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Association between Health Literacy and Subgroups of Health Risk Behaviors among Chinese Adolescents in Six Cities: A Study Using Regression Mixture Modeling.
Int J Environ Res Public Health. 2019 09 30; 16(19)IJ

Abstract

Adolescents engage in health risk behaviors (HRBs) that influence their current and future health status. Health literacy (HL) is defined as how well a person can get and understand the health information and services, and use them to make good health decisions. HL can be used to participate in everyday activities actively and apply new information to the changing circumstances. HRBs commonly co-occur in adolescence, and few researchers have examined how HL predicts multiple HRBs in adolescence. In this study we examined the subgroups of HRBs, and investigated heterogeneity in the effects of HL on the subgroups. In total, 22,628 middle school students (10,990 males and 11,638 females) in six cities were enrolled by multistage stratified cluster sampling from November 2015 to January 2016. The measurement of HL was based on the Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ). Analyses were conducted with regression mixture modeling approach (RMM) by Mplus. By this study we found four latent classes among Chinese adolescents: Low-risk class, moderate-risk class 1 (smoking/alcohol use (AU)/screen time (ST)), moderate-risk class 2 (non-suicidal self-injury (NSSI)/suicidal behaviors (SB)/unintentional injury (UI)), and high-risk class (smoking/AU/ST/NSSI/SB/UI) which were 64.0%, 4.5%, 28.8% and 2.7% of involved students, respectively. Negative correlations were found between HL and HRBs: higher HL accompanied decreased HBRs. Compared to the low-risk class, moderate-risk class 1 (smoking/AU/ST), moderate-risk class 2 (NSSI/SB/UI), and high-risk class (smoking/AU/ST/NSSI/SB/UI) showed OR (95%CI) values of 0.990 (0.982-0.998), 0.981 (0.979-0.983) and 0.965 (0.959-0.970), respectively. Moreover, there was heterogeneity in the profiles of HRBs and HL in different classes. It is important for practitioners to examine HRBs in multiple domains concurrently rather than individually in isolation. Interventions and research should not only target adolescents engaging in high levels of risky behavior but also adolescents who are engaging in lower levels of risky behavior.

Authors+Show Affiliations

Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China. yangrong@stu.ahmu.edu.cn. MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China. yangrong@stu.ahmu.edu.cn. NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China. yangrong@stu.ahmu.edu.cn.Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China. lidanlin@stu.ahmu.edu.cn. MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China. lidanlin@stu.ahmu.edu.cn. NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China. lidanlin@stu.ahmu.edu.cn.Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China. hujie@stu.ahmu.edu.cn. MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China. hujie@stu.ahmu.edu.cn. NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China. hujie@stu.ahmu.edu.cn.Department of Occupational and Environmental Health, School of Public Health, Guilin Medical University, No 1 Zhiyuan Road, Guilin 541199, China. tianrun@stu.glmc.edu.cn.Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China. wyhayd@163.com. MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China. wyhayd@163.com. NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China. wyhayd@163.com.Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China. fbtao@ahmu.edu.cn. MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China. fbtao@ahmu.edu.cn. NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China. fbtao@ahmu.edu.cn.MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China. fangjun@ph.sojo-u.ac.jp. NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China. fangjun@ph.sojo-u.ac.jp. Department of Toxicology, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China. fangjun@ph.sojo-u.ac.jp. Faculty of Pharmaceutical Science, Sojo University, Ikeda 4-22-1, Kumamoto 860-0082, Japan. fangjun@ph.sojo-u.ac.jp.Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei 230032, China. zhangshichen@ahmu.edu.cn. MOE Key Laboratory of Population Health across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China. zhangshichen@ahmu.edu.cn. NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei 230032, China. zhangshichen@ahmu.edu.cn.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31574957

