Perceptions of and Reactions to Sustainability Menu Label Designs

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

Participants will be randomized to view a fast-food online ordering menu with one of seven labeling schemes applied: (1) a QR code on all items (control); (2) Low Sustainability labels; (3) Unsustainable labels; (4) Environmental Harm labels; (5) High Environmental Harm labels; (6) High Environmental Cost labels; and (7) numeric Environmental Cost labels on all items. All fast-food menus will include a selection of main entrée items. The control QR code and numeric environmental cost labels will display labels on all menu items. All other label conditions will apply labels only to items with higher environmental impact as defined by ingredient-level environmental impact estimates based on the Cool Food Pledge Calculator.

Participants will be shown the menu and the label in isolation and will then be asked about interpretations of the label, reactions to the label, perceived message effectiveness (PME) of the label, how helpful the participants find the label to be, and the 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 participants were randomized (if applicable) in random order and asked about the perceived appeal, healthfulness, and environmental impact of the menu items.

The primary outcome in this exploratory study will be intention to purchase a hypothetical menu item with the label shown. 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, perceived level of appeal of menu items, perceived level of healthfulness of menu items, and perceived environmental impact of menu items.

• Control (QR) Labels (Behavioral): Participants will view a fast-food restaurant menu with main entrée items. Each menu item will be displayed with an image of the item, name, price, and total calories. Control (QR) labels will be displayed beneath each item. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
• Low Sustainability Labels (Behavioral): Participants will view a fast-food restaurant menu with main entrée items. Each menu item will be displayed with an image of the item, name, price, and total calories. Low Sustainability labels will be displayed beneath select items. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
• Unsustainable Labels (Behavioral): Participants will view a fast-food restaurant menu with main entrée items. Each menu item will be displayed with an image of the item, name, price, and total calories. Unsustainable labels will be displayed beneath select items. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
• Environmental Harm Labels (Behavioral): Participants will view a fast-food restaurant menu with main entrée items. Each menu item will be displayed with an image of the item, name, price, and total calories. Environmental Harm labels will be displayed beneath select items. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
• High Environmental Harm Labels (Behavioral): Participants will view a fast-food restaurant menu with main entrée items. Each menu item will be displayed with an image of the item, name, price, and total calories. High Environmental Harm labels will be displayed beneath select items. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
• High Environmental Cost Labels (Behavioral): Participants will view a fast-food restaurant menu with main entrée items. Each menu item will be displayed with an image of the item, name, price, and total calories. High Environmental Cost labels will be displayed beneath select items. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.
• Numeric Environmental Cost Labels (Behavioral): Participants will view a fast-food restaurant menu with main entrée items. Each menu item will be displayed with an image of the item, name, price, and total calories. Numeric environmental cost labels will be displayed beneath each item. Participants will view the menu and then the label in isolation and then be asked about a hypothetical intention to purchase a menu item with the label.

Primary outcomes

• Intention to purchase [Immediately after viewing the menu excerpt and label image]: Intention to purchase is measured with the survey question: "How likely would you be to purchase a menu item with this label?" Response options are a 7-point Likert scale: 1=Very unlikely, 2=Unlikely, 3=Somewhat unlikely, 4=Neither likely nor unlikely, 5=Somewhat likely, 6=Likely, 7=Very likely. A higher rating is better.

Secondary outcomes

• Label interpretation [Immediately after viewing the menu excerpt]: Label interpretation is assessed with a survey question: "Imagine that you are in a fast-food restaurant (such as Burger King) to order lunch. Next are questions about the label, as displayed on the menu example below. If you saw this label next to an item on the menu, what would you think the label indicates about the item? \[check all that apply\]". Response options provided are a range of statements about the menu item: 1="This menu item is unhealthy", 2="This menu item is healthy" 3="This menu item is good for the environment", 4="This menu item used a lot of natural resources (e.g. land, water) to produce", 5="This menu item will keep you full for a long time", 6="This menu item is bad for the environment", and 7="This menu item will cost consumers more to purchase". Also included are 8="I don't know" and 9="Other" option with open-text entry.
• Perceived label understandability [Immediately after viewing the menu excerpt and label image]: After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statement: "This label is easy to understand". Response options are a unipolar 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
• Perceived label believability [Immediately after viewing the menu excerpt and label image]: After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statement: "This label is believable to me". Response options are a unipolar 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
• Perception that label grabbed attention [Immediately after viewing the menu excerpt and label image]: After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statement: "This label grabs my attention". Response options are a unipolar 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
• Perceived message effectiveness (PME) as assessed by the University of North Carolina (UNC)-PME scale [Immediately after viewing the menu excerpt and label image]: Perceived message effectiveness (PME) is measured using the unipolar 3-item University of North Carolina (UNC)-PME scale. Participants will be asked how much each label discourages consumption of or evokes concern of unpleasantness about consumption of foods with the label. After viewing the label, participants will be asked how much the participant agrees or disagrees with the following statements: "This label discourages me from wanting to eat foods with this label", "This label makes foods with this label seem unpleasant", and "This label makes me concerned about the health effects of eating menu items with this label". Response options are a 5-point Likert scale: 1=Not at all, 2=A little bit, 3=Somewhat, 4=Quite a bit, 5=A great deal. A higher ranking is better.
• Perceived label helpfulness [Immediately after viewing the menu excerpt and label image]: Perceived label helpfulness is measured with the survey question: "How helpful would you find this label when deciding what to order at a fast-food restaurant?" Response options are a 7-point Likert scale: 1=Very unhelpful, 2=Unhelpful, 3=Somewhat unhelpful, 4=Neither helpful nor unhelpful, 5=Somewhat helpful, 6=Helpful, 7=Very helpful. A higher ranking is better.

Other outcomes

• Perceived level of appeal of food items [Immediately after viewing each menu item]: Perceived level of appeal of food item is measured after showing participants two different individual menu items separately by label condition. After showing each item, the survey question asks, "How appealing do you think this item is?", and response options are a 7-point Likert scale: 1=Very unappealing, 2=Unappealing, 3=Slightly unappealing, 4=Neither appealing nor unappealing, 5=Slightly appealing, 6=Appealing, 7=Very appealing. A higher ranking is better
• Perceived level of healthfulness of food item [Immediately after viewing each menu item]: Perceived level of healthfulness of labeled food item is measured after showing participants two different individual menu items separately by label condition. After showing each item, the survey question asks, "How healthy do you think this item is?", and response options are a 7-point Likert scale:1=Very unhealthy, 2=Unhealthy, 3=Slightly unhealthy, 4=Neither unhealthy nor healthy, 5=Slightly healthy, 6=Healthy, 7=Very healthy. A higher ranking is better.
• Perceived level of environmental impact of food item [Immediately after viewing each menu item]: Perceived level of environmental impact of labeled food item is measured after showing participants two different individual menu items separately by label condition. After showing each item, the survey question asks, "What do you think the environmental impact of this item is?", and response options are a 7-point Likert scale:1=Extremely high environmental impact, 2=Very high environmental impact, 3=High environmental impact, 4=Moderate environmental impact, 5=Low environmental impact, 6=Very low environmental impact, 7=Extremely low environmental impact.

Sex: All, ages: 18 Years to any, 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 the attention check question included in the survey

• Julia A Wolfson, PhD, MPP, Principal investigator, Johns Hopkins Bloomberg School of Public Health

NIH grants: R01DK139327