Adolescent Health Literacy Research Articles

Adolescent health literacy: sociodemographic determinants and its relationship with substance use avoidance.

Adolescence is a critical period for health literacy (HL) development and for decision-making regarding substance use behaviors. Little is known about which sociodemographic factors are related to the three major components of HL (i.e. functional, interactive, critical HL) and the extent to which these components of HL moderate the relationship between sociodemographic determinants of substance use avoidance and avoidance for adolescents. This study aimed to identify sociodemographic determinants of functional, interactive, critical and composite HL among adolescents, and to assess HL's role as a determinant and moderator of substance use avoidance. Data were collected from 675 adolescents (mean age = 15.5 years, ~53% girls, ~32% Hispanic/Latine) through Qualtrics survey panels and in school settings. Participants completed surveys on social and demographic factors, HL, and substance use. Binary and multinomial logistic regressions were used to address the study aims. In adjusted analyses, adolescents who were girls, Hispanic/Latine (vs. White), food secure, English proficient, had private communications with health providers, and thosewithout impaired decision-making had higher odds of having high HL. Having higher functional, interactive and composite HL increased the odds of substance use avoidance and moderated the effect of age, with younger adolescents with higher HL (vs. low HL) having greater odds of substance use avoidance. Our findings suggest that HL may act as a protective factor against the initiation of substance use in younger adolescents. Thus, HL may be a good intervention strategy to delay substance use initiation for younger adolescents.

Assessment of the psychometric properties of the eHealth Literacy Scale for Brazilian adolescents.

With the increase in digitalization of adolescents and health services, the population must demonstrate digital health literacy skills to be able to navigate online health information, as well as identify, evaluate, and apply relevant information. The present study aimed to investigate the psychometric properties of the adapted version of the eHealth Literacy Scale (eHEALS-BrA) for Brazilian adolescents. This study was conducted between September 2022 and May 2023, involving a total of 260 adolescents aged 13 to 19, with a mean age of 15.64 years (SD = 1.84), all of whom were enrolled in public schools in Brazil. Structural validity was evaluated by confirmatory factor analysis (CFA). The reliability of the instrument was assessed using Cronbach's alpha (α) and McDonald's omega (ω), and test-retest reliability. Questionnaires about sociodemographic aspects, health-related characteristics, and internet use were administered and used as discriminant validation measures. Convergent Validity was determined by correction with the domains of the World Health Organization Quality of Life-Bref (WHOQOL-Bref) instrument. For test-retest reliability, 67 participants completed the eHEALS-BrA a fortnight later. The average eHEALS-BrA score was 28.05 points (SD = 5.05). CFA revealed that the model with the best fit had a single factor (χ2 = 49.884 [df = 20, p = 0.0002], CFI = 0.934, TLI = 0.908, RMSEA = 0.076(CI:0.05-0.10), and SRMR = 0.045). The instrument demonstrated good reliability, with satisfactory internal consistency (α and ω = 0.71) and stability (ICC = 0.82, 95% CI:0.70-0.89). The eHEALS-BrA was correlated with the physical, psychological, and environmental domains of the WHOQOL-Bref (p = 0.001) (convergent validity). Higher scores were found among male adolescents, individuals who practiced physical activity, those with better self-rated health, those who considered the internet useful for searching for health information (discriminant validity), and those with better self-rated skills related to using the internet (convergent validity) (p < 0.05). The eHEALS-BrA demonstrated adequate psychometric properties for measuring digital health literacy in Brazilian adolescents.

