HPV and COVID-19 vaccines: Social media use, confidence, and intentions among parents living in different community types in the United States.

Our study measured parental confidence and intention/uptake of two adolescent vaccines (HPV and COVID-19), focusing on differences among community types including urban, suburban, and rural. Although social media provides a way for misinformation to spread, it remains a viable forum for countering misinformation and engaging parents with positive vaccine information across community types. Yet, little is understood about differences in social media use and vaccine attitudes and behaviors for parents living in rural, suburban and urban areas. We sought to determine how to better reach parents living in different community types with targeted social media channels and messaging. In August 2021, we used a cross-sectional survey programmed in Qualtrics to collect data from 452 parents of children ages 9 to 14 living in different community types across the United States. Participants came from a survey panel maintained by CloudResearch. Survey questions asked about demographics, political affiliation, community type, social media use, health and vaccine information sources, and attitudes and behaviors regarding the HPV and COVID-19 vaccines. Our sample of parents (n = 452) most frequently used Facebook (76%), followed by YouTube (55%), and Instagram (43%). When comparing social media use by community type, parents used the top platforms at similar rates. Social media use was associated with vaccine confidence and intention/uptake in unadjusted models but not in adjusted models. Further, there were no significant differences in HPV vaccine confidence or intention/uptake by community type (i.e., rural, suburban, urban). For the COVID-19 vaccine, parents in rural communities were less likely to have vaccine confidence and intention/uptake in the unadjusted model. For both HPV and COVID-19 vaccines, political affiliation was the only common factor associated with both vaccine confidence and intention/uptake. Parents who identified as Democrat compared to Republican had greater confidence in the vaccines and had higher odds of vaccine intention/uptake for their children. Although rurality has been associated with vaccine confidence in the past we did not find that in our study. Instead, political affiliation appeared to explain most of the variation in vaccine confidence and intention/uptake, suggesting that more research is needed to identify best practices for using social media to reach parents with different political beliefs.

Viewer Reactions to EVALI Storylines on Popular Medical Dramas: A Thematic Analysis of Twitter Messages.

Previous research has found an association between awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) and lower intention to use e-cigarettes among young people. This study utilized Twitter data to evaluate if the January 2020 depiction of EVALI on New Amsterdam, Chicago Med, and Grey's Anatomy-three popular primetime medical dramas-could be a potential innovative avenue to raise awareness of EVALI. We obtained tweets containing e-cigarette-related search strings from 1/21/2020 to 02/18/2020 and filtered these with storyline-specific keywords, resulting in 1,493 tweets for qualitative coding by two trained human coders. Content codes were informed by prior research, theories of narrative influence, and e-cigarette related outcomes. Of 641 (42.9%) relevant tweets, the most frequent content codes were perceived realism (n = 292, 45.6%) and negative response (n = 264, 41.2%). A common theme among these tweets was that storylines were unrealistic because none of the characters with EVALI used THC-containing products. Approximately 12% of tweets (n = 78) mentioned e-cigarette knowledge and 28 (4.4%) mentioned behavior, including quitting e-cigarettes because of viewing the storylines. Implications for health communication research utilizing social media data and maximizing the achievement of positive health-related outcomes for storylines depicting current health topics are discussed.

"Better Than Any DARE Program": Qualitative Analysis of Adolescent Reactions to EVALI Television Storylines.

