Food SelectionNCT06909019
MENU Study: Online Experiment
A study testing Low Climate Impact Labels, High Climate Impact Labels and Traffic Light Labels in people with Food Selection, run by Johns Hopkins Bloomberg School of Public Health at 1 site in United States.
Trial 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… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Food Selection
- What is being tested?
- Low Climate Impact Labels, High Climate Impact Labels and Traffic Light Labels
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 6,294 participants
- Where
- 1 siteUnited States
- Study dates
- 1 Apr 2025to 23 Apr 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- 18 years of age or older
- Member of the NORC AmeriSpeak Panel
- Residing in the United States
Who cannot join
- <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)
Trial locations and contacts
1 site in 1 country.
United States1 site
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland, 21205
About this study
Official title: The Menu Labels for Environmental Impact and Nutrition Study (MENU Study): Online Experiment
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.
Read the detailed description
This online randomized trial will test the relative effects of climate impact menu label designs on the healthfulness of consumers' fast-food meal choices and perceptions of menu items. The survey research firm National Opinion Research Center (NORC) will recruit a nationally representative sample of 6,000 adults aged 18 years and older who speak English and reside in the United States from the Center's AmeriSpeak Panel.
Participants will complete a between-subjects online experiment in which the participants will be randomized to view two fast-food online ordering menus (in randomized 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. Each restaurant menu will be presented across 2 pages; page 1 will display all main items, and page 2 will display categories for side, dessert, and drink items. Labels will only appear alongside main menu items and will be assigned using thresholds for greenhouse gas emissions set a priori in kilograms of carbon dioxide (CO2) equivalent per kilogram of food. Each hypothetical order must include between 1 and 4 items. Participants will be required to select 1 main item and, optionally, up to 3 additional items (drinks, sides, desserts). After completing the meal ordering task, participants will be prompted to answer questions about the whether the participant noticed the correct label for the participant's condition, whether the participant used the label when making meal selections, perceptions of the labeled menu items and the labeling condition which the participants were randomized to view, knowledge of the relative climate impact of food items and consumer behaviors, and support of governmental and policies and practices regarding food and nutrition. Additionally, participants will be asked about level of food security, use of GLP-1 agonists, personal values, dietary patterns, and other demographic information. Participation in the study will last approximately 10 minutes.
The primary outcome will be the healthfulness of meal orders selected from the online menu, indicated by a modified Nutrient Profile Index meal score for all food items ordered. Secondary outcomes will be total greenhouse gas emissions per meal ordered, total calories ordered, whether a sugar-sweetened beverage was ordered, and perceived message effectiveness of the climate-impact labels.
Analyses will be conducted overall (summing the meal selections across both restaurants) and stratified by restaurant.
- Conditions
- Food Selection
- Being tested
- Control (QR) Labels, Low Climate Impact Labels, High Climate Impact Labels, Traffic Light Labels, Climate Grade Labels
- Keywords
- food labeling, climate labeling, choice behavior
- Medical subject headings
- Food Preferences
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Control (QR) LabelsBehavioural
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).
Low Climate Impact LabelsBehavioural
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).
High Climate Impact LabelsBehavioural
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).
Traffic Light LabelsBehavioural
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).
Climate Grade LabelsBehavioural
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).
| Study group | Role | What they receive |
|---|---|---|
| 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. Receives: 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. Receives: 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. Receives: 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. Receives: 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. Receives: Behavioral: Climate Grade Labels |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: During online survey ordering task, up to 10 minutes
Secondary outcomes (19)
Nutrient Profile Index score
The healthfulness of the fast-food main item selections, measured with a 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.
Measured: During online survey ordering task, up to 10 minutes
Total greenhouse gas emissions
Cumulative total kilograms of carbon equivalent (kgCO2e) per kilogram of food for all meal items. Beverages are excluded and assessed through other secondary outcomes. Beverages are excluded and assessed through secondary outcomes (#5 \& #11).
Measured: During online survey ordering task, up to 10 minutes
Frequency of red meat selected
Measured as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include an item containing red meat.
Measured: During online survey ordering task, up to 10 minutes
Total energy selected (number of calories)
The total number of calories in participants' hypothetical meal orders, calculated as the sum of calories across all menu items selected. Higher values indicate more calories selected.
Measured: During online survey ordering task, up to 10 minutes
Total amount of saturated fat (grams) selected
The total amount of saturated fat in participants' hypothetical meal orders, calculated as the sum of saturated fat (grams) across all menu items selected. Higher values indicate more saturated fat selected.
