Status and determinants of health literacy among adolescents in Guangdong, China.

BACKGROUND: Previous studies for non-communicable disease cotrol, including cancer, have mostly relied on health literacy in adults. However, limited studies are available for adolescents. This study aimed to assess the status and determinants of health literacy in in-school adolescents in Guangdong, China. MATERIALS AND METHODS: A total of 3,821 students aged 13-25 years were selected by multi-stage cluster sampling. After the questionnaire of health literacy was answered, the total scores for health knowledge (18 questions), skills (5 questions) and behaviors (14 questions) were determined. The total scores for health literacy and each subscale were recoded into adequate and inadequate subgroups, and logistic regression models were used to identify factors associated with each outcome variable. RESULTS: The prevalence of adequate health literacy was 14.4%, and the prevalences for adequate knowledge, skills and behavior were 22.4%, 64.7% and 6.6%, respectively. Students coming from prestigious schools and having parents with higher education had higher odds of having adequate knowledge, skills and behaviors. Female students had higher odds of having adequate knowledge and behaviors. Students in grade 7-8 had higher odds of having adequate knowledge and skills. The health knowledge was positive associated with health skills (odds ratio [OR]=2.1, 95% confidence interval [CI] 1.7-2.5) and behaviors (OR=3.0, 95% CI 2.3-4.0), and health skills were positive associated with health behaviors (OR=2.6, 95% CI 1.8-3.8). CONCLUSIONS: Further efforts should be made to increase adolescents' health knowledge and behaviors, especially for low grade and male students in non-prestigious schools.

[Using log-binomial model for estimating the prevalence ratio].

To estimate the prevalence ratios, using a log-binomial model with or without continuous covariates. Prevalence ratios for individuals' attitude towards smoking-ban legislation associated with smoking status, estimated by using a log-binomial model were compared with odds ratios estimated by logistic regression model. In the log-binomial modeling, maximum likelihood method was used when there were no continuous covariates and COPY approach was used if the model did not converge, for example due to the existence of continuous covariates. We examined the association between individuals' attitude towards smoking-ban legislation and smoking status in men and women. Prevalence ratio and odds ratio estimation provided similar results for the association in women since smoking was not common. In men however, the odds ratio estimates were markedly larger than the prevalence ratios due to a higher prevalence of outcome. The log-binomial model did not converge when age was included as a continuous covariate and COPY method was used to deal with the situation. All analysis was performed by SAS. Prevalence ratio seemed to better measure the association than odds ratio when prevalence is high. SAS programs were provided to calculate the prevalence ratios with or without continuous covariates in the log-binomial regression analysis.