Introduction. Research suggests that awareness of e-cigarette, or vaping, product-use associated lung injury (EVALI) among adolescents is associated with increased harm perception of e-cigarettes. The depiction of EVALI on three primetime medical dramas offers an opportunity to examine the use of these storylines for tobacco prevention education. Methods. We conducted four focus groups with seventh- and eighth-grade students at an urban middle school. Participants viewed three clips of scenes followed by a facilitated discussion as to the influence of the clips on knowledge and perceptions of e-cigarettes and the use of clips for tobacco prevention education. Two research assistants double-coded notes from the focus groups using a qualitative content analysis approach. Results. Our final sample included 78 adolescents; we obtained self-reported demographic information for 75. The majority of participants were 13 to 14 years of age (82.7%) and identified as cisgender female (52.0%) and Black (52.0%). No participants had knowledge of EVALI prior to viewing the clips. Comments made both during and after watching suggest the clips may have reinforced knowledge and perceptions of harm; participants stated that the clips could be a useful intervention tool. Viewing the clips also generated unprompted discussion about flavored products, tobacco advertising, other television programs, and marijuana. Conclusions. Clips featuring the depiction of EVALI on medical dramas may be an effective tool for raising awareness of e-cigarette use-related harms. These results offer a promising first step for future collaborative research between public health, adolescents, and schools to develop tobacco prevention education utilizing these clips.

A Year of Child Injury Prevention on Instagram.

Injury is the leading cause of death for children but little is known about what types of injury prevention messages are communicated on Instagram. Conducted in the United States, the aim of this study was to better understand child injury prevention messages on Instagram to develop recommendations for the future. Informed by Social Cognitive Theory, a quantitative content analysis was conducted on all Instagram posts from selected organizations from May 2018 through April 2019. Of the 818 injury prevention posts, almost all included an image (575, 70%) or video (211, 26%). Of the 575 images, 245 (42.46%) had in image that did not match the topic of the post. Regarding injury prevention recommendations, 579 posts (71%) provided a clear action that parents should take. For these posts, 115 (20%) had an image that communicated the desired safety recommendation, but many more (285, 50%) did not; in 23 cases it was not clear if there was a match or not. There are missed opportunities for child health and injury organizations to reach parents and caregivers through Instagram. Posts made during the study period often lacked specificity about action-oriented measures and failed to utilize images that demonstrated the recommended practices. Organizations posting on Instagram and other social media platforms should provide clear action tips and utilize images that depict child injury prevention recommendations.

Health Literacy Among In-Care Older HIV Diagnosed Persons with Multimorbidity: MMP NYS (Excluding NYC).

Older persons living with diagnosed HIV (PLWDH) are also at risk for age-related chronic conditions. With conflicting results on studies assessing health literacy and durable viral suppression, this study is the first in assessing this relationship using representative data on older in-care HIV-diagnosed persons with multimorbidity. Weighted data collected 2009-2014 from the Medical Monitoring Project (MMP) was used. Health literacy was assessed using the three-item Brief Health Literacy Screen (BHLS). The mean health literacy score was 11.22 (95% CI 10.86-11.59), and the mean multimorbidity was 4.75 (SE = 0.32). After adjusting, health literacy (OR 0.87, 95% CI 0.77-0.99) was found to be significantly associated with durable viral suppression. Adequate health literacy can help with achieving durable viral suppression. For these persons, addressing health literacy might increase their ability to access and navigate the healthcare system, thereby helping them stay engaged and maintain adherence to HIV care.

A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability.

Objective: social inequalities in health are believed to arise in part because individuals make use of social and economic resources in order to improve survival. In recent years, health literacy has received increased attention as a factor that can help explain differences in health outcomes. However, examination of life course predictors of health literacy has been limited. Methods: life course data from the Wisconsin Longitudinal Study 1957-2011 were used to examine predictors of health literacy in old age (N = 2,122), using the Newest Vital Sign. Generalised structural equation modelling was used to model pathways to health literacy. Results: predictors of health literacy included educational attainment, and adolescent cognitive and non-cognitive skills, and, in men, rate of cognitive decline from middle to later life. Discussion: numerous studies have documented health literacy issues among older adults, and recommendations have been made for ways to improve health literacy for this population. This study reports on risk factors across the life course that are associated with health literacy later in life, identifying possible intervention targets to reduce risk of poor health as people age. Our results suggest that a range of life course factors, beginning in early life, predict health literacy. Further research studying health literacy over the life course is warranted.

