Online Food and Beverage Labels and Vending Machine Selections (VLO)

A Large-scale, Long-term, Randomized Trial of Nutrition Labeling Interventions

The aim of this study is to compare the impact of 5 different types of front of package (FOP) food and beverage labels: 1) calorie labels [control], 2) green labels on healthy foods, 3) red/yellow/green labels on less healthy/moderately healthy/healthy foods, 4) physical activity calorie equivalent labels, and 5) "High in" nutrient warning labels) on consumers' beverage and snack selections.

Study Overview

• Status: Completed
• Conditions: Obesity; Weight Gain; Food Preferences
• Intervention / Treatment: Behavioral: Exposure to calorie information; Behavioral: Exposure to healthy labels only; Behavioral: Exposure to healthiness information; Behavioral: Exposure to physical activity equivalents; Behavioral: Exposure to "high in" nutrient warning labels

Detailed Description

This project involves an online randomized experiment. We are working with an external survey company that will recruit 8,000 participants to complete an online survey in which they will be randomized to one of the five different label conditions: 1) calorie labels (control condition); 2) single green traffic light labels (on healthy foods); 3) multiple traffic light labels (red traffic light labels applied to less healthy foods, yellow applied to moderately healthy foods, and green on healthy foods); 4) physical activity labels (calorie content displayed in terms of physical activity equivalents); 5) "High in" warnings (applied to all products exceeding thresholds for calories, saturated fat, sugar, or sodium content). Participants will be instructed to select products to purchase in a mock vending machine. After purchasing their products, they will be asked to answer questions about their perceptions of the different labels.

• Study Type: Interventional
• Enrollment (Actual): 8145
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • University of Pennsylvania

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Participants will be US adults
• Ages 18 or older
• With an over-sample of adults with lower educational attainment (some college or less)

Exclusion Criteria:

• Younger than 18
• Non-US
• Educational quota filled

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Control; Calorie labels shown on front of product packaging	Behavioral: Exposure to calorie information; Calories for all beverages and foods
Experimental: Green labels; Green label added to front of product packaging for healthy products; no additional labels shown for "less healthy" products	Behavioral: Exposure to calorie information; Calories for all beverages and foods; Behavioral: Exposure to healthy labels only; Green labels only for beverages and foods scored as healthy
Experimental: Traffic light labels; Red/yellow/green labels added to front of product packaging for less healthy/moderately healthy/healthy products, respectively	Behavioral: Exposure to calorie information; Calories for all beverages and foods; Behavioral: Exposure to healthiness information; All beverages and foods labeled as either healthy (green), moderately healthy (yellow), or less healthy (red)
Experimental: Physical activity calorie equivalent labels; Labels added to front of product packaging that display products' calorie content in terms of physical activity required to burn those calories	Behavioral: Exposure to calorie information; Calories for all beverages and foods; Behavioral: Exposure to physical activity equivalents; All beverages and foods labeled with physical activity required to burn their calories
Experimental: "High in" nutrient warning labels; Labels added to front of product packaging that signal when the product exceeds thresholds for sugar, sodium, saturated fat, or calorie content	Behavioral: Exposure to calorie information; Calories for all beverages and foods; Behavioral: Exposure to "high in" nutrient warning labels; Warning labels only for beverages and foods that exceed the thresholds for sugar, sodium, saturated fat, or calorie content

