Low Health Literacy Is Associated With Energy‐Balance‐Related Behaviors, Quality of Life, and BMI Among Rural Appalachian Middle School Students: A Cross‐Sectional Study

Abstract

BACKGROUND: Many studies document associations between low health literacy (HL) and poor health behaviors and outcomes. Yet, HL is understudied among adolescents, particularly from underserved, rural communities. We targeted rural adolescents in this cross-sectional study and explored relationships between HL and (1) energy-balance-related health behaviors and (2) body mass index (BMI) and quality of life (QOL). METHODS:Surveys were administered to 7th graders across 8 middle schools in rural Appalachia. HL was assessed using the Newest Vital Sign. Energy-balance-related behaviors and QOL were assessed using validated instruments. Height and weight were objectively measured. Analyses were conducted using the Hodges-Lehmann nonparametric median difference test. RESULTS:Of the 854 adolescent students (mean age = 12; 55% female), 47% had limited HL. Relative to students with higher HL, students with lower HL reported significantly lower frequency of health-promoting behaviors (water, fruit and vegetable intake, physical activity, sleep), higher frequency of risky health behaviors (sugar-sweetened beverages, junk food, screen time), and had higher BMI percentiles and lower QOL (all p < .05). CONCLUSIONS:Low HL is associated with energy-balance-related behaviors, BMI, and QOL among rural, Appalachian adolescents. Findings underscore the relevance of HL among rural middle school students and highlight implications for school health.

The relationship between health literacy and health-related quality of life among school-aged children in regional China

“…The findings among students from our study were consistent with that have been documented in adults [ 21 ]. Moreover, although very few studies regarding HL-HRQoL association were available from children and adolescents worldwide, such a positive HL-HRQoL relationship observed in our study was also in line with that reported among children and adolescents in similar studies from Virginia of USA [ 22 ], Belo Horizonte city of Brazil [ 23 ] and Chongqing city of China [ 24 ]. However, the age-groups of participants were different between our study and the three mentioned above [ 22 – 24 ].…”

“…Moreover, although very few studies regarding HL-HRQoL association were available from children and adolescents worldwide, such a positive HL-HRQoL relationship observed in our study was also in line with that reported among children and adolescents in similar studies from Virginia of USA [ 22 ], Belo Horizonte city of Brazil [ 23 ] and Chongqing city of China [ 24 ]. However, the age-groups of participants were different between our study and the three mentioned above [ 22 – 24 ]. Participants were students aged 11–13 years in the Virginia study [ 22 ], 15–19 years in the Belo Horizonte study [ 23 ] and 12–15 years in the Chongqing study [ 24 ], while participant’s age ranged widely from 9 to 17 years in our study.…”

“…However, the age-groups of participants were different between our study and the three mentioned above [ 22 – 24 ]. Participants were students aged 11–13 years in the Virginia study [ 22 ], 15–19 years in the Belo Horizonte study [ 23 ] and 12–15 years in the Chongqing study [ 24 ], while participant’s age ranged widely from 9 to 17 years in our study. Furthermore, the instruments used to assess either HL or HRQoL were different, but the consistent findings were observed in the three studies and ours [ 22 – 24 ].…”

“…Four domains, mainly including health-related knowledge, belief, skills and behaviors, are usually integrated into a scale to assess personal HL level among both adult and adolescent population worldwide [ 16 – 20 ]. HL was identified to be positively associated with HRQoL within adults [ 21 ] and school-aged children and adolescents [ 22 – 24 ]. Among these very few available studies on the relationship between HL and HRQoL among school students, participants were limited to those students with a narrow range of age-groups (11–13, 15–19 or 12–15 years old) and thus the separate results could not be extrapolated to general population of children and adolescents [ 22 – 24 ].…”

Health Literacy and Health Behavior: Associated Factors in Surabaya High School Students, Indonesia

“…Health literacy (HL) is recognized widely as a strong factor for the health outcome and HBs in adolescence [33][34][35][36][37][38]. WHO defined HL as a person's capacity to obtain and comprehend health information and services, as well as to use this information to make better health decisions [39].…”