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.

Managing health in inequitable contexts: Health capacities as integral to life course health development.

Health behavior models are widely used in prevention research with children and adolescents; yet, many of these models were developed based on adult experiences and fail to consider the development of health constructs. The concept of health capacity development is a theoretical model of how health capacities, the health-related developmental sociocultural resources individuals use to regulate their coactions with their environments to sustain health, develop. Health capacities are formed through person-environment transactions and thus, are informed by, and help individuals manage, the opportunities and constraints situated in their environments. The extent to which health capacities support long-term adaptive health development varies; yet, health capacities may be leveraged for adaptative functioning. Grounded in the Life Course Health Development (LCHD) framework and the principles of Relational Developmental Systems (RDS) metatheory, the development of three health capacities, their role in managing person-environment coactions, and their potential for facilitating displays of resilient functioning in inequitable contexts are described. Implications of the model, its limitations, and avenues for future research are discussed.

Liberatory Media Literacy as Protective Against Posttraumatic Stress for Emerging Adults of Color.

Emerging adults (i.e., age 18-25 years) of color in the United States are exposed to race/ethnicity-related traumatic events in online settings. Although an emerging literature documents the mental health consequences of such online exposures among adolescents, the association between these exposures and symptoms of posttraumatic stress disorder (PTSD) remains understudied in emerging adults. Furthermore, little is known about strengths-based factors that may be protective for emerging adults of color faced with such exposures. The current study aimed to fill these gaps by examining the potential of liberatory media literacy (i.e., the ability to critically read, evaluate, support, and create media and technology that represents people of color in their full humanity) to ameliorate the association between exposure to traumatic events online and PTSD symptoms. Emerging adults of color (N = 325, Mage = 22.24, 56.0% male) were recruited to complete a self-report online survey that assessed exposure to race/ethnicity-related traumatic events in online settings, liberatory media literacy, and PTSD symptoms. The results of moderation analysis indicated that increased exposure to traumatic events online was associated with higher PTSD symptoms, ß = .22, and that the inclusive media and technology component of liberatory media literacy was protective in this association, ß = .19. However, these effects were small, f2 = .22-.23. The potential of liberatory media literacy as a strengths-based asset for emerging adults of color are discussed. Increasing inclusive media and technology skills may be an important target for intervention.

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.

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.

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 [...].

Parenting, Peers, and Alcohol Use Initiation Among Black, White, and Black-White Adolescents: Evidence Using Discrete-Time Survival Analysis.

Alcohol use among Biracial adolescents remains understudied. This study examined how parenting and peer factors relate to age of alcohol use onset among Black, White, and Biracial Black-White adolescents and emerging adults. We used Add Health data to produce a final analytic sample of 13,528 adolescents who self-identified as White, Black, or Biracial Black-White. Discrete-time survival analysis implemented within logistic regression indicated Black adolescents showed the lowest probability of alcohol use onset by age 18, followed by Biracial adolescents, and White adolescents. The probability of alcohol use onset increased for Monoracial Black and White adolescents at ages 16, 18, and 21. Descriptively our model suggest that Biracial adolescents exhibit a sharp decline in their probability of alcohol use onset at age 16 and a sharp increase at age 21. However, this trend did not differ significantly from the other racial groups. Consistent with social control and learning theories, low parental acceptance, high parental control, and peer substance use were associated with alcohol use onset. Alcohol use onset trajectories differed for Monoracial and Biracial adolescents with Biracial individuals reporting greater alcohol onset in adulthood. Prevention efforts should continue to target parental acceptance, parental control, and peer substance use.

Housing and Food Insecurity, Health Literacy, and Maladaptive Coping Behaviors.

