Higher food literacy scores are associated with healthier diet quality in children and adolescents: the development and validation of a two-dimensional food literacy measurement tool for children and adolescents

BACKGROUND/OBJECTIVESMost child and adolescent food literacy measurement tools focus on nutrition and food safety. However, the importance of aspects related to the food system such as food distribution and food waste and their effects on environmental sustainability is growing. We therefore developed and validated a two-dimensional tool for children (8–12 years old) and adolescents (13–18 years old) that can comprehensively measure food literacy. The association of food literacy with diet quality and self-reported health was assessed.SUBJECTS/METHODSFirst, we developed a food literacy conceptual framework that contains food system and literacy dimensions through a literature review, focus group interviews, and expert review. After a face validity study, we conducted the main survey (n = 200) to validate the questionnaire. Construct validity and reliability were assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Cronbach''s alpha.RESULTSAs a result of the Delphi study, content validity was confirmed for the remaining 30 items after two items were excluded (content validity ratio = 0.86). Eleven items were excluded from the EFA results, while the CFA results indicated appropriate fit indices for the proposed model (comparative fit index = 0.904, root mean square error of approximation = 0.068). The final food literacy questionnaire consisted of 19 questions and comprised 5 factors: production, distribution, selection, preparation and cooking, and intake. Food literacy was positively associated with diet quality, as assessed by the Nutrition Quotient score, in both children and adolescents and with self-reported health in adolescents.CONCLUSIONSBased on this integrated conceptual framework, a two-dimensional 19-item food literacy measurement tool was developed and verified for practical use to improve the diet quality and food-related environmental sustainability awareness of children and adolescents.     

Barriers to Food Literacy: A Conceptual Model to Explore Factors Inhibiting Proficiency

Food literacy research typically conceptualizes food-related knowledge and skills as contributing to improved health and nutrition; however, there is limited research examining the process that leads to this improvement. This article reviews the literature reporting barriers to food literacy proficiency in order to examine the relationship between food-related knowledge, attitudes, and behaviors. Informed by these barrier types, its central objective is to develop a model of food literacy proficiency that highlights the relationship between nutrition education and health-related outcomes. This model will help researchers, educators, and nutrition professionals implement effective interventions with enhanced capacity to change food-related behaviors.     

Young Children's Food-Related Knowledge: Kindergartners’ Free Categorization of Food Items

ObjectiveStudies concerning young children's food-related knowledge have dealt mostly with specific types of knowledge or with researchers’ predetermined categories. This approach may neglect certain aspects of children's knowledge and may limit the understanding of its general structure. The present study aimed to examine and analyze a wide scope of young children's constructed food-related knowledge.MethodsQualitative thematic analysis of 40 kindergartners’ free categorizations of food items.ResultsChildren's food-related knowledge was broad and derived from 3 primary sources: personal experience, environmental experience, and perceived messages. Novel aspects of knowledge were found, such as different treatments of food and partial familiarity with nutrients.Conclusions and ImplicationsThe findings demonstrated the existence of various types of young children's food-related knowledge. Attention to the broad spectrum of their knowledge and its possible sources may contribute to the design of relevant and effective nutrition education interventions aimed at young children.     

Acceptance of a Novel Food is Related to Caregiver Perceptions of Infant and Toddler Food-related Receptive Language

ObjectiveLanguage development, both what is understood (receptive language) and spoken (expressive language), is considered critical to a child's ability to understand and interact with their environment. However, little research has investigated the role children's early language skills might play in their food acceptance. The objective of this study was to explore the relationships between young children's food-related receptive language (FRL) and food-related expressive language (FEL) and acceptance of novel food.MethodsCaregivers (n = 54) reported their perceptions of children's (aged 7–24 months) FRL and FEL using the MacArthur-Bates Communicative Development Inventory. Novel food acceptance was observed (grams consumed) during a laboratory visit. Multivariable linear regression tested associations between FRL, FEL, and novel food acceptance, by child age (infants [aged from 7 to < 12 months], toddlers [aged 12–24 months]), and at a significance level of P < 0.1 for hypothesis-generating research.ResultsChildren's FRL and food acceptance differed by age (F = 8.08, P = 0.01). Among toddlers, greater FRL was associated with greater novel food acceptance (0.22 g [95% confidence interval, ?0.04 to 0.49]), P = 0.09). In infants, greater FRL was associated with lower novel food acceptance (?0.80 g [95% confidence interval, ?1.53 to ?0.07], P = 0.03). No association between FEL and novel food acceptance was noted in either group.Conclusions and ImplicationsToddlers’ understanding of food-related vocabulary may facilitate food acceptance; however, young infants may not yet have sufficient FRL to facilitate novel food acceptance.     

