Self-efficacy is purported to be an important predictor of health
promoting behavior [59–63], and we in this study thought eating
self-efficacy would be related to both BMI and health literacy.
Eating self-efficacy was measured using a modified 15-item
version of the Eating Self-Efficacy Scale (ESES) questionnaire
[64], previously validated by McCann et al. [65]. To improve the
measure’s literacy level and ease of use, we modified the Likert
scale from 9 points to 7 points (1 = highest self-efficacy) and
simplified the vocabulary in the instructions and some questions;
we piloted the revised questionnaire with children in the health
center waiting room. The final instrument was written at a middle
3rd grade reading level (Flesh–Kincaid readability [66]). The parent
and child questionnaires mirrored each other and subjects were
assisted with reading and responding to the questions. Questions
included items such as ‘‘how hard is it to stop eating too much
. . .after work (school); when you feel upset, when you are with
friends or family’’, etc.
To adjust for parental health literacy, we administered the
STOFHLA, described above, to all parents in their preferred
language (English or Spanish). Parental weight and height were
also measured in the same manner as described for children.
Height was entered into the Tanita Analyzer to return a calculated
BMI for each parent. Finally, we recorded child age, gender,
ethnicity, and grade in school as potential confounders of both BMI
Z-score and health literacy skill. We used insurance status
(Medicaid/Private/CHP) and parental education as proxies for
socioeconomic status.