The Relationship Between a Healthy People 2030 Health Literacy-Related Objective (HC/HIT02) and Cancer Prevention and Screening Behaviors.

Healthy People 2030 highlights the importance of both personal and organizational health literacy (HL) to improving population health. Yet, most research focuses on personal-level HL or fails to study the effect of both types of HL on health behavior. This study explored the relationships between organizational HL (Healthy People 2030 objective: decrease the proportion of adults who report poor communication with their health care provider), personal-level HL, and cancer prevention and screening behaviors. Data were collected using Qualtrics Panel. Participants who indicated they had a non-emergency room provider visit in the last 12 months were included in the analyses. Participants (n=549, Mean age = 41.44 years, SD = 15.91; 51.9% female; 54.3% White, 28.8% Hispanic/Latino/a/x) completed measures of personal and organizational HL and reported on their cancer prevention (e.g., cigarette smoking) and screening (e.g., mammogram) behaviors. Hierarchical linear and logistic regressions predicting cancer prevention and screening behaviors, respectively, from organizational HL, personal HL, and demographic covariates, were estimated. Regarding the results, higher organizational HL was related to higher fruit and vegetables consumption and physical activity after accounting for personal-level HL and demographic covariates. Higher personal-level HL was related to lower physical activity, binge-drinking, and cigarette smoking, and higher odds of pap smear screening, prostate-specific antigen testing, and completing all eligible screenings after accounting for organizational-level HL and demographic covariates. The findings support that personal-level and organizational HL may be differentially important to improving cancer prevention and screening behaviors. Policies that address improving both personal-level and organizational-level HL are needed.

Health literacy and adolescents' substance use behaviors and correlates: a scoping review.

From 2011 to 2023, substance use increased by 23% worldwide. Given that substance use initiation is highest during adolescence, it is crucial to identify amenable correlates of substance use prevention [e.g. health literacy (HL)], which, if embedded in interventions, may improve uptake and outcomes. Hence, this study conducted a scoping review to answer the question: What is known from the existing literature about the relationship between HL and substance use correlates and behaviors in adolescents? Five electronic databases and the bibliography of review articles were searched and a total of 1770 records were identified. After removing duplicates and engaging in three levels of screening to identify studies that included adolescents ≤ 25 years old and assessed the relationship between general HL (vs. behavior/disease-specific health knowledge) and substance use behaviors and correlates, 16 studies were retained. Studies assessed alcohol-related (n = 11), tobacco-related (n = 12), electronic vapor product use-related (n = 4), cannabis-related (n = 1), and amphetamines/methamphetamines-related (n = 1) outcomes. Studies spanned Africa, Asia, Europe, and North and Central America. Most studies included substance use as an outcome and found an inverse relationship between HL and use. Few studies examined substance use correlates (e.g. risk perception). There were no longitudinal or intervention studies. This review highlighted that the topic of adolescent HL and its relationship with substance use remains inadequately researched. Notable gaps for future studies include intervention and longitudinal designs, expansion of outcomes (e.g. more studies on marijuana, prescription drug misuse, vaping, substance use-related correlates), and examining HL as a mediator or moderator of substance use and its correlates.

Examining provider anticipatory guidance for adolescents' preventive health: A latent class approach.

BACKGROUND: Low rates of anticipatory guidance (AG) are reported across studies with adolescents, and little is known about how these conversations differ across early versus middle adolescence. This study explored adolescent-provider AG conversations for preventive health skills; the study objectives were to (1) identify patterns of provider-adolescent AG conversations across early and middle adolescence and (2) determine socio-demographic characteristics associated with these AG conversations. DESIGN AND METHOD: Data from the 2019 National Survey of Children's Health were used to identify patterns of provider-adolescent AG conversations. The sample included 5500 early and 6730 middle adolescents (Mage = 14.67 years old, SD = 1.71, 51.7% boys, 79% White). Multiple group latent class analysis and multinomial regressions were estimated using four indicators of AG conversations (i.e., skills to manage health and healthcare, changes in healthcare that happen at 18, making positive choices about health, and receiving a medical history summary). RESULTS: Three types of AG conversations were identified: high AG, low AG, and parent unaware. Among early and middle adolescents, adolescents that were older, girls, had private health insurance, and a personal provider were less likely to receive high AG compared to other types of AG. CONCLUSIONS: Policies and strategies to engage adolescents in AG conversations during and outside of the medical appointment are needed. PRACTICE IMPLICATIONS: Tools, such as brief screeners, can be used to ensure all adolescents are receiving high AG. School-based health centers, community centers and organizations, and telehealth appointments with medical professionals may be additional opportunities for adolescents to receive AG.

