What Consumers Don't Know Can Hurt Them: Consumer Evaluations and Disease Risk Perceptions of...

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SCOT BURTON AND ELIZABETH H. CREYER

What Consumers Don’t Know Can Hurt Them:Consumer Evaluations and Disease Risk Perceptions

of Restaurant Menu ItemsLegislation that mandates the provision of nutrition information onrestaurant menus has been proposed in several states. This researchpresents findings from an experiment that investigates how the provi-sion of nutrition information and a health claim influence consumers’attitudes towards the product, nutrition-related attitudes, disease riskperceptions, source credibility judgments, and nutrient value estimatesfor restaurant menu items. In addition, how the nutrition frame (orcontext) within which a menu item is evaluated moderates these effectsis examined. The results indicate that providing target item nutritioninformation, as well as a nutritional context, affects consumers’ atti-tudes, perceptions, and judgments. In addition, the context interactswith the provision of both a health claim and nutrition information forthe target item. The theoretical, managerial, consumer welfare, andpublic policy implications of our research findings are discussed.

INTRODUCTION

As Surgeon General of the United States, David Satcher warned that theobesity epidemic spreading throughout the nation could soon overtake to-bacco as the leading cause of preventable deaths. More specifically, the ris-ing death toll resulting from illnesses and diseases directly related to beingoverweight, and those worsened by obesity, threaten to wipe out medicaladvances made in the treatment of the two major causes of death in theUnited States, heart disease and cancer (U.S. Department of Health andHuman Services 2001). Overweight and obese individuals are not the onlyones facing the high costs associated with their conditions. The U.S. De-partment of Health and Human Services estimates that obesity costs theUnited States over $117 billion a year (U.S. Department of Health and Hu-man Services 2001). Identifying the primary cause of the obesity epidemic

SUMMER 2004 VOLUME 38, NUMBER 1 121

Scot Burton is a Professor and Wal-Mart Chair in the Department of Marketing and Logistics, Sam M. Walton College of Business, University of Arkansas, Fayetteville ([email protected]).Elizabeth H. Creyer is an Associate Professor, Department of Marketing and Logistics, Sam M. Wal-ton College of Business, University of Arkansas, Fayetteville ([email protected]). The order ofauthorship was determined by a random draw. Correspondence may be addressed to either author.

The Journal of Consumer Affairs, Vol. 38, No. 1, 2004ISSN 0022-0078Copyright 2004 by The American Council on Consumer Interests

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122 THE JOURNAL OF CONSUMER AFFAIRS

is not difficult—Americans are simply consuming too many calories giventheir level of physical activity.

Determining the best way to persuade consumers to eat more healthfuldiets is, however, a challenging endeavor (Balasubramanian and Cole2002; Kozup, Creyer, and Burton 2003). One promising yet relatively un-explored area of research that may help stem the rising tide of obesity fo-cuses on better understanding how to assist consumers make more health-ful foods choices when dining out. As the final review of the HealthyPeople 2000 report prepared by agencies of the U.S. government states,although the passage of the Nutritional Labeling and Education Act of1990 (NLEA) has increased the availability of nutrition information in thesupermarket, “a significant challenge remains on the fronts for away-from-home foods purchased at fast-food outlets, restaurants, cafeterias, andother food service outlets” (U.S. Department of Health and Human Ser-vices 2000, p. 79). Since information regarding the nutrient content offood prepared outside the home is often not available, consumers usuallyhave little knowledge of the calories, saturated fat, cholesterol, and othernutritional attributes provided by these foods. The absence of reliable nu-trition information for foods consumed outside the home is an especiallyimportant issue since Americans are eating an increasing number of theirmeals at fast-food and table-service restaurants (Kozup, Creyer, and Bur-ton 2003). Between 1970 and 1996, the amount of food dollars spent onmeals prepared outside the home rose from 26% to 38% (Lin, Frazão, andGuthrie 1999).

Specific Research Objectives

Consumers have easy access to important nutrition information whenevaluating most food products while shopping in supermarkets and gro-cery store retailers because the Nutrition Facts panel on product packag-ing presents information regarding key nutrients in a format which is rel-atively easy to read and understand. However, given that Americans areeating less food prepared inside the home, and since the disclosure of nu-trition information for foods served for immediate consumption is not re-quired, many consumers are unable to evaluate accurately the healthful-ness of their overall diets. Within the context of restaurant menu items, thepurpose of this research is to examine how nutrient value estimates, dis-ease risk perceptions, source credibility judgments, attitudes, and purchaseintentions are affected by 1) the provision of nutrition information, 2) ahealth claim, and 3) the nutritional frame or the context within which themenu item is presented.

