Patient Understanding of Food Labels. The Role of Literacy and Numeracy

Division of General Internal Medicine and Public Health, Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 12/2006; 31(5):391-8. DOI: 10.1016/j.amepre.2006.07.025
Source: PubMed


Comprehension of food labels can be important for patients, including those with chronic illness, to help follow dietary recommendations. Patient comprehension of food labels was examined, along with the relationship of comprehension to their underlying literacy and numeracy skills.
From June 2004 to April 2005, a cross-sectional study of 200 primary care patients was performed. A 24-item measure of food label comprehension was administered. Literacy was measured with the Rapid Estimate of Adult Literacy in Medicine (REALM), and numeracy with the Wide Range Achievement Test, third edition (WRAT-3).
Most patients (89%) reported using food labels. While 75% of patients reported at least a high school education and 77% had 9th-grade literacy skills, only 37% had 9th-grade math skills. On average, patients answered 69% (standard deviation, 21%) of the food-label questions correctly. Common reasons for incorrect responses included misapplication of the serving size, confusion due to extraneous material on the food label, and incorrect calculations. For example, only 37% of patients could calculate the number of carbohydrates consumed from a 20-ounce bottle of soda that contained 2.5 servings. Higher comprehension of food labels was significantly correlated (all p values were less than 0.001) with higher income (rho=0.39), education (rho=0.49), literacy (rho=0.52), and numeracy (rho=0.67).
Patients demonstrated deficits in understanding nutrition labels. Poor label comprehension was highly correlated with low-level literacy and numeracy skills, but even patients with higher literacy could have difficulties interpreting labels. Providers need to consider patients' literacy and numeracy when providing dietary recommendations. Opportunities may exist for the U.S. Food and Drug Administration to promote changes to make food labels more comprehensible.

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Available from: Rebecca Pratt Gregory, Jan 06, 2015
    • "Aspects of health information and decision-making using numbers and numerical constructs (such as balancing the risks and benefits of different medical procedures, and understanding and taking medication correctly) differ from those aspects of health information transmitted via words (such as a description of diseases and treatments). Within this context there is an increasing recognition of the importance of numeracy as a 'stand-alone' risk factor for poor health (Rothman et al., 2006; Ancker and Kaufman, 2007; Donelle et al., 2007; Peters et al., 2007). In their systematic review Berkman et al. (2011) reviewed the small number of published studies exploring numeracy and health including accuracy of risk perception, knowledge, skills taking medication, and disease prevalence and severity. "
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    ABSTRACT: The relative contributions of functional literacy and functional numeracy to health disparities remain poorly understood in developed world contexts. We seek to unpack their distinctive contributions and to examine how these contributions are framed by place-based deprivation and rurality. We present a multilevel logistic analysis of the 2011 Skills for Life Survey (SfLS), a representative governmental survey of adults aged 16-65 in England. Outcome measures were self-assessed health status and the presence of self-reported long-term health conditions. Exposure variables were functional literacy (FL) and functional numeracy (FN). Age, sex, individual socio-economic status, ethnicity, whether English was a first language, non-UK birthplaces, housing tenure and geography were included as potential confounders and mediators. Geography was measured as area-based deprivation and urban/rural status. FL and FN were both independently associated with self-assessed health status, though the association attenuated after taking account of confounders and mediators. For long-term conditions, the association with FN remained significant following inclusion of confounders and mediators whilst FL attenuated to non-significance. Rurality did not influence these associations. Area deprivation was a significant factor in attenuating the association between FL and self-assessed health status. Policy makers and health professionals will need to be aware of the distinctive impact of FN as well as FL when combating health inequalities, promoting health and managing long-term conditions.
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    • "Recently, there has been a great deal of interest in making the nutritional content of food (e.g., nutrition labels) easier for consumers to understand (e.g., Cowburn & Stockley, 2005; George, 2014; Rothman et al., 2006; Scaperotti & De Leon, 2009; Silk et al., 2008). "

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