The relationship between health literacy and correlates of adolescents' obesogenic and substance use behaviors.

PURPOSE: Risk perception (RP) and self-efficacy are targeted in adolescent health behavior interventions, however these variables have not been explored in relation to health literacy (HL). HL may affect how adolescents assess, prioritize, and integrate information when forming RP and self-efficacy and, ultimately, their health behaviors. This study assessed the relationship between functional, interactive, and critical HL and adolescents' behavior-specific RP and self-efficacy and health behaviors. DESIGN AND METHODS: Cross-sectional data were collected from 380 adolescents attending high school via an online survey. Survey measures included demographics, functional, interactive, and critical HL, and substance use and obesogenic behavior-related beliefs, attitudes, and behaviors. Pearson correlations and regressions were estimated. RESULTS: The relationship between HL and RP, self-efficacy, and behaviors varied by behavior and HL type. Critical HL was related to obesogenic-specific RP and behaviors, while interactive and critical HL were related to self-efficacy. Interactive and critical HL were related to substance use-specific RP and self-efficacy while functional and interactive HL were related to substance use behaviors. HL moderated several RP/behavior and self-efficacy/behavior relationships. CONCLUSIONS: The significant relationships between HL and RP and self-efficacy highlight how HL may be an underlying factor or help shape adolescents' perceptions and beliefs adolescents have about behaviors and themselves, which ultimately influence their behaviors. PRACTICAL IMPLICATIONS: Adolescent interventions should be assessed to determine what underlying HL skills are needed for behavior change and assess and address HL directly as adolescents with low HL may be at a disadvantage for intervention uptake and outcomes.

Missed routine pediatric care and vaccinations in US children during the first year of the COVID-19 pandemic.

The COVID-19 pandemic has decreased uptake of pediatric preventive care, including immunizations. We estimate the prevalence of missed pediatric routine medical visits and vaccinations over the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey of 2074 US parents of children ≤12 years in March 2021 to measure the proportion of children who missed pediatric care and vaccinations over the first 12 months of the COVID-19 pandemic. Poisson regression models were fitted to estimate adjusted prevalence ratios (aPR). All analyses were weighted to represent the target population. Overall, 41.3% (95%CI 38.3-43.8) of parents reported their youngest child missed a routine medical visit due to the COVID-19 pandemic. Missed care was more common among children ≥2 years compared to <2 years (aPR 1.82; 95%CI 1.47-2.26) and Hispanics compared to non-Hispanic Whites (aPR 1.31; 95%CI 1.14-1.51). A third of parents (33.1%; 95%CI 30.7-35.5) reported their child had missed a vaccination. Compared to the 2019-20 flu season, pediatric influenza vaccination decreased in 2020-21 (51.3% vs. 62.2%; p < 0.0001). A high proportion of US children ≤12 years missed routine pediatric care during the COVID-19 pandemic. Catch-up efforts are needed to ensure continuity of preventive care for all children.

Development and validation of assessments of adolescent health literacy: a Rasch measurement model approach.

