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Chronic DiseaseNCT07422922

Click & Pick Study

A study testing Suite of healthy food policies in people with Chronic Disease, run by University of Pennsylvania 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

Unhealthy diets significantly contribute to major preventable chronic diseases including type 2 diabetes, obesity, heart disease and stroke, which disproportionally impact racial/ethnic minority groups and those with lower income [1-3]. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Chronic Disease
What is being tested?
Suite of healthy food policies
Could I receive a placebo?
No, everyone receives an active treatment
How many people
300 participants
Where
1 siteUnited States
Study dates
25 Feb 2026to 21 Apr 2028
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 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • ≥18 years old
  • Not currently eligible for or participating in SNAP or another government program that automatically qualifies the person for SNAP (e.g., WIC, TANF)
  • Meets the following income eligibility requirements:
  • For participants living in the Houston or San Antonio areas, their household income must be greater than 165% of the federal poverty level, but less than the Texas state median household income (based on the 2023 American Community Survey) for their household size [11].
  • For participants living in the Philadelphia area, their income must be greater than 200% of the federal poverty level, but less than the Pennsylvania state median household income (based on the 2023 American Community Survey) for their household size [11].
  • Reports consuming food from McDonald's or a similar fast-food chain at least once a month
Show all 13Show fewer
  • Does most of the grocery shopping for the household
  • Can adhere to the study schedule (e.g., receive a lunch on a Wednesday)
  • Has regular internet access
  • Has a smart phone that can take pictures
  • Resident of Houston, TX, San Antonio, TX or Philadelphia, PA or the surrounding areas and plans to be there for the next six weeks
  • Household size of six or fewer people
  • Have an address eligible for receiving Grubhub+ and Walmart+ deliveries

Who cannot join

  • Does not meet all of the inclusion criteria
  • Cognitive impairment; per PIs discretion
  • Participant is under 18 years old
  • Does not speak English or Spanish

Trial locations and contacts

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

Julianna Catania, MPH contact

(215) 839-9689

julianna.catania@pennmedicine.upenn.edu

Eva Fabian, MPH contact

Eva.Fabian@Pennmedicine.upenn.edu

United States1 site, 1 recruiting

  • University of Pennsylvania

    Philadelphia, Pennsylvania, 19104

    Julianna Catania, MPH, 609-385-8219, julianna.catania@pennmedicine.upenn.edu

    Eva Fabian, MPH, Eva.Fabian@Pennmedicine.upenn.edu

    Recruiting

Other trials in United States

About this study

Official title: A Longitudinal, Randomized-Controlled Experiment of Healthy Food Policies in Online Retail Settings

Unhealthy diets significantly contribute to major preventable chronic diseases including type 2 diabetes, obesity, heart disease and stroke, which disproportionally impact racial/ethnic minority groups and those with lower income [1-3]. Although taxes and warning labels targeting sugar-sweetened beverages (SSB) have been successful at shifting behavior [4-7], there are many other ultra-processed food products that contribute to unhealthy diets [8]. What is less well-known is whether a suite of healthy food policies that are expanded to target a range of ultra-processed foods can shift dietary choices and intake in meaningful ways. Our research team's long-term goal is to identify and understand the degree to which combinations of healthy food policies can improve nutrition security and reduce nutrition-related diseases.

Read the detailed description

To advance our understanding of policies needed to support nutrition security and health, our overall objective is to examine the degree to which a suite of healthy food policies in online food retailers can increase the purchase and intake of healthy foods and beverages while reducing the purchase and intake of unhealthy ultra-processed foods and beverages.

To accomplish this objective, we will use an innovative online grocery store and restaurant platforms to randomize participants to either: 1) control (no taxes, warning labels, or healthy checkout regulations on any products); or 2) a suite of healthy food policies (ultra-processed food and beverage taxes, front-of-pack nutrition labeling, and healthy check out regulations that restrict the promotion of ultra-processed products on the checkout page). We will recruit 300 adults with lower income across Houston and San Antonio, TX, and Philadelphia, PA to shop once per week for six weeks in both our online grocery store and restaurant. Week 1 will be a baseline (control) week without interventions, followed by three weeks of the interventions. In the last two study weeks, we will introduce unhealthy food marketing (e.g., banner ads) into the online platforms to mimic what we expect industry will do to counter public health policy efforts.

