Labels; Behavioral: Warning UPF, Red, Icon-plus-text Labels; Behavioral: Warning UPF, Yellow, Text-only Labels; Behavioral: Contains Food Additives, Red, Icon-plus-text Labels; Behavioral: Ultra-Processed, Yellow, Icon-plus-text Labels; Behavioral: Ultra-Processed, Red, Icon-plus-text Labels; Behavioral: Ultra-Processed, Red, Text-only Labels; Behavioral: Warning UPF, Yellow, Icon-plus-text Labels

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT07214805

5R01DK139327-02 (U.S. NIH Grant/Contract)

IRB00034378-2

Details and patient eligibility

About

The primary objective of this study is to explore perceptions and understanding of different menu label designs related to ultra-processed foods (UPF). Participants will be randomized to view a fast-food online menu excerpt featuring one of sixteen labeling conditions and then will answer questions about the participant's reactions to and interpretations of the label, perceived label effectiveness, the intention to purchase a menu item with the label, as well as the participant's perceptions of fast-food menu items with and without the label.

Full description

This survey will explore the perceptions and understanding of different hypothetical UPF menu label designs. The survey research firm CloudResearch will recruit a sample of ~12,400 adults aged 18 years and older who reside in the United States.

This exploratory study will use a factorial experiment to assess different UPF label designs. Participants will be randomized to view a fast-food menu excerpt with one of sixteen labeling schemes, varying by message ("Ultra-Processed" vs. "Contains Food Additives" vs. "Warning: Ultra-Processed" vs. "Warning: UPF"), background and text color (red background with white text vs. yellow background with black text), and type (icon-plus-text vs. text-only). All menus will consist of a selection of food and beverage items, and select items will have the UPF label.

Participants will be shown the menu and the label in isolation and will then be asked about the participant's interpretations of the label, reactions to the label, perceived message effectiveness (PME) of the label, how helpful the participant finds the label to be, and the participant's intention to purchase a menu item with the label. The participants will also be shown two different individual fast-food items with the label to which the participant was randomized in random order and asked about the perceived appeal and healthfulness of the menu items.

The primary outcome will be intention to purchase a hypothetical menu item with the label. Secondary outcomes include label interpretation, perceived label understandability, perceived label believability, perception that the label grabbed attention, perceived message effectiveness (PME) of the label, perceived helpfulness of the label. Other outcomes include perceived level of appeal of menu items, and perceived level of healthfulness of menu items.

Enrollment: 14,720 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• - 18 years of age or older
• Member of the CloudResearch panel
• Residing in the United States

Exclusion criteria

• <18 years of age
• Not residing in the United States
• Completed the survey implausibly quickly based on the distribution of the time to complete the survey among all participants
• Failed the built-in Qualtrics survey fraud detection measures
• Failed attention check question included in the survey

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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14,720 participants in 16 patient groups

Ultra-Processed, Red, Icon-plus-text Labels

Experimental group

Description:

A red icon-plus-text label that reads "ULTRA-PROCESSED" in white text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Ultra-Processed, Red, Icon-plus-text Labels

Contains Food Additives, Red, Icon-plus-text Labels

Experimental group

Description:

A red icon-plus-text label that reads "CONTAINS FOOD ADDITIVES" in white text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Contains Food Additives, Red, Icon-plus-text Labels

Warning Ultra-Processed, Red, Icon-plus-text Labels

Experimental group

Description:

A red icon-plus-text label that reads "WARNING: ULTRA-PROCESSED" in white text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Warning Ultra-Processed, Red, Icon-plus-text Labels

Warning UPF, Red, Icon-plus-text Labels

Experimental group

Description:

A red icon-plus-text label that reads "WARNING: UPF" in white text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Warning UPF, Red, Icon-plus-text Labels

Ultra-Processed, Yellow, Icon-plus-text Labels

Experimental group

Description:

A yellow icon-plus-text label that reads "ULTRA-PROCESSED" in black text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Ultra-Processed, Yellow, Icon-plus-text Labels

Contains Food Additives, Yellow, Icon-plus-text Labels

Experimental group

Description:

A yellow icon-plus-text label that reads "CONTAINS FOOD ADDITIVES" in black text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Contains Food Additives, Yellow, Icon-plus-text Labels

Warning Ultra-Processed, Yellow, Icon-plus-text Labels

Experimental group

Description:

A yellow icon-plus-text label that reads "WARNING: ULTRA-PROCESSED" in black text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Warning Ultra-Processed, Yellow, Icon-plus-text Labels

Warning UPF, Yellow, Icon-plus-text Labels

Experimental group

Description:

A yellow icon-plus-text label that reads "WARNING: UPF" in black text will be placed beneath ultra-processed menu items. Labels will include a triangle icon with an exclamation point directly preceding the label text.

Treatment:

Behavioral: Warning UPF, Yellow, Icon-plus-text Labels

Ultra-Processed, Red, Text-only Labels

Experimental group

Description:

A red text-only label that reads "ULTRA-PROCESSED" in white text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Ultra-Processed, Red, Text-only Labels

Contains Food Additives, Red, Text-only Labels

Experimental group

Description:

A red text-only label that reads "CONTAINS FOOD ADDITIVES" in white text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Contains Food Additives, Red, Text-only Labels

Warning Ultra-Processed, Red, Text-only Labels

Experimental group

Description:

A red text-only label that reads "WARNING: ULTRA-PROCESSED" in white text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Warning Ultra-Processed, Red, Text-only Labels

Warning UPF, Red, Text-only Labels

Experimental group

Description:

A red text-only label that reads "WARNING: UPF" in white text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Warning UPF, Red, Text-only Labels

Ultra-Processed, Yellow, Text-only Labels

Experimental group

Description:

A yellow text-only label that reads "ULTRA-PROCESSED" in black text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Ultra-Processed, Yellow, Text-only Labels

Contains Food Additives, Yellow, Text-only Labels

Experimental group

Description:

A yellow text-only label that reads "CONTAINS FOOD ADDITIVES" in black text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Contains Food Additives, Yellow, Text-only Labels

Warning Ultra-Processed, Yellow, Text-only Labels

Experimental group

Description:

A red text-only label that reads "WARNING: ULTRA-PROCESSED" in black text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Warning Ultra-Processed, Yellow, Text-only Labels

Warning UPF, Yellow, Text-only Labels

Experimental group

Description:

A yellow text-only label that reads "WARNING: UPF" in black text will be placed beneath ultra-processed menu items.

Treatment:

Behavioral: Warning UPF, Yellow, Text-only Labels