Fathers' Representation in Observational Studies on Parenting and Childhood Obesity: A Systematic Review and Content Analysis.

BACKGROUND: The involvement of fathers in caregiving has increased substantially over the past 30 years. Yet in child and adolescent psychopathology, few studies include fathers as research participants and few present results for fathers separate from those for mothers. We test for the first time whether a similar pattern exists in research on parenting and childhood obesity. OBJECTIVES: To conduct a systematic review and quantitative content analysis of observational studies on parenting and childhood obesity to (1) document the inclusion of fathers, relative to mothers, as research participants and (2) examine characteristics of studies that did and did not include fathers. This study presents new data on the number and gender of parent research participants. SEARCH METHODS: We searched title, abstract, and Medical Subject Headings term fields in 5 research databases (PubMed, EMBASE, Academic Search Premier, PsycINFO, and CINAHL) using terms combining parents or parenting (e.g., mother, father, caregiver, parenting style, food parenting) and obesity (e.g., obesity, body weight, overweight) or obesity-related lifestyle behaviors (e.g., diet, snacking, physical activity, outdoor play, exercise, media use). SELECTION CRITERIA: We identified and screened studies as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) published between January 2009 and December 2015, examining links between parenting and childhood obesity, including parents or caregivers as research participants, and written in English. We excluded interventions, nonhuman studies, dissertations, conference abstracts, and studies on youths with specific medical conditions. Of 5557 unique studies, 667 studies were eligible. DATA COLLECTION AND ANALYSIS: For each of the 667 studies, 4 coders were trained to code characteristics of the study (e.g., publication year, geographic region, journal, study focus) and parent research participants (e.g., parent gender, demographic background, biological relationship with child, and residential status). We established intercoder reliability before coding the full sample of studies (mean Krippendorf's alpha = .79; average percentage agreement = 94%). MAIN RESULTS: Of the studies, 1% included only fathers. By contrast, 36% included only mothers. Although slightly more than 50% of studies (n = 347) included at least 1 father, only 57 studies reported results for fathers separate from those for mothers. When we combined them with studies including only fathers, 10% of studies overall reported results for fathers. Samples sizes of fathers were small compared with mothers. Of studies with fathers, 59% included 50 or fewer fathers, whereas 22% of studies with mothers included 50 or fewer mothers. The mean sample size for fathers across all eligible studies was 139, compared with 672 for mothers. Overall, fathers represented 17% of parent participants across all eligible studies. CONCLUSIONS: This study unequivocally demonstrates that fathers are underrepresented in recent observational research on parenting and childhood obesity. Public health implications. The underrepresentation of fathers in obesity research compromises the development of effective family interventions for childhood obesity prevention. Targeted opportunities and incentives are needed to support research with fathers.

A systematic review of media parenting in the context of childhood obesity research.

BACKGROUND: We conducted a systematic review to obtain studies on childhood obesity and parenting published between 2009 and 2015, and draw out those studies with a particular focus on media parenting. Our analysis addresses two major aims: 1) to describe how media use and media-related parenting practices and skills are operationalized in studies and 2) to explore whether studies measured ecological factors (e.g. individual-, family-, and community-level factors), which could be associated with media parenting practices. METHODS: Using a standardized, multi-stage process, we identified and screened articles focused on parenting and childhood obesity (N = 667). Studies were eligible for this analysis if they measured media parenting and/or the home media environment, resulting in a sample of 103 studies. We used quantitative content analysis to code the full text articles for content related to our study aims; analyses were performed using SAS 9.4. RESULTS: Seventy nine percent of studies measured media use, 82 % measured media parenting, and 65 % measured the home media environment. Studies measuring media use focused on a limited number of devices; while all studies measured child/parent use of televisions, only 3 % measured use of smartphones, 1 % measured use of laptops, and no studies measured use of tablets. Measures of parenting practices focused largely on rules specific to limiting screen time. Although 60 % of studies measured at least one ecological factor, child-specific and neighborhood/community-level factors were rarely measured. CONCLUSIONS: More detailed measurements of media use that reflects current technology trends and diverse contexts of use are needed to better understand media use and parent regulation of child media exposure. Measures of the ecological context can more fully assess factors impacting media parenting and, subsequently, child risk for overweight and obesity.