BACKGROUND: Stressors related to social determinants of health (SDH), such as housing and food insecurity, are implicated in chronic disease risk. Maladaptive strategies for coping with these stressors may exacerbate risk. OBJECTIVE: Given the limited research on SDH-related stressors and maladaptive coping, this study examined the relationship between two SDH-related stressors (housing and food insecurity) and maladaptive coping behaviors (i.e., emotional eating and stress-related cigarette and alcohol use) in adults. Further, because health literacy (HL), another SDH, may be a protective factor, this study explored whether HL moderated these relationships. METHODS: Data were collected from adults (N = 500, Mean age = 49.01 years, standard deviation = 16.36; 40% White) in the United States. A series of hierarchical logistic regressions predicting maladaptive coping behaviors from demographics, SDH-related stressors (i.e., housing or food insecurity), and HL variables were estimated. KEY RESULTS: Housing insecurity was associated with increased odds of emotional eating (odds ratio [OR] = 1.48, p < .001), stress-related cigarette use (OR = 1.34, p = .001), and stress-related alcohol use (OR = 1.32, p = .001). Food insecurity was associated with increased odds of emotional eating (OR = 1.49, p = .012), stress-related cigarette (OR = 1.68, p = .002), and stress-related alcohol use (OR = 1.49, p = .013). Higher functional HL scores were associated with decreased odds of emotional eating after accounting for housing (OR = 0.79, p = .017) and food insecurity (OR = 0.76, p = .004). Communicative and critical HL moderated the relationship between food insecurity and emotional eating. CONCLUSIONS: Examining HL in relation to SDH-related stressors and maladaptive coping behaviors is complex. HL may be less protective for maladaptive coping behaviors that are likely addictive. Because HL domains may require cooperation between individuals and systems related to stressors, multi-systemic interventions are necessary to reduce maladaptive coping behaviors. [HLRP: Health Literacy Research and Practice. 2022;6(4):e280-e289.] Plain language summary: Stress related to inadequate resources for housing and food may be related to adults' poor coping behaviors (e.g., emotional eating and stress-related cigarette and alcohol use). Adults who experienced housing and food insecurity were more likely to report emotional eating and using cigarettes and alcohol when stressed. Adults with higher functional health literacy were less likely to report emotional eating.

Health literacy and health behaviors in parent-adolescent dyads: an actor-partner interdependence model approach.

OBJECTIVE: Health literacy (HL), skills for accessing, appraising and using health information in health decision-making is implicated in adolescents' health behaviors. HL skills develop through scaffolding, modeling, practice and opportunity. Therefore, adolescents' HL skills are likely closely tied to parents' HL and health behaviors. Yet, no studies have examined the dyadic interdependence of the relationship between HL and health behaviors between parents and adolescents. The purpose of this study was to determine the interdependence of adolescents' and parents' HL and health behaviors. METHODS AND MEASURES: Data were collected from 300 parent-adolescent dyads via Qualtrics Panel. Dyads completed identical measures of their HL, diet, physical activity, sedentary activity, cigarette-smoking, vaping, and alcohol binge-drinking behaviors. Data were analyzed using Pearson correlations and the Actor-Partner Interdependence Model. RESULTS: Within-dyad correlations were significant for HL and all health behaviors assessed. After controlling for covariates and partner effects, adolescents' HL was related to their sugar-sweetened beverage intake, sedentary activity, and substance use. After controlling for covariates and actor effects, adolescents' HL was related to parents' sedentary activity, binge-drinking, and vaping while parents' HL was related to adolescents' sedentary activity. CONCLUSION: Our results suggest that there is interdependence in these relationships especially for risk behaviors.

Census Tract Demographics Associated with Libraries' Social, Economic, and Health-Related Programming.

Background: Public libraries can contribute to reducing economic, social, and health inequities through their programming and practices. However, the extent to which libraries regularly provide programming that improve the social determinants of health (SDH) in underserved communities is unclear. Objective: This study explored the relationship between census tract demographic characteristics and library programming implicated in the SDH for underserved groups at risk for health disparities. Method: A stratified random sample of libraries (n = 235) who completed the 2017 Public Libraries Survey were recruited. Librarians completed surveys about their libraries' economic, social, and health-related programming. Libraries' census tract demographic characteristics were taken from the 2013-2017 American Community Survey. Linear regressions were estimated to determine the relationship between relevant census tract demographic characteristics and programming offered at libraries in the census tracts. Results: Higher proportions of racial and ethnic minorities were associated with more frequent economic and social programs, but results were mixed for health-related programs. Lower proportions of populations with no more than a high school diploma or GED were related to more frequent economic, social, and health-related programs. Conclusions: The inequitable distribution of SDH-related library programming highlights gaps in libraries' responsiveness to community needs. Libraries' programming likely perpetuate systemic inequities.

The Relationship Between Health Literacy and Mental Health Attitudes and Beliefs.