BACKGROUND: Health literacy (HL) is implicated in improved health decision-making and health promotion, and reduced racial, ethnic, and socioeconomic health disparities. Three major areas of HL include functional, interactive, and critical HL. HL skills develop throughout the lifespan as individuals' psychosocial and cognitive capacities develop and as they accumulate experiences with navigating health systems. Though adolescence is marked by increased involvement in health decision-making, most HL studies and measures of HL have focused on adults. Both the adult and adolescent HL literature are also limited by the paucity of validated test-based measures for assessing HL. The existing test-based validated HL measures for adolescents were originally designed for adults. However, adolescents are at an earlier phase of developing their HL skills (e.g., fewer experiences navigating the health system) compared to adults and measures originally designed for adults may assume prior knowledge that adolescents may lack therein underestimating adolescents' HL. This study developed and validated test-based assessments of adolescents' functional, interactive, and critical HL. METHODS: Items were generated in an iterative process: focus groups with adolescents informed item content, cognitive interviews with adolescents and expert consultation established content and face validity of the initial items, and items were revised or removed where indicated. High school students (n = 355) completed a measurement battery including the revised HL items. The items were evaluated and validated using Rasch measurement models. RESULTS: The final 6-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (23 items) fit their respective Rasch models. Item-level invariance was established for gender (male vs. female), age (12-15-year-olds vs. 16-18-year-olds), and ethnicity in all assessments. The assessments had good convergent validity with an established measure of functional HL and scores on the assessments were positively related to reading instructions before taking medicine and questioning the truthfulness of health information found online. CONCLUSIONS: These assessments are the first test-based measures of adolescents' interactive and critical HL, the first test-based measure of functional HL designed for adolescents, and the first composite test-based assessment of all three major areas of HL. These assessments should be used to inform strategies for improving adolescents' HL, decision-making, and behaviors.

Plans to Vaccinate Children for Coronavirus Disease 2019: A Survey of United States Parents.

In a national survey of 2074 US parents of children ≤12 years of age conducted in March 2021, 49.4% reported plans to vaccinate their child for coronavirus disease 2019 when available. Lower income and less education were associated with greater parental vaccine hesitancy/resistance; safety and lack of need were primary reasons for vaccine hesitancy/resistance.

Applying the information-motivation-behavioral skills model to explain adolescents' fruits and vegetables consumption.

Inadequate fruits and vegetables consumption in adolescence increases adolescents' current and future chronic disease risk and is predictive of inadequate consumption in adulthood. Given that adolescents' engagement in dietary behaviors is complicated by intrapersonal, interpersonal, and environmental factors, a health behavior model of change incorporating all of these factors is most appropriate to inform research and intervention efforts. Yet, common preventive health behavior models used to explain adolescents' dietary behaviors do not adequately account for these factors. The current study explored the utility of a comprehensive, predictive model, that is the Information-Motivation-Behavioral Skills (IMB) model, for explaining adolescents' fruits and vegetables consumption in a cross-sectional national sample. Study hypotheses included (1) health information and motivation for fruits and vegetables would directly be related to fruits and vegetables consumption; and (2) the relationship between fruits and vegetables consumption and health information and motivation would be mediated by behavioral skills for consumption. Data from the adolescent diet-related surveys of the Family Life, Activity, Sun, Health, and Eating (FLASHE) study (N = 1646) were used. Structural equation modeling was used to test study hypotheses. Fruits and vegetables-related information and motivation were positively related to adolescents' fruits and vegetables consumption. For information and personal motivation (specifically fruits and vegetables preferences), the relationship with fruits and vegetables consumption was partially mediated through behavioral skills. These preliminary findings support the utility of the IMB model to explain adolescents' fruits and vegetables consumption.

Trends in Health Behavior Patterns Among U.S. Adults, 2003-2015.

Background: Over the last two decades, considerable resources from U.S. federal and philanthropic entities were dedicated to improving preventive and reducing chronic disease risk behaviors. Purpose: Given the population health efforts to improve health behaviors in adults, this study explored how health behavior patterns shifted over the years by exploring multiple health behavior patterns. Methods: Data were obtained from the odd years between 2002 and 2016 Behavioral Risk Factor Surveillance System. Latent class analyses including fruit and vegetables, physical activity, cigarette smoking, and heavy and binge drinking were conducted for each year. Results: Three-class models best fit the data and were most interpretable. Each year included Healthy or Physically Active (preventive behaviors, no risk behaviors), Apathetic (no preventive/risk behaviors), and Binge-drinking groups. Gender and age consistently distinguished the Healthy/Physically Active groups from the Apathetic and Binge-drinking groups across the years. Conclusions: This study confirms health behavior clusters exist and have been stable across time. This is encouraging as trends have not gotten worse, but there is room for improvement. Repetition of the groups across years suggests that despite population-level interventions, a large segment of the U.S. population at risk for chronic diseases are not engaging in preventive health.