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Three specific research issues are addressed. First, how nutrition infor-mation influences consumers’ disease risk estimates and product evalua-tions (i.e., nutrient value estimates, attitude towards the product, nutrition-related attitude, perceived source credibility, and purchase intentions) fortarget and non-target menu items is explored. Second, whether the provi-sion of two different health claims on a restaurant menu moderates the ef-fects of nutrition information on the dependent measures is considered.Third, we explore whether nutritional framing, that is, the nutritional con-text within which the menu item is presented, moderates the influence ofthe health claims and nutrition information on product evaluations anddisease risk perceptions.

The remainder of this article is organized as follows. First, we brieflydiscuss the rationale for this research from theoretical, managerial, andconsumer welfare perspectives and provide background information re-garding the national overweight and obesity epidemic. The results of anexperiment that examines the effects of nutrition information, healthclaims, and context on adult consumers’ evaluations of restaurant menuitems are then discussed. Finally, the theoretical, managerial, consumerwelfare, and public policy implications of our findings are presented andopportunities for additional research identified.

Theoretical Perspective

Although there are several streams of research within the marketing andbehavioral decision theory literatures that provide insight into how con-sumers may potentially construct evaluations of restaurant menu items,prior research on “context effects” is particularly relevant to our research.For example, perceptual factors such as the circumstances that accompanythe decision process have been shown to exert a powerful influence onjudgment and choice processes (Slovic, Fischhoff, and Lichtenstein 1977).Perceived changes in the values of the decision alternatives have also beenshown to have a significant impact on decision outcomes (Payne 1982;Puto 1987).

One area of context effects research that may be most pertinent to thefocus of this research is the study of how a “standard of comparison” in-fluences judgment and choice processes. A standard of comparison is thepoint of reference against which the choice options are compared (Puto1987). The point of reference determines the decision frame, that is, theperspective from which the options are evaluated (Kahneman and Tversky1984). Prior research has shown that a consumer’s expectations, his or herspecific buying objectives, promotional messages, and the ability to justify

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one’s decision can all influence the frame within which options are evalu-ated (Lehmann and Pan 1994; Simonson and Tversky 1992; Slovic, Fisch-hoff, and Lichtenstein 1982). For example, consider possible consumer re-sponses to the introduction of a new diet soft drink. If consumers expect a diet soft drink to be calorie-free, as most are, then a new diet drink with25 calories may be evaluated somewhat negatively. That is, when a prod-uct fails to match expectations, then negative consumer responses such asdissatisfaction or disappointment are likely to occur (Oliver 1993). An-other aspect of context that can have a significant influence on decisionprocesses is contrast effects. Simonson and Tversky (1992) distinguishbetween background contrast and local contrast effects. During the deci-sion process, consumers typically compare a specific option to other pos-sible alternatives. When the current set of alternatives influences the deci-sion, Simonson and Tversky (1992) refer to this as a local context effect.Background context effects occur when the decision process is influencedby previous options. In the case of nutrient values for menu alternativeswhere consumers must consider many nutrients (e.g., fat, cholesterol,sodium) measured with large differences in recommended daily values(e.g., 2400mg. for sodium, 65g. for fat, 300mg. for cholesterol) acrossmany item types, local context effects should be particularly influentialrelative to background effects.

We extend prior research on the effects of local context in several ways.Whereas others have primarily focused on choice sets comprised of op-tions that differ simply in terms of the values of their attributes, we alsoconsider how a different type of information used to define the options(i.e., a health claim) interacts with the decision frame to influence con-sumers’ judgments and evaluations. Specifically, we anticipate that effectsof both target item nutrition information and two specific health claims fo-cusing on the relationships between diet and the risks of cancer and heartdisease will be moderated by the nutrition frame created by alternative(non-target) menu items. For example, provision of a frame that presentsvery negative nutrition information (compared to a no-frame control), willhave a greater positive effect on attitudes and intentions for a target itemwith relatively unfavorable nutrient levels as compared to when there is ei-ther no target item nutrient information or relatively favorable informa-tion. In addition, moderating effects should extend to more subjectivetypes of claims, such as heart and cancer health claims; provision of an un-healthy nutrition frame for the non-target options is expected to accentu-ate effects on disease risk evaluations for a target item that includes ahealth claim. It is also anticipated that the provision of target item nutri-

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tion information and a health claim for the target item will interact. The ef-fect of a health claim on disease risk evaluations should be greater whenthere is target nutrition information available than when there is no nutri-tion information available. Given no nutrition-specific information, theclaim will play a predominant role in consumer perceptions of disease risklikelihood; when nutrition information is available, it is viewed as morerelevant and credible than a claim (Keller et al. 1997; Mitra et al. 1999).

In contrast to most prior studies examining local context, we are notsolely concerned about consumer responses to a specific target item. Forexample, researchers typically explore how preference for a given optionis affected by changes in context such as the introduction of a new optioninto the choice set (Lehman and Pan 1994). Instead, we also consider howinformation presented for the target option affects evaluations of other al-ternatives in the choice set. Furthermore, prior context effects research hasprimarily focused on broader dependent measures such as choice and pref-erence. This research, however, focuses on more specific evaluative as-pects of the options such as nutrition-related attitudes, nutrient value esti-mates, and disease risk perceptions. Finally, we extend previous researchon the effects of context into a new substantive domain (i.e., the evaluationof restaurant menu items) that has important public policy and consumerhealth and welfare implications.

