Evaluating Food Messaging Campaigns for Young Adults

Evaluating a Counter-marketing Campaign to Improve Diet Quality Among Young Adults

This study aims to determine whether online social media campaigns improve diet quality among young adults. Young adults will be exposed to one of three social media campaigns.

Study Overview

• Status: Not yet recruiting
• Conditions: Communication; Nutrition; Diet Quality; Social Media; Young Adults; Diet Intervention
• Intervention / Treatment: Behavioral: Counter-marketing; Behavioral: Health education; Behavioral: Control (neutral) messages

Detailed Description

In this 3-arm parallel randomized controlled trial, participants will be randomized to one of three arms: 1) Control (neutral) messages, 2) Health education messages that focus on describing the health harms of consuming sugary drinks and processed snack foods, or 3) Counter-marketing messages that focus on exposing and undermining deceptive, harmful, or misleading marketing practices used by food companies to sell unhealthy foods. In each arm, participants will follow private Instagram accounts corresponding to their study arm. The study team will post campaign messages to the Instagram accounts. Participants will complete dietary recalls and answer online survey questions.

• Study Type: Interventional
• Enrollment (Estimated): 750
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Amanda Food Policy Lab Study Team; Phone Number: 408-598-2672; Email: foodpolicylab@stanford.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• 18-29 years old
• Reside in the US
• Speak English
• Use Instagram 3-4 times per week or more
• Consume sugary drinks 5-6 times per week or more and consume sweet and salty snacks 5-6 times per week or more

Exclusion Criteria:

• Younger than 18 years or older than 29 years
• Do not reside in the US
• Do not speak English
• Use Instagram less than 3-4 times per week
• Consume sugary drinks less than 5-6 times per week or consume sweet and salty snacks less than 5-6 times per week

