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Food ChoicesMENUNCT07910604

Environmental Harm Menu Labels and the Healthfulness of Real-World Fast-Food Orders

A study testing Traffic-Light Style Environmental Harm Menu Labels in people with Food Choices, run by Johns Hopkins Bloomberg School of Public Health at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The primary objective of this study is to evaluate whether repeated exposure to environmental harm menu labels on fast-food restaurant menus improves the healthfulness of real-world fast-food meal orders. Read more about this study

Who is it for?
Ages 18 to 64 yearsHealthy volunteers can take part
Conditions the study is for
Food Choices
What is being tested?
Traffic-Light Style Environmental Harm Menu Labels
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
450 participants
Where
1 siteUnited States
Study dates
2 Nov 2026to 1 Apr 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

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 to 64 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Aged 18 to 64 years
  • Consumes fast food two or more times per month
  • Willing to eat meat
  • Lives or works within the greater Washington, D.C./Baltimore metropolitan area, defined as the counties and county equivalents within the Baltimore-Columbia-Towson, MD and Washington-Arlington-Alexandria, DC-VA-MD-WV Core Based Statistical Areas (excluding Jefferson County, West Virginia)
  • Has access to the internet during the daytime
  • Has access to an internet-capable device (smartphone, tablet, or computer)
Show all 11Show fewer
  • Able to send and receive phone calls and text messages at a unique primary phone number (number if not affiliated with a separate prospective or enrolled participant record)
  • Available to receive a weekly lunch delivery one day per week (Tuesday-Friday, 11:00 am - 3:00 pm) for seven weeks at a consistent address within the sample frame (this includes screening for potentially disruptive travel plans during ordering period)
  • Within the delivery zone for both restaurants in the study
  • Willing to complete training on lunch ordering procedures
  • Willing and able to complete dietary recalls and surveys

Who cannot join

  • Under 18 years of age
  • Over 64 years of age
  • Consumes fast food fewer than two times per month
  • Pescatarian, vegetarian, or vegan (due to menu content)
  • Lives and works outside of the greater Washington, D.C./Baltimore metropolitan area
  • Lacks access to the internet during the daytime
Show all 14Show fewer
  • Lacks access to an internet-capable device
  • Unable to send and receive phone calls and text messages at a unique primary phone number (phone number is affiliated with a separate prospective or enrolled participant record)
  • Lives or works outside the delivery zone for either or both study restaurants
  • Unavailable to receive seven weeks of consecutive lunch deliveries on a selected day Tuesday through Friday between 11:00 am and 3:00 pm at a consistent address within the sample frame
  • Unwilling to complete training on lunch ordering procedures
  • Unwilling or unable to complete dietary recalls and surveys
  • Fails verification via Cloudfare Turnstile check when accessing REDCap Interest Survey
  • Answers the hidden bot-detection question embedded in the Interest Survey

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Nina Carr, MPH, MBA contact

240-405-2823

ncarr6@jhu.edu

Julia Wolfson, PhD, MPP contact

213-359-2915

jwolfso7@jhu.edu

United States1 site, 1 recruiting
  • Johns Hopkins Bloomberg School of Public Health

    Baltimore, Maryland, 21205

    Nina Carr, MPH, MBA, 240-405-2823, ncarr6@jhu.edu

    Julia Wolfson, PhD, MPP

    Recruiting

Other trials in United States

About this study

Official title: Longitudinal Trial Evaluating the Effect of Environmental Harm Menu Labels on the Healthfulness of Real-World Fast-Food Meal Orders

The primary objective of this study is to evaluate whether repeated exposure to environmental harm menu labels on fast-food restaurant menus improves the healthfulness of real-world fast-food meal orders. Participants will be randomized to view either a control (QR code) label or traffic-light style environmental harm labels on two alternating fast-food restaurant menus, and will order one lunch per week for seven weeks through a study ordering website, with each meal delivered to the participant the following day.

Read the detailed description

Fast-food restaurants, where more than one-third of Americans eat on a typical day, are an important setting for dietary interventions aimed at reducing nutrition-related chronic diseases. Prior research on eco-labels, including this team's preliminary studies, has tested labels in online randomized experiments in which food choices are hypothetical. This trial tests the degree to which repeated exposure to environmental harm labels on fast-food menus promotes healthier food choices over time in a real-world setting in which participants receive and consume the foods the participant chooses.

A total of 450 adults aged 18 to 64 years who consume fast food at least twice per month will be recruited from the greater Baltimore/Washington, D.C. metropolitan area. Participants will be randomized 1:1 into two groups (approximately 225 per group) using a computer-generated simple randomization sequence, to view one of two labels: control QR code label vs. traffic-light style environmental harm labels with the sequence in which the two restaurant menus are presented during the ordering period also randomized 1:1. The environmental harm labels were identified through preliminary studies within the parent project, which tested ecolabel text, designs, and schemes for effectiveness in increasing the healthfulness of hypothetical fast-food meal orders.

Over seven weeks, participants will order one lunch per week from a website designed to imitate the experience of ordering fast food using a commercial online platform. Menus alternate each week between a burger restaurant and a sandwich restaurant, with the starting menu randomized. In Week 1, all participants order from an unlabeled menu, establishing a within-person baseline; in Weeks 2-7, participants view menus with the participants randomized label condition applied to the main item menus. Each meal selected is delivered to the participant the following day via a third-party food delivery service coordinated by study staff. Participants must order at least one main item and must spend a minimum amount of a predetermined meal budget on each order, with unspent funds returned at the end of the study, to reflect real-world cost trade-offs in food choice.