Measured: During online survey ordering task, up to 10 minutes
Total amount of sugar (grams) selected
The total amount of sugar in participants' hypothetical meal orders, calculated as the sum of sugar (grams) across all menu items selected. Higher values indicate more sugar selected.
Measured: During online survey ordering task, up to 10 minutes
Total amount of protein (grams) selected
The total amount of protein in participants' hypothetical meal orders, calculated as the sum of protein (grams) across all menu items selected. Higher values indicate more protein selected.
Measured: During online survey ordering task, up to 10 minutes
Total amount of fiber (grams) selected
The total amount of fiber in participants' hypothetical meal orders, calculated as the sum of fiber (grams) across all menu items selected. Higher values indicate more fiber selected.
Measured: During online survey ordering task, up to 10 minutes
Total amount of sodium (milligrams) selected
The total amount of sodium in participants' hypothetical meal orders, calculated as the sum of sodium (milligrams) across all menu items selected. Higher values indicate more sodium selected.
Measured: During online survey ordering task, up to 10 minutes
Frequency of sugar-sweetened beverage selected
Measured as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include a sugar-sweetened beverage.
Measured: During online survey ordering task, up to 10 minutes
Percentage of participants with knowledge of the climate impact of foods
This outcome will measure participants' knowledge of the relative climate impacts of meals with different main proteins. Participants are prompted to numerically rank three meals by climate impact. The exact prompt is: "Please rank the below food options from smallest (1) to largest (3) climate impact. Write "1" next to the food option with the smallest climate impact, "2" next to the option with the middle climate impact, and "3" next to the option with the largest climate impact." Each rank item reads "Meal in which the main protein is beef", "Meal in which the main protein is chicken", and "Meal in which the main protein is tofu". Responses will be analyzed by % who correctly rank the 3 items by experimental condition.
Measured: During online survey post-ordering task, up to 10 minutes
Percentage of participants with knowledge of the climate impact of menu items
This outcome will measure participants' knowledge of the relative climate impacts of menu items by label condition. Via two questions, one per restaurant, participants are prompted to indicate "Which menu item below has a larger contribution to climate change (i.e., produces more greenhouse gas emissions)?". Three response options are provided: two images of main menu items by label condition and "The menu items have the same climate impact". Responses will be analyzed as the % who answer both questions correctly by label condition.
Measured: During online survey post-ordering task, up to 10 minutes
Frequency of participants with attention to labels
Measured by whether participants noticed labels on the menus, in addition to calorie labels. The exact question is, "On the menus you saw, did you notice any labels (other than calories) next to or below the menu items?" Response options are "Yes", "No", and "Don't Know".
Measured: During online survey post-ordering task, up to 10 minutes
Frequency of participants who recall labels that also correctly identify purpose of labels
Measured by whether participants who noticed labels, in addition to calorie labels, correctly identify the purpose of the labels. Response options are "Sugar", "Sodium", "QR code", "Climate Impact", "Organic", "Healthy", "Unhealthy", "None of these", and "I don't know/ I can't remember".
Measured: During online survey post-ordering task, up to 10 minutes
Perceived message effectiveness (PME) as assessed by the University of North Carolina (UNC) PME scale
This modified 4-item UNC-PME scale measures how much the label placed beneath high climate impact menu items, discouraged consumption or evoked concern or unpleasantness about consumption of high climate impact foods. Responses to all questions will be measured on a 5-point unipolar Likert scale from 1=Not at all to 5= A great deal. The higher the score, the higher the perceived effectiveness.
Measured: During online survey post-ordering task, up to 10 minutes
Total price of meal order
Measured by the cumulative total price (USD) of participants' hypothetical meal orders per restaurant, based on the prices displayed on the survey menus.
Measured: During online survey ordering task, up to 10 minutes
Perceived level of appeal of food items
Measured by the level of appeal attributed to 8 main menu items, 4 from each restaurant, by label condition. All items are assessed on a 7-point Likert scale with response options of "Very unappealing", "Unappealing", "Slightly unappealing", "Neither appealing nor unappealing", "Slightly appealing", "Appealing", "Very appealing" for each food item. Higher score, higher appeal.
Measured: During online survey post-ordering task, up to 10 minutes
Perceived level of healthfulness of food items
Measured by the level of healthfulness attributed to 8 main menu items, 4 from each restaurant, by label condition. All items are assessed on a 7-point Likert scale with response options of "Very unhealthy", "Unhealthy", "Slightly unhealthy", "Neither unhealthy nor healthy", "Slightly healthy", "Healthy," "Very healthy" for each food item.
