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Association between Health Literacy and Subgroups of Health Risk Behaviors among Chinese Adolescents in Six Cities: A Study Using Regression Mixture Modeling

Author

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  • Rong Yang

    (Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
    MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
    NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China)

  • Danlin Li

    (Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
    MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
    NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China)

  • Jie Hu

    (Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
    MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
    NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China)

  • Run Tian

    (Department of Occupational and Environmental Health, School of Public Health, Guilin Medical University, No 1 Zhiyuan Road, Guilin 541199, China)

  • Yuhui Wan

    (Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
    MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
    NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China)

  • Fangbiao Tao

    (Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
    MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
    NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China)

  • Jun Fang

    (MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
    NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China
    Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
    Faculty of Pharmaceutical Science, Sojo University, Ikeda 4-22-1, Kumamoto 860-0082, Japan)

  • Shichen Zhang

    (Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China
    MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China
    NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China)

Abstract

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.

Suggested Citation

  • Rong Yang & Danlin Li & Jie Hu & Run Tian & Yuhui Wan & Fangbiao Tao & Jun Fang & Shichen Zhang, 2019. "Association between Health Literacy and Subgroups of Health Risk Behaviors among Chinese Adolescents in Six Cities: A Study Using Regression Mixture Modeling," IJERPH, MDPI, vol. 16(19), pages 1-14, September.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:19:p:3680-:d:272271
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    References listed on IDEAS

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    1. Vermunt, Jeroen K., 2010. "Latent Class Modeling with Covariates: Two Improved Three-Step Approaches," Political Analysis, Cambridge University Press, vol. 18(4), pages 450-469.
    2. Li‐Chun Chang, 2011. "Health literacy, self‐reported status and health promoting behaviours for adolescents in Taiwan," Journal of Clinical Nursing, John Wiley & Sons, vol. 20(1‐2), pages 190-196, January.
    3. Nutbeam, Don, 2008. "The evolving concept of health literacy," Social Science & Medicine, Elsevier, vol. 67(12), pages 2072-2078, December.
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    Cited by:

    1. Xianbing Song & Danlin Li & Jie Hu & Rong Yang & Yuhui Wan & Jun Fang & Shichen Zhang, 2020. "Moderating Role of Health Literacy on the Association between Alexithymia and Depressive Symptoms in Middle School Students," IJERPH, MDPI, vol. 17(15), pages 1-9, July.
    2. Dorota Kleszczewska & Joanna Mazur & Katarzyna Porwit & Anna Kowalewska, 2022. "Who Is Able to Resist What Is Forbidden?—The Relationship between Health Literacy and Risk Behaviours in Secondary School Students in the Broader Social and Educational Context," IJERPH, MDPI, vol. 19(15), pages 1-16, July.
    3. Bingdong Song & Weirong Hu & Wanxia Hu & Rong Yang & Danlin Li & Chunyu Guo & Zhengmei Xia & Jie Hu & Fangbiao Tao & Jun Fang & Shichen Zhang, 2020. "Physical Disorders are Associated with Health Risk Behaviors in Chinese Adolescents: A Latent Class Analysis," IJERPH, MDPI, vol. 17(6), pages 1-14, March.

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