A Content Analysis of Food References in Television Programming Specifically Targeting Viewing Audiences Aged 11 to 14 Years

ObjectiveExamine food in cable television programming specifically targeting 11- to 14-year-olds (“tweens”).DesignContent analysis of food-related scenes (FRS)—in which food was shown, mentioned, and/or consumed—in 880 minutes of programming was conducted.SettingFive days of afternoon/early evening television programs on the Disney Channel.Main Outcome Measures and AnalysisFood references were compared with USDA MyPlate and classified according to modified Ratio of Recommended to Restricted Food Components.ResultsThe authors found 331 FRS, averaging 16.6 scenes/h. Preponderance of FRS was physiological needs (40.7%), followed by display (10%), party (8.5%), social event (8%), and retail store (6.6%). Snacks dominated 41% of FRS, and breakfast, lunch, and dinner were much lower in frequency. Half of FRS was visual only, followed by verbal only. Food references were not congruent with MyPlate recommendations; 42% of food items did not fit into MyPlate food groups. Only 24% of food items were fruit or vegetables, which is considerably less than recommended by MyPlate guidelines. Using modified Ratio of Recommended to Restricted Food Components, 66% of food items scored < 1.0, signifying less nutritious.Conclusions and ImplicationsTween television programming regularly includes non-nutritious food, which likely influences tweens' attitudes and behaviors. Television programming may consider past approaches to tobacco smoking and health messages on television. More attention is warranted regarding television programming by nutrition educators, researchers, health professionals, and industry specialists.     

Associations of Food Allergy-Related Dietary Knowledge,Attitudes, and Behaviors Among Caregivers of Black and White Children With Food Allergy

BackgroundThe increasing prevalence of pediatric food allergy (FA) in the United States has disproportionately affected non-Hispanic Black youth. However, racial and other socioeconomic disparities in FA management among caregivers of children with FA remain unclear.ObjectiveTo determine associations between socioeconomic, clinical, and health care factors and FA-related knowledge, attitudes, and behaviors among caregivers of Black and White children with FA.DesignCross-sectional survey analysis from the Food Allergy Outcomes Related to White and African American Racial Differences Study.Participants/settingsLongitudinal cohort of caregivers of 385 Black and White children with FA ages birth to 12 years residing in Chicago, Illinois, Cincinnati, Ohio, and Washington, DC from 2017 to March 2021.Main outcome measuresThere were 3 primary outcomes of interest: (1) FA knowledge assessed by scores from the Knowledge Survey, (2) FA-related attitudes assessed by newly developed survey, and (3) food-related behaviors assessed by the FORWARD Diet and Purchasing Habit Surveys completed 6 months postenrollment.AnalysesMultivariable linear and logistic regression.ResultsThe overall response rate to the 6-month postenrollment survey was 51.3% (385 of 751). White caregivers represented 69.4% of the participants. Black race was associated with a 1.5-point mean decrease in FA knowledge score (95% CI: ?2.2 to ?0.7) compared with White caregivers, and a graduate degree or bachelor’s degree was associated with associated with a 1.7-point mean increase (95% CI: 0.8-2.7) and 1.1-point mean increase (95% CI: 0.2-2.0) in FA knowledge score, respectively, compared with caregivers who had less than a bachelor’s degree. Multiple FAs and ever visited the emergency department for a food-related allergic reaction were also associated with higher levels of FA knowledge. Ever visited the emergency department for FA was also associated with higher odds of 2 measures of FA attitudes reflecting parental anxiety. Greater FA knowledge scores were consistently associated with lower odds of several FA-related food purchasing and eating behaviors assumed to have elevated risk of FA. Eating food prepared at school was the only FA behavior associated with race. Compared with White children, Black children were 2.5 times more likely to eat school-prepared foods (95% CI: 1.2-5.6).ConclusionsFindings from this study identified socioeconomic, racial, and clinical factors associated with caregivers’ FA-related knowledge, attitudes, and behaviors, but further research is warranted to better understand these relationships.     