A key aim of the study is to simulate how food companies will respond to healthy eating policies if they were to be implemented in the real world. For that reason, we will increase the intensity of non-checkout advertisements for unhealthy foods during the last two weeks of the intervention period because this is likely how industry would respond in the real-world if the U.S. adopted any of the policies we are testing. Therefore, we are trying to measure the extent to which that advertising would undermine the policy effects. This is a critical component of our study because many nutrition policy experiments look at the impact of a policy in a static situation that does not account for a likely industry response. The advertisements we are using will mimic what's normally seen in delivery/grocery apps such as ads for sugar-sweetened beverages like Coke or Pepsi.

Participants will be given money to spend in these online platforms and purchases will be delivered to them via a real food retail store and restaurant. Participants will complete surveys at baseline and after 6 weeks of shopping and will complete two dietary recalls administered over the phone during the baseline week and during the fourth week (4 recalls total). The rationale underlying the proposed research is based on our work showing that beverage taxes and warning labels greatly reduce SSB purchases.

The specific aims of the study are:

  • Aims 1: To evaluate the effects of three healthy food policies (ultra-processed food and beverage taxes, front-of-pack nutrition warning labels, and healthy checkout regulations) on purchases across online grocery store and restaurant settings.
  • Aim 2: To evaluate the effects of three healthy food policies (ultra-processed food taxes, front-of-pack nutrition warning labels, and healthy checkout regulations) on dietary quality.
  • Aim 3: To understand the degree to which unhealthy food marketing counters the effects of a suite of healthy food policies.
Conditions
Chronic Disease
Being tested
Suite of healthy food policies
Keywords
chronic disease, behavioral economics, warning label, nutrition, ultra-processed food, unhealthy food, sugar-sweetened beverage, advertisement restriction, nutrition policy
Medical subject headings
Chronic Disease

What participants receive

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

  • Suite of healthy food policiesBehavioural

    A suite of healthy food policies in an online restaurant and grocery store including ultra-processed food and beverage taxes, front-of-pack nutrition labeling, and healthy check out regulations that restrict the promotion of ultra-processed products on the checkout pages.

Study groups in NCT07422922
Study groupRoleWhat they receive
ControlNo interventionNot described
InterventionExperimentalNot described
Receives: Behavioral: Suite of healthy food policies

What is being measured

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

  1. Average kcals purchased per participant per day from unhealthy ultra-processed food products that are targeted by our suite of healthy food policies

    We will sum the number of kcals from ultra-processed food products purchased in the online grocery store and divide that by the number of people in the household and 7 days per week. We will then add that to the number of kcals from ultra-processed foods purchased from the online restaurant to calculate total kcals from ultra-processed foods purchased per study participant per day. We will also examine these outcomes separately in the grocery store and restaurant context.

    Measured: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)

Secondary outcomes (12)

  1. Average sodium, saturated fat, and added sugars purchased per participant per day from unhealthy ultra-processed food products that are targeted by our suite of policies

    Using the same approach as our primary outcome, our secondary behavioral outcomes will be the average sodium, saturated fat, and added sugars purchased per participant per day. We will also examine these outcomes separately in the grocery store and restaurant context.

    Measured: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)

  2. Average overall kcals, sodium, saturated fat, and added sugars from all foods purchased in the online grocery store and restaurant per participant per day

    We will create this outcome using the same approach as our primary outcome, except we will look at all foods and beverages purchased, not just ultra-processed foods and beverages. We will also examine these outcomes separately in the grocery store and restaurant context.

    Measured: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)

  3. Percentage of total dollars per order spent on products targeted by our suite of healthy food policies

    To create this outcome for each week of the study, we will divide the number of dollars spent on targeted ultra-processed products by the total dollars spent and multiply by 100.

    Measured: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)

  4. Total dollars spent on food and beverage products purchased outside of the study grocery store and restaurant

    We will sum together the total amount of dollars spent on food and beverages purchased outside the study using outside receipts submitted by the participants.

    Measured: Baseline to Week 6

  5. Total dollars spent on sugar sweetened beverages, candy, and fast food purchased outside of the study grocery store and restaurant

    Total dollars spent on sugar sweetened beverages, candy, and fast food purchased outside the study using outside receipts submitted by the participants.

