Appendix D - Healthy Symbol Experiment Questionnaire

Questionnaire
Healthy Symbol Experimental Study
OMB Control No: 0910-New

Expiration Date: xx/xx/2022

Paperwork Reduction Act Statement: According to the Paperwork Reduction Act of 1995, an agency may not
conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0910-New. The
time required to complete this information collection is estimated to average 10 minutes per response for the
pretest and test survey, and 15 minutes per response for the experiment pretest and study, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspects of this collection of information, including
suggestions for reducing burden to [email protected].

----------------------------------------------------------------------------------------------------------------[INTRODUCTION –FDA NOTES ARE IN LIGHT BLUE. INSTRUCTIONS TO
PROGRAMMERS ARE IN BLACK]
[1. INFORMATION IN ALL CAPS IN BRACKETS IS NOT DISPLAYED; SOME ARE
INSERTION DIRECTIONS;
2. RESPONSE OPTION CODES/INDICATORS ARE NOT DISPLAYED;
3. IF NO “GO TO” INSTRUCTIONS, PROCEED TO NEXT QUESTION;
4. SHOW “MISSED QUESTION” NOTIFICATION IF RESPONDENT SKIPS A
QUESTION, BUT LET THEM PROCEED AFTER THAT WITHOUT ANSWERING;
5. PLEASE ADD AN OPTION FOR “DON’T KNOW” TO EVERY QUESTION;
6. MAKE SURE TO CLEARLY, VISUALLY OR SPACIALLYSEPARATE “DON’T
KNOW” VISUALLY FROM THE OTHER RESPONSE OPTIONS;
7. CODE ALL “DON’T KNOW” AS “8” UNLESS “8” IS ALREADY BEING USED.
THEN USE “88”;
7. FOR SECTION B, ENSURE THE LABEL IS VIEWABLE AT ALL TIMES;
8. PLEASE ENSURE NO SCROLLING IS NEEDED TO ANSWER ANY QUESTIONS
ON A 13” MONITOR.]

[SECTION A: AFFECT, PAST LABEL-READING, BEHAVIOR, SELF-REPORTED
LITERACY, SELF-REPORTED HEALTH]
[DISPLAY THE FOLLOWING AND INSERT “NEXT” BUTTON]
Thank you for agreeing to participate. This survey is being conducted on behalf of the U.S. Food
and Drug Administration. We are interested in your views about certain food products. Please
read each question carefully and then select the answer that best suits you. It usually takes about
15 minutes to answer all the questions. The information you provide will be kept strictly
confidential.
1

Please click the “NEXT” button to begin the study.
[NEW SCREEN]
[AFFECTIVE STATE; AZJEN 2011. Mittelman & Epstein, 2009; Rosenberg, 2009; Perez
2018; USE AS CONTROL VARIABLE]
How are you feeling at the moment?
Negative ---------------------------------Positive
Bad----------------------------------------Good
[PAST BEHAVIOR: AZJEN 2011. CONTROL VARIABLE] [INSERT IMAGE OF A
NUTRITION FACTS]
When buying a food product for the first time, how often do you use the Nutrition Facts label?
1 = Always
2 = Most of the time
3 = Sometimes
4 = Rarely
5 = Never
6 = Never seen the label
[SELF-REPORTED LITERACY; adapted from Johnson et al. (2010)]
How do you rate your reading ability” (1 = poor, 5 = excellent
[NUTRITION SELF-EFFICACY/LITERACY; Tian 2021]
1) Please rate your familiarity with nutrition labels:
Not at all - A little bit – Somewhat - Quite a bit - Extremely
2) Please rate your knowledge of nutrition labels compared to the average buyer:
Not at all - A little bit – Somewhat - Quite a bit - Extremely
3) Please rate your confidence of understanding nutrition labels compared to the average buyer:
Not at all - A little bit – Somewhat - Quite a bit - Extremely
4) How often do you have a problem understanding nutrition labels?
Always – Often – Sometimes – Occasionally - Never

Compared to other people your age, would you say your health is…?
Excellent………………….5
Very good………………...4
Good………………….…..3
Fair…………………….….2
2