Determining the Effectiveness of an Adult Food Literacy Program Using a Matched Control Group

ObjectiveTo determine the effect of Food Sensations for Adults on food literacy behaviors and selected dietary behaviors.MethodsA quasi-experimental design using preprogram and postprogram questionnaires over 4 weeks with a control group (n = 75) matched for sex, age group, and socioeconomic disadvantage to program participants (n = 867). General linear mixed models assessed change in food literacy behavior frequency in 3 self-reported domains (plan and manage, selection, and preparation) and fruit and vegetable servings.ResultsPostprogram, Food Sensations for Adults participants reported modest yet statistically significant score improvements in 2 of the 3 domains of food literacy behaviors in the plan and manage (12.4%) and preparation (9.8%) domains, as well as servings of vegetables (22.6% or 0.5 servings).Conclusion and ImplicationsQuasi-experimental designs indicate food literacy programs can produce modest short-term changes across a range of food literacy and dietary behaviors.     

Are We Closer to International Consensus on the Term ‘Food Literacy’? A Systematic Scoping Review of Its Use in the Academic Literature (1998–2019)

(1) Background: The term ‘food literacy’ has gained momentum globally; however, a lack of clarity around its definition has resulted in inconsistencies in use of the term. Therefore, the objective was to conduct a systematic scoping review to describe the use, reach, application and definitions of the term ‘food literacy’ over time. (2) Methods: A search was conducted using the PRISMA-ScR guidelines in seven research databases without any date limitations up to 31 December 2019, searching simply for use of the term ‘food literacy’. (3) Results: Five hundred and forty-nine studies were included. The term ‘food literacy’ was used once in 243 articles (44%) and mentioned by researchers working in 41 countries. Original research was the most common article type (n = 429, 78%). Food literacy was published across 72 In Cites disciplines, with 456 (83%) articles from the last 5 years. In articles about food literacy (n = 82, 15%), review articles were twice as prevalent compared to the total number of articles (n = 10, 12% vs. n = 32, 6%). Fifty-one different definitions of food literacy were cited. (4) Conclusions: ‘Food literacy’ has been used frequently and broadly across differing article types and disciplines in academic literature internationally. However, agreement on a standardised definition of food literacy endorsed by a peak international agency is needed in order to progress the field.     

Associations between Food Security Status and Diet-Related Outcomes among Students at a Large,Public Midwestern University

BackgroundFood insecurity is a growing issue of concern on college campuses. While many studies have focused on predictors of food insecurity, fewer studies have examined how food insecurity affects diet and diet-related outcomes among college students.ObjectiveThe objective of this study was to examine differences in dietary intake, food and cooking agency, and body mass index (calculated as kg/m²) by food security status in a sample of college students at a large, public midwestern university.DesignWe conducted a cross-sectional online survey administered from March to June 2018.ParticipantsStudents were recruited from a random sample (n=2,000) provided by the university, which included an oversample of minority racial/ethnic students from lower-income households and first-generation students. The response rate was 43% (n=851). After excluding students with missing data, the final sample was 754 enrolled students.Main outcome measuresFood security status was measured using the US Adult Food Security Survey Module. Dietary intake was assessed using the National Cancer Institute dietary screener questionnaire. Cooking and food agency was measured using the Cooking and Food Provisioning Action Scale, a new validated questionnaire. Body mass index was calculated from self-reported height and weight.Statistical analysis performedDifferences between food security categories and diet-related outcomes were examined using generalized linear models. Models adjusted for sociodemographic covariates, such as student’s age, sex, race/ethnicity, and receipt of financial aid.ResultsCompared to students with high food security, low food security was associated with lower intake of fruits, and very low food security was associated with higher intakes of total added sugar and added sugar from sugar-sweetened beverages. Marginal and very low food security were positively associated with body mass index. Marginal, low, and very low food security were inversely associated with cooking and food agency.ConclusionsStudents with food insecurity experience diet-related challenges that could translate into health disparities over time. More research is needed to understand the longitudinal effects of food insecurity on student health and well being.     

Agrifood consumer competency and organic food purchase intentions according to food-related lifestyle: based on data the 2019 Consumer Behavior Survey for Food

