Background Internet addiction has emerged as a major global concern as a potential adverse impact of internet exposure on adolescents. Internet addiction is associated with many demographic variables; however, there is a lack of consensus on its relationship with health literacy. Therefore, the aim of the present study was to assess the rates of internet addiction and health literacy level among middle school students (grades 7 to 12) in Chongqing, China, as well as to investigate the association between them. Methods A cross-sectional, questionnaire-based study was conducted among 8971 students who were randomly selected by using stratified cluster sampling between November and December 2019. The Internet Addiction Diagnostic Questionnaire, Adolescent Health Literacy Scale and a self-designed basic information questionnaire were used to collect data. Chi-square tests were performed to compare the differences in the distribution of internet addiction across health literacy levels as well as some sociodemographic characteristics. Multivariate logistic regression analyses were conducted to identify the association between health literacy and internet addiction. Results The prevalence of internet addiction among middle school students in Chongqing was 6.1%. The percentage of the students who spent more than 4 hours online every day in the past week was 14.3%. In addition, 26.7%, 26.0%, 28.3% and 26.3% of the participants reported low functional, interactive, critical and total health literacy, respectively. After adjusting for the confounding effects of demographics, multivariate regression analysis showed that critical health literacy was a protective variable for internet addiction, while functional, and interactive health literacy were the risk variable (P<0.05). Furthermore, the internet addiction rates were higher among boys, students with good peer relationships, and students without parental supervision, whereas internet addiction rates were lowest among students in grade 12. Conclusions The prevalence of internet addiction among middle school students in Chongqing is relatively high. Internet addiction is strongly negatively associated with critical health literacy, but it is positively associated with functional and interactive health literacy but not total health literacy. This study provides preliminary evidence for the predictive role of health literacy in internet addiction of adolescents.
Adolescents are prone to multiple health risk behaviors. These might lead to insufficient sleep, which is inconducive to adolescent growth. Therefore, this study explored the impact of a cluster of adolescent health risk behaviors on sleep time, providing a reference for designing relevant intervention measures. From November to December 2019, a stratified cluster sampling method was used to sample middle and high schools in 4 functional districts of Chongqing, China. A total of 8546 participants were selected for a questionnaire survey. Two-step clustering helped identify the health risk behavior clusters. Multivariate logistic regression models helped examine the association between the different clusters and sleep time. The rate of insufficient sleep was 65.8%. Three types of clusters were identified, namely (1) high-risk (poor) cluster (17.3%), (2) low physical activity (medium) cluster (55.1%), and (3) low-risk (good) cluster (27.6%). The high-risk and low physical activity clusters showed that the adjusted OR values of 1.471 (1.266-1.710) and 1.174 (1.052-1.310) were significantly associated with insufficient sleep ( P < .001). Adolescent health risk behaviors were clustered, and different clusters had different sleep time. Schools authorities and healthcare practitioners should formulate effective intervention measures according to the characteristics of different clusters to promote healthy growth among adolescents.
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