Consumer Welfare Perspectives

Healthy People 2010, a prevention agenda for the nation prepared by the National Institutes of Health, includes 28 specific categories of ob-jectives for improving the health of Americans, such as 1) reducing thenumber of new cases of cancer and deaths due to cancer, 2) reducing thedisease burden of diabetes, and 3) improving cardiovascular health. Im-proving the healthfulness of Americans’ diets would be major step towardsthe accomplishment of many of these objectives. In addition, nutrition andoverweight is explicitly identified as a category objective with the specificgoal “to promote health and reduce chronic disease associated with dietand weight” (U.S. Department of Health and Human Services 2000, p. 3).Many believe that this can be best accomplished by reducing Americans’dependence on fast food, which typically contains high levels of both fatand sugar (Spake 2002).

One of the primary objectives of the NLEA was to provide consumerswith information that would encourage more healthful eating patterns. Theincreasing proportion of Americans who are overweight and obese sug-

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gests that in the past decade consumers, in general, have not made sub-stantial improvements in their diets. Given the fact that the NLEA mandateon nutrient information disclosure does not apply to food served for im-mediate consumption plus the fact that consumers are consuming increas-ing amounts of food prepared outside the home, raises an important ques-tion. What if the NLEA were to be amended to include foods served bytake-out and table-service restaurants?

Significant increases in the incidence of illnesses and diseases directlyand indirectly related to being overweight, combined with an increase inconsumption of foods prepared outside the home, has raised an interest inthe provision of nutrition information in restaurants. For example, legisla-tion has been proposed recently in several states (New York, New Hamp-shire, Maine, and Pennsylvania) and the District of Columbia that wouldrequire chain restaurants with ten or more locations nationally to disclosecalorie and other nutrition information (see Connolly 2003). In addition tosuch proposed legislation, several restaurant chains are in the process ofbecoming more proactive concerning the nutritional value of their fare andtheir provision of nutrition information. Applebee’s, the world’s largest ca-sual dining chain, recently announced their collaboration with WeightWatchers International that will result in the chain offering low-calorie al-ternatives on many entrees, appetizers, and desserts (Horovitz 2003). Dar-den Restaurants Inc., the owner of Red Lobster and Olive Garden, is test-ing a new restaurant concept in which nothing on the menu is more than500 calories and servers can provide detailed nutritional information onitems via handheld computers. Thus, legislation combined with tacticalchanges by major chain restaurants should have a large impact on the nu-tritional information available at restaurants over the next several years.Given such looming changes, public policy makers will benefit from a bet-ter understanding of how consumers use nutrition information and healthand nutrient claims to evaluate restaurant menu items.

However, since the availability of nutrition information currently is re-quired only for those menu items associated with a specific health claim,accurately determining the nutrient content of most menu items may bedifficult, if not impossible, at many table-service restaurants. Given a lackof available nutrition information about target items, many consumers maydraw inferences regarding the healthfulness of a product based on infor-mation that is easily available in the immediate environment. This raisesan interesting issue. Are consumers’ evaluations of a restaurant menu iteminfluenced by context?

For example, will consumers’ health-related evaluations of a lean, 8

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ounce rib-eye steak differ depending on whether the other choice alter-native is a low fat, low calorie salad or a high fat, high calorie food such asa three-quarter pound bacon cheeseburger? According to classical eco-nomic theory, each choice alternative is assumed to have a specific utilityor objective value; this assumption is called “value maximization.” How-ever, a number of research studies (e.g., Prelec, Wernerfelt, and Zettel-meyer 1997) have shown that consumer preferences and choices often are strongly influenced by context. A better understanding of the effects of context on consumer product evaluations and disease risk perceptionsmay provide substantial competitive advantages. For instance, this knowl-edge could be helpful when designing an integrated marketing communi-cations plan such as the one implemented by Subway that positions theirrelatively low fat sandwiches against higher fat alternatives of fast-foodcompetitors.1

Our research compares how consumers evaluate menu items when nu-trition information is available, relative to when it is not provided. The nu-tritional values used to define the non-target menu item stimuli are basedon estimates of the nutrient levels of actual foods served in popular table-service restaurants such as Applebee’s, Denny’s, and Olive Garden. Givenproposed legislation that would require chain restaurants to disclose calo-rie and nutrition information, comparisons of consumers’ product eval-uations and disease risk perceptions under conditions of no nutritioninformation (i.e., the status quo in most restaurants) versus conditions ofnutrition information disclosures are a particularly important aspect of thisresearch. The introduction of easily accessible, useful nutrition informa-tion into judgment and choice situations now characterized by a sparsenessof information potentially has profound effects that could influence thehealthfulness of diets and disease risk for many thousands of Americanscurrently at risk. Acquiring a better understanding of these effects is likelyto be of interest to academic researchers, marketing managers, public pol-icy makers, and consumer welfare advocates.

