Building Food Literacy and Positive Relationships with Healthy Food in Children through School Gardens

Background: Improving food and nutrition literacy is fundamental to tackling the Middle East and North Africa (MENA) region’s enormous challenges, including malnutrition and food insecurity. To direct initiatives, it is crucial to assess the region’s food and nutrition literacy. Thus, we aimed to review studies on food/nutrition literacy status in the MENA countries and illuminate the region’s research gaps in these areas, in terms of assessment, policy, and program implementation. Methods: PubMed and Google Scholar databases were searched between 18 December and 8 May 2022, to identify relevant articles published up to 2022 in the MENA region. Results: Twelve studies were included in this review. Lebanon, Palestine, and Iran are the only three MENA countries where nutrition and/or food literacy were assessed. People in these countries mostly had inadequate food and/or nutrition literacy levels, especially in the skills rather than the cognitive domain. Food and/or nutrition literacy showed associations with food habits, food-label use, food-consumption patterns, school performance, food security, dietary diversity, and nutrient adequacy. The MENA countries developed no policies or programs to address food and nutrition literacy. Conclusion: This review is a wake-up call for researchers and policymakers to develop a robust approach to combat food and nutrition literacy concerns in the MENA region.

The notion of food or nutrition literacy refers to a person's ability to acquire, understand, and process food and nutrition-related information to make appropriate nutritional decisions.The aim of this study is to present the concepts of nutrition and food literacy, to indicate the methods of their measurement and the factors determining their level, and to determine their importance.The study is based on a selective review of the literature.Food and nutrition literacy is defined as a distinct form of health literacy.The difference between food and nutrition literacy is not clearly defined.Both nutrition and food literacy can be related to the categories of health literacy proposed by Nutbeam, including functional, interactive, and critical categories.However, food literacy appears to be more complex and, as stated by many authors, it corresponds with most of Nutbeam's categories.Nutrition literacy in the literature is generally described as the category of functional literacy.The level of nutrition and food literacy depends on many factors, such as age, gender, and level of education.Several instruments are available to determine the level of food and nutrition literacy.The most popular tools are the Nutrition Literacy Scale (NLS), Nutrition Literacy Assessment Instrument (NLit), Newest Vital Sign (NVS), Electronic Nutrition Literacy Tool (e-NutLit), and Short Food Literacy Questionnaire (SFLQ).Adequate levels of food and nutrition literacy are associated with beneficial dietary choices, which may be important in the prevention of chronic non-communicable diseases.Education and health communication interventions are crucial to improve food and nutrition literacy.

Stok et al., 2018). Therefore, while the beginning or end points of emerging adulthood can differ in other research contexts, for the purposes of the current dissertation, we will consider emerging adults to be those aged between 18 and 25. The Challenge of Navigating Food Choices in Emerging AdulthoodThe road to adulthood is often described as a winding path marked by newfound independence and autonomy as well as new challenges and responsibilities, making it sometimes difficult to navigate (Arnett, 2014).As emerging adults navigate the complex landscape of adulthood, they have greater autonomy, including Food literacy is often used in the literature alongside related concepts such as health, media, and nutrition literacy (Truman et al., 2020;Velardo, 2015).These interconnected concepts collectively play a crucial role in the promotion of health and well-being, however, each with their own specific focus (Truman et al., 2020).Health literacy, nutrition literacy, and food literacy all describe a spectrum of skills, knowledge, and abilities necessary to make informed and appropriate decisions that enhance one's health (Krause et al., 2018; Truman et al., 2020;Velardo, 2015).While health literacy pertains to the ability to obtain, process, understand, and utilize health information and services to make appropriate health decisions (Murimi, 2013;Nutbeam, 2000), food literacy is considered a distinct form of health literacy that explicitly focuses on health literacy skills within a food-specific context (Velardo, 2015).Nutrition literacy, focusing on the comprehension and utilization of nutrition information for making healthy dietary choices, is often regarded as a subset of food literacy (Krause et al., 2018;Thomas et al., 2019;Vettori et al., 2019).In addition, media literacy is a broader concept aimed at developing critical skills necessary for accessing, interpreting, analyzing, evaluating, and creating messages across various media platforms (Aufderheide, 2018;Livingstone, 2004;Potter, 2010).While media literacy is frequently applied in health contexts to shield individuals from potential negative media effects (Potter, 2010; Truman et al., 2020), it also plays an essential role in the concepts of food and nutrition literacy (Boedt et al., 2021;Fox & Marinescu, 2020).The intersection of media and food/nutrition literacy emphasizes the importance of obtaining and evaluating food-and nutrition-related information and media messages, recognizing how media shape perceptions of food, nutrition, and health, and enabling individuals to make informed dietary decisions based on media content (Boedt et al., 2021;Fox & Marinescu, 2020; Truman et al., 2020).In essence, health, nutrition, media, and food literacy are interconnected pillars that each have a unique focus to collectively empower individuals to be healthier and more informed (Truman et al., 2020).It is worth noting that the relative importance of each type of literacy varies depending on an individual's life stage and the specific situations and challenges they encounter (Barton & Hamilton, 2005).For emerging adults, who often face the responsibility of managing everyday foodrelated matters independently for the first time, food literacy becomes increasingly crucial (Slater et al., 2018).and the specific content of the domains can differ over a person's life course (Cullen et al., 2015; Vidgen, 2016a).First, the competencies related to food literacy may differ depending on one's cultural background, such as socioeconomic status or geographic location.For example, a person with a lower income may need to learn how to stretch their food budget and make nutritious meals with limited resources.In comparison, a person with a higher income may need to learn how to navigate a range of specialty food options.Second, food literacy should be viewed as a "no-end competence," meaning that different competencies or levels are needed during a life course depending on individual or environmental changes (Cullen et