Participants will complete brief online surveys at baseline and endline. The baseline survey collects demographics, food security status, food-related behaviors, and personal health; the endline survey collects participants' experience with the ordering task, perceptions of the menus and food ordered, experience with the label condition to which the participants were randomized, fast-food consumption outside of study-provided lunches, knowledge of the environmental impact of foods, and current food security status.

The primary outcome is the healthfulness of food selections during the weekly meal orders, measured with a modified Nutrient Profile Index score. Secondary outcomes include selection of a beef item, the total energy of the order, and other nutrients of the order. All study activities are conducted remotely; there are no in-person study visits.

Conditions
Food Choices
Being tested
Control (QR Code) Menu Labels, Traffic-Light Style Environmental Harm Menu Labels
Keywords
Food labeling, Menu labeling, Environmental impact, Sustainability, Fast food

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Control (QR Code) Menu LabelsBehavioural

    A control label consisting of a QR code is applied to the main items on both restaurant menus in Weeks 2-7. The label carries no environmental information.

  • Traffic-Light Style Environmental Harm Menu LabelsBehavioural

    Traffic-light style environmental harm labels are applied to the main items on both restaurant menus in Weeks 2-7. Each label conveys the environmental harm of the item, defined for participants as how much water and land are required to produce it. Harm levels are assigned from ingredient-level land use and water use factors applied to the ingredients of each menu item.

Study groups in NCT07910604
Study groupRoleWhat they receive
Control LabelPlacebo comparatorParticipants order one lunch per week for seven weeks from two alternating fast-food restaurant menus. The Week 1 menu is unlabeled. In Weeks 2-7, a control label consisting of a QR code is applied to all main items on the restaurant menus. Participants in this arm are randomized in equal numbers to begin with the burger restaurant menu or the sandwich restaurant menu in Week 1; the two restaurants then alternate weekly, so that each participant sees the first restaurant in Weeks 1, 3, 5 and 7 and the other restaurant in Weeks 2, 4 and 6.
Receives: Behavioral: Control (QR Code) Menu Labels
Environmental Harm LabelsExperimentalParticipants order one lunch per week for seven weeks from two alternating fast-food restaurant menus. The Week 1 menu is unlabeled. In Weeks 2-7, traffic-light style environmental harm labels are applied to all main items on the restaurant menus. Participants in this arm are randomized in equal numbers to begin with the burger restaurant menu or the sandwich restaurant menu in Week 1; the two restaurants then alternate weekly, so that each participant sees the first restaurant in Weeks 1, 3, 5 and 7 and the other restaurant in Weeks 2, 4 and 6.
Receives: Behavioral: Traffic-Light Style Environmental Harm Menu Labels

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Modified Nutrient Profile Index score of weekly fast-food meal orders

    The primary outcome measure will be the healthfulness of the 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. Higher score better. 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 from the meal score and assessed separately.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

Secondary outcomes (7)
  1. Nutrient Profile Index score of the weekly fast-food main item

    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. Higher score better.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

  2. Total energy of the weekly meal order

    Total calories of each weekly meal order, summed across all items ordered, derived from the nutrient composition of the items selected.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

  3. Protein content of the weekly meal order

    Protein content of each weekly meal order, in grams, summed across all items ordered and derived from the nutrient composition of the items selected.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

  4. Fiber content of the weekly meal order

    Fiber content of each weekly meal order, in grams, summed across all items ordered and derived from the nutrient composition of the items selected.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

  5. Saturated fat content of the weekly meal order

    Saturated fat content of each weekly meal order, in grams, summed across all items ordered and derived from the nutrient composition of the items selected.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

  6. Sugar content of the weekly meal order

    Sugar content of each weekly meal order, in grams, summed across all items ordered and derived from the nutrient composition of the items selected.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

  7. Sodium content of the weekly meal order

    Sodium content of each weekly meal order, in milligrams, summed across all items ordered and derived from the nutrient composition of the items selected.

    Measured: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Nov 2026
  2. Study start2 Nov 2026
  3. Primary completion1 Apr 2029 (estimated)
  4. Study completion1 Apr 2029 (estimated)

Resources

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
The trial has two arms, defined by the label condition applied to the menus during the ordering period: a control (QR code) label and traffic-light style environmental harm labels. Participants are randomized 1:1 to one of two label conditions, so that approximately 225 participants are assigned to each arm. Menu sequence is a counterbalancing factor randomized within each arm so that restaurant and week are not confounded. All participants order from an unlabeled menu in Week 1, establishing a within-person baseline. In Weeks 2-7, the randomized label condition is applied to all main items on the restaurant menus, and the two restaurants alternate weekly. Randomization occurs after baseline data collection and the ordering training are complete, and assignment remains fixed for the remainder of the study.
Masking
None (open label)
Enrolment
450 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07910604
Sponsor's protocol ID
IRB00036491-1
Other IDs
R01DK139327
Acronym
MENU
Status last verified
Nov 2026
First submitted
27 Oct 2026
Last updated
4 Nov 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Investigators will share individual-level data without identifiers with co-investigators and members of the study team who will participate in data analysis. After findings are published, per the Data Management and Sharing Plan, investigators will upload de-identified datasets to the Open Science Framework (OSF) repository, a free open platform to share research. Stored data on OSF will have a unique, persistent URL for citing and sharing.

Questions about this trial

What is this clinical trial studying?

A study testing Traffic-Light Style Environmental Harm Menu Labels in people with Food Choices, 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 11 inclusion and 14 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: looking for participants now, as of the sponsor's last update on 4 Nov 2026. 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?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Nina Carr, MPH, MBA (240-405-2823, ncarr6@jhu.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Modified Nutrient Profile Index score of weekly fast-food meal orders (time frame: Once weekly for seven weeks (Week 1 unlabeled baseline; Weeks 2-7 labeled)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 4 Nov 2026.

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