1. Menu Labelling and the Savvy Diner Campaign Canadian Public Health Association Conference May 29, 2014 Presentation by: Lisa Swimmer, MHsc, RD Lswimme@toronto.ca

2. What is Menu Labelling? Menu labelling applies principles of food labelling to the eating out environment. Menu labelling makes clear and standardized information about the nutrient content of food available at the point of purchase in restaurants and other foodservice establishments.

3. Calls for Regulatory Action on Menu Labelling 20072009 20122013 2010 2012 2009-20122009

4. Ontario’s Healthy Kids Panel: Change the Food Environment Recommendation 2.3 “Require all restaurants, including fast food outlets and retail grocery stores, to list the calories in each item on their menus and to make this information visible on menu boards.”

5. Provincial Progress on Menu Labelling “Parents have told us they want our support in keeping their kids healthy. We are committed to giving parents and their kids the information they need to make healthy choices. “ – Ontario Health Minister Deb Matthews

6. Toronto Public Health’s Interest in Menu Labelling

7. Toronto Food Strategy Report Recommends Local Action 2010 A FOOD STRATEGY for TORONTO: EMPOWER RESIDENTS WITH FOOD SKILLS AND INFORMATION “Require Nutrition Information on Restaurant Menus…The Medical Officer of Health will report to the Board of Health on a City bylaw requiring selected nutrition information to be posted on the menus of chain restaurants in Toronto.”

8. Rationale to Take Local Action

9. Building an Evidence-Based Rationale for Local Action on Menu Labelling High rates of obesity, chronic diseases High frequency of eating out Calorie and sodium levels are high in restaurant foods Levels of calories and sodium vary widely within the same food category Consumers can’t estimate nutrient content Consumers want nutrition information and have a right to know May lead to healthier menu items May lead to healthier choices

10. Pushing for Provincial Action, Ready for Local Action 2013

11. Engaging the Public Purpose: Support potential menu labelling policy by highlighting consumers' right and need to know when it comes to calories and sodium. Target audience: Educated, mid to high income 18-34 year old adults who go to restaurants regularly.

12. Several Concepts Considered A traditional campaign, no specific campaign website, no social media

13. Several Concepts Considered A traditional campaign with unique branding/URL that could link to existing website, no social media

14. Several Concepts Considered A social media campaign with a dedicated Facebook page and a sharable video

15. The Preferred Concept Public engagement approach, use of social media, unique branding/URL, unique website (blog), dedicated Facebook page

16. The Savvy Diner Campaign Launched June 17, 2013 Transit and bus shelter posters Mall posters Online ads Savvy Diner website with: quiz click to show your support shareable badges blog add your voice video Facebook page

17. Savvy Diner Videos http://youtu.be/spHdiLAO4ykhttp://youtu.be/GCppcoHwQ5Y

18. The Savvy Diner Website (Blog) and Facebook Page 14,000+ supporters2650 Likes

19. Savvy Diner “Add Your Voice” 500 submissions received

20. Interesting Ways to Engage the Public and Build Public Support The average Canadian sit-down restaurant meal has: More than half of the calories needed per day One and a half times (151%) the amount of sodium needed per day Includes an appetizer and main. Dessert adds 549 more calories. Meals identified by the restaurants as being “healthy” were low in calories but still had half the amount of sodium needed per day Scourboutakos, MJ, Semnani-Azad, Z & L’Abbe, MR. JAMA Internal Medicine, May 2013. Here’s What the Research Says…

21. Here’s what will gain the public’s attention 1730 calories 2750 mg of sodium + 210 calories 370 mg of sodium How much calories and sodium would I get? Caesar Salad (side order) Spaghetti & Meatballs Total: 1940 calories and 3120 mg of sodium

22. …and this large difference between similar menu items No two chicken wraps are created equal VS Restaurant Chain #1 700 calories 970 mg sodium Restaurant Chain #2 1370 calories 2960 mg sodium

23. Using social media to get the message across in an interesting way

25. Evaluation Objectives Evaluate (unaided and aided) the campaign’s reach and recall Explore the campaign’s likeability, message comprehension, and relevance Understand the campaign’s effectiveness for sparking thought on the issue Establish interest levels on the menu labelling issue before and after exposure to the campaign Evaluate the motivational power of the campaign to change residents’ attitudes

26. Methodology Summary An online survey was designed and fielded to Toronto residents aged 18-34, who regularly eat at/order from restaurants The survey was fielded immediately following the media campaign A total of n=1010 respondents completed the survey Survey Sample Breakdown N= Total1010 Those Who Viewed Ads Previous To The Survey 345 Males468 Females542 Those Who Viewed Ads Within The Survey 665 18-24 years344 25-34 years666

27. Socio- Demographic Profile of Respondents

28. Survey respondents were recruited to be regular restaurant diners 72% of respondents eat quick-service restaurant meals at least once a week and 45% eat sit-down restaurant meals at least once a week

29. Socio- Demographic Profile of Respondents 87% have obtained at least some post-secondary education 78% indicate they work outside the home either full or part-time

30. Socio- Demographic Profile of Respondents Household income levels are split between those who report $59,999 or LESS (50%) and those who report $60,000 or MORE (50%).

31. Socio-Demographic Profile of Respondents Half of the survey respondents (50%) indicate a “White/North American” ethnic background; close to one third (32%) of respondents report either South, South East, or East “Asian” ethnic background.

