MENU Study: Online Experiment

NCT06909019 | Completed

• 2 other identifiers: IRB000274511R01DK139327-01
• Study Type: interventional
• Target: 6,294
• Locations: 1 country
• Sites: 1

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.

Conditions

Food Selection

Keywords

food labeling; climate labeling; choice behavior

Outcome Measures

Primary Outcomes (1)

• Modified Nutrient Profile Index score

  Healthfulness of fast-food meal selections, measured with a modified Nutrient Profile Index (NPI) score. NPI scores are based on the United Kingdom (UK) Ofcom Nutrient Profiling Model, which is used to score individual foods in the UK to determine which ones can be marketed to children. The NPI is a 0 to 100-point score for foods; a score of \>=64 is considered healthy. NPI awards points from nutrients to encourage (e.g., fiber, protein) and nutrients of concern (e.g., sodium, sugar) per 100 grams. The investigators will generate a modified NPI score to evaluate the healthfulness of full meals comprised of multiple food items. This measure will be determined by calculating the weighted mean NPI score of all food items selected per meal, with each item's NPI score weighted by its proportionate contribution of mass in grams to the total mass of the meal. Beverages are excluded and assessed through secondary outcomes.

  During online survey ordering task, up to 10 minutes

Secondary Outcomes (19)

• Nutrient Profile Index score

  During online survey ordering task, up to 10 minutes

• Total greenhouse gas emissions

  During online survey ordering task, up to 10 minutes

• Frequency of red meat selected

  During online survey ordering task, up to 10 minutes

• Total energy selected (number of calories)

  During online survey ordering task, up to 10 minutes

• Total amount of saturated fat (grams) selected

  During online survey ordering task, up to 10 minutes

Other Outcomes (2)

• Participant's knowledge of the climate impact of consumer behaviors as assessed by survey

  During online survey post-ordering task, up to 10 minutes

• Participant's level of support for food and nutrition policies as assessed by survey

  During online survey post-ordering task, up to 10 minutes

Study Arms (5)

Control (QR) Labels

PLACEBO COMPARATOR

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

Low Climate Impact Labels

EXPERIMENTAL

A green icon-plus-text label that reads "LOW CLIMATE IMPACT" in white text against a green background will be placed on two restaurant menus beneath main menu items with a low climate impact using a predetermined threshold of estimated greenhouse gas emissions set at \<2.6 kgCO2e. 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 Climate Impact Labels

High Climate Impact Labels

EXPERIMENTAL

A red icon-plus-text label that reads "HIGH CLIMATE IMPACT" in white text against a red background will be placed on two restaurant menus beneath main menu items with a high climate impact using a predetermined threshold of estimated greenhouse gas emissions set at \>=9.2 kgCO2e. 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 Climate Impact Labels

Traffic Light Labels

EXPERIMENTAL

Traffic Light labels will be placed on two restaurant menus beneath all main menu items. Using predetermined estimated greenhouse gas emission thresholds, each item will be assigned one of three icon-plus-text labels within this scheme: low-, medium-, or high-impact label, set in kgCO2e at \<2.6, \>=2.6 \& \<9.2, and \>=9.2, respectively. Each will read, "HIGH CLIMATE IMPACT" within a red label, "MED. CLIMATE IMPACT" in a yellow label, and "LOW CLIMATE IMPACT" in a green label. Text for all labels 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: Traffic Light Labels

Climate Grade Labels

EXPERIMENTAL

Climate Grade labels will be placed on two restaurant menus beneath all main menu items, using predetermined estimated greenhouse gas emission thresholds to assign one of five icon-plus-text labels which indicate a specific climate impact grade (A, B, C, D, and F). Thresholds are set in kgCO2e as follows: \[A\] \<1.7, \[B\] \>=1.7 \& \<2.6, \[C\] \>=2.6 \& \<9.2, \[D\] \>=9.2 \& \<28, \[F\] \>=28. All labels are solid black with a white globe icon followed by white text which reads "CLIMATE 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: Climate Grade Labels

Interventions

Control (QR) Labels BEHAVIORAL

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).

Control (QR) Labels

Low Climate Impact Labels BEHAVIORAL

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 Climate Impact 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).

Low Climate Impact Labels

High Climate Impact Labels BEHAVIORAL

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, High Climate Impact 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).

High Climate Impact Labels

Traffic Light Labels BEHAVIORAL

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, 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).

Traffic Light Labels

Climate Grade Labels BEHAVIORAL

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, Climate 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).

Climate Grade Labels

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years of age or older
• Member of the NORC AmeriSpeak Panel
• Residing in the United States

You may not qualify if:

• \<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)

Sponsors & Collaborators

• Johns Hopkins Bloomberg School of Public Health: lead
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): collaborator
• University of California, Davis: collaborator
• Harvard School of Public Health (HSPH): collaborator
• University of Pennsylvania: collaborator

Study Sites (1)

Johns Hopkins Bloomberg School of Public Health

Baltimore, Maryland, 21205, United States

Location

Related Publications (1)

• Reimold AE, Falbe J, Kim BF, Musicus AA, Carr N, Santo R, Cho C, Leung CW, Roberto CA, Wolfson JA. The impact of restaurant menu eco labels on consumer meal selections: a randomized controlled trial. Am J Prev Med. 2026 Jan 9:108265. doi: 10.1016/j.amepre.2026.108265. Online ahead of print.

  PMID: 41520993 DERIVED

MeSH Terms

Conditions

Food Preferences

Interventions

Product Labeling

Condition Hierarchy (Ancestors)

Feeding Behavior; Behavior

Intervention Hierarchy (Ancestors)

Product Packaging; Industry; Technology, Industry, and Agriculture

Study Officials

• Julia A Wolfson, PhD MPP

  Johns Hopkins Bloomberg School of Public Health

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: 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.

Study Record Dates

• First Submitted: March 26, 2025
• First Posted: April 3, 2025
• Study Start: April 1, 2025
• Primary Completion: April 23, 2025
• Study Completion: April 23, 2025
• Last Updated: May 29, 2025

Record last verified: 2025-05

Locations

US (1)