Although health literacy has been a public health priority area for over a decade, the relationship between health literacy and dietary quality has not been thoroughly explored.
To evaluate health literacy skills in relation to Healthy Eating Index scores (HEI) and Sugar-Sweetened Beverage (SSB) consumption, while accounting for demographic variables.
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 0–6) to assess health literacy.
Statistical analyses performed
Descriptive statistics, ANOVA, and multivariate linear regression.
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 healthy eating index scores, while controlling for all other variables. Other significant predictors of HEI scores included age, gender, and SNAP participation. Health literacy also significantly predicted sugar-sweetened beverages 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 SSB kilocalories/day. Age was the only significant covariate in the SSB model.
While 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.