BACKGROUND: Mental health first aid programs show promise in reducing stigma and increasing help-seeking. However, the success of these and other mental health interventions are likely affected by health literacy. Yet, health literacy is understudied in the mental health literature and rarely considered in mental health interventions. OBJECTIVE: This study explored the relationship between health literacy and mental health stigma, aversion to mental health help-seeking, and willingness to interact with individuals with mental illnesses. METHODS: Adults (N = 601, mean age = 45.64) completed online surveys of their health literacy and mental health attitudes and beliefs. Hierarchal linear regression models were estimated to examine the relationship between health literacy and mental health attitudes and beliefs. Path models were estimated to determine if stigma mediated the relationship between health literacy and (1) aversion to help-seeking and (2) willingness to interact with individuals with mental illnesses. KEY RESULTS: Adults with higher functional and communicative health literacy had lower mental health stigma and aversion to mental health help-seeking. Adults with higher communicative health literacy and empowerment were more willing to interact with individuals with mental illnesses. Mental health stigma partially mediated the relationships between communicative health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses. Mental health stigma fully mediated the relationships between functional health literacy and aversion to mental health help-seeking and willingness to interact with individuals with mental illnesses. CONCLUSIONS: Results support including health literacy in mental health interventions and reiterate addressing stigma in community and clinical settings. [HLRP: Health Literacy Research and Practice. 2022;6(4):e270-e279.] Plain Language Summary: Many adults with mental health problems do not get help because of negative beliefs about mental health. We found that adults with more skills for accessing, understanding, and using health information had fewer negative opinions and were more willing to interact with others with mental health problems. Improving those skills may reduce negative opinions about mental health and seeking help.

"The Way you Interpret Health": Adolescent Definitions and Perceptions of Health Literacy.

BACKGROUND: Adolescents are required to take increased responsibility for their health. Although health literacy is implicated in adults' health decision-making and health behaviors, little is known about adolescents' health literacy and its relationship to their health behaviors. Furthermore, adolescent health literacy research overlooks adolescent development-specific needs and skills. Therefore, we qualitatively explored adolescents' (1) definitions of health literacy, preventive health behaviors, and health risk behaviors; and (2) perception of the health literacy/health behavior relationship. METHODS: Six semi-structured focus groups were conducted with adolescents (N = 37) who answered questions about their perceptions of health literacy, preventive health behaviors, and health risk behaviors. Focus groups were coded using thematic analysis. Themes representing adolescents' definitions of health literacy were secondarily coded for alignment with definitions in the literature. RESULTS: Some of adolescents' health literacy definitions aligned with the adult health literacy literature. They considered health literacy a tool for informed decision-making, but acknowledged not always using these skills. CONCLUSIONS: Adolescents' definitions of health literacy were multidimensional, going beyond numeracy and literacy skills. Developmental characteristics and adolescents' definition of health risk behaviors were related to use of health literacy skills. Opportunities for adolescents to develop and practice health literacy skills are discussed.

Disparities in Adolescents' Obesogenic Behaviors, 2005-2017.

Objectives: Given the increasing national-level efforts to reduce disparities in obesogenic behaviors in youth, in this paper, we assessed the change in disparities in meeting guidelines for fruits and vegetables intake (FV), physical activity (PA), and sedentary behavior (SB) among adolescents in the United States in the last 13 years. Methods: Using the Youth Risk Behavior Surveillance System (2005-2017), overall and characteristic-specific (sex, age, race/ethnicity) disparities ratios for meeting FV, PA, and SB guidelines were calculated using the Extended Gastwirth Index Method. Linear regressions, one-way analysis of variance, and posthoc tests assessed change in characteristic-specific disparities over the years. Linear and quadratic trends assessed change in characteristic-specific contributions to overall disparities. Results: Sex-specific and age-specific disparities increased for meeting FV and PA and decreased for meeting SB guidelines. Race/ethnicity-specific disparities decreased for meeting FV and SB guidelines. Characteristics-specific contributions to overall disparities for each behavior changed over the years. Conclusions: Disparities in obesogenic behaviors are still an ongoing concern despite national-level efforts to improve adolescents' behaviors. The methodology allowed for meaningful disparities ratios that facilitated comparison of categorical demographic characteristics across the years and identifying targetable intervention groups to reduce disparities.

Adolescents' Health Literacy and Decision-making: A Qualitative Study.

Objective: Adolescents assume increased responsibility for their health, particularly regarding health decision-making for lifestyle behaviors. Prior research suggests a relationship between health literacy (HL) and health behaviors in adolescents. Yet, the specific role of HL in adolescents' health decision-making is unclear. This study qualitatively explored adolescents' use of HL in their health decision-making. Methods: Six focus groups with adolescents (N = 37, Mage = 16.49, 86% girls) were conducted. Adolescents' responses to questions about their HL use were coded using thematic analysis. Results: Adolescents identified passive and active HL engagement and several individual (eg, future orientation, risk perception) and environmental (eg, access to resources/information, media) factors that influenced their use of HL in health decision-making. Feedback from others, subjective health, and ability to navigate multiple sources of information also determined adolescents' confidence in their HL skills. Conclusions: Our results support expanding the types of HL studied/measured in adolescents and provide insight on how HL can be leveraged to improve adolescents' health decision-making. Though there was no guiding theory for this study, results support using the Information-Motivation-Behavior Skills model to assess the HL/health decision-making relationship in adolescence.