Citation

Yang, Rong, et al. "Association Between Health Literacy and Subgroups of Health Risk Behaviors Among Chinese Adolescents in Six Cities: a Study Using Regression Mixture Modeling." International Journal of Environmental Research and Public Health, vol. 16, no. 19, 2019.
Yang R, Li D, Hu J, et al. Association between Health Literacy and Subgroups of Health Risk Behaviors among Chinese Adolescents in Six Cities: A Study Using Regression Mixture Modeling. Int J Environ Res Public Health. 2019;16(19).
Yang, R., Li, D., Hu, J., Tian, R., Wan, Y., Tao, F., Fang, J., & Zhang, S. (2019). Association between Health Literacy and Subgroups of Health Risk Behaviors among Chinese Adolescents in Six Cities: A Study Using Regression Mixture Modeling. International Journal of Environmental Research and Public Health, 16(19). https://doi.org/10.3390/ijerph16193680
Yang R, et al. Association Between Health Literacy and Subgroups of Health Risk Behaviors Among Chinese Adolescents in Six Cities: a Study Using Regression Mixture Modeling. Int J Environ Res Public Health. 2019 09 30;16(19) PubMed PMID: 31574957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Health Literacy and Subgroups of Health Risk Behaviors among Chinese Adolescents in Six Cities: A Study Using Regression Mixture Modeling. AU - Yang,Rong, AU - Li,Danlin, AU - Hu,Jie, AU - Tian,Run, AU - Wan,Yuhui, AU - Tao,Fangbiao, AU - Fang,Jun, AU - Zhang,Shichen, Y1 - 2019/09/30/ PY - 2019/08/28/received PY - 2019/09/26/revised PY - 2019/09/28/accepted PY - 2019/10/3/entrez PY - 2019/10/3/pubmed PY - 2019/10/3/medline KW - Chinese adolescents KW - health literacy KW - health risk behaviors KW - latent class analysis KW - regression mixture modeling JF - International journal of environmental research and public health JO - Int J Environ Res Public Health VL - 16 IS - 19 N2 - Adolescents engage in health risk behaviors (HRBs) that influence their current and future health status. Health literacy (HL) is defined as how well a person can get and understand the health information and services, and use them to make good health decisions. HL can be used to participate in everyday activities actively and apply new information to the changing circumstances. HRBs commonly co-occur in adolescence, and few researchers have examined how HL predicts multiple HRBs in adolescence. In this study we examined the subgroups of HRBs, and investigated heterogeneity in the effects of HL on the subgroups. In total, 22,628 middle school students (10,990 males and 11,638 females) in six cities were enrolled by multistage stratified cluster sampling from November 2015 to January 2016. The measurement of HL was based on the Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ). Analyses were conducted with regression mixture modeling approach (RMM) by Mplus. By this study we found four latent classes among Chinese adolescents: Low-risk class, moderate-risk class 1 (smoking/alcohol use (AU)/screen time (ST)), moderate-risk class 2 (non-suicidal self-injury (NSSI)/suicidal behaviors (SB)/unintentional injury (UI)), and high-risk class (smoking/AU/ST/NSSI/SB/UI) which were 64.0%, 4.5%, 28.8% and 2.7% of involved students, respectively. Negative correlations were found between HL and HRBs: higher HL accompanied decreased HBRs. Compared to the low-risk class, moderate-risk class 1 (smoking/AU/ST), moderate-risk class 2 (NSSI/SB/UI), and high-risk class (smoking/AU/ST/NSSI/SB/UI) showed OR (95%CI) values of 0.990 (0.982-0.998), 0.981 (0.979-0.983) and 0.965 (0.959-0.970), respectively. Moreover, there was heterogeneity in the profiles of HRBs and HL in different classes. It is important for practitioners to examine HRBs in multiple domains concurrently rather than individually in isolation. Interventions and research should not only target adolescents engaging in high levels of risky behavior but also adolescents who are engaging in lower levels of risky behavior. SN - 1660-4601 UR - https://www.unboundmedicine.com/medline/citation/31574957/Association_between_Health_Literacy_and_Subgroups_of_Health_Risk_Behaviors_among_Chinese_Adolescents_in_Six_Cities:_A_Study_Using_Regression_Mixture_Modeling_ DB - PRIME DP - Unbound Medicine ER -