BACKGROUND/OBJECTIVESThe increased consumers’ interests in health and food safety have increased the demand for organic foods. Many studies have been performed on consumers’ purchase intentions for organic foods and their influencing factors, and various studies have shown that the prices of organic foods and the consumers’ willingness to pay are important influencing factors. This study examined the payment value of organic foods and agrifood consumer competency index according to the food-related lifestyles in South Korean consumers.SUBJECTS/METHODSA cross-sectional analysis was performed using the 2019 Consumer Behavior Survey for Food. A total of 6,176 participants aged 19 to 74 years (male: 2,783, female: 3,393) were included in the analysis.RESULTSThree factors were extracted by factor analysis (rational consumption-seeking type, convenience-seeking type, and health, and safety-seeking type) to explain the consumers’ food-related lifestyles. The results of cluster analysis suggested that consumers were classified into 3 food-related lifestyles as the ‘exploratory consumers’ (n = 2,485), ‘safety-seeking consumers’ (n = 1,544), and ‘passive consumers’ (n = 2,147). Exploratory consumers showed a significantly higher willingness to pay for imported organic foods (P < 0.05). Safety-seeking consumers had a significantly higher willingness to pay for domestic organic foods (P < 0.05). For the agrifood consumer competency index, exploratory consumers had the highest score, followed in order by safety-seeking consumers and passive consumers.CONCLUSIONSThese results provide basic data in understanding consumption tendency for organic foods and agrifoods based on food-related lifestyles of South Korean consumers.     

Understanding the Psychological Distress of Food Insecurity: A Qualitative Study of Children’s Experiences and Related Coping Strategies

BackgroundFood insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress.ObjectiveTo critically explore the psychological distress associated with children’s food insecurity using children’s own reports of their experiences.DesignIn-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity.Participants/settingSixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year.ResultsChildren discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents’ well-being, anger and frustration about not having enough food, embarrassment about their family’s food situation, strain on the family’s dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family’s food situation, and appreciating their parents for providing food and resources.ConclusionsFood insecurity contributes to children’s psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children’s growth and development and deserves investigation in future studies.     

Acculturation and Food Intake Among Ghanaian Migrants in Europe: Findings From the RODAM Study

ObjectiveThis study examined the role of migration and acculturation in the diet of Ghanaian migrants in Europe by (1) comparing food intake of Ghanaian migrants in Europe with that of Ghanaians living in Ghana and (2) assessing the association between acculturation and food intake.DesignData from the cross-sectional multicenter study Research on Obesity and Diabetes among African Migrants were used. Food intake was assessed using a Ghana-specific food propensity questionnaire (134 items and 14 food groups); foods were grouped based on a model of dietary change proposed by Koctürk-Runefors.SettingGhana, London, Amsterdam, and Berlin.ParticipantsA total of 4,534 Ghanaian adults living in Ghana and Europe, with complete dietary data. Of these, 1,773 Ghanaian migrants had complete acculturation data.Main Outcome MeasureFood intake (the weighted intake frequency per week of food categories).AnalysisLinear regression.ResultsFood intake differed between Ghanaians living in Ghana and Europe. Among Ghanaian migrants in Europe, there were inconsistent and small associations between acculturation and food intake, except for ethnic identity, which was consistently associated with intake only of traditional staples.Conclusions and ImplicationsFindings indicate that migration is associated with dietary changes that cannot be fully explained by ethnic, cultural, and social acculturation. The study provides limited support to the differential changes in diet suggested by the Koctürk-Runefors’ model of dietary change.     

Development and Pilot Testing of a Food Literacy Curriculum for High School-Aged Adolescents

Adolescent obesity and poor diet quality are increasingly prevalent and could be mitigated with attainment of food literacy. However, as these programs for adolescents are lacking, the purpose of this project was to develop a food literacy curriculum for high school-aged adolescents. The curriculum was designed in accordance with food literacy attributes and components utilizing Backward Design, Social Cognitive Theory, and Constructivism. After expert committee review, pilot testing was completed in two low-income communities by a trained facilitator and observer. Detailed observations were collected during pilot testing to assess achievement of learning objectives. Modifications were made to lesson procedures as required. The resulting curriculum, Teens CAN: Comprehensive Food Literacy in Cooking, Agriculture, and Nutrition, contains 12 modules of experiential lessons and application activities within three topics. Agriculture lessons concentrate on the food supply chain and food environments; nutrition lessons include food groups while focusing on nutrients of concern for underconsumption; and cooking lessons include food safety, budgeting, and preparation. Teens CAN provides a comprehensive and necessary approach to advancing food literacy in adolescents. Future directions include assessing dietary implications after participating in Teens CAN lessons and employment of an innovative two-tiered cross-age teaching model.     

Development and validation of a Food Preoccupation Questionnaire

ObjectiveExisting Food Preoccupation Questionnaires do not take account of food-related thoughts that have a positive emotional valence. We report on the development and validation of a questionnaire that provides independent assessments of thought frequency and emotional valence (positive, negative or neutral).MethodIn Study 1 questionnaire items were validated against a three-day diary measure with 40 males and females. In Study 2 the questionnaire was administered to 130 males and females alongside a range of other measures.ResultsThe questionnaire showed good construct validity, internal reliability, and test–retest reliability. Dieters and females scored higher on frequency and negativity subscales. There was also a significant interaction between sex and diet status on thought frequency, with females showing a stronger relationship between the two.DiscussionThe questionnaire should be useful for exploring the cognitive impact of dieting and relationships between food preoccupation, food processing biases and overeating.     

