MENU Study: Online Experiment

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.

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.

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 as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include an item containing red meat.

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.

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.

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.

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.

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.

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 as a dichotomous variable (yes/no) indicating whether participants' hypothetical meal orders include a sugar-sweetened beverage.

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.

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 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 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".

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 by the cumulative total price (USD) of participants' hypothetical meal orders per restaurant, based on the prices displayed on the survey menus.

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 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 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.

This outcome will measure participants' knowledge of the effectiveness of specific consumer behaviors on reducing climate change. The exact behaviors presented are: "Eat less red meat", "Eat organic foods", "Eat local, seasonal foods", "Drive less", "Use less plastic", "Save energy at home", "Recycle", "Eat fewer dairy products", "Waste less food", and "Use reusable grocery bags". Response options are: "Not effective at all", "Slightly effective", "Moderately effective", "Very effective", Extremely effective" "I don't know".

Measured by the level of support or opposition for policies and practices regarding food, nutrition, and consumer information. This outcome is measured across five survey items with response options of "Strongly oppose", "Oppose" Somewhat oppose", "Neither support nor oppose", "Somewhat support", "Support", "Strongly support" for each specific policy described.