1.K. Scientific session: Health literacy of children and adolescents across Europe

Abstract Health literacy is developed throughout the life course. Enhancing health literacy at an early age is especially important since it may impact both current and future health skills and outcomes. Low health literacy in child and adolescent populations has been linked to worse health outcomes and health disparities in Europe, making health literacy of children and adolescents an important public health topic. Developing and delivering targeted interventions and services for these age groups requires insight and data on the development and state of health literacy in early age. However, child and adolescent health literacy is still an under-researched topic. This is partly due to a lack of appropriate measurement instruments and methods to involve children in research. In the past years, new studies on child and adolescent health literacy have emerged in several European countries. In this workshop, innovative studies from Germany, the Netherlands and the UK on HL in childhood and adolescence are introduced and discussed. Both methodological findings as well as empirical data will be presented. In Germany, an instrument to measure child health literacy was developed and validated for primary school children. This instrument, the HLS-Child-Q15, has been used both in Germany and in the Netherlands to study the relationship between children’s health literacy and their health behaviors and outcomes. In the UK, methods of involving primary school children in health literacy research were studied. Experiences with a Children’s Advisory Group will be shared. Another study in the Netherland focuses on the health literacy profiles and needs of adolescent patients with rheumatic diseases. The format of this workshop will be 4x10-minute presentations (including questions) followed by a 20-minute interactive discussion, reflecting on the relevance of these results to further research, health promotion and health services. which will be followed by Q&amp;A and an open discussion with the audiences. This workshop offers a forum for researchers, health educators, practitioners and policy-makers interested in health literacy measurement and research in children and adolescents. Key messages • Child and adolescent health literacy is an important, yet under-researched public health topic. • Child health literacy is an important predictor of their health behavior and outcomes.

Health literacy from the perspectives of children and adolescents - a meta-ethnography

Abstract Background The current literature on health literacy rarely considers the views of children and adolescents. The aim of our qualitative evidence synthesis was therefore to develop a child- and adolescent-centered conceptualization of health literacy. Methods We conducted a meta-ethnography of qualitative studies. Our iterative literature search considered the literature up to November 2023. We dually screened 1596 abstracts and 97 full texts, assessed the methodological limitations of the 32 included studies, and considered 21 data-rich studies in the analysis. We extracted first- and second-order constructs, translated the studies into each other, and developed a coherent argumentation. We dually assessed the trustworthiness of the evidence. Results The resulting model comprises micro-, meso-, macro- and chronosystems. It highlights the influence of demographic, cognitive and psychological factors on the development of health literacy in children and adolescents at the micro level, the social environment, including family, friends, peers, teachers, and health professionals at the meso level, and the media and internet, the health and education system, the living environment, and the social narrative about health at the macro level. The chronosystem shows the impact of upbringing, development, and experience. Children absorb health information actively and passively, employing various strategies to evaluate its trustworthiness. They seek advice from their social environment, which acts as a source of information and influencing factor. Different types of information are weighed up and ranked before action is not taken. Conclusions Existing models of health literacy are too one-dimensional to be applied to children and adolescents and do not consider their social and living environment. The proposed model offers a comprehensive understanding of health literacy in children and adolescents. It can be used as a basis for future interventions to improve health literacy. Key messages • Health literacy of children and adolescents is significantly influenced by a combination of internal and external factors. • By incorporating the perspectives of children and adolescents, we have developed a more inclusive and nuanced understanding of health literacy.

11.K. Scientific session: Roots of public health: school health literacy to enhance population health outcomes in Europe