“Come with us for a week,for a month,and see how much food lasts for you:” A Qualitative Exploration of Food Insecurity in East Harlem,New York City

BackgroundFood insecurity refers to uncertain access to food on a consistent basis and the stress experienced by families who worry about having sufficient resources to provide balanced meals in their households. Food insecurity has a disproportionate influence on people of color. A robust body of evidence links food insecurity to poor health outcomes.ObjectiveTo document experiences of food insecurity among linguistically and ethnically diverse residents of the East Harlem neighborhood of New York City by exploring the ways in which food availability and cost intersect with household budgets, personal preferences, and shopping strategies.DesignIn-depth qualitative interviews were conducted with adult residents of New York City’s East Harlem neighborhood to provide insights about the links between food insecurity, well-being, and quality of life.Participants/settingThirty-seven adult residents of East Harlem were recruited through purposive sampling. Eligibility requirements included living in an East Harlem zip code (10029 or 10035); being aged 18 years or older; being the main food shopper and food decision-maker in the household; and speaking English, Spanish, or Mandarin Chinese. The study was conducted from February to May 2018.Statistical analyses performedInterviews were analyzed using a grounded theory approach. Codes were organized into broad thematic topics and cross-case analyses were conducted.ResultsParticipants discussed overall perceptions of food insecurity and seven themes related to the challenges of and strategies for coping with food insecurity: intermittent vs chronic food insecurity, shopping and budgeting strategies, pantries as a vital community resource, social support systems, food insecurity and health, frustration with an unjust system, and pride in “making it work.”ConclusionsTo manage food insecurity, many study participants carefully managed food spending, dedicated substantial time to visiting stores and accessing food pantries, and relied on a public benefits cycle that left many without sufficient financial resources at the end of each month.     

Challenges and opportunities for measuring the impact of a nutrition programme amongst young people at risk of food insecurity: A pilot study

Food insecurity in Australia is increasing. Organisations within the charitable food sector aim to manage, and in some cases are implementing strategies to prevent, food insecurity, such as food literacy programmes. This pilot study describes the challenges and opportunities for evaluating the impact of a food literacy programme, FoodMate by SecondBite^?, which aims to reduce food insecurity amongst ‘at risk’ young people. Three community agencies working with ‘at risk’ young people delivered an 8‐week food literacy programme in Melbourne, Australia. A pre‐test/post‐test design was used and outcome measures included: (i) food intake, (ii) diet quality, (iii) cooking confidence and (iv) food independence. These were assessed via questionnaires and 24‐hour recalls at three time points: pre‐programme (T1), post‐programme (T2) and at 4 to 6‐week follow‐up (T3). Twenty‐one young people aged 16–25 years participated in this pilot study. The response rate for the questionnaire and 24‐hour recalls declined across the study: T1 (n = 21), T2 (n = 11) and T3 (n = 9). Some positive effects were associated with the programme but attrition rates were high and the majority of participants did not complete all measures. Although results were inconclusive, this study describes some common challenges of conducting a food literacy intervention with vulnerable young people and highlights the benefit of nutrition researchers and practitioners working together to conduct evaluation of such programmes.     

Spanish Validation of the Self-Perceived Food Literacy Scale: A Five-Factor Model Proposition

Food literacy is a combination of functional, critical, and relational skills that pave the way for navigating the food system properly, taking personally and contextually available resources into account. The aim was to validate the Spanish version of the self-perceived food literacy scale in university students to explore the factorial structure of it and to correlate food literacy with other variables. The sample was composed of 362 Spanish university students (314 women). The full questionnaire was administered online and also assessed adherence to a Mediterranean diet, impulsivity, and health-related quality of life for convergent validity testing purposes. Confirmatory factor analysis was conducted to determine the factor structure of the food literacy scale. The Spanish version of the scale showed good indices of internal consistency (Cronbach’s α = 0.894). Confirmatory factor analysis revealed a five-factor model that had a better fit index than the seven-factor model of the original scale. External validity was assessed by showing significant correlations with the rest of the variables. Therefore, the Spanish version of the scale is a reliable and valid measure of food literacy. It could be used to promote policies at Spanish universities to improve the food-related behaviors of students.