The relationship between food parenting practices, parental diet and their adolescents' diet.

OBJECTIVE: To determine whether parents' and adolescents' dietary behaviors for fruits and vegetables [FV], junk foods, and sugar sweetened beverages [SSBs] align with parents' food parenting practices for these behaviors. DESIGN: Data from the Family Life, Activity, Sun, Health and Eating (FLASHE), a cross-sectional, internet-based study, were analyzed. PARTICIPANTS: Parent and adolescent dyads (n = 1859) representative of the general U.S. MAIN OUTCOME MEASURES: Dependent variables: adolescent and parental dietary behaviors. INDEPENDENT VARIABLES: parents' food parenting practices for FV, SSBs, and junk food were assessed. ANALYSIS: General linear models with test of equal slopes were used to test study aims. RESULTS: Parents' diets and food parenting practices were consistent with their dietary behaviors. For their adolescents, parenting practices for FV consumption was positively related to adolescents' FV consumption, but parents/caregivers' rules/limits to avoid junk food/SSBs were positively related to adolescents' junk foods and SSBs consumption. CONCLUSIONS AND IMPLICATIONS: Continued parental modeling of dietary practices is important during adolescence. Future analyses should investigate adolescents' perceptions of parents' practices and behaviors as well as their exposure from other sources and their effect on adolescent (dietary) decision-making.

The Relationship Between Health Literacy, Cancer Prevention Beliefs, and Cancer Prevention Behaviors.

While cancer prevention behaviors have been clearly defined, many people do not engage in these risk-reduction behaviors. Factors such as cancer prevention beliefs and limited health literacy may undermine cancer prevention behavior recommendations. This study explored the relationships between cancer prevention beliefs, health literacy, and cancer prevention behaviors. Data were analyzed from the 2013 Health Information National Trends Survey (n = 1675). Regression analyses for four cancer prevention belief (prevention is not possible, cancer is fatal, there are too many recommendations for prevention, everything causes cancer) statements were modeled, including health literacy and sociodemographic variables as predictors. In addition, separate regression analyses predicted four cancer prevention behaviors (fruit and vegetable consumption, physical activity, cigarette smoking) from cancer prevention beliefs, health literacy, and sociodemographic variables. Participants with low health literacy were more likely to hold fatalistic cancer prevention beliefs than those with higher health literacy. Cancer prevention beliefs were related to less fruit and vegetable consumption, fewer days of physical activity, and with being a nonsmoker after controlling for sociodemographic variables. Health literacy was not a significant predictor of cancer prevention behaviors. Given the relationship between health literacy and cancer prevention beliefs, research is needed to ascertain how to empower patients with low health literacy to have a more realistic understanding of cancer.

Adolescent health literacy and health behaviors: A systematic review.

OBJECTIVES: To systematically review and synthesize literature on the relationship between health literacy and health behaviors in adolescents. METHODS: Searches in PsychInfo, PUBMED/MEDLINE, and Educational Resources Information Center (ERIC) were conducted. Studies were included if they reported original data on the relationship between health literacy and a health behavior in adolescents, were written in English, and the population did not have a chronic illness or disability. RESULTS: Seventeen studies met inclusionary criteria. Definition and measurement of health literacy, and theoretical frameworks varied across studies. Studies investigated the relationship between functional and media health literacy and adolescent health behaviors, thirteen reported significant, linear relationships. CONCLUSIONS: The results suggest that there is a meaningful relationship between health literacy and adolescents' health behaviors. To fully understand the role of health literacy in adolescents' health decision-making, future research should use comprehensive definitions and measures of health literacy, and integrate health behavior and adolescent development theoretical frameworks in study design.

Linking Childhood Cultural Health Capital Factors with Adult Health Literacy.