Abstract This workshop will present empirical results from three representative studies on health literacy and digital health literacy conducted in primary and secondary schools in Wales and Germany: (1) Digital Health Literacy in Schools, (2), HLCA HL-Kids, (3) WHO HBSC Wales. While research on child and adolescent health literacy has gained traction in the past decade, only a few studies focus on health literacy in schools. While the European Commission and WHO, as well as most European governments, highlight the importance of schools to support children’s health literacy, schools remain neglected as a research context. With only little evidence available, it is difficult to derive strategies and programs to promote health literacy in schools. We aim to provide practical novel knowledge and contribute to closing the school health literacy gap that is prevalent in Europe. In turn, this will also contribute to European public health development and population health outcomes. Levels of health literacy in child and adolescent populations across European countries and age groups are alarmingly low, making low health literacy a severe risk factor for health outcomes. Low health literacy is associated with worse health conditions and unhealthy behaviours, and in turn, impacts school attainment and educational outcomes. Evidence suggests that health literacy acts as a determinant of health and itself is influenced by other social determinants of health, such as education, intertwining health and education. All studies conducted so far provide evidence that low health literacy follows a social gradient, with children from less affluent families being more likely to have lower health literacy, widening preexisting health inequities observed in almost all health domains within Europe. While effective interventions on the individual and system levels are needed to enhance health literacy, implementation and evaluation research concerning children’s health literacy is rare. Workshop objectives The aim of this workshop is to present findings from three representative studies on health literacy and digital health literacy in primary and secondary schools: (i) The 1st speaker will introduce a study on health literacy and health behaviours of children aged 8-11 (ii) The 2nd speaker will discuss the influence of living environments on health literacy in 4th-grader school kids (iii) The 3rd presentation will have its focus on navigating the infodemic through digital health literacy in adolescent students (iv) The 4th speaker will show links between digital health literacy and health behaviour in adolescent students The format of this workshop will be 4x10-minute presentations followed by a 20-minute panel discussion with the audience, reflecting the relevance of the results to public health research, practice, and policy. The chairs will provide a brief introduction to the concept and moderate the presentations and panel discussion. Key messages • Our results show that health literacy should be addressed as early as in primary schools and that the places, households, and environments children grow up are critical social determinants of health. • Digital health literacy has proven to be a valid learning topic in secondary schools and is linked to digital and media literacy, allowing us to define it as a targeted curriculum item.

Adolescent mental health literacy and help-seeking behaviours. Cross-Sectional survey in Barcelona

Abstract Background Adolescents’ mental health information and help-seeking is critical for preventing the development of mental disorders. This study aims to examine the relationship between mental health literacy and information and help-seeking behaviours, as well as the effects of age and gender. Methods A cross-sectional online survey on a representative sample of 2,240 secondary school students in Barcelona from 11 randomly selected schools. Participants are evenly distributed by age (25% each course) and gender. Results Most adolescents show good recognition of mental disorders and knowledge of mental health (M = 6.39/10; SD = 1.97 and M = 7.75/10; SD = 1.21 respectively). They report having good literacy (M = 3.25/5; SD = 0.71) to search and manage online health information (eHealth literacy), and around half of them affirm having enough knowledge about mental health for them. Search engines (35.7%) and talking to family/friends (31.8%) are preferred for mental health information-seeking, but 19.8% chose not to engage in active information-seeking behaviour. When having mental health concerns, they prefer seeking help (“I would not ask for help” M = 2.4/7; SD = 1.93), and turning to family (M = 4.7/7; SD = 2.4) and friends (M = 4/7; SD = 2.1), instead of health professionals (M = 2.5/7; SD = 3.5). Chi-square test reveals that: lower recognition of mental disorders is associated with not help-seeking; lower mental health knowledge is associated with beliefs that information for mental health promotion, prevention, and care is unnecessary; and higher eHealth literacy is related to information searching in social media, but not to active searching. The ANOVA test reveals a significant gender-age interaction in certain variables, particularly in the recognition of mental disorders, which is higher in girls and increases with age. Conclusions Higher eHealth literacy is related to information-seeking on social media, but not to active search. Girls have a higher level of recognition of mental disorders. Key messages • Adolescents need a support network to seek mental health help, as they often avoid seeking professional help. • Mental health promotion activities would benefit from further exploration of gender differences.

Relationship between microbiota awareness, nutrition literacy, and health literacy among adolescents.

Microbiota awareness, nutritional literacy, and health literacy levels in adolescents have a significant impact on their health and well-being. This research was conducted to examine the relationship between microbiota awareness, nutrition literacy, and health literacy in adolescents. This research was structured with a descriptive-correlational design. The study population comprised adolescents aged 10-19 years, living in Türkiye (n = 739), between June 2022 and February 2024. Data were analyzed using SPSS 22.0, G*Power 3.1, and R programming language 4.1.3. The total effect of the health literacy variable on nutritional literacy was 0.2311, and this was statistically significant at a 95% confidence interval (CI) (p < 0.05). In terms of the health literacy variable, the direct effect of the nutrition literacy variable on the microbiota awareness variable was 0.2888, and this was statistically significant at the 95% CI (p < 0.05). In terms of the nutritional literacy variable, the direct effect of the health literacy variable on the microbiota awareness variable was 0.1707, and this was statistically significant at the 95% CI (p < 0.05). Nutrition literacy had a partial mediating role in the effect of health literacy on microbiota awareness (lower limit CI: 0.045; upper limit CI: 0.0894). The most accurate prediction of machine learning approaches to predict microbiota awareness was made with random forest with shapley additive explanations values, and the most important variable that should be in the model to predict the microbiota awareness variable was the nutrition literacy variable. Microbiota awareness increased as health literacy and nutrition literacy increased. In the machine learning approach prediction, the most important variables affecting microbiota awareness were health literacy and nutritional literacy. Longitudinal studies on microbiota awareness are recommended.

Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review.

Adolescent health literacy is critical for navigating the complex landscape of modern healthcare and making informed decisions that influence long-term health outcomes. This comprehensive review synthesizes current research on integrating digital tools and interactive learning approaches to enhance health literacy among adolescents. We explore the use of digital technologies, such as mobile apps and virtual reality, which cater to the preferences of this tech-savvy generation, offering personalized and accessible health information. The effectiveness of interactive learning methodologies, including simulations and role-playing, is also examined, highlighting their potential to increase engagement and retention of health-related knowledge. We address the importance of mental health literacy and the role of social media and peer education in disseminating health information effectively. Our review identifies gaps in the current literature, particularly the need for studies that consider long-term outcomes and the impact of socioeconomic and cultural factors on health literacy initiatives. We propose a multidimensional approach to health literacy education that incorporates innovative technologies and interactive methods to meet the diverse needs of adolescents in various contexts. The findings suggest that an integrated approach, including digital and critical health literacy, is essential for developing comprehensive health education programs that are both informative and engaging for adolescents.

Psychometric properties of the Functional Literacy Questionnaire among Portuguese adolescents.

Robust tools to assess self-reported adolescent functional health literacy are lacking. In Portugal, the only available tool is the Newest Vital Sign for Portuguese adolescents (NVS-PTeen), though presenting modest validity and reliability properties. A new instrument-the Functional Literacy Questionnaire (FLiQ)-was developed, inspired by the NVS-PTeen, but following the European Regulation for food labeling and targeting a balanced assessment of numeracy and verbal comprehension skills. This study aimed to evaluate several psychometric properties of the FLiQ when administered to Portuguese adolescents. We conducted a longitudinal observational study with three phases: (1) Delphi panel with health literacy experts; (2) self-administration of FLiQ and NVS-PTeen to adolescents in 7th to 9th grades; and (3) re-administration of FLiQ four weeks after baseline, to the same group of participants. FLiQ's content validity was excellent, with an Average-Content Validity Index of .95. Overall, 372 adolescents (50.3% girls) aged between 12-17 years (median age: 13) participated in the study. Of these, 150 completed the test-retest assessment. Internal consistency was good (Kuder-Richardson Fornula-20 = .70), as well as test-retest reliability (Intraclass Coefficient Correlation = .82). FLiQ total score was weakly correlated with the school year (rho = .174), and moderately with Portuguese (rho = .348) and Mathematics grades (rho = .333). Factor analysis indicated a two-dimension structure, reflecting numeracy and verbal comprehension skills. Item response theory analysis revealed differences in difficulty and discrimination capacity among items, all with adequate fit values. FLiQ is a valid and reliable tool. It can be used to monitor functional health literacy levels in Portuguese adolescents.

Mental health literacy of adolescents in Bermuda, according to age, gender and race.

Mental health literacy (MHL) is an important part of the help-seeking process, yet there is a lack of knowledge about the MHL of adolescents in the Caribbean. This region is important to study as it is underrepresented in mental health research globally. The aim of this study is to explore the ability of adolescents in Bermuda to recognize depression and social phobia (social anxiety) and their beliefs about the sources of help for a peer with these mental health problems. This cross-sectional study surveyed middle and high school students aged 10-19 years in Bermuda. Online surveys conducted between November 2022 and June 2023 gathered demographic data including age, gender and race, and assessed the ability to recognize depression and social anxiety from descriptions provided in randomly assigned vignettes, and beliefs about sources of help. Across 15 middle and high schools, 2423 adolescents (out of 3593 eligible participants) completed all demographic and MHL survey questions (1139 males, 1272 females). Recognition rates for depression and social anxiety were 60% and 53%, respectively. Compared to females, males endorsed a greater variety of help sources. Reporting symptoms of depression or anxiety reduced the likelihood of endorsing multiple sources of help. MHL of adolescents in Bermuda is sub-optimal, particularly for social anxiety. Mental health promotion programs may be useful in improving recognition rates.