METHODOLOGY

Design

The study was a 3 (nutrient levels of the target menu item) X 2 (nutri-tional frame created by the provision or absence of nutrition informationfor the three non-target menu items) X 3 (health claim for the target menuitem) between-subjects experiment. The three conditions for the target

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item nutrient level manipulation condition included a control (no informa-tion), unfavorable, and favorable conditions. In the favorable condition,nutrient levels for the target item were 11 grams of total fat (17% DailyValue (DV)), 3.5 grams of saturated fat (18% DV), 60 milligrams of cho-lesterol (20% DV), and 480 milligrams of sodium (20% DV). Nutrient lev-els for the target item in the unfavorable condition were as follows: 33grams of total fat (51% DV), 10 grams of saturated fat (50% DV), 190 mil-ligrams of cholesterol (63% DV), and 1600 milligrams of sodium (67%DV). In the control condition, nutrition information was not provided,which reflects the current norm in most restaurants. Pot roast was chosenas the target menu item since it is a familiar item commonly served in avariety of restaurants and because of its ambiguity from a nutritional per-spective. Generally, pot roast can be among the more nutritional fareoffered by dinner houses (Hurley and Schmidt 1996). However, addingmashed potatoes with gravy, vegetables with butter, and a fattier cut ofmeat significantly increases the meal’s level of fat and saturated fat. Thus,the nutrient levels used in both the favorable and unfavorable conditionswere feasible and realistic.

For the nutritional frame factor, there was either a frame provided by in-cluding nutrition information for three non-target items (lasagna, chickenfajitas, and chicken chow mein) or no frame provided (a control conditionwith no nutrition information for the three alternative menu items). Whennutrition information was provided for the alternative items, nutrient lev-els were based on estimates from testing conducted by the Center for Sci-ence in the Public Interest (CSPI 1997). The results of their analysis indi-cated that these items generally were not healthful choices based on levelsof fat and saturated fat. In the condition in which nutrient values were pro-vided for these non-target menu items, values ranged from 38 to 56 gramsof fat (from 58% to 86% DV), 11 to 20 grams for saturated fat (55% to100% DV), 185 to 217 milligrams for cholesterol (62% to 72% DV), and2050 to 2600 milligrams for sodium (85% to 108% DV). Note that the lev-els of fat, saturated fat, and sodium for the three contextual items were lesshealthful than either the favorable or unfavorable nutrition conditions forthe target item.

Health claim conditions for the target item included a cancer claim, aheart healthy claim, or no claim; wording of the claims were based onmodel claim statements recommended by the FDA. These claims are ofparticular interest to researchers due to the hundreds of thousands ofAmericans who die each year due to diet-related coronary heart diseaseand diet-related cancers (Centers for Disease Control 2002). For the can-

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cer claim, the item was noted on the menu stimulus as “a healthy selection”and a footnoted claim stated the following: “A diet low in fat and rich infruits and vegetables may reduce the risk of some types of cancer.” In theheart claim condition, the item was described as “a heart healthy selection”and the footnoted claim stated: “A diet low in saturated fat and cholesterolmay reduce the risk of coronary heart disease.” Both claims were consis-tent and permissible for the nutrient levels in the favorable condition forthe target item, but the claims were not consistent with the target item nu-trient levels in the unfavorable condition. In the control condition, nohealth claim was provided.

The conditions related to the target item nutrition information andhealth claim and the nutrition frame information were presented on a four-color menu stimulus designed by the researchers for the study. There were18 different versions of the menu stimulus, given the 3 X 3 X 2 betweensubjects design.

Sample, Procedure, and Pilot Study

Study Sample and Procedure

Participants in the study were members of a consumer household re-search panel in a southern state. Panel members were mailed packets thatincluded one of the randomly assigned 18 menu stimuli, a survey that in-cluded measures of interest, and a stamped self-return envelope. Com-pleted surveys were returned by 377 total respondents, for a response rateof 51%. For the three nutrient level conditions, sample sizes ranged from118 to 130; for the three claim conditions there were between 120 and 127respondents; and for the context manipulation, there were 181 and 191 par-ticipants. Participants ranged in age from 18 to 88 years (mean age was48), the median level of education was one to three years of college, and60% were female. The reported number of times meals had been pur-chased at restaurants in the past month ranged from 0 to 80.

Pilot Study

The realism of the stimuli, effectiveness of the manipulations, and mea-sures were tested in a pilot study involving 140 students. The pilot studyindicated that the menu stimuli were perceived as realistic, the nutritionvalue manipulations for the target and non-target items performed as de-sired, and reliabilities of the multi-item measures were acceptable.