A content analysis of food advertisements appearing in parenting magazines.

OBJECTIVE: Childhood obesity is a growing problem in the USA. As parents play a major role in shaping a child's diet, the present study examines food advertisements (ads) directed towards parents in parenting and family magazines. DESIGN: Given the potential for magazines to influence attitudes and knowledge, we used content analysis to examine the food ads appearing in four issues each of six different parenting and family magazines from 2008 (n 24). SETTING: USA. SUBJECTS: Food ads in parenting and family magazines. RESULTS: We identified 476 food ads, which represented approximately 32 % of all ads in the magazine sample. Snack foods (13 %) were the most frequently observed food ads, followed by dairy products (7 %). The most frequently used sales theme was 'taste' (55 %). Some ads promoted foods as 'healthy' (14 %) and some made specific health claims (18 %), such as asserting the product would help lower cholesterol. In addition to taste and health and nutrition appeals, we found several themes used in ad messages to promote products, including the following: 'convenience', 'economical', 'fun' and 'helping families spend time together'. We also found that over half (n 405, 55·9 %) of products (n 725) advertised were products of poor nutritional quality based on total fat, saturated fat, sodium, protein, sugar and fibre contents, and that ads for such products were slightly more likely to use certain sales themes like 'fun' (P = 0·04) and 'no guilt' (P = 0·03). CONCLUSIONS: Interventions should be developed to help parents understand nutritional information seen in food ads and to learn how various foods contribute to providing a balanced family diet.

Organizational Health Literacy and Health Among New York State Medicaid Members.

BACKGROUND: The definition of health literacy has recently expanded beyond the idea of individual skills to include the system and environment the individual interacts with to receive care, known as organizational health literacy (OHL). However, neither the prevalence of OHL nor the impact of OHL on individuals' perceptions of their health and healthcare have been examined in New York's Medicaid managed care population. OBJECTIVE: This study aimed to estimate the prevalence of organizational health literacy in the New York State (NYS) Medicaid Managed Care (MMC) program. METHODS: A brief measure to assess organizational health literacy was developed from responses to two questions in the 2018 NYS Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Generalized Estimating Equation models were developed to analyze the association between organizational health literacy and three aspects of perceptions of health and health care, controlling for demographic differences and clustering effects from health insurance plans. Missing data were handled using multiple imputation. KEY RESULTS: Among 3,598 members included in the study, 20% of the MMC members reported inadequate organizational health literacy. These members were more likely to be older, less educated, from racial and ethnic minority groups, and less fluent with English. They are more likely to have poorer self-reported health (odds ratio [OR] 1.49), lower perceived access to health care (OR 6.97), and lower satisfaction with their health care (OR 6.49) than members who did not report inadequate organizational health literacy. CONCLUSIONS: Our results suggest that a proportion of the NYS MMC population faces inadequate organizational health literacy, which can present a barrier to health care access and result in patients having a significantly poorer health care experience. Using an existing data source that is part of existing data collection allows for routine assessment of organizational health literacy, which can help inform health plans about areas for potential improvement. [HLRP: Health Literacy Research and Practice. 2023;7(3):e154-e164.].

PLAIN LANGUAGE SUMMARY: Our study looked at the impact of organizational health literacy on the perceptions of health and health care of NYS Medicaid Managed Care population. We used existing CAHPS questions to assess organizational health literacy and found that lower organizational health literacy led to worse perceptions of health and health care. This article illustrates an opportunity to demonstrate how organizational health literacy can be measured with annual CAHPS collections.