Food literacy (FL) and nutrition literacy (NL) are concepts that can help individuals to navigate the current food environment. Building these skills and knowledge at a young age is important for skill retention, confidence in food practices and supporting lifelong healthy eating habits. The objectives of this systematic review were to: (i) identify existing tools that measure FL and NL among children and/or adolescents and (ii) describe the psychometric properties. A 4-phase protocol was used to systematically retrieve articles. The search was performed in May 2021. Study characteristics and psychometric properties were extracted, and a narrative synthesis was used to summarise findings. Risk of bias was assessed using the COSMIN checklist. Six databases were searched to identify current tools. Children (2-12 years) and adolescents (13-18 years) participated in this study. Twelve tools were identified. Three tools measured FL, 1 tool measured NL, 4 tools measured both FL and NL, and 4 tools measured subareas of NL-more specifically, critical NL, food label and menu board literacy. Most tools were self-reported, developed based on a theoretical framework and assessed some components of validity and/or reliability for a specific age and ethnic group. The majority of tools targeted older children and adolescents (9-18 years of age), and one tool targeted preschoolers (3-6 years of age). Most widely used definitions of FL and NL do not acknowledge life-stage specific criterion. Continued efforts are needed to develop a comprehensive definition and framework of FL and NL appropriate for children, which will help inform future assessment tools.

Existing definitions of food literacy (FL) and nutrition literacy (NL) in particular refer to individual knowledge, motivation, competences, and awareness, which determine the relationship between individuals and food, the food system, and nutrition information. Several authors proposed specific conceptualization of the terms. Nevertheless, the description of analogies and differences between FL and NL is still lacking, as is an integrated framework which highlights the meaning of the concepts. This work aims to describe and discuss evidence provided by the literature in order to develop and propose a comprehensive conceptualization of FL and NL to the scientific community. We systematically reviewed six databases, considering the search terms of FL and NL. We collected the antecedents, components, and consequences of both FL and NL. We underlined and traced similarities of the concepts as well as prerogative features through the content analysis of definitions. We obtained 14 definitions of NL and 12 definitions of FL; 42 papers presented antecedents and 53 papers contained consequences. We observed that NL could be considered a specific form of FL. In addition, we noted that the consequences of NL are included in the subset of the consequences of FL and the conceptual limits of FL correspond to the outcome of healthful diet. We conclude that FL and NL build a multifaceted concept which implies both individual and public perspectives. We propose a conceptualization which could be useful to develop an executive framework aimed at providing healthy eating for the population.

Background A healthy diet is a key factor in people’s long-term health. The nutritional health literacy and food literacy of the population play a crucial role in this. In 2021, comprehensive data on these competences were collected for the first time in Austria. Methods Almost 3,000 people were surveyed online. Nutrition health literacy was assessed with the newly developed Nutrition Health Literacy Scale (NHLS) and food literacy with the Self-Perceived Food Literacy Scale Short-Form (SPFL-SF). Scores and subscores were calculated. Associations between socio-demographic and socio-economic factors and the competences surveyed were assessed using t-tests, variance analysis, correlations, and multivariate regression models. Results In terms of nutritional health literacy, respondents score an average of 60 out of 100 points, with judging (51 points) and applying (60 points) nutritional information being the most difficult. In the area of food literacy, respondents score an average of 62 out of 100 points. The most challenging areas are ‘healthier choices’ (44 points), ‘healthy snacking’ (52 points) and ‘healthy eating in exceptional circumstances’ (54 points). In both areas, men and people with less formal education score lower. In the case of nutritional health literacy, people aged 65 and over have greater difficulties. Conversely, this group performs better in the area of food literacy. Differences by income can only be seen for nutritional health literacy, to the detriment of low-income groups. Conclusions Possible options for action include the provision of quality-assured and target-group-specific information, the implementation of appropriate tools to facilitate the assessment of foods, and measures to strengthen assessment skills, digital health literacy, food and nutrition skills. Key messages • The survey showed that there is potential for improvement in both nutritional health literacy and food literacy. • The biggest challenge is to evaluate and use nutritional information and to stick to a healthy diet without making exceptions.

