Health literacy, food marketing literacy and unhealthy diet in European adolescents

Background

Unhealthy dietary behaviours in adolescence are shaped by individual choices, health literacy and the ability to critically evaluate food marketing and misinformation. This study examined whether general health literacy and food marketing literacy were associated with unhealthy dietary patterns among adolescents.

Methods

Cross-sectional baseline data from SUNRISE were analysed in 1,980 adolescents with complete HLSAC and food marketing literacy data. Dietary variables included breakfast consumption, fruit/vegetable intake, sweets and sweetened beverages. An unhealthy diet indicator was defined as ≥ 3 of six dietary risks. Food marketing literacy was calculated from 27 items covering misleading messages, persuasive intent, nutrition misinformation resistance and healthy eating self-efficacy. Multivariable logistic regression estimated odds ratios, adjusted for age, gender and country.

Results

48.4% met criteria for unhealthy diet. Health literacy and food marketing literacy were strongly correlated (Spearman ρ = 0.62) and both were inversely correlated with dietary risk score (ρ = −0.29 for both). In adjusted models, higher health literacy was associated with lower odds of unhealthy diet (OR per 1 SD increase=0.77, 95% CI 0.66–0.89, p < 0.001). Food marketing literacy showed an independent protective association (OR per 1 SD increase=0.71, 95% CI 0.62–0.80, p < 0.001). Among subdomains, healthy eating self-efficacy showed the strongest association (OR = 0.51, 95% CI 0.45–0.58, p < 0.001), followed by misinformation resistance (OR = 0.77, 95% CI 0.64–0.94, p = 0.009) and nutrition information literacy (OR = 0.84, 95% CI 0.73–0.96, p = 0.011).

Conclusions

General health literacy and food marketing literacy are independently associated with healthier dietary patterns in adolescents. Strengthening adolescents’ capacity to evaluate nutrition information and resist misleading food marketing may help improve diet quality across European settings. (GA101136829).

Key messages

• Higher health literacy and food marketing literacy are independently linked to lower odds of unhealthy diet in adolescents.

• Strengthening skills to resist food marketing and misinformation may improve adolescent diet quality across Europe.