Adolescents engage in health risk behaviors (HRBs) that influence their current and future health status. Health literacy (HL) is defined as how well a person can get and understand the health information and services, and use them to make good health decisions. HL can be used to participate in everyday activities actively and apply new information to the changing circumstances. HRBs commonly co-occur in adolescence, and few researchers have examined how HL predicts multiple HRBs in adolescence. In this study we examined the subgroups of HRBs, and investigated heterogeneity in the effects of HL on the subgroups. In total, 22,628 middle school students (10,990 males and 11,638 females) in six cities were enrolled by multistage stratified cluster sampling from November 2015 to January 2016. The measurement of HL was based on the Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ). Analyses were conducted with regression mixture modeling approach (RMM) by Mplus. By this study we found four latent classes among Chinese adolescents: Low-risk class, moderate-risk class 1 (smoking/alcohol use (AU)/screen time (ST)), moderate-risk class 2 (non-suicidal self-injury (NSSI)/suicidal behaviors (SB)/unintentional injury (UI)), and high-risk class (smoking/AU/ST/NSSI/SB/UI) which were 64.0%, 4.5%, 28.8% and 2.7% of involved students, respectively. Negative correlations were found between HL and HRBs: higher HL accompanied decreased HBRs. Compared to the low-risk class, moderate-risk class 1 (smoking/AU/ST), moderate-risk class 2 (NSSI/SB/UI), and high-risk class (smoking/AU/ST/NSSI/SB/UI) showed OR (95%CI) values of 0.990 (0.982–0.998), 0.981 (0.979–0.983) and 0.965 (0.959–0.970), respectively. Moreover, there was heterogeneity in the profiles of HRBs and HL in different classes. It is important for practitioners to examine HRBs in multiple domains concurrently rather than individually in isolation. Interventions and research should not only target adolescents engaging in high levels of risky behavior but also adolescents who are engaging in lower levels of risky behavior.
Objectives The aim of this study was to examine the association between health literacy (HL) and sleep problems with mental health of Chinese students in combined junior and senior high school. Methods A cross-sectional study was conducted among seven hundred and seventy-five students from a combined junior and senior high school in Shenyang on December 16, 2016. HL, sleep problems, anxiety symptoms and depressive symptoms were measured by self-reported validated instruments. Multiple logistic regression models were used to examine the association of HL and sleep problems with mental health problems. Results The prevalence of anxiety symptoms and depressive symptoms was 24.6% and 45.2%, respectively. Low HL was significantly associated with anxiety symptoms ( OR = 2.457, 95%CI : 1.493–4.045) and depressive symptoms ( OR = 5.164, 95%CI : 3.233–8.250). Sleep problems were significantly positively correlated with anxiety symptoms ( OR = 4.237, 95%CI : 2.831–6.341) and depressive symptoms ( OR = 3.170, 95%CI : 2.084–4.823). The students who had sleep problems with low HL had the highest risks of anxiety symptoms ( OR = 11.440, 95%CI : 5.564–23.520) and depressive symptoms ( OR = 19.470, 95%CI : 8.143–46.558). Conclusion Our findings suggest that Chinese students in combined junior and senior high school who had sleep problems with low HL are at risk of exhibiting anxiety symptoms and depressive symptoms. Intervention programs of mental health problems should enhance HL level and improve sleep quality.
Non-suicidal self-injury (NSSI) is prevalent among adolescents. Low health literacy (HL) and problematic mobile phone use (PMPU) are risk factors of NSSI. But so far, no study has examined the interactive role of HL and PMPU on NSSI. In this context, the present study aimed to examine the interactions of HL and PMPU and their impact on NSSI in a school-based sample of Chinese adolescents. A total of 22,628 junior and high school students (10,990 males and 11,638 females) were enrolled in this study. The outcomes were self-reported HL, PMPU and NSSI. Analyses were conducted with chi-square tests and logistic regression models. The prevalence of NSSI was 32.1%. Low HL and PMPU were significantly associated with NSSI independently (ORlow HL = 1.886, 95% CI = 1.723–2.065, ORPMPU = 2.062, 95% CI = 1.934–2.199). Interaction analysis indicated that low HL and PMPU were interactively associated with increased risks of NSSI (OR = 2.617, 95% CI = 2.375–2.884). In all, our findings indicate that HL and PMPU are associated with NSSI independently and interactively. The intervention programs of NSSI should consider the adolescents HL levels and PMPU.
Psychological symptoms are common among adolescents in China, which are associated with various negative consequences. There has been a pressing need for additional research of factors responsible for the occurrence of psychological symptoms during this developmental period, among which childhood maltreatment, personal coping style, one’s levels of social support, and self-esteem deserve our attention. The association between childhood maltreatment and psychological symptoms is evident; however, the possible mediating effect of the other three factors mentioned above remains unclear. Hence, the current study aims to investigate the possible mediating roles of social support, coping style, and self-esteem in the relationship between childhood maltreatment and the development of psychological symptoms among adolescents. An adolescent-based health survey was conducted between 2013 and 2014 in 15 schools in China. A total of 9,704 students (aged 11–19 years) were enrolled and measures on childhood maltreatment, social support, coping styles, self-esteem, and psychological symptoms were completed. It was found that childhood maltreatment was positively correlated with psychological symptoms and negative coping styles, and negatively correlated with social support, positive coping styles, and self-esteem ( p < .001). Social support, coping styles, and self-esteem mediated the relationship between childhood maltreatment and psychological symptoms. The estimated effect of childhood maltreatment on the occurrence of psychological symptoms could be explained by the mediation of social support, positive coping styles, negative coping styles, and self-esteem, whose ratio of roles came to 13.8%, 7.5%, 20.9%, and 10.3%, respectively. These findings indicate a need to promote social support, self-esteem, and positive coping styles, and decrease the level of negative coping styles, to markedly reduce the impact of psychological symptoms of childhood maltreatment among adolescents.
Background Lower health literacy (HL) has been known to be involved in a range of common mental and physical disorders among adolescent students. Ample studies indicated low HL is associated with a series of chronic diseases even psychological diseases, nevertheless, little is known about this relationship among adolescents. In this context, the study aimed to examine associations between psychosomatic symptoms (physical and psychological symptoms) and HL in junior and senior high school students in China, and to provide guidance for improving the physical and mental health in Chinese adolescents. Methods A total of 22,628 junior and high school students in China were enrolled in this study. HL and psychosomatic symptoms were measured by self-report validated questionnaires. Multiple linear regression analyses were conducted to examine the associations between six sub-scales of HL and physical / psychological symptoms. Results Multiple linear regression analysis demonstrated that the sub-scales of HL showed a significantly negative association with physical symptoms and psychological symptoms (P < 0.05 for each). Physical symptoms was most strongly associated with IR (β = − 0.134), followed by SM (β = − 0.093), DB (β = − 0.059), SA (β = − 0.058) and PA (β = − 0.054). No statistically significant difference was found between HA and physical symptoms (P > 0.05). Meanwhile, psychological symptoms were most strongly associated with IR (β = − 0.160), followed by SA (β = − 0.129), SM (β = − 0.069), DB (β = − 0.031), HA (β = − 0.026) and PA (β = − 0.021). Conclusion These results indicated the importance of identifying the association of HL with physical and psychological symptoms, and provided the evidence that lower HL may serve as a critical and independent risk factor for poor health outcomes. Meanwhile, to maintain students’ desirable healthy status public health efforts for enhancing their HL level are urgently needed in adolescents.
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