32. Other Psychographic Characteristics 90% of survey respondents go onto the internet daily. Only 2% of respondents report they ‘never’ visit social media sites.

33. Savvy Diner Evaluation Highlights Overall, positive evaluation results: o Reach, Recall, Likability, Relevance, Message Comprehension, Issue Perception Those who noticed the campaign prior to taking the survey had higher scores across the board, particularly for ‘Likability’, and ‘Relevance’ The ads and website were effective in changing perceptions about menu labelling 72% of people who saw the ads took action 66% were supportive of menu labelling; only 3% were not at all supportive of menu labelling

34. Campaign Recall: Unaided 24% of respondents recalled seeing an ad about “Health issues relating to food in restaurants”, and, of them, 39% accurately described the ‘Savvy Diner’ campaign unaided. “You have the right to know the level of sodium and the calories in your food when you go to a restaurant. Online survey respondent “It was about making more information available for foods when you go to a restaurant, calorie and salt content, etc.” Online survey respondent “It was about the importance of knowing the nutritional value in restaurant food because it could be a lot worse than you expect. We should have the knowledge about we intake.” Online survey respondent

35. Campaign Recall: Semi-Aided 38% of respondents recalled seeing an ad “about restaurant menu labelling” and, of them, 42% of them accurately described the ‘Savvy Diner’ campaign. “It said ‘It's time for menu labelling’, there was some catchy slogan...” Online survey respondent “The ad has some slogans about sodium, the ads each have a different colour.” Online survey respondent “They say it's your right to know if your restaurant meal contains 3 days worth of sodium.” Online survey respondent “Talked about how we should know if a salad has more calories than a burger.” Online survey respondent

36. Campaign Recall: Aided Percent of Respondents who have Definitely or Probably seen these ads 28% 34% 32% Percent of Respondents who have Definitely or Probably seen these ads 28% 34% 32% 11% “Definitely visited this site” 13% “Probably visited this site” 11% “Definitely visited this site” 13% “Probably visited this site”

37. Comprehension of campaign key messages “It is necessary to have restaurants label the sodium and calories in their meals so that consumers can make informed choices about the food they eat.” Online survey respondent “I think that the purpose of this campaign is to encourage restaurants to put nutritional facts in their menus in order to enable potential consumers to understand what they will be taking into their system.” Online survey respondent Comprehension of the campaign’s intended message was high with 82% of respondents describing some portion of the issue.

38. Savvy Diner: Message Comprehension “The intention is to promote healthier eating for people who enjoy dining in restaurants. They want to bring awareness to the fact that menu labeling is absent, and people who dine might not be eating as healthy as they would like to believe.” Online Survey Respondent “The intended message was for the general public to be more aware of how much and what they are consuming when eating out, and how important it is for restaurants and fast food establishments to provide nutritional information to their customers.” Online survey respondent “The ad campaign is designed to lobby for the addition of nutritional information on restaurant menus. The campaign is based on empowerment, informing people of facts they have perhaps overlooked, and calling them to action to support the cause of nutritional information on menus.” Online survey respondent “The intended message was for the general public to be more aware of how much and what they are consuming when eating out, and how important it is for restaurants and fast food establishments to provide nutritional information to their customers.” Online survey respondent “The intended message of the campaign is to increase awareness that restaurant meals contain a lot of calories and sodium. It also advocates for these two things to be shown on restaurant menus so consumers can make more informed choices.” Online survey respondent

39. Main Message Word Cloud “In your own words, what do you think the intended message of this campaign is…describe in detail.”

40. Savvy Diner Ads: Likability Campaign ads were well-liked by majority of survey respondents, particularly those who had viewed the ads previous to completing the survey (78% liked them or really liked them).

41. Savvy Diner Ads: Relevance A higher level of relevance is seen across all ads from those who saw the campaign prior to taking the survey (66%) compared to those who only viewed within the survey; however low level of “disagreement” seen from all respondents.

42. Savvy Diner website (www.SavvyDiner.ca) High levels of site “likability” and “relevance”, especially from those who have visited the site prior to the survey (87% like it and 73% find it relevant)

43. Issue Perception The ads encouraged respondents to think about menu labelling and their ability to make healthy decisions

44. Campaign effective in changing perceptions on menu labelling. A 21% increase is seen in “I was very personally interested” with 30% of survey respondents reporting BEFORE taking the survey and 51% AFTER taking the survey.

45. Issue Perception: Overall Support 66% of survey respondents support calorie and sodium information on the menu 3 % are not at all supportive 38% of females are extremely supportive, compared to 25% of males

46. Overall Observations Those that are shown the campaign like it, find it relevant and are largely encouraged to find out more, which suggests the creative elements are effective Positive attitude change is seen as a result of exposure to this campaign All three executions “Indulge”, “Hamburger” and “Sodium” received consistently high results, however “Hamburger” (and “Sodium” for males) found most relevant of the three Females are particularly ‘interested’ and find this issue particularly ‘important’ The ads’ “call to action” to savvydiner.ca is effective and “word of mouth” on the issue is realistically achieved only AFTER site visits

47. What We Learned… Use a combination of traditional and social media Ensure sufficient resources (budget and staffing) Use an evidence-informed approach to push the boundaries Consider timing to take advantage of media attention on public policy issues Always expect the unexpected

48. Thank you for listening! For further information: Lisa Swimmer, MHSc, RD Acting Supervisor, Chronic Disease and Injury Prevention Lswimme@toronto.ca (416) 338-3561