Click & Pick Study

May 15, 2026 updated by: University of Pennsylvania

A Longitudinal, Randomized-Controlled Experiment of Healthy Food Policies in Online Retail Settings

Unhealthy diets significantly contribute to major preventable chronic diseases including type 2 diabetes, obesity, heart disease and stroke, which disproportionally impact racial/ethnic minority groups and those with lower income [1-3]. Although taxes and warning labels targeting sugar-sweetened beverages (SSB) have been successful at shifting behavior [4-7], there are many other ultra-processed food products that contribute to unhealthy diets [8]. What is less well-known is whether a suite of healthy food policies that are expanded to target a range of ultra-processed foods can shift dietary choices and intake in meaningful ways. Our research team's long-term goal is to identify and understand the degree to which combinations of healthy food policies can improve nutrition security and reduce nutrition-related diseases.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

To advance our understanding of policies needed to support nutrition security and health, our overall objective is to examine the degree to which a suite of healthy food policies in online food retailers can increase the purchase and intake of healthy foods and beverages while reducing the purchase and intake of unhealthy ultra-processed foods and beverages.

To accomplish this objective, we will use an innovative online grocery store and restaurant platforms to randomize participants to either: 1) control (no taxes, warning labels, or healthy checkout regulations on any products); or 2) a suite of healthy food policies (ultra-processed food and beverage taxes, front-of-pack nutrition labeling, and healthy check out regulations that restrict the promotion of ultra-processed products on the checkout page). We will recruit 300 adults with lower income across Houston and San Antonio, TX, and Philadelphia, PA to shop once per week for six weeks in both our online grocery store and restaurant. Week 1 will be a baseline (control) week without interventions, followed by three weeks of the interventions. In the last two study weeks, we will introduce unhealthy food marketing (e.g., banner ads) into the online platforms to mimic what we expect industry will do to counter public health policy efforts.

A key aim of the study is to simulate how food companies will respond to healthy eating policies if they were to be implemented in the real world. For that reason, we will increase the intensity of non-checkout advertisements for unhealthy foods during the last two weeks of the intervention period because this is likely how industry would respond in the real-world if the U.S. adopted any of the policies we are testing. Therefore, we are trying to measure the extent to which that advertising would undermine the policy effects. This is a critical component of our study because many nutrition policy experiments look at the impact of a policy in a static situation that does not account for a likely industry response. The advertisements we are using will mimic what's normally seen in delivery/grocery apps such as ads for sugar-sweetened beverages like Coke or Pepsi.

Participants will be given money to spend in these online platforms and purchases will be delivered to them via a real food retail store and restaurant. Participants will complete surveys at baseline and after 6 weeks of shopping and will complete two dietary recalls administered over the phone during the baseline week and during the fourth week (4 recalls total). The rationale underlying the proposed research is based on our work showing that beverage taxes and warning labels greatly reduce SSB purchases.

The specific aims of the study are:

  • Aims 1: To evaluate the effects of three healthy food policies (ultra-processed food and beverage taxes, front-of-pack nutrition warning labels, and healthy checkout regulations) on purchases across online grocery store and restaurant settings.
  • Aim 2: To evaluate the effects of three healthy food policies (ultra-processed food taxes, front-of-pack nutrition warning labels, and healthy checkout regulations) on dietary quality.
  • Aim 3: To understand the degree to which unhealthy food marketing counters the effects of a suite of healthy food policies.

Study Type

Interventional

Enrollment (Estimated)

300

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • ≥18 years old
  • Not currently eligible for or participating in SNAP or another government program that automatically qualifies the person for SNAP (e.g., WIC, TANF)
  • Meets the following income eligibility requirements:

For participants living in the Houston or San Antonio areas, their household income must be greater than 165% of the federal poverty level, but less than the Texas state median household income (based on the 2023 American Community Survey) for their household size [11].

For participants living in the Philadelphia area, their income must be greater than 200% of the federal poverty level, but less than the Pennsylvania state median household income (based on the 2023 American Community Survey) for their household size [11].

  • Reports consuming food from McDonald's or a similar fast-food chain at least once a month
  • Does most of the grocery shopping for the household
  • Can adhere to the study schedule (e.g., receive a lunch on a Wednesday)
  • Has regular internet access
  • Has a smart phone that can take pictures
  • Resident of Houston, TX, San Antonio, TX or Philadelphia, PA or the surrounding areas and plans to be there for the next six weeks
  • Household size of six or fewer people
  • Have an address eligible for receiving Grubhub+ and Walmart+ deliveries

Exclusion Criteria:

  • Does not meet all of the inclusion criteria
  • Cognitive impairment; per PIs discretion
  • Participant is under 18 years old
  • Does not speak English or Spanish

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention
Behavioral: Suite of healthy food policies
A suite of healthy food policies in an online restaurant and grocery store including ultra-processed food and beverage taxes, front-of-pack nutrition labeling, and healthy check out regulations that restrict the promotion of ultra-processed products on the checkout pages.
No Intervention: Control

