The concept of food literacy is evolving and expanding, increasing the need for a comprehensive measurement tool for food literacy. This study aimed to develop a validated food literacy questionnaire based on an expanded conceptual framework for food literacy. A literature review of existing frameworks and questionnaires for food literacy and focus group interviews (n = 12) were conducted to develop a conceptual framework and candidate questions. A Delphi study (n = 15) and pilot survey (n = 10) to test the preliminary questionnaire’s content and face validity were conducted, which were followed by the main survey (n = 200). Construct validity and reliability were assessed using exploratory factor analysis (EFA) and Cronbach’s alpha, respectively. Criterion validity was assessed by comparing food literacy scores with food knowledge scores (FN-score) and nutrient quotient scores (NQ-score). By integrating and revising the six existing conceptual frameworks and focus group interview results, we proposed a two-dimensional conceptual framework comprising a literacy dimension and a food system dimension. After reviewing 560 items and categorizing them into 18 domains (3 in the literacy dimension × 6 in the food system dimension), 32 questions were selected. As a result of the Delphi study, two items were deleted, and content validity was confirmed for the remaining 30 items (content validity ratio (CVR) = 0.92). Ten items were revised during the face validation process, and five items were excluded as a result of the EFA. The final food literacy questionnaire comprised 25 questions related to five factors: production, selection, preparation and cooking, intake, and disposal. Food literacy scores were positively associated with FN- and NQ-scores, confirming the reliability and criterion validity of the final questionnaire. The two-dimensional food literacy conceptual framework developed in this study systematically encompasses complex food literacy concepts by adding a food systems dimension (production, selection, preparation and cooking, intake, and disposal domain) to the existing literacy dimension (functional, interactive, and critical literacy domain). Based on this integrated conceptual framework, a 25-item food literacy questionnaire was developed and validated for practical use.

Park D, et al. Nutr Res Pract. 2022 Apr;16(2):272-283. https://doi.org/10.4162/nrp.2022.16.2.272

Objectives To understand a 20-year trend of gender-specific smoking prevalence among adults in South Korea. Design Age-period-cohort analysis using the intrinsic estimator method was applied to examine the separate contribution of age, period and cohort effect on smoking prevalence. The Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework was used to explain the observed smoking trends by mapping potential determinants and to address policy implications. Setting General adult population in South Korea. Participants 34 828 men and 43 632 women who aged 19–78 years, were not currently pregnant and were without a prior diagnosis of cardiovascular disease or cancer. Outcome measures Gender-specific current smoking prevalence using the 1998–2017 Korea National Health and Nutrition Examination Survey. Results Our results showed gender-specific age and birth cohort effects. More specifically, the smoking prevalence peaked at their mid-20s (prevalence rate ratio (PRR): 1.54, 95% CI: 1.49 to 1.59) and cohort born in 1959–1963 (PRR: 1.63, 95% CI: 1.57 to 1.70) and then decreased in men. On the other hand, in women, the smoking prevalence consistently increased until their mid-40s (PRR: 1.53, 95% CI: 1.27 to 1.84) and in recent birth cohort groups (PRR in 1994–1998 cohort: 1.55, 95% CI: 1.13 to 2.13). The period effects declined from 1998−2002 to 2003–2007, following increasing fluctuations in both genders. The smoking-DPSEEA framework showed the absence of policy actions to target female smokers and emphasised a proactive approach that tackles the upstream causes for smoking in women. Conclusions Men and women are clearly in different phases of the smoking epidemic in Korean population, and gender-tailored policies should be implemented.

The risk of chronic disease and mortality may differ by metabolic health and obesity status and its transition. We investigated the risk of cardiovascular disease (CVD) and cancer incidence and mortality according to metabolic health and obesity status and their transition using the nationally representative Korea National Health and Nutrition Examination Survey (KNHANES) and the Ansan-Ansung (ASAS) cohort of the Korean Genome and Epidemiology Study. Participants that agreed to mortality linkage (n = 28,468 in KNHANES and n = 7530 adults in ASAS) were analyzed (mean follow-up: 8.2 and 17.4 years, respectively). Adults with no metabolic risk factors and BMI <25 or ≥25 kg/m² were categorized as metabolically healthy non-obese (MHN) or metabolically healthy obese (MHO), respectively. Metabolically unhealthy non-obese (MUN) and metabolically unhealthy obese (MUO) adults had ≥1 metabolic risk factor and a BMI < or ≥25 kg/m², respectively. In KNHANES participants, MUN, and MUO had higher risks for cardiovascular mortality, but not cancer mortality, compared with MHN adults. MHO had 47% and 35% lower risks of cancer mortality and all-cause mortality, respectively, compared to MHN. Similar results were observed in the ASAS participants. Compared to those persistently MHN, the risk of CVD was greater when continuously MUN or MUO. Transitioning from a metabolically healthy state to MUO also increased the risk of CVD. Few associations were found for cancer incidence. Using a nationally representative cohort and an 18-year follow-up cohort, we observed that the risk of CVD incidence and mortality and all-cause mortality, but not cancer incidence or mortality, increases with a continuous or a transition to an unhealthy metabolic status in Koreans.

Park D, et al. Clin Nutr Res. 2019 Apr;8(2):79-90. https://doi.org/10.7762/cnr.2019.8.2.79

Food literacy refers to the knowledge, skills, and attitudes required for individuals to choose foods that promote health. As the rate of diet-related diseases increases, food literacy is becoming more important. However, there are no tools available to evaluate food literacy among the Korean elderly. We derived 547 questions from a literature review and, after three rounds of Delphi surveys, selected 33 preliminary questions. We calculated the content validity ratio of the questions and applied a face validity procedure. We then selected 32 questions, assessed their validity, and distributed them as a questionnaire to 205 elderly people. We then conducted exploratory factor analysis (EFA) to determine the validity of the questionnaire and used an internal consistency index (Cronbach’s α coefficient) to determine reliability. Based on the factor analysis, 13 questions were selected, distributed among three factors, and evaluated using the Kaiser–Meyer–Olkin (KMO) and Bartlett sphericity tests. The factor analysis showed that KMO was 0.872, which is a highly acceptable score, and the Bartlett sphericity test was χ² = 1,374.69 at p = 0.00. The food literacy questionnaire developed in this study will likely be helpful for improving the healthcare of elderly people.