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Counter-marketing messages; Participants will view a 10-week Instagram-delivered counter-marketing campaign exposing deceptive and harmful marketing practices used by food companies to sell sugary drinks and processed snack foods. Messages are drawn from those identified as most promising in prior message-development research and are targeted to values important to young adults (e.g., autonomy, respect).	Behavioral: Counter-marketing; Participants will receive messages focused on exposing and undermining deceptive, harmful, or misleading marketing practices used by food companies to sell unhealthy foods. Messages are delivered via Instagram posts.
Experimental: Health education messages; Participants will view a 10-week Instagram-delivered health education campaign about the health consequences of sugary drinks and processed snack foods. Messages are adapted from existing public health campaigns about these foods.	Behavioral: Health education; Participants will receive messages about the health consequences of sugary drinks and processed snack foods. Messages are delivered via Instagram posts.
Active Comparator: Control (neutral) messages; Participants will view a 10-week Instagram-delivered campaign about fire and home safety, a topic unrelated to diet. Messages are adapted from existing public health campaigns about these issues.	Behavioral: Control (neutral) messages; Participants will receive messages describing neutral topic unrelated to food (fire and home safety). Messages are delivered via Instagram posts.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diet quality (Healthy Eating Index-2020 score)	Overall diet quality calculated from up to two unannounced, nonconsecutive 24-hour dietary recalls (1 weekend day, 1 weekday) collected via NCI's Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) at each time point. Healthy Eating Index-2020 scores reflect alignment with the US Dietary Guidelines for Americans; higher scores indicate healthier diet quality (i.e., greater intake of fruits, vegetables, whole grains, dairy, protein, and unsaturated fats and lower intake of saturated fat, sodium, added sugars, and refined grains).	At 0-months (baseline), 3-months (immediately post- intervention), and 9-months (6-months post-intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Consumption of target food groups	Consumption of the food groups targeted in the campaigns (sugary drinks, processed sweet and salty snack foods) will be assessed using two unannounced, nonconsecutive 24-hour dietary recalls (1 weekend day, 1 weekday) collected via NCI's Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) at each time point. Servings of each target food group will be calculated and summed such that higher values indicate higher consumption of the target food groups.	At 0-months (baseline), 3-months (immediately post-intervention), and 9-months (6-months post-intervention)
Internalized weight stigma	Survey items will assess internalized weight stigma using the 11-item Modified Weight Bias Internalization Scale (e.g., "I am less attractive than most other people because of my weight."). Responses will be measured on 5-point Likert scale ranging from "Strongly disagree" (1) to "Strongly agree" (5). Responses will be coded such that higher scores indicate higher internalized weight stigma. Responses to the 11 items will be averaged.	At 0-months (baseline), 3-months (immediately post-intervention), and 9-months (6-months post-intervention).
Disordered eating attitudes and behaviors	Survey items will assess disordered eating attitudes and behaviors using the Eating Disorder Examination Questionnaire (EDE-Q), a 28-item self-report questionnaire assessing the range, frequency, and severity of disordered eating attitudes and behaviors, including restraint, eating concern, shape concern, and weight concern. Responses will be measured on a 6-point scale, ranging from "No days" or "None of the times" or "Not at all" or "Not at all markedly" (each coded as 0) to "Every day" or "Every time" or "Markedly" or "Moderately" (each coded as 5). Following scoring guidance, global scores will be calculated as follows: analyses will sum responses within each of the 4 subscales (restraint, eating concern, shape concern, and weight concern), divide those scores by the number of items in the subscale, sum the subscale scores, and divide this sum by 4. Higher global scores indicate higher frequency or severity of disordered eating attitudes and behaviors.	At 0-months (baseline), 3-months (immediately post-intervention), and 9-months (6-months post-intervention)
Attitudes toward unhealthy food companies	Survey items will assess the extent to which participants feel positively or negatively toward food companies that sell unhealthy foods with 2 items: "How do you feel about companies that sell sugary drinks?" and "How do you feel about companies that sell processed sweet and salty snack foods?" Each item will be measured on a 5-point Likert scale ranging from "Very unfavorably" (1) to "Very favorably" (5). Responses to these items will be averaged. Higher scores indicate more positive attitudes toward unhealthy food companies.	At 0-months (baseline), 3-months (immediately post-intervention), and 9-months (6-months post-intervention)
Perceived alignment of healthy eating with values	Survey items will assess the extent to which participants view healthy eating behaviors (such as reducing their sugary drink consumption) as aligned with personal values such as autonomy and respect with two items: "When I limit how much I drink sugary drinks, I'm doing my part to disempower companies that try to cover up scientific evidence" and "When I limit how much I eat sweet and salty snacks, I'm doing my part to disempower companies that try to cover up scientific evidence." Responses will be measured on a 5-point Likert scale ranging from "Strongly disagree"(1) to "Strongly agree" (5). Responses to these items will be averaged. Higher scores indicate higher perceived alignment of healthy eating with values.	At 0-months (baseline), 3-months (immediately post-intervention), and 9-months (6-months post-intervention)
Externalized weight stigma	Survey items will assess the extent to which participants hold negative views about people with higher body weight using the 20-item Universal Measure of Bias - Fat Scale (UMB-FAT). Response items will be measured on a 5-point Likert scale ranging from "Strongly agree" (1) to "Strongly disagree" (5). Responses to these items will be averaged. Higher scores indicate higher externalized weight stigma.	At 0-months (baseline), 3-months (immediately post-intervention), and 9-months (6-months post-intervention)
Attribution of individual responsibility for weight	Survey items will assess the extent to which participants attribute responsibility for body weight to individuals using the 16-item Causal Attribution for Obesity scale. Response items will be measured on a 5-point Likert scale ranging from "Strongly agree" (1) to "Strongly disagree" (5). Responses to these items will be averaged. Higher scores indicate stronger attribution of responsibility to individuals for their body weight.	At 0-months (baseline), 3-months (immediately post-intervention), and 9-months (6-months post-intervention)

Collaborators and Investigators

• Sponsor: Stanford University
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Principal Investigator: Anna H. Grummon, Stanford School of Medicine

Study record dates

Study Major Dates

• Study Start (Estimated): September 1, 2027
• Primary Completion (Estimated): April 1, 2029
• Study Completion (Estimated): April 1, 2029

Study Registration Dates

• First Submitted: August 12, 2026
• First Submitted That Met QC Criteria: August 14, 2026
• First Posted (Actual): August 17, 2026

Study Record Updates

• Last Update Posted (Actual): August 17, 2026
• Last Update Submitted That Met QC Criteria: August 14, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavior; Communication
• Other Study ID Numbers: 85231; R01DK142823 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We will post study materials (including the Study Protocol, Statistical Analysis Plan, de-identified participant data, and Analytic Code) to a public repository (e.g., GitHub or similar) upon publication of study findings.
• IPD Sharing Time Frame: We will post study materials (including the Study Protocol, Statistical Analysis Plan, de-identified participant data, and Analytic Code) to a public repository (e.g., GitHub or similar) upon publication of study findings.
• IPD Sharing Access Criteria: Anyone will be able to access materials via the public repository.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No