Characterizing the Influence of Television Health Entertainment Narratives in Lay Populations: A Scoping Review.

OBJECTIVE: To conduct a scoping review of published literature examining the influence of health storylines from fictional television programs on viewers. DATA SOURCE: We performed literature searches in Medline, PsycINFO, and Mass Media Complete in October 2021, and examined bibliographies of included articles and conducted forward searching using Web of Science with included articles. STUDY INCLUSION AND EXCLUSION CRITERIA: Selected studies were required to be original research published in English, involve exposure to fictional television programming by individuals not in the medical field, and assess associations between exposure and health-related outcomes. DATA EXTRACTION: Article screening and data abstraction were performed by two independent researchers using DistillerSR (Cohen's κ range: .73-1.00). DATA SYNTHESIS: We analyzed and qualitatively described the data using methods of scoping reviews described by PRISMA-ScR. RESULTS: Of 5,537 unique records identified, 165 met inclusion criteria. The most frequently studied program was ER (n = 22, 13.3%). Most studies had adult participants (n = 116, 70.3%) and used quantitative methods (n = 136, 82.4%). The most frequently examined health topics were sexual behavior (n = 28, 17.0%) and mental health (n = 28, 17.0%). Exposure had a positive influence on viewers' health-related outcomes in 28.5% (n = 47) of studies. CONCLUSION: Health storylines on fictional television influence viewers. Future research could address gaps identified in this review to further elucidate the influence of this programming on health promotion and disease prevention.

'It was a freak accident': an analysis of the labelling of injury events in the US press.

OBJECTIVES: Given that the news media shape our understanding of health issues, a study was undertaken to examine the use by the US media of the expression 'freak accident' in relation to injury events. This analysis is intended to contribute to the ongoing consideration of lay conceptualisation of injuries as 'accidents'. METHODS: LexisNexis Academic was used to search three purposively selected US news sources (Associated Press, New York Times and Philadelphia Inquirer) for the expression 'freak accident' over 5 years (2005-9). Textual analysis included both structured and open coding. Coding included measures for who used the expression within the story, the nature of the injury event and the injured person(s) being reported upon, incorporation of prevention information within the story and finally a phenomenological consideration of the uses and meanings of the expression within the story context. Results The search yielded a dataset of 250 human injury stories incorporating the term 'freak accident'. Injuries sustained by professional athletes dominated coverage (61%). Fewer than 10% of stories provided a clear and explicit injury prevention message. Stories in which journalists employed the expression 'freak accident' were less likely to include prevention information than stories in which the expression was used by people quoted in the story. CONCLUSIONS: Journalists who frame injury events as freak accidents may be an appropriate focus for advocacy efforts. Effective prevention messages should be developed and disseminated to accompany injury reporting in order to educate and protect the public.

The association of understanding of medical statistics with health information seeking and health provider interaction in a national sample of young adults.

Numeracy, or, "the ability to use and understand numbers in daily life" is a critical component of health literacy. However, little research has focused on numeracy in young adults (ages 18-29). We used a national sample to examine how health-information seeking, trust in sources, and interactions with health care providers differ for young adults with lower and higher numeracy. We included respondents ages 18 to 29 (n = 661) from the latest administration (2008) of the Health Information National Trends Survey (HINTS). There were no significant differences between those with lower and higher numeracy for most sociodemographic variables, nor did numeracy predict trust in health information sources. However, there were several differences for health-information seeking and health-provider interactions. Those with lower numeracy were significantly more likely to say their most recent search took a lot of effort (46% vs. 24%, p = .0008) and was frustrating (45% vs. 22%, p = .0038). Those in the lower numeracy group also reported more negative interactions with health providers, including feeling less able to rely on their provider (62% vs. 86%, p < .0001), and less likely to say their provider made sure they understood information (70% vs. 88%, p = .0001) and helped with any uncertainty (51% vs. 75%, p < .0001), even when adjusting for other variables. Our data suggest that limited comfort with numbers and statistics can influence a variety of health-related factors for young adults. More research is needed to understand how health literacy skills--including numeracy--influence health-information seeking, patient-provider relationships, and health outcomes, for young adults.

