Associations of Health Literacy and Menu-Labeling Usage With Sugar-Sweetened Beverage Intake Among Adults in Mississippi, 2016

Purpose: Examine association of health literacy (HL) and menu-labeling (ML) usage with sugar-sweetened beverage (SSB) intake among adults in Mississippi. Design: Quantitative, cross-sectional study. Setting: 2016 Mississippi Behavioral Risk Factor Surveillance System data. Participants: Adults living in Mississippi (n = 4549). Measures: Outcome variable was SSB intake (regular soda, fruit drinks, sweet tea, and sports/energy drinks). Exposure variables were 3 HL questions (find information, understand oral information, and understand written information) and ML usage among adults who eat at fast-food/chain restaurants (user, nonuser, and do not notice ML). Analysis: Multinomial logistic regressions were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for SSB intake >= 1 time/d (reference: 0 times/d) associated with HL and ML. Results: In Mississippi, 46.8% of adults consumed SSB >= 1 time/d, and 26.9% consumed >= 2 times/d. The odds of consuming SSBs >= 1 time/d were higher among adults with lower HL (aOR = 1.7; 95% CI = 1.3-2.2) than those with higher HL. Among adults who ate at fast-food/chain restaurants, the odds of consuming SSBs >= 1 time/d were higher among nonusers of ML (aOR = 2.3; 95% CI = 1.7-3.1) and adults who did not notice ML (aOR = 1.8; 95% CI = 1.3-2.6) than ML users. Conclusion: Adults with lower HL and adults who do not use or notice ML consumed more SSBs in Mississippi. Understanding why lower HL and no ML usage are linked to SSB intake could guide the design of interventions to reduce SSB intake in this population.