    Measured: Baseline to Week 6

  6. Healthy Eating Index Score (HEI-2020)

    The HEI is a tool to assess how well a participant's diet aligns with the 2015-2020 Dietary Guidelines for Americans and can be used to measure the efficacy of nutrition interventions [9]. We will average intake estimates from the two 24-hour dietary recall interviews conducted at baseline and again at follow up (Week 4).

    Measured: Change between baseline and Week 4

  7. Change in usual intake for: energy (kcals), discretionary calories, SSB servings per day, total fruit servings/day, total vegetable servings/day, daily intake of key macronutrients, and daily intake of whole grains

    We will average intake estimates from the two NDSR 24-hour dietary recall interviews conducted at baseline and again at follow up (Week 4) [10].

    Measured: Change between baseline and Week 4

  8. Food and beverage product perceptions

    During the final survey (Week 7), participants will view four ultra-processed products. Those in the intervention group will see those products with any applicable warning labels and those in the control group will see the same products without any warning labels. Participants will then rate how healthy or unhealthy they believe the product to be.

    Measured: Final survey (administered Week 7)

  9. Nutrient content knowledge

    During the final survey (Week 7), participants will also be asked about their knowledge of different nutrients of concern, and we will determine whether they provide the correct answer or not. They will view the same four ultra-processed products as the food and beverage product perceptions questions and be asked whether or not the product has low, medium, or high amounts of calories, sodium, saturated fats, and added sugars.

    Measured: Final survey (administered Week 7)

  10. Warning label perceptions

    At the end of the final study survey (Week 7), participants will be shown the warning labels used in the study and asked about perceived message effectiveness.

    Measured: Final survey (administered Week 7)

  11. Policy opinions

    During the final survey (Week 7), participants will also answer four questions about their support or opposition for the suite of healthy food policies.

    Measured: Final survey (administered Week 7)

  12. Online store perceptions

    We will assess the acceptability of the online grocery store and restaurant (e.g., overall difficulty of using the grocery store/restaurant, satisfaction with number of options) and realism of the online grocery store and restaurant (e.g., extent to which participants' selections are similar to usual purchases, extent to which it felt real).

    Measured: Final survey (administered Week 7)

Timeline

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

  1. First posted20 Feb 2026
  2. Study start25 Feb 2026
  3. Primary completion21 Apr 2028 (estimated)
  4. Study completion21 Apr 2028 (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
Masking
None (open label)
Enrolment
300 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07422922
Sponsor's protocol ID
855856
Other IDs
1R01DK136779-01
Status last verified
May 2026
First submitted
12 Feb 2026
Last updated
18 May 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified data available for public use and associated documentation will be available to the research community free of charge through the Data Sharing for Demographic Research (DSDR) data repository hosted at ICPSR. Data and datasets will be kept and available to share for at least three years following completion of the project, in accordance with NIH regulations. Datasets in DSDR will be findable and identifiable through a study digital object identifier (DOI) minted by ICPSR.

Publications

  • US Burden of Disease Collaborators; Mokdad AH, Ballestros K, Echko M, Glenn S, Olsen HE, Mullany E, Lee A, Khan AR, Ahmadi A, Ferrari AJ, Kasaeian A, Werdecker A, Carter A, Zipkin B, Sartorius B, Serdar B, Sykes BL, Troeger C, Fitzmaurice C, Rehm CD, Santomauro D, Kim D, Colombara D, Schwebel DC, Tsoi D, Kolte D, Nsoesie E, Nichols E, Oren E, Charlson FJ, Patton GC, Roth GA, Hosgood HD, Whiteford HA, Kyu H, Erskine HE, Huang H, Martopullo I, Singh JA, Nachega JB, Sanabria JR, Abbas K, Ong K, Tabb K, Krohn KJ, Cornaby L, Degenhardt L, Moses M, Farvid M, Griswold M, Criqui M, Bell M, Nguyen M, Wallin M, Mirarefin M, Qorbani M, Younis M, Fullman N, Liu P, Briant P, Gona P, Havmoller R, Leung R, Kimokoti R, Bazargan-Hejazi S, Hay SI, Yadgir S, Biryukov S, Vollset SE, Alam T, Frank T, Farid T, Miller T, Vos T, Barnighausen T, Gebrehiwot TT, Yano Y, Al-Aly Z, Mehari A, Handal A, Kandel A, Anderson B, Biroscak B, Mozaffarian D, Dorsey ER, Ding EL, Park EK, Wagner G, Hu G, Chen H, Sunshine JE, Khubchandani J, Leasher J, Leung J, Salomon J, Unutzer J, Cahill L, Cooper L, Horino M, Brauer M, Breitborde N, Hotez P, Topor-Madry R, Soneji S, Stranges S, James S, Amrock S, Jayaraman S, Patel T, Akinyemiju T, Skirbekk V, Kinfu Y, Bhutta Z, Jonas JB, Murray CJL. The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018 Apr 10;319(14):1444-1472. doi: 10.1001/jama.2018.0158.