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Purchasing Beverages With Calories	Participants will select a beverage to purchase from the online vending machine. Outcome is binary: purchased a beverage with calories or not.	The survey will take up to 20 minutes.
Calories Purchased From Beverages, if Beverage With Calories Chosen	Participants will select a beverage to purchase from the online vending machine. Outcome is calories in beverage chosen to purchase - only for those participants who chose a beverage with calories.	The survey will take up to 20 minutes.
Calories Purchased From Snacks	Participants will select a snack to purchase from the online vending machine. Outcome is calories in snacks chosen to purchase.	The survey will take up to 20 minutes.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Likelihood of Selecting a Healthy Beverage	Participants will select a beverage to purchase in the virtual store. Outcome is percentage of people selecting a healthy beverage (green labeled in the traffic light condition)	The survey will take up to 20 minutes.
Likelihood of Selecting a Moderately Healthy Beverage	Participants will select a beverage to purchase in the virtual store. Outcome is percentage of people selecting a moderately healthy beverage (yellow labeled in the traffic light condition)	The survey will take up to 20 minutes.
Likelihood of Selecting a Less Healthy Beverage	Participants will select a beverage to purchase in the virtual store. Outcome is percentage of people selecting a less healthy beverage (red labeled in the traffic light condition)	The survey will take up to 20 minutes.
Likelihood of Selecting a Healthy Snack	Participants will select a snack to purchase in the virtual store. Outcome is percentage of people selecting a healthy snack (green labeled in the traffic light condition)	The survey will take up to 20 minutes.
Likelihood of Selecting a Moderately Healthy Snack	Participants will select a snack to purchase in the virtual store. Outcome is percentage of people selecting a moderately healthy snack (yellow labeled in the traffic light condition)	The survey will take up to 20 minutes.
Likelihood of Selecting a Less Healthy Snack	Participants will select a snack to purchase in the virtual store. Outcome is percentage of people selecting a less healthy snack (red labeled in the traffic light condition)	The survey will take up to 20 minutes.
Saturated Fat Purchased From Beverages	Participants will select a beverage to purchase from the online vending machine. Outcome is saturated fat in beverage chosen to purchase.	The survey will take up to 20 minutes.
Sodium Purchased From Beverages	Participants will select a beverage to purchase from the online vending machine. Outcome is sodium in beverage chosen to purchase.	The survey will take up to 20 minutes.
Total Sugar Purchased From Beverages	Participants will select a beverage to purchase from the online vending machine. Outcome is total sugar in beverage chosen to purchase.	The survey will take up to 20 minutes.
Saturated Fat Purchased From Snacks	Participants will select a snack to purchase from the online vending machine. Outcome is saturated fat in snack chosen to purchase.	The survey will take up to 20 minutes.
Sodium Purchased From Snacks	Participants will select a snack to purchase from the online vending machine. Outcome is sodium in snack chosen to purchase.	The survey will take up to 20 minutes.
Total Sugar Purchased From Snacks	Participants will select a snack to purchase from the online vending machine. Outcome is total sugar in snack chosen to purchase.	The survey will take up to 20 minutes.
Perceived Healthiness of a Healthy Beverage	This variable will be measured on a 5-point Likert scale ranging from "very unhealthy" to "very healthy".	The survey will take up to 20 minutes.
Perceived Healthiness of a Moderately Healthy Beverage	This variable will be measured on a 5-point Likert scale ranging from "very unhealthy" to "very healthy".	The survey will take up to 20 minutes.
Perceived Healthiness of a Less Healthy Beverage	This variable will be measured on a 5-point Likert scale ranging from "very unhealthy" to "very healthy".	The survey will take up to 20 minutes.
Perceived Healthiness of a Healthy Snack	This variable will be measured on a 5-point Likert scale ranging from "very unhealthy" to "very healthy".	The survey will take up to 20 minutes.
Perceived Healthiness of a Moderately Healthy Snack	This variable will be measured on a 5-point Likert scale ranging from "very unhealthy" to "very healthy".	The survey will take up to 20 minutes.
Perceived Healthiness of a Less Healthy Snack	This variable will be measured on a 5-point Likert scale ranging from "very unhealthy" to "very healthy".	The survey will take up to 20 minutes.
Noticing Trial Labels	Participants will respond "yes," "no," or "not sure" to the item: "When you were selecting a beverage and a snack, did you notice any other nutrition labels on or next to the products?"	The survey will take up to 20 minutes.
