Effect of Maternal Health Literacy and WIC Participation on Selection of Sugar-Sweetened Beverages and Energy Dense Foods

Abstract

Background: In the United States almost a quarter of children 2-5 years of age are considered overweight or obese. Many potential causes have been implicated including low maternal health literacy and high intake of sugar-sweetened beverages (SSBs). The effects of maternal health literacy, Women, Infant, and Children (WIC) participation, on selection of SSBs and energy dense foods needs to be examined. Aims: To examine correlations between maternal health literacy and selection of SSBs and energy dense foods during a feeding simulation (FS) for their children. WIC participation and SSB (or 100% juice) selection was also examined. Methods: Thirty-two mothers of 2 and 3-year-old children completed a demographic survey, and health literacy assessment (Newest Vital Sign, NVS) and a child feeding simulation (FS). For the FS, participants were presented with 37 discreet food and beverage choices with representation from each food group and some non-food group (e.g. soda, non-carbonated sugar-sweetened beverage, butter). The outcome variable comprised ratings of respondents from the NVS scale. The scale was dichotomized into two separate groups, representing “low-health-literacy” and “high-health-literacy”. Stratified analyses were conducted to examine whether percentage of calories as well as total number of calories selected daily varied by caloric density grouping of foods and beverages into “Go” (‘Almost Anytime’ foods), “Slow” (‘Sometimes’ foods), and “Whoa” (‘Once in a While’ foods). Results: Results indicate about a third of mothers had either high likelihood/possible limited health literacy. Mothers with lower scores on a health literacy assessment were not more likely to select less healthy choices. Examination of distribution of the percentage of calories consumed in three different caloric density groups were not statistically significant, indicating that there is no difference in the types of calories which are dense, or healthy by how health literate a respondent was. In addition, there was a not statistically significant difference among mean total number of daily calories consumed by health literacy level. Parents who were more likely to choose an SSB or juice during breakfast had a lower rating on the NVS questionnaire (p=0.108), whereas parents who choose a sugar-sweetened beverage or juice for lunch (p=0.305) or dinner (p=0.323) actually had a higher NVS score. However, none of these findings were statistically significant. WIC participants were significantly more likely to choose a SSB or juice for breakfast than were non-WIC participants (p=0.004). There were no significant differences in whether parents chose sugar-sweetened beverages or juice for lunch (p=0.427), dinner (p=0.433), or snack time (p=1.000). Conclusions: Health literacy and WIC participation does not appear to have an impact on selection of energy-dense foods and SSBs. Clinical implications: Health literacy is an important parameter to consider when educating patients but dietary implications may not be relevant.