Peer Reviewed

BackgroundFood and nutrition literacy is an emerging term which is increasingly used in policy and research. Though research in this area is growing, progression is limited by the lack of an accepted method to measure food and nutrition literacy. The aim of this study is to develop a valid and reliable questionnaire to assess food and nutrition literacy in elementary school children in the city of Tehran.MethodsThe study was conducted in three phases. To develop Food and Nutrition Literacy (FNLIT) questionnaire, a comprehensive literature review and a qualitative study were initially performed to identify food and nutrition literacy dimensions and its components. Content and face validity of the questionnaire were evaluated by an expert panel as well as students. In the second phase, construct validity of the scale was evaluated using Explanatory Factor Analyses (EFA) and Confirmatory Factor Analyses (CFA). In the last phase (confirmatory phase), the final version of the questionnaire was evaluated on 400 students.ResultsFindings show Content Validity Ratio (CVR) and Content Validity Index (CVI) of the 62-item questionnaire at acceptable levels of 0.87 and 0.92, respectively. EFA suggested a six-factor construct, namely, understanding food and nutrition information, knowledge, functional, interactive, food choice, and critical. The results of CFA indicated acceptable fit indices for the proposed models. All subscales demonstrated satisfactory internal consistency (Cronbach’s alpha≥0.70), except for critical skill subscale (0.48). The intraclass correlation coefficient (ICC = 0.90, CI: 0.83–0.94) indicated that Food and Nutrition Literacy (FNLIT) scale had satisfactory stability. Each phase of development progressively improved the questionnaire, which resulted in a 46-item (42 likert-type items and 4 true-false items) Food and Nutrition Literacy (FNLIT) scale. The questionnaire measured two domains with 6 subscales, including: 1) cognitive domain: understanding and knowledge; 2) skill domain: functional, food choice, interactive, and critical skills.ConclusionThe developed food and nutrition literacy scale is a valid and reliable instrument to measure food and nutrition literacy in children. This measure lays a solid empirical and theoretical foundation for future research and tailored interventions to promote food and nutrition literacy in this age group.

BackgroundFood literacy is capturing the attention worldwide and gaining traction in the Arab countries. Strengthening food and nutrition literacy among Arab teenagers are important promising empowering tools which can protect them from malnutrition. This study aims to assess the nutrition literacy status of adolescents with the food literacy of their parents in 10 Arab countries.MethodsThis cross-sectional study involving a convenient sample of 5,401 adolescent-parent dyads (adolescents: mean age ± SD: 15.9 ± 3.0, females: 46.8%; parents: mean age ± SD: 45.0 ± 9.1, mothers: 67.8%) was launched between 29 April and 6 June 2022 in 10 Arab nations. The Adolescent Nutrition Literacy Scale (ANLS) and the Short Food Literacy Questionnaire (SFLQ) were used to meet the study aims.ResultsMore than one-quarter (28%) of adolescents had poor nutrition literacy, with 60% of their parents being food illiterate. The top three countries with nutritionally” less literate” adolescents were Qatar (44%), Lebanon (37.4%), and Saudi Arabia (34.9%). Adolescents’ age, gender, education level, primary caregivers, employment status, and the inclusion of nutrition education in the schools’ curriculum predicted the nutrition literacy levels of Arab adolescents. Besides, parental weight status, health status, parent’s food literacy level, and the number of children per household were significant determinants too. Adolescents studying at a university and having parents with adequate food literacy had the highest odds of being nutritionally literate (OR = 4.5, CI = 1.8–11.5, p = 0.001, OR = 1.8, CI = 1.6–2.1, p < 0.001, respectively).ConclusionNutrition literacy inadequacy among Arab adolescents is a prioritized challenge to be tackled.

The concepts of nutrition (or nutritional) (NL) literacy, food literacy (FL), and the extensively described concept of health literacy (HL) are based on the same idea of increasing the degree to which individuals and groups can access and use specific information needed to make health decisions that benefit the community. More specifically, the terms of FL and NL refer to a set of knowledge, competencies, and abilities that are necessary for people to use information regarding food and nutrition in order to achieve and preserve a healthful diet. Nonetheless, the core elements of the two constructs partially differ, since NL mostly involves nutritional information and individuals’ capacity or interest in relation to accessing and using such information in order to maintain nutritional health status, while FL considers mainly the relationship between people and food (or food system) and the capacity to use food responsibly. From a public health nutrition perspective, NL/FL could help to identify individuals with low diet quality and unhealthy eating habits that make them at higher risk of chronic diseases and other health consequences. In fact, although a very large amount of information about food and nutrition is now available to citizens/consumers, they often struggle to recognize evidence-based information and effectively manage their diet in the current “dietary infodemic”. Thus, there is a need to develop and implement interventions in order to increase the public's NL/FL level, beginning from establishing valid instruments to measure the NL/FL and finding specific targets on which to intervene by education and other preventive measures, so as to develop specific awareness to counteract the pressure from GDOs and the effects generated by commercial determinants.