Health literacy in adolescents and young adults in Benin: French translation and validation of the health literacy measure for adolescents (HELMA).

The Health Literacy Measure for Adolescents (HELMA) is a self-assessment validated tool used to measure health literacy in adolescents. This study aims to evaluate the psychometric properties of the French translation of the Health Literacy Measure for Adolescents (F-HELMA). The HELMA questionnaire was translated according to the World Health Organization's (WHO) recommendation for translation and adaptation of instruments. It was pre-tested with 30 students. Subsequently, 495 adolescents and young adults from five senior secondary high schools in Benin completed the questionnaire. A sample of 44 participants completed the questionnaire twice over a 2-week period to determine the test-retest reliability. Construct validity was evaluated using confirmatory factor analysis (CFA) and convergent validity was analyzed the Health Literacy Assessment Tool. The F-HELMA-French translation of the Health Literacy Measure for Adolescents, showed moderate to good psychometric properties. CFA showed good fit indices for a seven-factor model. Reliability figures fell within an acceptable range; Cronbach's alpha ranged from 0.64 (moderate) to 0.89 (good) across the different subscales, and the intraclass coefficient (ICC) ranged from 0.82 to 0.96, indicating good test-retest reliability. Pearson correlation with HLAT-8 showed good convergent validity (r = 0.54, p < 0.001). This study provides support for the use of the F-HELMA, as a valid and reliable instrument to measure health literacy in adolescents and young adults in West African French speaking countries.

Evaluation of adolescents' cardiovascular health behaviors and health literacy levels in Turkey

PurposeThe study aimed to examine the relationship between cardiovascular health behaviors and health literacy levels of adolescents. Design and methodsCross-sectional design was used in this study. The sample consisted of 1228 students from two secondary schools in Turkey. The study data were collected in 2020. The data were collected via the Cardiovascular Health Behavior Scale and the The Health Literacy Scale. ResultsCardiovascular Health Behavior Scale for Children mean score was 56.07 ± 10.80. The Health Literacy Scale total mean score of the students was 30.93 ± 5.31. The mean scores of the Cardiovascular Health Behavior Scale for those who were 14 years old, female, studying in the 8th grade, whose parents were primary school graduates, and presence of a person who has had a heart attack in the family were found to be statistically significantly higher. The average health literacy score of students who were female, high income, and who had parents with a baccalaureate or graduate degree was found to be statistically significantly higher. The Cardiovascular Health Behavior Scale and The Health Literacy Scale showed a weak negative correlation. ConclusionsThe cardiovascular health behaviors and health literacy of adolescents were found to be moderate. In order to improve adolescents' health literacy and help them develop good cardiovascular health habits from an early age, interventions should be planned and overseen in collaboration. Practice implicationsAdolescent health promotion requires that nurses assess adolescents' cardiovascular health behaviors and health literacy levels. To achieve the objectives of enhanced cardiovascular health behaviors and better health literacy, parent cooperation is also required.

Functional Ovulatory Menstrual Health Literacy Amongst Adolescent Females in Western Australia

