Effect of a Novel Intervention on Caloric and Menu Board Literacy Among Low-Income Preadolescent Schoolchildren

Background: Hip Hop H.E.A.L.S (Healthy Eating And Living in Schools) is a school-based, interactive multimedia intervention incorporating hip-hop music, cartoons, and video games. HEALS teaches caloric and menu board literacy and promotes smarter food choices with the aid of calorie postings at the point-of-purchase. Methods: We enrolled 202 low-income schoolchildren aged 8-11 years into two day, one hour per-day HEALS sessions using a pretest/posttest intervention design. Baseline, immediate posttest and 6-month posttest were administered to children. We assessed calorie and menu board-literacy with a 6-item, multiple-choice questionnaire. Test items include four knowledge-based and two behavioral skill questions, modeled after the validated CATCH Health Behavior Questionnaire and After-School Student Questionnaire. Results: Overall, caloric and menu board literacy improved significantly across all domains. Prior to the intervention (BT), 31% of children knew what calories are compared to 91% immediately following the program (IT), and 48% 6 months later (DT). Regarding knowledge of daily caloric requirements 22% BT, 70% IT, 57% DT. Menu board literacy also improved in two domains: identification of calorie dense items (52% BT, 88% IT, 75% DT); identification of low-calorie items (67% BT, 87% IT, 81% DT). Understanding of caloric balance also improved (51% BT, 73% IT, 64% DT). All p-values were significant across BT, IT and DT (p<.05). Conclusion: Our findings suggest that HEALS significantly improves caloric and menu board literacy among low-income schoolchildren. Larger randomized studies are needed to confirm our findings and determine whether such knowledge and skills can lead to improved food-purchasing behavior.