Health Literacy, Digital Health Literacy, and COVID-19 Pandemic Attitudes and Behaviors in U.S. College Students: Implications for Interventions.

The COVID-19 pandemic has been accompanied by rapidly emerging evidence, changing guidance, and misinformation, which present new challenges for health literacy (HL) and digital health literacy (DHL) skills. This study explored whether COVID-19-related information access, attitudes, and behaviors were associated with health literacy and digital health literacy among college students in the United States. Self-reported measures of health literacy, along with items on pandemic-related attitudes, behaviors, information sources, and social networks, were collected online using a managed research panel. In July 2020, 256 responses were collected, which mirrored the racial/ethnic and gender diversity of U.S. colleges. Only 49% reported adequate HL, and 57% found DHL tasks easy overall. DHL did not vary by HL level. In multivariable models, both HL and DHL were independently associated with overall compliance with basic preventive practices. Higher DHL, but not HL, was significantly associated with greater willingness to get a COVID-19 vaccine and the belief that acquiring the disease would negatively impact their life. On average, respondents discussed health with 4-5 people, which did not vary by HL or DHL measures. The usage of online information sources varied by HL and DHL. The study findings can inform future student-focused interventions, including identifying the distinct roles of HL and DHL in pandemic information access, attitudes, and behaviors.

Identifying HPV vaccine narrative communication needs among parents on social media.

Sharing personal experiences is an important communication strategy in public health, including vaccination. This study sought to understand if parents would be receptive to learning about the HPV vaccine from other parent experiences, and what format this information should take on social media. In May 2020, we conducted a qualitative study of six online focus groups across the U.S. with parents (n = 48) of children ages 9-14. Using a text-based discussion format, we discussed their experiences getting information about the HPV vaccine and using Twitter to learn about health topics. Four coders structured qualitative findings by themes including content, delivery, and source of information. An accompanying survey was used to describe participant Twitter use and HPV vaccine knowledge and attitudes. The average participant age was 44.6 years old, 63% were mothers, and the majority had high HPV vaccine knowledge. Parents indicated that they want to hear from other parents about their experiences with the HPV vaccine. However, it was hard to know where to find this information. When experiences are shared on social media, the negative ones are more memorable and more personal. Parents thought Twitter could be an important space to communicate about the HPV vaccine if it was done in a credible, verifiable, and authentic way. Parents want to learn about the HPV vaccine through other parent experiences, especially when this aligns with science supporting the vaccine. Public health and medical communities must embrace this mix of evidence and lived experiences to deliver and discuss health information.

Development of Personas to Communicate Narrative-Based Information About the HPV Vaccine on Twitter.

Introduction: Personas are based on real-life typologies of people that can be used to create characters and messages to communicate important health information through relatable narrative storylines. Persona development is data-driven and can involve multiple phases of formative research and evaluation; however, personas are largely underutilized in digital health research. The purpose of this study was to create and document persona development to deliver narrative-focused health education for parents on Twitter with the goal of increasing uptake of HPV vaccination among adolescents. Methods: Leveraging data from a mixed-method study conducted in the U.S. with a diverse population of parents with adolescents ages 9-14, we used both qualitative and quantitative data (e.g., the National Immunization Survey-Teen, focus groups, and social media) to create personas. These data sources were used to identify and develop key characteristics for personas to reflect a range of parents and their diverse understandings and experiences related to HPV vaccination. A parent advisory board provided insight and helped refine persona development. Results: Four personas emerged and were characterized as the (1) Informed Altruist, (2) Real Talker, (3) Information Gatherer, and (4) Supporter. Characteristics differed across personas and provided insights into targeted narrative strategies. Described attributes included demographics, psychographics, communication style, vaccine goals and aspirations, vaccine challenges and frustrations, and vaccine hesitancy. Discussion: This work demonstrates how multiple data sources can be used to create personas to deliver social media messages that can address the diverse preferences and needs of parents for HPV vaccine information. With increasing usage of social media for health information among parents, it is important for researchers to consider marketing and design thinking to create health communication messages that resonate with audiences.

