Consumer Understanding of Calorie Labeling: A Healthy Monday E-Mail and Text Message Intervention

Objective. To assess caloric knowledge of participants and determine if an e-mail and/or text message intervention could increase knowledge of recommended daily caloric intake. Design. Randomized, control trial. Setting. Johns Hopkins Hospital Cobblestone Café. Participants. The 246 participants reported eating at the Café at least twice/week. Intervention(s). Participants randomized to control, e-mail, or text condition. The text and e-mail conditions received a message on four consecutive Mondays stating the recommended daily caloric intake. Main outcome measures. Knowledge of the government reference value of 2,000 calories. Analysis. Intention-to-treat analysis was conducted. Multivariate logistic regression examined the effectiveness of text and e-mail messaging for improving knowledge of the government calorie reference value. Results. Baseline awareness of the daily calorie reference value in study population was low. Participants in the text message condition were twice as likely to know the government calorie reference value compared to controls (p =.047, odds ratio = 2.2, 95% confidence interval [1.01, 4.73]). No significant differences were found for the e-mail condition (p =.5). Conclusions and implications. Many people do not know the daily recommended caloric intake. Public education on the government calorie reference value is necessary for menu-labeling interventions to be more effective. Weekly text messaging can serve as an effective modality for delivering calorie information and nutrition education.