We examine the impact of three sets of government regulations on the demand for cigarettes by teenagers in the United States. These are: (1) the excise tax on cigarettes, (2) the Fairness Doctrine of the Federal Communications Commission, which resulted in the airing of anti-smoking messages on radio and television from July 1, 1967 to January 1, 1971,and (3) the Public Health Cigarette Smoking Act of 1970, which banned pro-smoking cigarette advertising on radio and television after January 1, 1971.Teenage price elasticities of demand for cigarettes are substantial and much larger than the corresponding adult price elasticities. The teenage smoking participation elasticity equals -1.2, and the quantity smoked elasticity equals -1.4. It follows that, if future reductions in youth smoking are desired, an increase in the Federal excise tax is a potent policy to accomplish this goal. The contention of the proponents of the advertising ban that the Fairness Doctrine failed in the case of teenagers is incorrect. According to our results, the doctrine had a substantial negative impact on teenage smoking participation rates. Extrapolations suggest that the advertising ban was no better or worse a policy than the Fairness Doctrine.

BackgroundFood and nutrition literacy is a newly emerged concept to connect food-related knowledge and skills to healthy diets. Its promotion is important to protect children as they eat too many low-nutrient, high-energy foods. Food and nutrition literacy promotion needs multi-dimensional interventions. In the process of developing an intervention to promote food and nutrition literacy, the present review protocol aims to critically examine the evidence in the area of school-based interventions for promoting food and nutrition literacy (FNLIT) in elementary school children.MethodsWe will search PubMed/MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest (from inception onwards). Additional studies will be identified through manual searching of reference lists. Quantitative studies (e.g., randomized controlled trial, quasi-randomized trials, and cluster randomized trials) evaluating the effect of interventions to promote food and nutrition literacy in elementary school children (5–12 years old) will be included. Main outcomes will be food and nutrition literacy at functional, interactive, and critical levels. Secondary outcomes will be dietary intake indicators (e.g., healthy eating index, DDS) and health outcome measures (e.g., reduction in BMI and less weight gain). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. The quality of the included studies will separately evaluate using the validated Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project (EPHPP). Data will be extracted by two reviewers from the identified relevant literature. Standard data synthesis and analysis will be used for the review.DiscussionThis systematic review will summarize the evidence regarding the components, implementation methods, and effectiveness of the interventions of food and nutrition literacy promotion in elementary school children. The results of this review will provide a useful reference for policymakers and curriculum developers to assess education curricula and develop practical learning and teaching strategies to improve students’ food and nutrition literacy.Systematic review registrationPROSPERO (CRD42019135118)

Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors. A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively. Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667). The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.

Analogous to health literacy, food literacy can be defined as a set of cognitive and social skills associated with the ability to acquire and understand information about food and nutrition to make appropriate nutritional decisions. In the literature, several terms such as food, nutrition, or nutritional literacy are used in parallel, differing in some aspects of their meaning. Food literacy is an important measure of the effectiveness of nutritional education interventions and appropriate instruments for its measurement should be available in every society. The aim of this study was the assessment of the validity and testing of a proposed model of the Short Food Literacy Questionnaire (SFLQ) culturally adapted into Polish. The analysis was performed on data from an online survey in a representative sample of 1286 adult internet users. Exploratory (EFA) and confirmatory factor (CFA) analyses were performed on two different subsets obtained through random splitting of the initial dataset. The Polish version of the SFLQ had good internal consistency (Cronbach’s α 0.841; Guttman split-half coefficient was 0.812). The EFA revealed that the tool had a three-factor latent structure. The distinguished dimensions were ‘information accessing’, ‘knowledge’, and ‘information appraisal’. The subscales also showed acceptable internal consistency based on the values of the Cronbach’s α coefficients (ranging from 0.768 to 0.845). The CFA confirmed a good fit of the three-factor model with at least five indexes achieving acceptable levels (CFI = 0.972, GFI = 0.963, AGFI = 0.940, NFI = 0.959, and RMSEA = 0.059). The validation of the Polish version of the SFLQ revealed, contrary to earlier reports, not a single but a three-factor structure of the instrument. The SFLQ will be an important tool for the assessment of the effectiveness of educational interventions and population studies analyzing the determinants of food literacy in Poland.

School food in <scp>E</scp>ngland: Are we getting it right?