Study objectiveTo assess the knowledge of ovulation and menstruation of adolescent females in Western Australia. MethodsA validated adolescent ovulatory menstrual health literacy questionnaire was used in a cross-sectional study, which included an open-response question inviting participants’ reflections. ResultsParticipants (n=297) were from two single sex and seven co-educational schools of varied socio-educational advantage. Mean chronological age was 15 years and mean gynaecological age was two years. The prevalence of dysmenorrhoea was 69%. Primary sources of information included mothers (91%), friends (61%) and, for post-menarcheal participants (n=274), mobile applications (52%). Most adolescents enjoyed finding out information about ovulatory menstrual health, and understood the information given to them. However, participants’ knowledge of ovulation, menstruation and their occurrence in the cycle were low. Attendance at a single sex or Catholic school or use of mobile applications did not confer a knowledge advantage overall (p<0.05), except for knowing the meaning of cervical mucus. Thematic content analysis of open-ended responses resulted in five themes, including normality, menstrual flow, charting, ovulation and dysmenorrhoea. ConclusionInadequate functional ovulatory menstrual health literacy hampers progression to acquiring complete health literacy. This has negative implications for progressing towards the interactive and critical ovulatory menstrual health literacy domains, which include providing an accurate menstrual history when engaging with healthcare providers.

Health Literacy in the Short Film Stunting “Konsumsi Bergizi Bikin Glowing”

Indonesia is a developing country with a low health index, one of which is indicated by the high prevalence of stunting. Stunting is a growth disorder in children due to chronic malnutrition that has an impact on long-term physical and cognitive health. This study aims to explore the messages in the short film "Nutritious Consumption Makes You Glowing" produced by the DIY Health Service in improving adolescent health literacy related to preventing stunting through the consumption of nutritious food and blood-boosting supplements. Using a qualitative approach, this study analyzed the content of the film and relevant literature. The results showed that this film succeeded in conveying health literacy effectively through direct socialization carried out by Bu Bidan. Messages about the importance of balanced nutrition and blood supplementation are conveyed in a way that is easy for adolescents to understand and accept. Scenes in the film depict changes in healthy lifestyles that are starting to be adopted by adolescents, showing that education through audiovisual media can influence people's nutritional behavior and awareness. Thus, this short film is an effective educational tool in improving health literacy and preventing stunting among adolescents.

Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology.

Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL. Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL.

Associations between digital health literacy and health system navigating abilities among Norwegian adolescents: validating the HLS19-DIGI scale using Rasch modeling

BackgroundDespite increasing global attention to health literacy and adolescents’ digital health information seeking, no unidimensional instruments measuring digital health literacy (DHL) in adolescents have reportedly been validated using Rasch modeling. Moreover, the evidence of adolescents’ abilities to navigate the health system (NAV-HL) in light of their DHL proficiency is still scarce. Therefore, our study aims to evaluate the psychometric properties of a DHL instrument (HLS19-DIGI scale) in order to investigate DHL in adolescents and young adults aged 16–25 and associations with abilities to navigate the health system.MethodsA population-based cross-sectional survey among 890 Norwegian adolescents was conducted during April–October 2020 using computer-assisted telephone interviewing. Rasch modeling, independent samples t-test, chi-square test, and binary regression models were used to analyze the data.ResultsThe HLS19-DIGI scale was sufficiently unidimensional, whereas no differential item functioning or disordered response categories were observed. However, relatively poor targeting was revealed indicating too many easy items for the target population. Yet, a high proportion (54%) of low DHL proficiency in adolescents was observed, as well as DHL was positively associated with the abilities to navigate the health system.ConclusionsThe HLS19-DIGI scale is considered a sufficiently unidimensional and valid instrument for measuring DHL in adolescents, which may be a useful tool for health authorities, public health workers, and health service providers. While DHL affects adolescents’ abilities to navigate the health system, future research should measure and examine their ability to utilize digital health services, separately.

"When one has no REAL illness"-analysis of the knowledge component of mental health literacy in children and adolescents of parents with a mental illness.

