Higher food literacy scores are associated with healthier diet quality in children and adolescents: the development and validation of a two-dimensional food literacy measurement tool for children and adolescents

Most child and adolescent food literacy measurement tools focus on nutrition and food safety. However, the importance of aspects related to the food system such as food distribution and food waste and their effects on environmental sustainability is growing. We therefore developed and validated a two-dimensional tool for children (8-12 years old) and adolescents (13-18 years old) that can comprehensively measure food literacy. The association of food literacy with diet quality and self-reported health was assessed.First, we developed a food literacy conceptual framework that contains food system and literacy dimensions through a literature review, focus group interviews, and expert review. After a face validity study, we conducted the main survey (n = 200) to validate the questionnaire. Construct validity and reliability were assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and Cronbach's alpha.As a result of the Delphi study, content validity was confirmed for the remaining 30 items after two items were excluded (content validity ratio = 0.86). Eleven items were excluded from the EFA results, while the CFA results indicated appropriate fit indices for the proposed model (comparative fit index = 0.904, root mean square error of approximation = 0.068). The final food literacy questionnaire consisted of 19 questions and comprised 5 factors: production, distribution, selection, preparation and cooking, and intake. Food literacy was positively associated with diet quality, as assessed by the Nutrition Quotient score, in both children and adolescents and with self-reported health in adolescents.Based on this integrated conceptual framework, a two-dimensional 19-item food literacy measurement tool was developed and verified for practical use to improve the diet quality and food-related environmental sustainability awareness of children and adolescents.