Meta-analysis of the association between health literacy and smoking

Abstract

INTRODUCTION Numerous studies have reported associations between health literacy and smoking-related behaviors or issues. However, no literature review has been conducted to synthesize these associations. Therefore, this review aimed to assess the associations between health literacy and smoking-related behaviors or issues. METHODS We searched published literature in four electronic databases (PubMed, CINAHL Plus, Scopus, and Web of Science) from inception to 22 February 2021. The search was limited to articles written in English and published in scientific journals. The reference lists of identified articles and Google Scholar were also manually searched. The extracted data regarding the association between health literacy and smoking was subjected to meta-analysis using Review Manager software (Review Manager, version 5.4.1). The results of the meta-analysis are reported as a weighted odds ratios (ORs) with 95% confidence interval (CI). Heterogeneity and publication bias were assessed using the Cochrane chi-squared test and I 2 value, and the funnel plot, respectively. RESULTS The initial database search yielded 1266 articles. Fourteen additional articles were obtained through a manual search. Finally, 66 articles were included in the analysis. The meta-analysis showed that 22 studies had a pooled OR (95% CI) for smoker of 1.49 (95% CI: 1.25-1.79) in the inadequate health literacy group, compared with the adequate health literacy group. There was a high heterogeneity (p<0.001, I 2 =80%). The visual inspection of the funnel plot showed evidence of publication bias. Moreover, previous studies reported that inadequate health literacy was significantly positively associated with a high possibility of current smoking compared with former smoking in those that had ever smoked and smoking relapse, and a low possibility of smoking cessation. CONCLUSIONS Improving health literacy may be useful to prevent smoking, promote smoking cessation, and avoid smoking relapse.

Investigation of the relationship of general and digital health literacy with various health-related outcomes

“…These results may be explained by the fact that HL is not a strong determinant of addictive behaviours, or in other words, the addictive effect of these substances has more influence on lifestyle factors than the level of health literacy. According to a recent meta-analysis, the odds of smoking are higher among those with inadequate HL, but this association was also dependent on the HL questionnaire used ( 28 ); therefore, the results are not consistent. There was no association between physical activity and GHL or DHL.…”

Assessing the Impact of a Health Education Anti-Smoking Program for Students: A Follow-Up Investigation

“…Certainly, targeted education has been shown to enhance individual awareness and proficiency [55]. There is some evidence that improving health literacy through health education can be advantageous in preventing smoking, aiding in smoking cessation, and preventing smoking relapse, along with addressing associated behaviors and issues [56]. However, a mere increase in knowledge does not necessarily translate to behavior change [57], although Sorensen et al [58] have found that an increase in knowledge aids in fostering positive attitudes towards abstaining from smoking.…”

Medication Adherence and Contraceptive Counseling

“…Being a smoker proved to double the likelihood of poor adherence, which should be noted, taking into account#, moreover, that the prescription of COCs to female smokers aged over 35 years would be discouraged, according to the medical eligibility criteria of the World Health Organization on the use of contraceptives [27]. Additionally, several studies warn that smoking is significantly and negatively associated with health-related quality of life, that smokers are less likely to adhere to their medication, that smokers demonstrate less adherence to protective behaviors, that smoking is linked to inadequate health literacy, and that smokers are less compliant with recommended preventive care and medication use [28][29][30][31][32].…”