    PubMed 29634829

  • Centers for Disease Control. Type 2 Diabetes. Centers for Disease Control. Published December 16, 2021. Accessed September 30, 2022. https://www.cdc.gov/diabetes/basics/type2.html#:~:text=Healthy%20eating%20is%20your%20recipe,them%20have%20type%202%20diabetes.

  • Centers for Disease Control. Adult obesity facts. Centers for Disease Control. Published May 17, 2022. Accessed September 30, 2022. https://www.cdc.gov/obesity/data/adult.html

  • Andreyeva T, Marple K, Marinello S, Moore TE, Powell LM. Outcomes Following Taxation of Sugar-Sweetened Beverages: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022 Jun 1;5(6):e2215276. doi: 10.1001/jamanetworkopen.2022.15276.

    PubMed 35648398

  • An R, Liu J, Liu R, Barker AR, Figueroa RB, McBride TD. Impact of Sugar-Sweetened Beverage Warning Labels on Consumer Behaviors: A Systematic Review and Meta-Analysis. Am J Prev Med. 2021 Jan;60(1):115-126. doi: 10.1016/j.amepre.2020.07.003. Epub 2020 Oct 12.

    PubMed 33059917

  • Clarke N, Pechey E, Kosite D, Konig LM, Mantzari E, Blackwell AKM, Marteau TM, Hollands GJ. Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis. Health Psychol Rev. 2021 Sep;15(3):430-453. doi: 10.1080/17437199.2020.1780147. Epub 2020 Jul 2.

    PubMed 32515697

  • Grummon AH, Hall MG. Sugary drink warnings: A meta-analysis of experimental studies. PLoS Med. 2020 May 20;17(5):e1003120. doi: 10.1371/journal.pmed.1003120. eCollection 2020 May.

    PubMed 32433660

  • Dong D, Bilger M, van Dam RM, Finkelstein EA. Consumption Of Specific Foods And Beverages And Excess Weight Gain Among Children And Adolescents. Health Aff (Millwood). 2015 Nov;34(11):1940-8. doi: 10.1377/hlthaff.2015.0434.

    PubMed 26526253

  • How the HEI is scored. Food and Nutrition Service U.S. Department of Agriculture. (n.d.). https://www.fns.usda.gov/cnpp/how-hei-scored

  • University of Minnesota Nutrition Coordinating Center (NCC). NDSR Software. Nutrition Coordinating Center (NCC). Published July 25, 2025. Accessed August 6, 2025. https://www.ncc.umn.edu/products/

  • U.S. Census Bureau (2023). Median Household Income in the Past 12 Months (In 2023 Inflation-adjusted Dollars) by Household Size American Community Survey 1-year estimates. Retrieved from <https://censusreporter.org>

Questions about this trial

What is this clinical trial studying?

A study testing Suite of healthy food policies in people with Chronic Disease, run by University of Pennsylvania 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 13 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: looking for participants now, as of the sponsor's last update on 18 May 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. 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 Julianna Catania, MPH ((215) 839-9689, julianna.catania@pennmedicine.upenn.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Average kcals purchased per participant per day from unhealthy ultra-processed food products that are targeted by our suite of healthy food policies (time frame: Change between baseline and Weeks 2-4 (Aim 1) and Weeks 5-6 (Aim 3)). 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 NCT07422922, which also lists 11 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 18 May 2026.

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