Poor…………….….…..….1
Don’t know……………….8
Prefer not to answer….….. 9
[SECTION B: SINGLE PRODUCT EVALUATION; PARTICIPANTS ARE ASKED TO
RESPOND TO QUESTIONS WHILE VIEWING A SINGLE PRODUCT]
[SELECT FROM SPREADSHEET COLUMN “RANDOM ASSIGNMENT”.]
[NEW SCREEN]
[THIS SECTION TO BE SEEN ONLY BY THOSE IN THE ‘SYMBOL’ CONDITIONS]
The Food and Drug Administration (FDA) is exploring the idea of developing a symbol that food
companies can put on food packages when the food meets FDA’s criteria for “healthy.” The food
label you will look at has such a symbol.
[THIS SECTION TO BE SEEN ONLY BY THOSE IN THE “SYMBOL WITH
DEFINITION” CONDITIONS]
[DISPLAY DEFINITION – SEE TEXT AT THE END OF THIS DOCUMENT]
Please read the following description of the symbol and then answer the questions that follow.
Were you aware that the claim “healthy,” if used on the food label, means that the food has to, by
law, meet certain nutritional criteria?
Yes ...………………………1
No …………………………2
Not sure ……………………3
[NEW SCREEN; INSERT ASSIGNED IMAGE; UNLESS OTHERWISE NOTED, FROM
HERE FORWARD ALL PARTICIPANTS RECEIVE.]
[PERCEPTIONS OF PRODUCT HEALTHFULNESS AND HEALTH BENEFITS;
COMMUNICATES PRODUCT IS A HEALTHY CHOICE]
Please take a moment to look at this food product. On a scale from 1 to 6, where 1 is “strongly
disagree” and 6 is “strongly agree”, how much do you disagree or agree with the following
statements?
[RANDOMIZE ITEMS; PUT ONLY 2 OR 3 ITEMS ON A SINGLE TABLE GRID TO
REDUCE THE NEED FOR SCROLLING; INSERT RESPONSE OPTION SCALE 1
THROUGH 6 ANCHORED BY 1=STRONGLY DISAGREE AND 6=STRONGLY
AGREE; PROVIDE A SELECTION BOX FOR INDICATING “ DON’T KNOW.”]
I consider this product to be a healthy food.
Including this product as part of my diet will improve my overall diet.
3

I consider this product to have some positive health qualities.
How healthy do you think is the food product?
(1= not healthy, 6=very healthy)
[BELTRAMINI BELIEVABILITY SCALE]
[NEW SCREEN; RANDOMIZE ITEMS; INSERT ASSIGNED IMAGE]
What is your reaction to how the manufacturer is communicating the healthfulness of the food ?
[GRID – PLEASE FORMAT AS BELOW AND INCLUDE DK AT END OF SCALE
AFTER RESPONSE ITEM]
Not Believable---------------------------------------------------------------Believable
1
2
3
4
5
6
Not Trustworthy -------------------------------------------------------------Trustworthy
Not Convincing -------------------------------------------------------------Convincing
Not Credible------------------------------------------------------------------Credible
Not Reasonable---------------------------------------------------------------Reasonable

[NEW SCREEN; RANDOMIZE GRID ITEMS; INSERT ASSIGNED IMAGE]
What is your attitude toward the product label?
[1-6 SCALE WITH DK AT END – HIGHLIGHTED]
Very Negative----------------------------------------------------------------Very Positive
Dislike very much ----------------------------------------------Like very much
Not appealing--------------------------------------------------Appealing
Unnatractive--------------------------------------------------Attractive
[ENSURE NO-SYMBOL CONDITION RECEIVES “PRODUCT LABEL” QUESTION;
FOLLOWING QUESTIONS ARE ON A 1-6 SCALE WITH A DK OPTION]
Please rate your emotions according to the way the [product label/symbol] makes you feel.
Happy/unhappy
Pleased/annoyed
Satisfied/unsatisfied
Contented/melancholic
Hopeful/despairing
Relaxed/bored;
Joyful/not joyful
[FOR SYMBOL CONDITIONS ONLY]
What is your attitude toward the symbol on the product?
Not official looking----------------------------------------Official looking
Ineffective looking -----------------------------------------Effective looking
4