Measured: During online survey post-ordering task, up to 10 minutes
Perceived level of climate impact of food items
Measured by the level of climate impact attributed to 8 main menu items, 4 from each restaurant, by label condition. All items are assessed on a 7-point Likert scale with response options of "Extremely high climate impact", "Very high climate impact", "High climate impact", "Moderate climate impact", "Low climate impact", "Very low climate impact", "Extremely low climate impact" for each food item.
Measured: During online survey post-ordering task, up to 10 minutes
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted3 Apr 2025
- Study start1 Apr 2025
- Primary completion23 Apr 2025
- Study completion23 Apr 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Food SelectionStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- 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.
- Masking
- None (open label)
- Enrolment
- 6,294 participants (actual)
Sponsor and investigators
- Lead sponsor
- Johns Hopkins Bloomberg School of Public Health
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), University of California, Davis, Harvard School of Public Health (HSPH), University of Pennsylvania
- Responsible party
- Sponsor
- Investigators
- Julia A Wolfson, PhD MPP, Principal investigator, Johns Hopkins Bloomberg School of Public Health
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06909019
- Sponsor's protocol ID
- IRB00027451
- Other IDs
- 1R01DK139327-01
- Status last verified
- May 2025
- First submitted
- 26 Mar 2025
- Last updated
- 29 May 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Wolfson JA, Tucker AC, Reimold AE, Musicus A, Carr N, Kim BF, Santo R, Cho C, Barquera Guevara DA, Choi E, Leung CW, Roberto CA, Falbe J. Eco-Focused Menu Labels on Full Meal Orders From Fast-Food Restaurants: A Randomized Clinical Trial. JAMA Health Forum. 2026 Jul 2;7(7):e262108. doi: 10.1001/jamahealthforum.2026.2108.
PubMed 42430158Reimold 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: An RCT. Am J Prev Med. 2026 Jun;70(6):108265. doi: 10.1016/j.amepre.2026.108265. Epub 2026 Jan 9.
PubMed 41520993
Study at a glance
From the registry record, last updated by the sponsor on 29 May 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Menu Labels for Environmental Impact and Nutrition Study (MENU Study): Online Experiment
- ClinicalTrials.gov ID
- NCT06909019
- Acronym / sponsor ID
- IRB00027451
- Conditions
- Food Selection
- Keywords
- food labeling, climate labeling, choice behavior
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 6,294 participants (actual)
- Lead sponsor
- Johns Hopkins Bloomberg School of Public HealthUniversity, hospital or other
- Collaborators
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), University of California, Davis, Harvard School of Public Health (HSPH), University of Pennsylvania
- Study start
- 1 Apr 2025 (actual)
- Primary completion
- 23 Apr 2025 (actual)
- Study completion
- 23 Apr 2025 (actual)
- First posted
- 3 Apr 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
This online randomized trial will test the relative effects of climate impact menu label designs on the healthfulness of consumers' fast-food meal choices and perceptions of menu items. The survey research firm National Opinion Research Center (NORC) will recruit a nationally representative sample of 6,000 adults aged 18 years and older who speak English and reside in the United States from the Center's AmeriSpeak Panel.
Participants will complete a between-subjects online experiment in which the participants will be randomized to view two fast-food online ordering menus (in randomized 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. Each restaurant menu will be presented across 2 pages; page 1 will display all main items, and page 2 will display categories for side, dessert, and drink items. Labels will only appear alongside main menu items and will be assigned using thresholds for greenhouse gas emissions set a priori in kilograms of carbon dioxide (CO2) equivalent per kilogram of food. Each hypothetical order must include between 1 and 4 items. Participants will be required to select 1 main item and, optionally, up to 3 additional items (drinks, sides, desserts). After completing the meal ordering task, participants will be prompted to answer questions about the whether the participant noticed the correct label for the participant's condition, whether the participant used the label when making meal selections, perceptions of the labeled menu items and the labeling condition which the participants were randomized to view, knowledge of the relative climate impact of food items and consumer behaviors, and support of governmental and policies and practices regarding food and nutrition. Additionally, participants will be asked about level of food security, use of GLP-1 agonists, personal values, dietary patterns, and other demographic information. Participation in the study will last approximately 10 minutes.
The primary outcome will be the healthfulness of meal orders selected from the online menu, indicated by a modified Nutrient Profile Index meal score for all food items ordered. Secondary outcomes will be total greenhouse gas emissions per meal ordered, total calories ordered, whether a sugar-sweetened beverage was ordered, and perceived message effectiveness of the climate-impact labels.
