A Food Label Literacy Intervention Tool to Fight Childhood Obesity Among Vulnerable Populations

Purpose:

This research was conducted by a school nurse in a school setting who recognized childhood obesity as an epidemic globally and specifically in the United States (Burke & Wang, 2011) and set out to identify and conduct research with a Food Label Literacy Intervention Tool. This was done to advocate for a vulnerable population of poor, minority students who grow up to be chronically ill adults. At least one fourth of all the children globally (Abela, Bagnasco, Arpesella, Vandoni, & Sasso, 2014), and approximately one third of all children and adolescents within the United States are obese or overweight (Nihiser, Merlo, & Lee, 2013). As a result of obesity children have a shorter life expectancy (Long, Mareno, Shabo, & Wilson, 2012), obesity and overweight is considered the second most preventable cause of death (Burke & Wang, 2011). These facts compelled the researcher to conduct the initial research study and to follow up by sharing the findings with an international body of nursing researchers by promoting healthy communities through health promotion, disease prevention and recognition of social, economic, and political determinants. Obese children are likely to become obese adults (Abela, et al., 2014) and will suffer from co-morbidities such as hypertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, and degenerative joint disease (McPhee & Papadakis, 2011). Childhood obesity may be due in part, to parents’ inability to make healthy food choices for their children.

Methods:

This study utilized the Nutrition Detectives™ Program, developed by Yale researchers, Dr. David Katz and Dr. Catherine Katz. The program was originally developed to be used to train students to read labels and as a result would accommodate parents with a low-literacy level. The curriculum was set up in five mini-sessions. To accommodate the parents’ schedules these mini-sessions were condensed into two 45-minute sessions. During the first week parents signed the consent forms, filled out the sociodemographic questionnaire, took the pre-test, and were taught mini-lessons one and two which covered (a) The link between food choices and health, (b) The  struggles of eating well in the modern world, and (c) Instruction on how to determine what nutritious foods to choose. During week two parents were introduced to five clues for interpreting food labels, which covered mini-lessons three through five which included the five clues to reading a food label: (1) Don’t be fooled by the big letters on the front of the package. Look for the itty bitty letters on the food label instead, (2) The first ingredient is always the biggest, (3) Avoid partially hydrogenated oil and high fructose corn syrup, (4) Avoid foods with a long ingredient list, and (5) Fiber is your friend, so look out for whole grain imposters. On the third week parents signed in and took the posttest.

Data analysis was conducted using SPSS version 20 (SPSS, 2012). Descriptive statistics were used to assess the sociodemographic data: percentages were used for categorical variables, while means and standard deviations (sds) were used for continuous variables. Since the sample size was small and the assumption of normal distribution was not met, non-parametric tests were used.

The Mann Whitney was used to assess the pre- and posttest food label literacy test results and was also used to test the difference in the pretest scores between the (a) two language groups (English and Spanish), (b) household incomes, (<$25,000 and $25,000 and higher), and (c) education level (< high school diploma and those with a high school diploma). The Kruskal-Wallis was used to test any difference in the pre- and posttest based on time lived in the United States, which was broken into three groups: (a) 10 years or less, (b) more than 10 years, and (c) entire life. Data was collected from 33 participants.

A Food Label Literacy and Nutrition Knowledge (FLLANK) (Katz et al., 2011) 10-question pre- and posttest on food label literacy was administered. Descriptive statistics were conducted for all sociodemographic data.

Results:

The Mann-Whitney test was used to detect changes in Food Label Literacy skills, differences between language groups, education level, and income levels. The Kruskal-Wallis test was used to assess difference in knowledge based on time lived in the United States. The mean age of those completing the program was 38.8 +/- 9.3 years. Women comprised 91% of the sample; Spanish was preferred by 70%; 61% had at least a high school education; and 39% reported an income of less than $25,000 which placed them below the United States federal poverty guidelines. Over 80% of participants had no previous nutrition or Food Label Literacy classes. On the 10-question pretest the mean score was 5.36 +/- 3.029. The mean post-test score was 8.45 +/- 1.395, p < 0.01%. The Mann Whitney of U=80.5 was significant at p=0.05, leading to the conclusion that respondents making more than $25,000 scored significantly better than those earning less than $25,000. Post-intervention results revealed that the lower income group had a mean of 8.23(+/-1.48), and the higher income group had a mean score of 8.86 (+/-1.069). The Mann Whitney comparing the two scores yields a U of 4.5 , p =0.39, concluding that post-intervention there was no difference between participants from higher income groups than those from lower income groups. The education level was divided into two groups: no high school and high school. The mean pretest scores for those who did not complete high school were 4.3 (+/-3.21) and 6.70 (+/- 2.42) for those who completed high school.  The Mann Whitney of 164.50 and a p = 0.007 reveals that those with a high school diploma scored significantly better on the pretest than those without a high school diploma. The posttest a mean was 8.08 (+/- 1.25) for those with less than high school, and 8.70 (+/- 1.45) for those with a high a high school diploma. The Mann Whitney result of a U = 90.00 and p = 0.147 indicates that post-intervention there was no significant difference between participants with and without a high school diploma.

Conclusion:

The initial findings of this research study indicate the Nutrition Detectives™ Program can be utilized as evidence based practice (EBP) because it was successful in helping Hispanic parents of elementary school children improve healthy food choices and demonstrates the capacity development for research by nurses as a method for reducing obesity and co-morbidities for children. This literacy intervention program has begun to close the gap in the categories of education, socioeconomic status, language preference, and time lived in the Unites States. It is the researcher’s recommendation for this Nutrition Detectives™ Program to be utilized globally among other vulnerable populations to educate parents and students to make healthy food choices which may reduce childhood obesity and co-morbidities.