Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2022 Dec 1;5(12):e2248320. doi: 10.1001/jamanetworkopen.2022.48320.
There is increasing interest in strategies to encourage more environmentally sustainable food choices in US restaurants through the use of menu labels that indicate an item's potential impact on the world's climate. Data are lacking on the ideal design of such labels to effectively encourage sustainable choices.
To test the effects of positive and negative climate impact menu labels on the environmental sustainability and healthfulness of food choices compared with a control label.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial used an online national US survey conducted March 30 to April 13, 2022, among a nationally representative sample of adults (aged ≥18 years) from the AmeriSpeak panel. Data were analyzed in June to October 2022.
Participants were shown a fast food menu and prompted to select 1 item they would like to order for dinner. Participants were randomized to view menus with 1 of 3 label conditions: a quick response code label on all items (control group); green low-climate impact label on chicken, fish, or vegetarian items (positive framing); or red high-climate impact label on red meat items (negative framing).
The main outcome was an indicator of selecting a sustainable item (ie, one without red meat). Secondary outcomes included participant health perceptions of the selected item and the Nutrition Profile Index (NPI) score of healthfulness.
Among 5049 participants (2444 female [51.6%]; 789 aged 18-29 years [20.3%], 1532 aged 30-44 years [25.9%], 1089 aged 45-59 years [23.5%], and 1639 aged ≥60 years [30.4%]; 142 Asian [5.3%], 611 Black [12.1%], and 3197 White [63.3%]; 866 Hispanic [17.2%]), high- and low-climate impact labels were effective at encouraging sustainable selections from the menu. Compared with participants in the control group, 23.5% more participants (95% CI, 13.7%-34.0%; P < .001) selected a sustainable menu item when menus displayed high-climate impact labels and 9.9% more participants (95% CI, 1.0%-19.8%; P = .03) selected a sustainable menu item when menus displayed low-climate impact labels. Across experimental conditions, participants who selected a sustainable item rated their order as healthier than those who selected an unsustainable item, according to mean perceived healthfulness score (control label: 3.4 points; 95% CI, 3.2-3.5 points vs 2.5 points; 95% CI, 2.4-2.6 points; P < .001; low-impact label: 3.7 points; 95% CI, 3.5-3.8 points vs 2.6 points; 95% CI, 2.5-2.7 points; P < .001; high-impact label: 3.5 points; 95% CI, 3.3-3.6 points vs 2.7 points; 95% CI, 2.6-2.9 points; P < .001). Participants in the high-climate impact label group selected healthier items according to mean (SE) NPI score (54.3 [0.2] points) compared with those in the low-climate impact (53.2 [0.2] points; P < .001) and control (52.9 [0.3] points; P < .001) label groups.
This randomized clinical trial's findings suggest that climate impact menu labels, especially negatively framed labels highlighting high-climate impact items (ie, red meat), were an effective strategy to reduce red meat selections and encourage more sustainable choices.
ClinicalTrials.gov Identifier: NCT05482204.
人们越来越关注通过使用菜单标签来鼓励美国餐厅更多地选择对环境更可持续的食物，这些标签可以表明食物对世界气候的潜在影响。然而，对于如何设计这种标签以有效地鼓励可持续选择，目前的数据还很缺乏。
本研究旨在比较正面和负面气候影响菜单标签与控制标签对食物的环境可持续性和健康程度的选择影响。
设计、设置和参与者：这是一项于 2022 年 3 月 30 日至 4 月 13 日期间在美国全国范围内进行的在线全国性成年人（年龄≥18 岁）的横断面研究，参与者来自 AmeriSpeak 小组。数据分析于 2022 年 6 月至 10 月进行。
参与者看到一份快餐菜单，并被提示选择他们想要点的晚餐的 1 道菜。参与者被随机分配到 3 种标签条件的菜单中查看：所有项目都有快速响应码标签（对照组）；鸡肉、鱼或素食项目上的绿色低气候影响标签（正面框架）；或红色肉类项目上的红色高气候影响标签（负面框架）。
主要结果是选择可持续项目的指标（即没有红色肉类的项目）。次要结果包括参与者对所选项目的健康认知和营养概况指数（NPI）的健康程度评分。
在 5049 名参与者中（2444 名女性[51.6%]；789 名年龄在 18-29 岁之间[20.3%]，1532 名年龄在 30-44 岁之间[25.9%]，1089 名年龄在 45-59 岁之间[23.5%]，1639 名年龄≥60 岁[30.4%]；142 名亚洲人[5.3%]，611 名黑人[12.1%]，3197 名白人[63.3%]，866 名西班牙裔[17.2%]），高和低气候影响标签都有效地鼓励从菜单中选择可持续的项目。与对照组相比，当菜单显示高气候影响标签时，有 23.5%的参与者（95%CI，13.7%-34.0%；P<0.001）选择了可持续的菜单项目，而当菜单显示低气候影响标签时，有 9.9%的参与者（95%CI，1.0%-19.8%；P=0.03）选择了可持续的菜单项目。在实验条件下，选择可持续项目的参与者对他们的订单评价比选择不可持续项目的参与者更健康，这体现在平均感知健康程度评分上（对照组：3.4 分；95%CI，3.2-3.5 分 vs 2.5 分；95%CI，2.4-2.6 分；P<0.001；低影响标签：3.7 分；95%CI，3.5-3.8 分 vs 2.6 分；95%CI，2.5-2.7 分；P<0.001；高影响标签：3.5 分；95%CI，3.3-3.6 分 vs 2.7 分；95%CI，2.6-2.9 分；P<0.001）。与低气候影响标签（53.2[0.2]分）和对照组（52.9[0.3]分）相比，高气候影响标签组的参与者选择了更健康的项目，根据平均（SE）NPI 评分（54.3[0.2]分；P<0.001）。
本随机临床试验的结果表明，气候影响菜单标签，特别是强调高气候影响项目（即红色肉类）的负面框架标签，是减少红色肉类选择和鼓励更可持续选择的有效策略。
ClinicalTrials.gov 标识符：NCT05482204。