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DEPENDENT MEASURES

Seven point scales assessed the following attitude and intention de-pendent measures: nutrition-related attitude, overall attitude towards theproduct, source credibility, and purchase intention. All scales were re-coded when necessary so that higher values indicated more positive re-sponses and all had coefficient alpha levels that exceeded .90. Measureswere drawn from those used in prior research on package labeling (e.g.,Burton, Biswas, and Netemeyer 1994; Kozup et al. 2003; Keller et al.1997). Specific items used for the multi-item scales and alpha estimates areshown in the Appendix.

Given both a health claim manipulation and nutrition information frameconditions based on analyses performed by CSPI on actual restaurantfoods, consumers’ disease risk perceptions and estimated nutrient levelsfor both the target and non-target menu items are important to consider.Thus, the multi-item measures described above, disease risk perceptions,and nutrient value estimates were assessed for both the target item and forone of the non-target items (chicken fajitas). To measure disease risk per-ceptions, participants were asked to consider whether, if included regularlyin one’s diet, the food product would decrease or increase their likelihoodof developing heart disease and cancer (Teisl et al. 1999; Garretson andBurton 2000). To obtain nutrient level estimates, respondents estimatedhow favorable the levels of fat, saturated fat, and cholesterol were for thetarget and non-target menu items. These disease risk perceptions and nu-trient level estimates were 9-point, single-item measures.

RESULTS

Findings for Nutrient Evaluations and Disease Risk Perceptions

Multivariate and univariate analyses of variance results and means forthe non-target and target items are shown in Tables 1 and 2, respectively.There are significant main effects for the nutrition frame and target nutri-tion information manipulations (p � .01) and a marginal effect (p � .10)for the health claim manipulation. The nutritional frame had strong effects(F-values ranging from 10.0 to 26.4) on nutrient level estimates and dis-ease risk perceptions for the non-target item (see right hand columns ofTable 1).2 As shown in Table 2, in each case, provision of the nutritioninformation for the non-target item (versus the no-information control

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condition) resulted in less favorable estimates of the fat, saturated fat, andcholesterol levels and increased the perceived risk of heart disease and can-cer. These findings indicate that study participants are unaware of the rel-atively unhealthful nutrient levels of the non-target item since communi-cating these levels has a significant effect on the subjects’ evaluations andperceptions.

As shown in the left-hand columns of Table 1, the nutritional frame ma-nipulation created a context that also influenced estimated fat, saturated fat(p � .01), and heart disease risk for the target item. As expected, the pro-vision of the (unfavorable) nutrition information for the alternative menuitems led to more favorable perceptions of the nutrient levels and lowerheart disease risk for the target item (see means in Table 2). Also as ex-pected, the nutrition information for the target brand affected estimatedfat, saturated fat, and cholesterol levels. Favorable target item nutritioninformation led to lower perceived risks of heart disease and cancer. TheF-values suggest that nutrition information for the non-target items (i.e.,the nutrition frame) and nutrition information for the target item havesimilar effects on perceived fat (F’s � 7.6 and 8.2, p’s � .01) and saturatedfat (F’s � 20.8 and 11.4, p’s � .01) levels of the target item.

Not only can nutrition information used to describe the non-target itemsserve as a frame for the evaluation of the target item, the reverse is alsotrue. That is, the results indicate that when the nutrition information for thetarget item serves as a frame of reference during the evaluation of the non-target item, there are significant or marginally significant effects for thethree nutrient level estimates and for the perceived risk of heart disease.The pattern of means shown in Table 2 and follow-up analyses indicatethat when favorable nutrition information for the target item is provided(as compared to when unfavorable nutrition information for the targetitem is provided), the mean nutrient level estimates for the non-target itemare significantly lower (p � .05).

Consistent with prior research (cf. Garretson and Burton 2000), thehealth claim for the target menu item affects disease risk perceptions (p �.01 for heart disease and p � .05 for cancer), but this claim effect does not extend to broader nutrient evaluations. Both the heart healthy claimand cancer claim tend to decrease the perceived likelihood of disease risk, relative to the no-claim condition. The individual heart healthy claim(M � 4.64) and the cancer claim (M � 4.68) lead to significantly (p � .01)lower perceived risk of heart disease than the no-claim condition (M �5.57). It is interesting to note that the general pattern of results suggests

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that the claims have a positive influence on disease risk even when theclaim is not specific to the disease. Specifically, the cancer claim, which fo-cuses on the fact that diets low in fat and high in fruits and vegetables re-duce the risk of cancer, also reduces the perceived risk of heart disease. Forthe likelihood of cancer, the pooled test of the health claim conditions ver-sus the no claim (control) condition is significant (t � �2.69, p � .01).The mean for the cancer claim condition (M � 4.48) is significantly lowerthan in the control condition (M � 5.03; p � .01), but the effect of a heartclaim on cancer risk does not reach significance (M � 4.78).

