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: 4.28). 12/2006; 31(5):391-8. DOI: 10.1016/j.amepre.2006.07.025
Source: PubMed

ABSTRACT 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.

Download full-text


Available from: Rebecca Pratt Gregory, Jan 06, 2015
  • Source
    • "Findings from the present study are consistent with past work suggesting that knowledge (Cowburn and Stockley, 2004; Grunert et al., 2010; Misra, 2007) and numeracy (Rothman et al., 2006) are important for nutrition label comprehension. However, past research has not compared the role of knowledge and numeracy. "
    British Food Journal 07/2014; 116(7). DOI:10.1108/BFJ-02-2013-0042 · 0.77 Impact Factor
  • Source
    • "By contrast, many information approaches are slow. For instance, nutrition information is currently presented in a numerical format (e.g., percentage of daily value or a calorie range) that people have difficulty evaluating (Liu et al. 2013; Rothman et al. 2006). Therefore, informationprovision policies can be improved by making nutrition information easier to understand and use. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Many policy interventions that address rising obesity levels in the United States have been designed to provide consumers with more nutrition information, with the goal of encouraging consumers to decrease their caloric intake. We discuss existing information-provision measures and suggest that they are likely to have little-to-modest impact on encouraging lower caloric intake, because making use of such information requires understanding and/or motivation, which many consumers lack, as well as self-control, which is a limited resource. We highlight several phenomena from the behavioral economics literature (present-biased preferences, visceral factors, and status quo bias) and explain how awareness of these behavioral phenomena can inform both more effective information-provision policies and additional policies for regulating restaurants and public school cafeterias that move beyond information to nudge people towards healthier food choices.
    Applied Economic Perspectives and Policy 10/2013; DOI:10.1093/aepp/ppt027 · 1.33 Impact Factor
  • Source
    • "The ability to process numbers and solve simple calculation problems is essential for everyday life situations, such as handling money and comparing prices, dealing with telephone numbers or time schedules. Consequently, a lack of these basic mathematical skills might lead to a profound handicap of normal functioning in everyday life (Martini, Domahs, Benke, & Delazer, 2003; Rothman et al., 2006; Zaunmüller et al., 2009). Amongst other abilities, an intact knowledge of arithmetic facts, such as simple multiplication tables, is essential. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Transcranial direct current stimulation (tDCS) is a non-invasive technique which has been used to modulate various cognitive functions in healthy participants as well as stroke patients. Despite the increasing number of tDCS studies, it still remains questionable whether tDCS is suitable for modulating performance in arithmetic tasks and whether a single tDCS session may cause brain activity changes that can be detected with functional magnetic resonance imaging (fMRI). We asked healthy participants to repeatedly solve simple multiplication tasks in three conditions: STIMULATION (anodal tDCS over the right angular gyrus, AG), SHAM (identical electrode set-up without stimulation), and CONTROL (no electrodes attached). Before and after tDCS, we used fMRI to examine changes in brain activity. Behavioural results indicate that a single session of tDCS did not modulate task performance significantly. However, fMRI measurements revealed that the neural correlates of multiplication were modified following a single session of anodal tDCS. In the bilateral AG, activity was significantly higher for multiplication problems rehearsed during active tDCS, as compared to multiplication problems rehearsed without tDCS or during sham tDCS. In sum, we present first neuro-functional evidence that tDCS modulates arithmetic processing. Implications of these findings for future tDCS studies and for the rehabilitation of acalculic patients with deficits in arithmetic fact retrieval are discussed.
    Neuropsychologia 04/2013; 51(7). DOI:10.1016/j.neuropsychologia.2013.03.023 · 3.45 Impact Factor
Show more