[EFFECTS PERCEPTION MEASURES]
The [symbol on the product/product label] makes me curious about the foods healthfulness
The [symbol on the product/product label]makes me interested in evaluating the nutrition facts of
the food
The [symbol on the product/product label]makes me want to buy the product
The [symbol on the product/product label]encourages me to make a healthful food choice
[OPEN-ENDED. ALLOW 250 CHARACTERS]
In your own words, please tell us comes to mind when you look at this symbol.
[NEW SCREEN; RANDOMIZE GRID ITEMS; INSERT ASSIGNED IMAGE; USE 1-6
RESPONSE SCALE]
[PURCHASE INTENTION]
Given the information shown on the front of the package,
How likely would you be to purchase the product?
very unlikely/very likely
How certain are you about buying the product?
uncertain/certain
[MANIPULATION CHECK]
[NEW SCREEN; INSERT SYMBOL]
Did you see this symbol on the front of the packaged food item that was presented?
Yes ...………………………1
No …………………………2
Not sure ……………………3
[SECTION C: COVARIATES; DIETARY INTERESTS/”NUTRITION MOTIVATIONSELF-EFFICACY”]
[NO LABEL VIEWING FROM THIS POINT FORWARD.]
Now we have some questions about your food habits.
For each of the following statements, please indicate how strongly you disagree or agree.
[GRID, RANDOMIZE ROWS]
1. Strongly disagree
2. Somewhat disagree
3. Neither agree nor disagree
4. Somewhat agree
5. Strongly agree
Don’t Know
If I eat a healthy diet I can reduce my chance of getting heart disease.
If I eat a healthy diet I can reduce my chance of getting cancer.
5

I am confident that I know how to choose healthy foods.
Eating a healthy diet is important for my long-term health
[SECTION D: BELIEFS ABOUT PRODUCT CATEGORY HEALTHFULNESS]
In general, how healthy are these foods, on a scale of 1 to 6, where 1 is “not at all healthy” and 6
is “very healthy”?
[RANDOMIZE ITEMS IN D, EXCEPT FOR ‘FRESH FRUIT AND VEGETABLES,’
WHICH SHOULD ALWAYS BE FIRST. INSERT RESPONSE OPTION SCALE 1
THROUGH 6 ANCHORED BY 1=NOT AT ALL HEALTHY AND 6=VERY HEALTHY.
PROVIDE SEPARATED OPTION FOR 8=DON’T KNOW. ]
Fresh fruit and vegetables
Whole grain breakfast cereal
Whole milk, unflavored
Regular (not diet) carbonated soft drink (Soda, Pop)
Vegetable-based frozen meal
Canned bean soup
[SECTION E: FOOD SHOPPING AND LABEL READING]
Now we have a few questions about your food shopping habits.
How much of your household’s food shopping do you do?
All of the food shopping ................................................................................. 5
Most of it ......................................................................................................... 4
About half of it ................................................................................................ 3
Only a little of it .............................................................................................. 2
None of it ........................................................................................................ 1
Don’t know ..................................................................................................... 8
[HOLD FOR QUESTION ABOUT CLAIMS OR FOP]
[SECTION F: DEMOGRAPHICS]
The following questions are for descriptive purposes.
What is the highest grade or level of school you have completed? Please select one answer.
1. Less than high school degree
2. High school graduate or GED
3. 1-3 years college/some college
4. College graduate - bachelor's degree
5. Postgraduate, master's degree, doctorate, law degree, other professional degree
6. Don’t know
7. Prefer not to answer
What year were you born?
6

[RANGE = 0-99]
[FOUR SPACES]
Do you identify as…. (please select one)
Female…………….1
Male……………….0
Are you of Hispanic or Latino origin? Please select one.
Yes………………..1
No…………………0
What is your race? You may choose one or more categories as they apply.
White
Black or African American
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaska Native
Prefer not to answer
The next few questions may seem a bit personal, but we need this information because this
survey is about health and nutrition.
What language(s) do you speak at home? (Select all that apply.)
English
Spanish
Other (specify) [other] _________________________________
How many total people, including yourself, currently live in your household? [RANGE 1-14]
How many of the people in your household are children 17 years and younger? [RANGE 0-14]
[OPEN ENDED – PRETEST ONLY]
Please provide any comments you have about this survey. Was any part of it hard or confusing?
If yes, which part? Thank you.
[OPEN ENDED]
Please provide any comment you wish.
Thank you very much.

7

[PLACEHOLDER DEFINITION OF “HEALTHY.” MAY CHANGE IF “HEALTHY
RULE” PUBLISHES PRIOR TO ADMINISTERING STUDY]

FDA Healthy Symbol
The FDA Healthy symbol is designed to help busy food shoppers easily and quickly
choose packaged foods at the grocery store that contribute to a healthy diet. Only
products that meet the FDA definition of a healthy food can have the FDA Healthy
symbol on their package.
To be labeled as “healthy,” and to display the FDA Healthy symbol, the food product
must meet nutritional requirements, including requirements for levels of certain nutrients
(e.g., sodium).
When you shop for groceries and are comparing different foods, look for food packages
with the FDA Healthy symbol to find products that FDA considers can contribute to a
healthy diet.
To learn more about the specific criteria for meeting the FDA definition of “healthy,” click
on [link].

8