The pattern of means for the three-way interaction for heart disease riskof the target item is shown across the two plots in Figure 1. The plot at thetop of the page shows that in the absence of a nutritional frame or healthclaim, target item nutrition information does not affect the perceived heartdisease risk (F(2,61) � 1, p � .50). However, when the (negative) nutri-tion context is provided (see bottom plot), positive target nutrition infor-mation reduces perceived risk, even in the absence of a health claim(F(2,60) � 8.6, p � .01). Also, note that the pattern of effects for the twoclaims differs across the control and favorable nutrition levels. Across bothnutrition frame conditions, the health claims do not appear to substantiallyinfluence perceived disease risk when the target nutrition level is unfavor-able (F’s � 1.0, p � .25), suggesting that study participants are not easilymisled by claims that are not consistent with nutrient levels (cf. Mitra et al.1999; Garretson and Burton 2000). When there is favorable nutrition in-formation provided for the target item and the unfavorable nutrition frameis provided, inclusion of a health claim does not further reduce perceivedheart disease risk; when there is no frame provided and the target infor-mation is favorable, the health claims significantly lower perceived heartdisease risk, as compared to the no-claim condition (p � .01).3

Effects on Attitudes, Purchase Intentions, and Source Credibility

To assess whether the effects of the experimental manipulations extendto broader attitude and purchase intention measures for the target and non-target items, a multivariate analysis of variance with univariate follow-upanalyses was performed. Results of the multivariate and univariate tests areshown in Table 3, and means are shown in Table 4. There are multivariatemain effects of the nutritional frame and the nutrition information manip-ulation. However, at times these effects must be interpreted with cautionbecause there are several significant univariate interactions between the in-dependent variables.

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FIGURE 1Effects of Nutrition Frame, Target Item Nutrition Information, and Health Claim on Esti-mated Heart Disease Risk

Incr

ease

d lik

elih

ood

of h

eart

dis

ease

No Nutrition Frame

Type of ClaimNo claim Heart claim Cancer claim

6.5

6.0

5.5

5.0

4.5

4.0

3.5

No nutrition informationUnfavorable nutrition informationFavorable nutrition information

Incr

ease

d lik

elih

ood

of h

eart

dis

ease

Nutrition Frame Provided


6.5

6.0

5.5

5.0

4.5

4.0

3.5


There are consistent univariate main effects of the nutritional frameacross the dependent variables. F-values shown in the left portion of Table3 and means in Table 4 indicate that when the nutrition information for the non-target items is provided, nutrition-related attitude (F � 23.9; p �.001), overall attitude towards the product (F � 27.3, p � .001), and pur-chase intentions (F � 19.5, p � .001) for the non-target item are all re-duced. Because the nutrient values (when provided) were based on esti-mates from CSPI testing, these findings show that effects of awareness of

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TAB

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TABLE 4Dependent Variable Means for Consumer Evaluation Measures

Target Items Non-Target Item Source

Attitude Attitude towards towards

Independent the Nutrition Purchase the Nutrition Purchase PerceivedVariables product attitude intentions product attitude intentions credibility

Health Claim: ControlNutrition Information:Control

No frame 5.42 5.15 4.85 5.27 4.38 5.03 4.57Frame present 5.18 5.13 5.18 4.70 4.28 4.40 5.45

UnfavorableNo frame 4.81 4.22 4.43 5.97 4.54 5.98 4.77Frame present 5.91 5.00 5.77 4.06 3.71 3.71 5.44

FavorableNo frame 5.38 4.92 5.18 5.78 5.07 5.28 5.12Frame present 4.97 5.48 4.67 4.94 3.49 4.83 4.98

Health Claim: HeartNutrition Information:Control




Health Claim: CancerNutrition Information:Control




NOTE: These measures are based on 7-point scales; higher scores indicate more favorable evaluations.

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FIGURE 2Effects of Nutrition Frame and Target Item Nutrition Information on Target Item Attitudeand Purchase Intentions

Att

itud

e to

war

dth

e pr

oduc

t

Nutrition InformationNo information Unfavorable Favorable

6.05.85.65.45.25.04.84.6

Nutrition frame not providedNutrition frame provided

Pur

chas

e in

tent

ions

Nutrition InformationNo information Unfavorable Favorable

6.5

6.0

5.5

5.0

4.5

4.0

3.5

Nutrition frame not providedNutrition frame provided

the (unfavorable) nutrition information for the non-target item extend toimportant measures of participants’ attitudes and purchase intentions.

The nutrition information for the target item has significant univariateeffects only on nutrition-related attitude, but the interaction of the frameand nutrition information is significant for target item purchase intentionsand product attitude. Relevant plots are shown in Figure 2. When there isno nutrition information for the target item, both the purchase intentionsand attitude toward the target item are essentially identical (t’s � 0.11 and

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0.22, respectively, p � .50), regardless of the presence of the frame. Whenthe target item nutrition information is unfavorable, provision of the neg-ative nutrition frame results in significantly greater purchase intentionsand more favorable product attitudes (t’s � 3.95 and 4.14, respectively, p � .01). (Recall that the unfavorable target item nutrition information wasslightly more favorable than that of the alternative menu items, when thisframe information was provided.) Interestingly, for the favorable target in-formation condition, neither attitudes nor purchase intentions differsignificantly (t’s � 1.14 and 0.20, respectively, p � .15) across the frameconditions.