Adult health outcomes are linked to childhood factors such as socioeconomic status via cultural health capital (CHC). Specifically, these factors shape opportunities for developing skills for navigating health environments via experience and the intergenerational transfer of health-related knowledge and skills. Health literacy (HL) is considered a part of and/or result of CHC. HL develops similarly to CHC via opportunities and experiences. Most research to date has ignored the effect of childhood factors on adult HL. The purpose of this study was to explore how childhood factors are related to adult HL. Data were collected from adults (N = 736, mean age = 40.65 years, standard deviation [SD] = 15.39; 52% female; 53.8% White, 31.3% Hispanic and Latino/a/e) in the United States using Qualtrics Panel. Multivariate ordinal and binary logistic regressions predicting HL (as measured by the Newest Vital Sign and Single-Item Literacy Scale) from childhood factors and accounting for demographic covariates were estimated. After accounting for covariates, such as the presence of an employed adult in a white-collar (odds ratio [OR] = 3.34) or blue-collar (OR = 3.68) occupation (versus unknown/not employed) increased the odds of being categorized as possible limited literacy and adequate literacy (versus limited literacy) as measured by the Newest Vital Sign. Similarly, having an employed adult during childhood who had a blue-collar occupation (vs. unknown/not employed) increased the odds of being categorized as adequate literacy (OR = 2.06) as measured by the Single-Item Literacy Scale. Because the adult's employment played a role in the child's adult HL after accounting for other factors and demographics, these findings support using a lifespan approach to assess and identify risk factors for lower HL. This study contributes to the growing body of evidence of how HL is interconnected with social determinants of health across the lifespan and the need to address HL skills in those with poor social determinants of health. [HLRP: Health Literacy Research and Practice. 2024;8(2):e79-e88.].

PLAIN LANGUAGE SUMMARY: Childhood conditions, such as family financial position, may be related to adult health literacy. Adults who had limited income as children were more likely to have lower health literacy than those whose family members had white-collar and blue-collar jobs. Therefore, it is important that childhood factors be considered when identifying groups that may benefit from health literacy interventions.

Effects of parental childhood cultural health environment on children's influenza and COVID-19 vaccination status.

Most studies examining factors associated with pediatric influenza (flu) and coronavirus disease (COVID-19) vaccination uptake focus on parental demographics. We examined whether the childhood cultural health environment (CHE) of parents (measured by self-reported regular attendance at doctor and dentist visits during childhood) was associated with flu and COVID-19 vaccination of their children. Using 2023 survey data from 397 US parents and causal inference methods, we estimated the average causal effect of parental CHE on flu vaccination rates (0.16 [95 % confidence interval: 0.06,0.27]) and COVID-19 (0.14 [95 % confidence interval: 0.04,0.24]), indicating that if all parents had attended regular doctor/dentist visits as children, flu and COVID-19 vaccination rates in children would be 16 % and 14 % higher, respectively, than if none had. Our findings suggest that early life exposure to medical and dental care has significant and lasting effects on the health of individuals and families.

Validation of the Assessments of Adult Health Literacy: A Rasch Measurement Model Approach.

Background: Both the World Health Organization and U.S. Department for Health and Human Services have emphasized the importance of health literacy (HL) to improving population health and reducing health disparities. HL includes three core areas/qualities: functional (i.e., health-related reading, writing, and numeracy), interactive/communicative (i.e., skills for interacting with multiple constituents and sources of information and navigating the health environment), and critical (i.e., personal and community advocacy for health). HL is implicated in medical adherence, preventive health, mental health stigma and help-seeking, and health decision-making. Though HL is critical to health and health decision-making, research on HL is still relatively limited, with most research focusing on functional HL. A major gap in research is related to the lack of measurement of interactive and critical HL. To address this gap, this study modified and assessed the validity of the Assessments of Adolescent Health Literacy (AAHL-Adolescent), test-based assessments of adolescents' functional, interactive, and critical HL, in an adult sample. Methods: One item from the AAHL-Adolescent item bank was modified to be more appropriate for an adult sample. Adults (n=2346) completed a measurement battery that included the HL item bank (12 functional, 15 interactive, and 9 critical HL questions), Newest Vital Sign (NVS), Single-Item Literacy Scale (SILS), demographics, and questions about HL-related behaviors. The assessments were evaluated and validated using Rasch measurement models. Convergent and criterion validity were assessed. Results: The final 7-item functional, 10-item interactive, and 7-item critical HL assessments and their composite (24 items) fit their respective Rasch models. Item-level invariance was established for gender, ethnicity, education, and age across all assessments. Differential item functioning for race was noted for two items on the interactive HL assessments. Good convergent validity with the NVS and SILS and good criterion validity with the HL-related behaviors were observed for all assessments. Conclusions: The AAHL-Adult is the first test-based instrument validated in the U.S. that includes assessments for all three core qualities of HL. These assessments have utility across multiple settings, including public health program planning and evaluation, intervention development and evaluation, and clinical settings.