Degree of Perceived Label Influence on Beverage Selection	Participants will respond on a 5-point scale ranging from "Not at all" to "A great deal" to the item: "How much did you use this label to help you decide what beverage to buy?"	The survey will take up to 20 minutes.
Degree of Perceived Label Influence on Snack Selection	Participants will respond on a 5-point scale ranging from "Not at all" to "A great deal" to the item: "How much did you use this label to help you decide what snack to buy?"	The survey will take up to 20 minutes.
Trust in Labels	Item: "How much do you trust or distrust the information on this label?". Responses will be measured on a 5-point Likert scale from "completely distrust" to "completely trust".	The survey will take up to 20 minutes.
Reactance to Labels	We will examine the average reactance to the label (said the label is trying to manipulate me, or annoys me). Each reactance item will be scored on a 5-pt likert scale from "not at all" to "a great deal".	The survey will take up to 20 minutes.
Attention to Labels	Item: "How much does this label grab your attention?". Responses will be measured on a 5-point Likert scale from "not at all" to "a great deal".	The survey will take up to 20 minutes.
Learned From Labels	Item: "To what extent did you learn something new from this label?". Responses will be measured on a 5-point Likert scale from "not at all" to "a great deal".	The survey will take up to 20 minutes.
Thinking About Health Effects	Item: "How much does this label make you think about the health effects of food and beverages?". Responses will be measured on a 5-point Likert scale from "not at all" to "a great deal"	The survey will take up to 20 minutes.
Perceived Discouragement	We will examine if they said the label discourages them from choosing unhealthy products. This item will be scored on a 5-pt likert scale from "not at all" to "a great deal"	The survey will take up to 20 minutes.
Perceived Encouragement	We will examine if they said the label encourages them to choose healthy products. This item will be scored on a 5-pt likert scale from "not at all" to "a great deal"	The survey will take up to 20 minutes.
Negative Emotional Reactions	We will examine the average negative emotional response to the label (said the label made them feel worried, scared, guilty, ashamed, or sad). Each emotion will be scored on a 5-pt likert scale from "not at all" to "a great deal".	The survey will take up to 20 minutes.
Perceived Control in Response to Labels	Participants will respond to the item "Overall does this label make you feel…" with one of 3 responses: "less in control of making healthy eating decisions", "more in control of healthy eating decisions", or "neither less nor more in control of making healthy eating decisions"	The survey will take up to 20 minutes.
Perceived Personal Stigmatization	Participants will respond to the item "How personally stigmatized does this label make you feel?" on a 5-pt likert scale from "not at all" to "a great deal".	The survey will take up to 20 minutes.
Perceived Obesity Stigma	We will examine the average stigma response to the label (the label stigmatizes people with obesity, the label increases blame toward people for being overweight). Each stigma item will be scored on a 5-pt likert scale from "not at all" to "a great deal".	The survey will take up to 20 minutes.
Disgust Toward People With Obesity	Participants will respond to the item "How disgusted do people with obesity make you feel?" on a 5-pt likert scale from "not at all" to "a great deal".	The survey will take up to 20 minutes.

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Principal Investigator: Christina A Roberto, PhD, University of Pennsylvania

Study record dates

Study Major Dates

• Study Start (Actual): November 16, 2022
• Primary Completion (Actual): December 3, 2022
• Study Completion (Actual): December 3, 2022

Study Registration Dates

• First Submitted: June 15, 2022
• First Submitted That Met QC Criteria: June 15, 2022
• First Posted (Actual): June 27, 2022

Study Record Updates

• Last Update Posted (Estimated): December 20, 2023
• Last Update Submitted That Met QC Criteria: December 18, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Keywords: food labeling; sugar-sweetened beverages; eating; drinking; choice behavior
• Additional Relevant MeSH Terms: Body Weight; Body Weight Changes; Weight Gain
• Other Study ID Numbers: 850263; R01DK113307 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: In the consenting process, participants agreed that de-identified data produced from this project may be distributed for future research studies without additional informed consent. After analysis, we will upload the de-identified data to ResearchBox for public sharing.
• IPD Sharing Time Frame: Starting 6 months after publication
• IPD Sharing Access Criteria: Public
• IPD Sharing Supporting Information Type: SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No