There also is a significant three-way interaction for the effects of the in-dependent variables on source credibility. The two plots presented in Fig-ure 3 display means when the nutritional frame is provided and when it isnot provided. When the nutrition frame is not provided and there is no nu-trition information for the target brand, the slope of the line from the no-claim condition through the heart and cancer claim conditions is positive(see the upper portion of Figure 3). Thus, when there is no nutrition frameand no target nutrition information, the health claims tend to increasesource credibility. Conversely, when the (negative) nutrition frame is pro-vided, there is a negative slope for this line (as shown in the bottom por-tion of Figure 3). In this case, negative information about the items createsa frame that leads to higher source credibility when there is no informationabout the target brand and no claim. However, the provision of a healthclaim within the negative information frame reduces credibility. The fol-low-up two-way univariate interaction between claim and frame is signifi-cant (F(2,124) � 2.41, p � .02).4

DISCUSSION

More than 300,000 Americans die each year from diet-related diseases,and the number of overweight and obese consumers continues to increase(U.S. Department of Health and Human Services 2002). It is widely be-lieved that this alarming trend is, at least in part, caused by the increase inthe amount of food consumed outside the home (Lin, Frazão, and Guthrie1999). Thus, the development of a greater understanding of consumers’nutrition-related evaluations of restaurant menu items provides an applieddecision context worthy of research by marketers, decision researchers,and other social scientists. This task environment is characterized by anumber of unique aspects. For example, restaurants must abide by man-dated health claim regulations but are free to use any number of different

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FIGURE 3Effects of Nutrition Frame, Target Item Nutrition Information, and Health Claim onSource Credibility

Sour

ce c

redi

bilit

y

No Nutrition Frame


5.7

5.5

5.3

5.1

4.9

4.7

4.5


Sour

ce c

redi

bilit

y

Nutrition Frame Provided


6.15.95.75.55.35.14.94.74.5


frames to present an assortment of nutrient information. This makes for acomplex research context that is not only theoretically intriguing, but alsohas important long-term implications for consumer health and welfare.

The purpose of this research was to examine the influence of 1) targetand non-target item nutrition information and 2) differing health claims onconsumers’ evaluations, health risk perceptions, and estimates of nutrient

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values of food items prepared outside the home. Of particular conceptualinterest is how nutrition information and health claims pertaining to a tar-get menu item interact with the nutritional frame created by nutrient in-formation (i.e., nutrition information for non-target items) within whichthe target item is evaluated. The two- and three-way interactions (see Fig-ures 1 and 2) are illustrative of the complexity of the evaluation task pre-sented to consumers, and extends current knowledge on the effects of acontextual frame created by competing products on target and non-targetattributes (e.g., nutrients) and general evaluations (attitudes, purchase in-tentions, and source credibility). Specifically, findings demonstrate themanner in which a frame created by objective (nutrient) information fornon-target items can interact with both a claim and objective informationabout the target item.

Given a primary menu target item for which a health claim manipula-tion was included, we were particularly concerned with the interactionsrelating to the target item and to the “status quo” control conditions, thatis, when no nutrition information is available for the target or non-targetmenu items. In terms of the three-way interaction for perceived heart dis-ease risk associated with the target item, when there is no nutrition frameor health claim, the favorable target nutrition information does not affectheart disease risk relative to either the control or negative information con-ditions. However, when the nutrition frame is added (see the bottom por-tion of Figure 1), favorable nutrition information reduces heart diseaserisk estimates significantly below the other target nutrition conditions,even when there is no health claim that focuses on disease risk presented.Here, the unfavorable frame information for the non-target items suppliesinformation that allows for a “better” interpretation of the favorable targetitem nutrition information than when there is no frame provided. Inter-estingly, Figure 1 plots suggest that consumers appear more capable of in-terpreting unfavorable nutrition information without need of additional in-formation, given that the means for disease risk remain relatively highacross various claim and nutrition frame conditions.

The significant three-way interactions also extend to perceptions ofsource credibility. When the (negative) nutrition frame is provided, andthere is no nutrition information about the target item, providing a healthclaim tends to reduce source credibility. Given exposure to the unfavorableinformation about the non-target items, consumers apparently question thehealth claim about the target item. However, when there is no nutritionframe and no target nutrition information, the claims tend to increasesource credibility, thus benefiting the restaurant. This implies that, in the

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current regulatory environment which does not mandate the provision ofnutrition information, unverifiable health claims are viewed as believableand enhance restaurant credibility.

