title: Readability and Content Characteristics of Powdered Infant Formula Instructions in the United States.
abstract: OBJECTIVE
  This study aimed to assess readability characteristics and layout features, including reading grade level, text point size, dimensions (length and width), diagrams, key directions (warnings, proper hygiene, preparation and use, and storage), and compliance to International Code provisions of English-language instructions affixed to a representative sample of brand-name and generic powdered, infant formula containers currently available for purchase in the US.
  
  
  METHODS
  During June 2014, comprehensive Internet searches were conducted to identify brand-name powdered infant formulas currently available for purchase in the US (n = 10). The English-language instruction section affixed to each formula container was evaluated for readability characteristics and layout features, including reading grade level, text point size, dimensions (length and width), diagrams, key directions (warnings, proper hygiene, preparation and use, and storage), and compliance to International Code.
  
  
  RESULTS
  Overall, containers were similar in circumference (50.8 ± 7.3 cm) and height (14.0 ± 0.0 cm) and held an average of 656.0 ± 12.3 g (range 629-663 g) of powdered infant formula. Both Directions for Preparation and Use and Storage Instructions sections had average reading difficulty scores at the college level. Step-by-Step Preparation Directions and Warnings and Safe Handling sections had reading difficulty between the 8th and 9th grade level. All container labels contained three diagrams depicting step-by-step preparation instructions and a feeding chart. Overall, infant formula containers reviewed in our study adhered to compliance to International Code provisions.
  
  
  CONCLUSIONS
  As negative health outcomes are associated with inappropriately prepared infant formula feedings, healthcare providers should routinely query infant caregivers regarding their formula preparation and administration practices.
authors.affiliation: AHEC Clear Health Communication Program, The Ohio State University College of Medicine, Columbus, OH, 43210, USA. Lorraine.Wallace@osumc.edu.
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
authors.affiliation: Whitehall Primary Care Center, Nationwide Children's Hospital, Columbus, OH, 43213, USA.
authors.forename: Patricia Fine
authors.initials: PF
authors.lastname: Rosenstein
authors.affiliation: AHEC Clear Health Communication Program, The Ohio State University College of Medicine, Columbus, OH, 43210, USA.
authors.forename: Noga
authors.initials: N
authors.lastname: Gal
mesh_terms: D000328:Adult; D032882:Comprehension; D005260:Female; D057220:Health Literacy; D006801:Humans; D007223:Infant; D041943:Infant Formula; D008297:Male; D010353:Patient Education as Topic / Q000379:methods; D011932:Reading; D014481:United States
keywords: Health literacy; Infant formula; Patient education; Readability; The International Code