Analyses will be conducted overall (summing the meal selections across both restaurants) and stratified by restaurant.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 5
- Model description
- 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.
| Arm | Type | Receives |
|---|---|---|
| Control (QR) Labels | Placebo comparator | Behavioral: Control (QR) LabelsA 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. |
| Low Climate Impact Labels | Experimental | Behavioral: Low Climate Impact LabelsA 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. |
| High Climate Impact Labels | Experimental | Behavioral: High Climate Impact LabelsA 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. |
| Traffic Light Labels | Experimental | Behavioral: Traffic Light LabelsTraffic 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. |
| Climate Grade Labels | Experimental | Behavioral: Climate Grade LabelsClimate 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. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (3 listed)
- 18 years of age or older
- Member of the NORC AmeriSpeak Panel
- Residing in the United States
Key exclusion criteria (4 listed)
- <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)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Control (QR) LabelsParticipants 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). | Behavioural | Control (QR) Labels |
| Low Climate Impact LabelsParticipants 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). | Behavioural | Low Climate Impact Labels |
| High Climate Impact LabelsParticipants 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). | Behavioural | High Climate Impact Labels |
| Traffic Light LabelsParticipants 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). | Behavioural | Traffic Light Labels |
| Climate Grade LabelsParticipants 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). | Behavioural | Climate Grade Labels |
Primary outcome
Modified Nutrient Profile Index score
Time frame: During online survey ordering task, up to 10 minutes
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.
19 secondary outcomes
Nutrient Profile Index score
Time frame: During online survey ordering task, up to 10 minutes
Total greenhouse gas emissions
Time frame: During online survey ordering task, up to 10 minutes
Frequency of red meat selected
Time frame: During online survey ordering task, up to 10 minutes
Total energy selected (number of calories)
Time frame: During online survey ordering task, up to 10 minutes
Total amount of saturated fat (grams) selected
Time frame: During online survey ordering task, up to 10 minutes
Total amount of sugar (grams) selected
Time frame: During online survey ordering task, up to 10 minutes
Total amount of protein (grams) selected
Time frame: During online survey ordering task, up to 10 minutes
Total amount of fiber (grams) selected
Time frame: During online survey ordering task, up to 10 minutes
Total amount of sodium (milligrams) selected
Time frame: During online survey ordering task, up to 10 minutes
Frequency of sugar-sweetened beverage selected
Time frame: During online survey ordering task, up to 10 minutes
Percentage of participants with knowledge of the climate impact of foods
Time frame: During online survey post-ordering task, up to 10 minutes
Percentage of participants with knowledge of the climate impact of menu items
Time frame: During online survey post-ordering task, up to 10 minutes
Frequency of participants with attention to labels
Time frame: During online survey post-ordering task, up to 10 minutes
Frequency of participants who recall labels that also correctly identify purpose of labels
Time frame: During online survey post-ordering task, up to 10 minutes
Perceived message effectiveness (PME) as assessed by the University of North Carolina (UNC) PME scale
Time frame: During online survey post-ordering task, up to 10 minutes
Total price of meal order
Time frame: During online survey ordering task, up to 10 minutes
Perceived level of appeal of food items
Time frame: During online survey post-ordering task, up to 10 minutes
Perceived level of healthfulness of food items
Time frame: During online survey post-ordering task, up to 10 minutes
Perceived level of climate impact of food items
Time frame: During online survey post-ordering task, up to 10 minutes
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 May 2025.
- Derived from this study: PubMed 42430158Wolfson JA, Tucker AC, Reimold AE, Musicus A, Carr N, Kim BF, Santo R, Cho C, Barquera Guevara DA, Choi E, Leung CW, Roberto CA, Falbe J. Eco-Focused Menu Labels on Full Meal Orders From Fast-Food Restaurants: A Randomized Clinical Trial. JAMA Health Forum. 2026 Jul 2;7(7):e262108. doi: 10.1001/jamahealthforum.2026.2108.
- Derived from this study: PubMed 41520993Reimold 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: An RCT. Am J Prev Med. 2026 Jun;70(6):108265. doi: 10.1016/j.amepre.2026.108265. Epub 2026 Jan 9.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Julia A Wolfson, PhD MPP principal investigator
Johns Hopkins Bloomberg School of Public Health
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Low Climate Impact Labels, High Climate Impact Labels and Traffic Light Labels in people with Food Selection, run by Johns Hopkins Bloomberg School of Public Health at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 29 May 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Modified Nutrient Profile Index score (time frame: During online survey ordering task, up to 10 minutes). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06909019, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 May 2025.