While the main effect of the target item nutrition information was notsignificant for either product attitude or purchase intentions, the interac-tions between the nutrition frame and the target nutrition information weresignificant and conceptually interesting. As shown in the top portion of Fig-ure 2, when there was no target nutrition information or favorable infor-mation, there was no effect of the frame and purchase intentions remainedreasonably constant. However, when the target information is unfavorable,provision of the frame leads to significant differences in purchase inten-tions, perhaps because the target item is the best among item choices thatare all relatively poor nutritionally.

CONSUMER WELFARE IMPLICATIONS

The results of this research, which clearly demonstrate the powerfulinfluence context and provision of nutrition information can exert on con-sumers’ evaluative processes, also have important implications for con-sumer welfare. These results are particularly important given proposedlegislation in several states that would require restaurant chains to providenutrition information on menus. In this study, the nutrient values used todefine the non-target items were based on CSPI test result estimates for ac-tual menu items. Study results show that providing the (unfavorable) nu-trition information for the non-target item affects nutrient evaluations and,more importantly, extends to important product attitude and purchase in-tentions dependent variables. These results suggest that consumers are notaware of the higher levels of fat, saturated fat, and cholesterol contained inthe non-target product. When they are exposed to these unfavorable nutri-ent levels, disease risk perceptions increase, and their attitudes toward theproduct and purchase intentions decrease, relative to the control conditionin which no nutrition information is presented. Such findings reinforceconcerns of policy-makers and consumer welfare advocates that manyconsumers may not be aware of the high levels of fat and saturated fat con-tained in the often large serving sizes offered by restaurants. It also sug-gests that if chain restaurants are forced by legislation to disclose nutritioninformation, many consumers’ attitudes and purchase intentions towarditems with very high levels of fat, saturated fat, and cholesterol, will de-cline. This, in turn, may motivate restaurants to offer more healthy alter-natives among their menu offerings.

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Consumers’ misperceptions about the healthfulness of restaurant foodssuggest that consumers who frequently eat food prepared outside the homemay not consider the long-term disease risk associated with their diet. Inthis study, when consumers became aware of the nutrient levels for thenon-target item, perceptions of disease risk likelihood increased and pur-chase intentions decreased. Recent litigation has charged major fast-foodretailers with use of deceptive marketing practices due to their failure toprovide adequate disclosures / information about health-related risks ofproduct consumption that have resulted in obesity and life-threatening dis-eases (Tyre 2002). Our findings, coupled with these recent court cases andproposed legislation for chain restaurants to disclose nutrition informa-tion, indicate that further research addressing the implications of inclusionof nutrition information on menus is warranted.

APPENDIX

MEASURES OF MULTI-ITEM DEPENDENT VARIABLES

Nutrition-related attitude (3 items; Cronbach’s coefficient alpha�.92)

“I think the nutrition level of these menu items is:” (endpoints of not nutritious atall /very nutritious; not healthy/ very healthy: poor/good)

Overall attitude towards the product (3 items; Cronbach’s coefficientalpha�.96)

“Based on the information shown on the menu, what is your overall attitude towardthe products below?” (endpoints of favorable/unfavorable, good/bad and posi-tive/negative)

Purchase intentions (2 items; Pearson correlation�.87)

“Assuming you were interested in buying one of these menu items, how probable isit that you would purchase the item, given the information shown on the menu?”(endpoints of very probable/not probable)

“How likely would you be to purchase this item, given the information shown on themenu?” (endpoints of very likely/very unlikely)

Source credibility (3 items; coefficient alpha�.96)

“Based on the information provided, I believe the restaurant selling these food prod-ucts is:” (endpoints of trustworthy/untrustworthy, dependable/not dependable, andhonest /dishonest)

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ENDNOTES

1. Subway instituted an advertising campaign focusing on the fact that they offer 7, six-inch delisandwiches that are less than 350 calories and contain less than 6 grams of fat and create a nutritionframe by comparing these menu offerings to the less nutritious offerings of fast food competitors likeMcDonald’s and Burger King.

2. Since the nutrient values of the non-target menu items were based on estimates from prior test-ing conducted by CSPI on actual foods sold at table-service and fast-food restaurants, the effects of themanipulations on estimated nutrient levels and disease risk are of interest for both the target and non-target items. For the non-target item the main effects of the nutrition frame (where nutrition informa-tion based on prior testing was provided for the items in one condition, but not the other) are of par-ticular interest.

3. The three-way interactions for the non-target item are of lesser theoretical and practical interestgiven that the health claim is manipulated only for the target item. For the sake of parsimony the three-way interactions for the non-target item are not described here.

4. Note that there are several significant univariate two-way interactions for the non-target brand,but the impact of these interactions are not strong relative to the main effects of the nutrition frame.While these interactions again suggest that both nutrition and health claim information on the targetitem tends to provide a frame for the non-target item, the interactions are of less theoretical or practi-cal interest here. However, relevant means are available in Table 4.

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