Location: Delta Obesity Prevention ResearchTitle: Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural lower Mississippi delta) Author
Submitted to: Journal Of The American Dietetic Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/25/2011
Publication Date: 7/1/2011
Citation: Zoellner, J., You, W., Connell, C., Smith-Ray, R.L., Allen, K., Tucker, K.L., Davy, B.M., Estabrooks, P. 2011. Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: Findings from the rural lower Mississippi delta. Journal Of The American Dietetic Association. 111(7):1012-1020. Interpretive Summary: The objective of this study was to evaluate the relationship of health literacy skills to diet quality and the consumption of sugar-sweetened beverages by adults in the Lower Mississippi delta areas of Arkansas and Louisiana. Dietary intake was measured using the Delta food frequency questionnaire. Data from the food frequency questionnaire were then used to assess diet quality by calculating Healthy Eating Index (HEI) score. Health literacy was based on answers to the Newest Vital Sign nutrition literacy survey. Adults were selected to be representative of the educational achievement and racial make-up of the delta population and to vary across age. Results indicated for every 1 point increase in health literacy, there was a 1.21 point increase in Healthy Eating Index score independent of education, income, race, sex, and participation in the Supplemental Nutrition Assistance Program (SNAP). Other predictors of a higher HEI score were being female and participating in SNAP. In addition, every 1 point increase in health literacy score was associated with 34 fewer kilocalories per day from sugar-sweetened beverages. Younger age was associated with more kilocalories per day from sugar-sweetened beverages. This study highlights and important relationship between health literacy and diet quality and sugar-sweetened beverage consumption. Further studies are needed to understand how health literacy affects access to, comprehension of, and adoption of nutrition recommendations.
Technical Abstract: Although health literacy has been a public health priority area for more than a decade, the relationship between health literacy and dietary quality has not been thoroughly explored. This study, evaluates health literacy skills in relation to Healthy Eating Index (HEI) scores and sugar-sweetened beverage (SSB) consumption while accounting for demographic variables. The design is a Cross-sectional survey. Participants were a community-based proportional sample of adults residing in the rural Lower Mississippi Delta. Instruments included a validated 158-item regional food frequency questionnaire and the Newest Vital Sign (scores range 0 to 6) to assess health literacy. Statistical analyses performed Descriptive statistics, analysis of variance, and multivariate linear regression. Results of 376 participants, the majority were African American (67.6%), without a college degree (71.5%), and household income level $20,000/year (55.0%). Most participants, (73.9%) scored in the two lowest health literacy categories. The multivariate linear regression model to predict total HEI scores was significant (R2 0.24; F 18.8; P 0.01), such that every 1-point increase in health literacy was associated with a 1.21-point increase in HEI scores, while controlling for all other variables. Other significant predictors of HEI scores included age, sex, and Supplemental Nutrition Assistance Program participation. Health literacy also significantly predicted SSB consumption (R2 0.15; F 6.3; P 0.01), while accounting for demographic variables. Every 1 point in health literacy scores was associated with 34 fewer kilocalories per day from SSBs. Age was the only significant covariate in the SSB model. Although, health literacy has been linked to numerous poor health outcomes, to our knowledge this is the first investigation to establish a relationship between health literacy and HEI scores and SSB consumption. Our study suggests that understanding the causes and consequences of limited health literacy is an important factor in promoting compliance to the Dietary Guidelines for Americans.