Emolabeling increases healthy food choices among grade school children in a structured grocery aisle setting.

Health literacy, the ability to acquire health-related knowledge and make appropriate health-related decisions, is regarded as a key barrier to meaningfully convey health information to children and can impact food choice. Emolabeling is an image-based labeling strategy aimed at addressing this problem by conveying health information using emotional correlates of health using emoticons (happy = healthy; sad = not healthy). To test the utility of such a method to promote healthy food choices among children, 64 children (59% girls, <5% non-White, mean BMI = 52nd percentile) in kindergarten through 5th grade were first given a brief 5-min lesson on how to use the emoticons, then asked to choose any 4 foods in each of 2 aisles structured to mimic a grocery aisle - there were 12 identical foods placed in the same location in each aisle with half being low calorie and half high calorie snacks. Foods were emolabeled in one aisle; no emolabels were used in the other aisle; the order that children were brought in each aisle was counterbalanced. Results showed that adding emolabels increased the number (M ± SD) of healthy foods chosen (3.6 ± 0.7 with vs. 2.3 ± 1.1 without emolabels present [95% CI 1.0, 1.5], R(2) = .67) and reduced the total calories (M ± SD) of foods chosen (193.5 ± 88.5 Cal with vs. 374.3 ± 152.6 Cal without emolabels present [95% CI -212.6, -149.0], R(2) = .70). Hence, adding emolabels was associated with healthier food choices among children, thereby demonstrating one possible strategy to effectively overcome health literacy barriers at these ages.