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Average kcals purchased per participant per day from unhealthy ultra-processed food products that are targeted by our suite of healthy food policies
Time Frame: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)
We will sum the number of kcals from ultra-processed food products purchased in the online grocery store and divide that by the number of people in the household and 7 days per week. We will then add that to the number of kcals from ultra-processed foods purchased from the online restaurant to calculate total kcals from ultra-processed foods purchased per study participant per day. We will also examine these outcomes separately in the grocery store and restaurant context.
Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Average sodium, saturated fat, and added sugars purchased per participant per day from unhealthy ultra-processed food products that are targeted by our suite of policies
Time Frame: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)
Using the same approach as our primary outcome, our secondary behavioral outcomes will be the average sodium, saturated fat, and added sugars purchased per participant per day. We will also examine these outcomes separately in the grocery store and restaurant context.
Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)
Average overall kcals, sodium, saturated fat, and added sugars from all foods purchased in the online grocery store and restaurant per participant per day
Time Frame: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)
We will create this outcome using the same approach as our primary outcome, except we will look at all foods and beverages purchased, not just ultra-processed foods and beverages. We will also examine these outcomes separately in the grocery store and restaurant context.
Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)
Percentage of total dollars per order spent on products targeted by our suite of healthy food policies
Time Frame: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)
To create this outcome for each week of the study, we will divide the number of dollars spent on targeted ultra-processed products by the total dollars spent and multiply by 100.
Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)
Total dollars spent on food and beverage products purchased outside of the study grocery store and restaurant
Time Frame: Baseline to Week 6
We will sum together the total amount of dollars spent on food and beverages purchased outside the study using outside receipts submitted by the participants.
Baseline to Week 6
Total dollars spent on sugar sweetened beverages, candy, and fast food purchased outside of the study grocery store and restaurant
Time Frame: Baseline to Week 6
Total dollars spent on sugar sweetened beverages, candy, and fast food purchased outside the study using outside receipts submitted by the participants.
Baseline to Week 6
Healthy Eating Index Score (HEI-2020)
Time Frame: Change between baseline and Week 4
The HEI is a tool to assess how well a participant's diet aligns with the 2015-2020 Dietary Guidelines for Americans and can be used to measure the efficacy of nutrition interventions [9]. We will average intake estimates from the two 24-hour dietary recall interviews conducted at baseline and again at follow up (Week 4).
Change between baseline and Week 4
Change in usual intake for: energy (kcals), discretionary calories, SSB servings per day, total fruit servings/day, total vegetable servings/day, daily intake of key macronutrients, and daily intake of whole grains
Time Frame: Change between baseline and Week 4
We will average intake estimates from the two NDSR 24-hour dietary recall interviews conducted at baseline and again at follow up (Week 4) [10].
Change between baseline and Week 4
Food and beverage product perceptions
Time Frame: Final survey (administered Week 7)
During the final survey (Week 7), participants will view four ultra-processed products. Those in the intervention group will see those products with any applicable warning labels and those in the control group will see the same products without any warning labels. Participants will then rate how healthy or unhealthy they believe the product to be.
Final survey (administered Week 7)
Nutrient content knowledge
Time Frame: Final survey (administered Week 7)
During the final survey (Week 7), participants will also be asked about their knowledge of different nutrients of concern, and we will determine whether they provide the correct answer or not. They will view the same four ultra-processed products as the food and beverage product perceptions questions and be asked whether or not the product has low, medium, or high amounts of calories, sodium, saturated fats, and added sugars.
Final survey (administered Week 7)
Warning label perceptions
Time Frame: Final survey (administered Week 7)
At the end of the final study survey (Week 7), participants will be shown the warning labels used in the study and asked about perceived message effectiveness.
Final survey (administered Week 7)
Policy opinions
Time Frame: Final survey (administered Week 7)
During the final survey (Week 7), participants will also answer four questions about their support or opposition for the suite of healthy food policies.
Final survey (administered Week 7)
Online store perceptions
Time Frame: Final survey (administered Week 7)
We will assess the acceptability of the online grocery store and restaurant (e.g., overall difficulty of using the grocery store/restaurant, satisfaction with number of options) and realism of the online grocery store and restaurant (e.g., extent to which participants' selections are similar to usual purchases, extent to which it felt real).
Final survey (administered Week 7)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Pennsylvania

Investigators

  • Principal Investigator: Christina Roberto, PhD, University of Pennsylvania
  • Principal Investigator: Pasquale Rummo, PhD, MPH, NYU Langone Health

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 25, 2026

Primary Completion (Estimated)

April 21, 2028

Study Completion (Estimated)

April 21, 2028

Study Registration Dates

First Submitted

February 12, 2026

First Submitted That Met QC Criteria

February 12, 2026

First Posted (Actual)

February 20, 2026

Study Record Updates

Last Update Posted (Actual)

May 18, 2026

Last Update Submitted That Met QC Criteria

May 15, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 855856
  • 1R01DK136779-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

De-identified data available for public use and associated documentation will be available to the research community free of charge through the Data Sharing for Demographic Research (DSDR) data repository hosted at ICPSR. Data and datasets will be kept and available to share for at least three years following completion of the project, in accordance with NIH regulations. Datasets in DSDR will be findable and identifiable through a study digital object identifier (DOI) minted by ICPSR.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Chronic Disease

Clinical Trials on Suite of healthy food policies

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Montenegro

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe