Screening for Health Literacy among SNAP-eligible Adults Using the Newest Vital Sign: Implications for Nutrition Facts Label Policy and Education

ABSTRACT

This study examines the role of computational and Nutrition Facts Label (NFL) skills in health literacy classifications using the Newest Vital Sign (NVS). A convenience sample of 144 SNAP-eligible adults was given an original and modified version of the NVS. Responses on NVS and modified NVS (NVS-M) were compared using a paired McNemar test, while the order of administration was evaluated using a chi-square test. Overall, significant differences between the paired NVS and NVS-M responses (p < 0.001) resulted in more classifications of adequate health literacy with the NVS-M. Stratification by order of administration revealed a version-specific priming effect, but a comparison of the first administration of each assessment showed no significant difference in classifications (p = 0.955). Common incorrect responses reflected computational errors and confounding serving size and servings per container. Nutrition education may improve NFL skills, while limited numeracy may undermine their utility. Differentiation among related health literacy concepts could improve measurement and screening.

KEYWORDS:

• Nutrition policy
• food labeling
• health literacy
• nutrition assessment
• nutrition education

Acknowledgments

The authors would like to acknowledge Katherine Richard and Sarah Sutton for their assistance in preparing this manuscript and Lisa Lachenmayr, Meredith Pearson, Katherine Speirs, Jane Kostenko, Abbi Kifer, Tiffani Stevenson, and Patty Fanflik for their help conducting the project. The authors would also like to acknowledge the support of Bonnie Abell, Daniel Allotey, JoAnn Barnes, Sabrina Barnes, David Carter, Mary D’Addario, Nicholas D’Alesandro, Steve Kearns, Rodney Palmer, Debbie Raseur, Tom Rosser, Felicia Turner, MaryJo Woods, and the staff of the Baltimore, Garrett, Kent, Montgomery, and St. Mary’s County Departments of Social Services. Finally, the authors would like to thank the individuals and families who participated in this research study.