Psychosocial correlates in patterns of adolescent emotional eating and dietary consumption.

Unhealthy eating behaviors, such as consumption of unhealthy diet and emotional eating, are common in adolescence and tend to co-occur. However, how these behaviors are patterned may vary among adolescents. This study identified patterns of dietary consumption and emotional eating behaviors in adolescents and examined the sociodemographic and psychosocial (e.g., self-efficacy beliefs and motivation) covariates associated with these eating patterns. Data were from the Family Life, Activity, Sun, Health and Eating study. Latent class analysis was used to estimate adolescent dietary patterns from dietary consumption (i.e., fruits, vegetables, sugar-sweetened beverages, junk food, etc.) and emotional eating variables (i.e., eating when feeling sad or anxious). The sample included 1,568 adolescents (Mean age = 14.48-years-old, 49% girls, 55% White). A four-class solution best fit the data (e.g., Bayesian Information Criteria [BIC] = 12263.568, three-class model BIC = 12271.622). Four unhealthy eating behavior patterns were identified: poor diet/high emotional eating, mixed diet/high emotional eating, poor diet/low emotional eating, and mixed diet/low emotional eating. Compared to the poor diet/high emotional eating group, the other groups were less likely to include older adolescents, girls, and adolescents who experienced food insecurity, and more likely to have higher self-efficacy for eating fruits and vegetables and limiting junk foods as well as motivation for consuming fruits and vegetables and limiting junk foods. Our findings highlight adolescents' complex dietary patterns that include dietary consumption and emotional eating behaviors. Future studies should examine other potential dietary patterns that include emotional eating. Efforts to address unhealthy patterns of adolescents' dietary consumption and emotional eating behaviors should be expanded.

Correction: Fleary et al. Census Tract Demographics Associated with Libraries' Social, Economic, and Health-Related Programming. Int. J. Environ. Res. Public Health 2022, 19, 6598.

The authors wish to make the following corrections to this paper [...].

Safety, Efficacy, and Ill Intent: Examining COVID-19 Vaccine Perceptions among the New Undervaccinated Moveable Middle in a U.S. Cohort, October 2022.

Individuals who received their primary vaccine series only (with no subsequent booster) may be a new type of "moveable middle" given their receipt of the original COVID-19 vaccination. One population within the moveable middle for whom tailored interventions may be needed is individuals with common mental disorders (CMD). The purpose of this paper is to understand the vaccine perceptions among this new moveable middle-the undervaccinated-and within the undervaccinated to examine the extent to which COVID-19 vaccine perceptions and motivations differ among those with and without symptoms of CMD. Using data from the CHASING COVID Cohort, we examine the relationship between vaccination status, CMD, and vaccine perceptions in the undervaccinated. Among 510 undervaccinated participants who had completed the primary vaccine series but were not boosted, the most common reasons for undervaccination focused on efficacy (not seeing a need for an additional dose, 42.4%; there not being enough evidence that a booster dose is effective, 26.5%; already having had COVID-19, 19.6%). Other concerns were related to safety (long-term side effects, 21.0%; short-term side effects, 17.6%) and logistics (plan to get a booster but haven't had time yet, 18.8%). Overall, the greatest vaccine concerns (over 30%) for the undervaccinated focused on efficacy and safety issues. Symptoms of depression or anxiety were associated with lower levels of vaccine efficacy and greater safety concerns in adjusted models. The implications of our study are that campaigns that are hoping to maximize vaccination uptake should consider focusing on and emphasizing messaging on efficacy and safety issues.