TY - JOUR
T1 - Online Randomized Controlled Trials of Restaurant Sodium Warning Labels
AU - Musicus, Aviva A.
AU - Moran, Alyssa J.
AU - Lawman, Hannah G.
AU - Roberto, Christina A.
N1 - Funding Information:
The authors would like to thank Joshua Roper, Catherine Bartoli, Jennifer Acquilante, Amanda Wagner, and Cheryl Bettigole at the Philadelphia Department of Public Health for contributing to discussions on implementation and policy considerations for sodium warning labels. They would also like to thank Sophia Hua for her help testing the online surveys. Ms. Musicus is supported by the National Institute of Environmental Health Sciences of NIH under Training Grant 5T32ES007069-37 . Dr. Moran is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of NIH under Training Grant 5T32DK007703 . The authors would like to thank the Leonard Davis Institute of Health Economics at the University of Pennsylvania for funding for this project. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of NIH. Author contributions: AAM, HL, and CAR conceptualized the study. AAM created all images for the survey, analyzed and interpreted the data, and drafted the manuscript. AJM critically reviewed the data analysis and manuscript. HL provided critical manuscript revisions. CAR obtained funding, oversaw data collection, and provided critical manuscript revisions. All authors approved the final version of the manuscript. Dr. Moran has received consultancy fees from the NYC Department of Health and Mental Hygiene. No other financial disclosures were reported by the authors of this paper.
Funding Information:
The authors would like to thank Joshua Roper, Catherine Bartoli, Jennifer Acquilante, Amanda Wagner, and Cheryl Bettigole at the Philadelphia Department of Public Health for contributing to discussions on implementation and policy considerations for sodium warning labels. They would also like to thank Sophia Hua for her help testing the online surveys. Ms. Musicus is supported by the National Institute of Environmental Health Sciences of NIH under Training Grant 5T32ES007069-37. Dr. Moran is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of NIH under Training Grant 5T32DK007703. The authors would like to thank the Leonard Davis Institute of Health Economics at the University of Pennsylvania for funding for this project. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of NIH. Author contributions: AAM, HL, and CAR conceptualized the study. AAM created all images for the survey, analyzed and interpreted the data, and drafted the manuscript. AJM critically reviewed the data analysis and manuscript. HL provided critical manuscript revisions. CAR obtained funding, oversaw data collection, and provided critical manuscript revisions. All authors approved the final version of the manuscript. Dr. Moran has received consultancy fees from the NYC Department of Health and Mental Hygiene. No other financial disclosures were reported by the authors of this paper.
Publisher Copyright:
© 2019 American Journal of Preventive Medicine
PY - 2019/12
Y1 - 2019/12
N2 - Introduction: Policymakers are interested in requiring chain restaurants to display sodium warning labels on menus to reduce sodium consumption. This study examined the influence of label design on consumers’ hypothetical choices, meal perceptions, and knowledge. Study design: Four sequential, randomized, controlled online experiments were conducted. Setting/participants: Across all 4 experiments, 10,412 sociodemographically diverse participants were recruited online through Survey Sampling International and Amazon Mechanical Turk. Intervention: Participants were randomized to view restaurant menus with either no sodium label (control) or 1 of 13 sodium warning labels that varied the text (e.g., “sodium warning” versus “high sodium”), icons (e.g., stop sign), and colors (red/black) used. Participants placed a hypothetical meal order and rated restaurant meal perceptions. Data were collected and analyzed in 2016–2019. Main outcome measures: The primary outcome was sodium content of hypothetical restaurant choices. Secondary outcomes included restaurant meal perceptions and sodium knowledge. Results: In Experiments 1–3, all warning labels reduced average sodium ordered across both restaurants (by 19–81 mg) versus controls, with some of the largest reductions from traffic light and stop sign labels, but results were not statistically significant. In a larger, preregistered replication (Experiment 4) testing traffic light and red stop sign labels versus control, traffic light and red stop sign labels significantly reduced average sodium ordered across both restaurants (−68 mg, p=0.002 and −46 mg, p=0.049, respectively). Warnings also significantly increased participants’ knowledge of sodium content and perceived health risks associated with high-sodium meals compared with no label. Conclusions: Traffic light and red stop sign warning labels significantly reduced sodium ordered compared with a control. Warning labels also increased knowledge about high sodium content in restaurant meals. Designs with warning text are likely to improve consumer understanding.
AB - Introduction: Policymakers are interested in requiring chain restaurants to display sodium warning labels on menus to reduce sodium consumption. This study examined the influence of label design on consumers’ hypothetical choices, meal perceptions, and knowledge. Study design: Four sequential, randomized, controlled online experiments were conducted. Setting/participants: Across all 4 experiments, 10,412 sociodemographically diverse participants were recruited online through Survey Sampling International and Amazon Mechanical Turk. Intervention: Participants were randomized to view restaurant menus with either no sodium label (control) or 1 of 13 sodium warning labels that varied the text (e.g., “sodium warning” versus “high sodium”), icons (e.g., stop sign), and colors (red/black) used. Participants placed a hypothetical meal order and rated restaurant meal perceptions. Data were collected and analyzed in 2016–2019. Main outcome measures: The primary outcome was sodium content of hypothetical restaurant choices. Secondary outcomes included restaurant meal perceptions and sodium knowledge. Results: In Experiments 1–3, all warning labels reduced average sodium ordered across both restaurants (by 19–81 mg) versus controls, with some of the largest reductions from traffic light and stop sign labels, but results were not statistically significant. In a larger, preregistered replication (Experiment 4) testing traffic light and red stop sign labels versus control, traffic light and red stop sign labels significantly reduced average sodium ordered across both restaurants (−68 mg, p=0.002 and −46 mg, p=0.049, respectively). Warnings also significantly increased participants’ knowledge of sodium content and perceived health risks associated with high-sodium meals compared with no label. Conclusions: Traffic light and red stop sign warning labels significantly reduced sodium ordered compared with a control. Warning labels also increased knowledge about high sodium content in restaurant meals. Designs with warning text are likely to improve consumer understanding.
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U2 - 10.1016/j.amepre.2019.06.024
DO - 10.1016/j.amepre.2019.06.024
M3 - Article
C2 - 31753271
AN - SCOPUS:85074898533
SN - 0749-3797
VL - 57
SP - e181-e193
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 6
ER -