Providing health messages to Hispanics/Latinos: understanding the importance of language, trust in health information sources, and media use.

Health communication is critical to promoting healthy lifestyles and preventing unhealthy behaviors. However, populations may differ in terms of their trust in and use of health information sources, including mass media, the Internet, and interpersonal channels. We used the 2005 Health Information National Trends Survey (HINTS) to test the hypothesis that Hispanics who are less comfortable speaking English would differ from Hispanics who are comfortable speaking English with respect to trust in health information sources and media use. Hispanics/Latinos comprised 9% of the 2005 HINTS sample (n = 496). Respondents not born in the United States regardless of race/ethnicity and all Hispanics were asked, "How comfortable do you feel speaking English?" Responses of "completely," "very," or "native speaker" were combined into "comfortable speaking English": all other responses were categorized as "less comfortable speaking English." Those comfortable speaking English reported higher trust for health information from newspapers (p < .05), magazines (p < .05), and the Internet (p < .01) compared with those less comfortable speaking English. They also reported more media exposure: daily hours listening to the radio and watching television (both p < .05) and days per week reading newspapers (p < .05). Hispanics comfortable speaking English reported much higher levels of Internet use (54% versus 14%, p < .0001). Hispanics who are not comfortable speaking English may be difficult to reach, not only because of language barriers and lower trust in media, but also because they report relatively little use of various media channels. These findings have important implications for health communications toward non-native speakers of English in general and Hispanics in particular.

Teens, dating violence, and media use: a review of the literature and conceptual model for future research.

Dating violence is highly prevalent among adolescents. Of importance, dating violence has been associated with negative physical and mental health outcomes for teens and high-risk behaviors such as unsafe sex practices. Although a growing body of research has examined the extent and nature of this problem, little research has considered aspects of the media that might be associated with risk for teen dating violence, such as time spent using media and effects of media content. This article provides an overview of the prevalence of teen dating violence, describes the potential for assessing media use as a risk factor, offers a conceptual model, and suggests ideas for future research.

Validation of the Rapid Estimate for Adolescent Literacy in Medicine Short Form (REALM-TeenS).

BACKGROUND: This study was designed to develop and validate a brief adolescent health literacy assessment tool (Rapid Estimate of Adolescent Literacy in Medicine Short Form [REALM-TeenS]). METHODS: We combined datasets from 2 existing research studies that used the REALM-Teen (n = 665) and conducted an item response theory analysis. The correlation between scores on the original 66-item REALM-Teen and the proposed REALM-TeenS was calculated, along with the decision consistency across forms with respect to grade level assignment of each adolescent and coefficient α. The proposed REALM-TeenS was validated with original REALM-Teen data from a third independent study (n = 174). RESULTS: Items with the largest discriminations across the scale, from low to high health literacy, were selected for inclusion in REALM-TeenS. From those, a set of 10 items was selected that maintained a reasonable level of SE across ability estimates and correlated highly (r = 0.92) with the original REALM-Teen scores. The coefficient α for the 10-item REALM-TeenS was .82. There was no evidence of model misfit (root mean square error of approximation < 0.001). In the validation sample, REALM-TeenS scores correlated highly with scores on the original REALM-Teen (r = 0.92), and the decision consistency across both forms was 80%. In pilot testing, administration took ∼20 seconds. CONCLUSIONS: The REALM-TeenS offers researchers and clinicians a brief validated screening tool that can be used to assess adolescent health literacy in a variety of settings. Scoring guidelines ensure that reading level assessment is appropriate by age and grade.