Mental Health Literacy (MHL) is important in promoting youth mental health. One key aspect of MHL is knowledge about mental disorders, which is particularly relevant for populations at risk for developing mental disorders, such as children of parents with a mental illness (COPMI), representing a mechanism within the transgenerational transmission. Currently, COPMI's level of disorder knowledge in general, and about the specific parental disorder has not been comprehensively researched. We, therefore, aimed to assess COPMI's disorder knowledge and clarify its association with COPMI's age and sex exploratively. To assess both general and disorder-specific knowledge, we took a novel approach that makes disorder knowledge comparable across samples and over time. A mixed method analysis of N = 181 semi-structured MHL interviews with COPMI (aged 5 to 17 years) was carried out in the COMPARE-family study in Germany. We conducted a DSM-oriented deductive qualitative content analysis to assess COPMI's general and specific disorder knowledge. Chi-square tests served to identify age and sex differences. Children revealed limited knowledge of mental disorders in general, whereas adolescents displayed more knowledge that was also partly consistent with descriptions of classification systems like the DSM-5. The level of specific knowledge about the parent's disorder depended on the disorder group. More children displayed adequate knowledge of somatic and anxiety disorders compared to trauma and depressive disorders, and more adolescents displayed adequate knowledge of depressive and anxiety disorders. COPMI's age and sex were found to be significantly associated with disorder knowledge: adolescents exhibited higher levels of adequate general and specific disorder knowledge, and males exhibited higher levels of adequate general disorder knowledge. Assessing COPMI's disorder knowledge and identifying associated age and sex differences yield valuable insights into the knowledge component of the MHL theory. Our findings can help to improve psychoeducational interventions for COPMI by orienting them to their prevailing levels of disorder knowledge. We recommend employing and extending the DSM-oriented deductive approach to assess knowledge within MHL. Analyses involving additional assessments within the COMPARE-family study are in preparation to identify potential knowledge gains over time, and associations to COPMI's own well-being and mental health symptoms.

Evaluation of health literacy and its association with medication adherence and quality of life in childhood-onset systemic lupus erythematosus.

Little is known about health literacy in childhood-onset systemic lupus erythematosus (cSLE) and how health literacy relates to medication adherence and psychosocial outcomes in this high-risk population. The objective of this study was to evaluate health literacy in adolescents and young adults with cSLE and its association with medication adherence and quality of life. Youth 10-24years with cSLE (n = 48) completed the Brief Healthy Literacy Screen (BHLS) and the Newest Vital Sign (NVS) to assess health literacy. Participants also completed validated measures of medication adherence and quality of life. Descriptive analyses were used to determine levels of health literacy. Bivariate correlations were used to evaluate associations between measures of health literacy with adherence and quality of life. A multivariable regression analyses was used to determine if health literacy was a significant predictor of adherence or quality of life, after adjusting for age, sex, race, and household income. Inadequate health literacy was common in this population, with 67% of youth categorized as having inadequate health literacy by the BHLS and 42% by the NVS. Higher medication adherence was associated with a higher BHLS score (r=.36, p = .017). BHLS was also significantly associated with better quality of life (r = 0.31, p = .034). Inadequate health literacy is prevalent among youth with cSLE. Higher health literacy is associated with higher medication adherence and better quality of life, suggesting that attention to health literacy could improve outcomes for this vulnerable population.

Is There a Meaningful Association Between Physical Literacy and Health Literacy? A Cross- Sectional Study in Older Adolescents

Health literacy (HL) is hypothesized to be associated with physical literacy (PL), but studies have rarely examined this association in adolescents. This study aimed to investigate the possible relationships between PL and physical activity levels (PAL), with HL in high-school adolescents. The participants in this cross-sectional study were high school students (n=204; 100 females; 16 to 19 years of age). Variables included evaluation of the HL, PL, and PAL. The Physical Activity Questionnaire for Adolescents was used for analysis of the PAL. PL was assessed by the Canadian Assessment of Physical Literacy, and the Physical Literacy Assessment of Youth (PLAYself). HL was evaluated using the European Health Literacy Survey Questionnaire. Univariate and multivariate correlations were calculated for the total sample and stratified by gender. Boys had greater PAL than girls (t test =6.76, p&lt;0.001), but no significant gender differences were found in PL and HL. The results showed no significant association between PL and HL in boys. PL was significantly associated with HL in girls (17% of the explained variance, p&lt;0.001), with PLAYself being a significant partial regressor (Beta =0.38, p&lt;0.001). Due to the established gender-specific associations between HL and PL, in developing and implementing educational strategies aimed at improving PL and HL in adolescents, a gender-specific approach is warranted.

Adolescent sexual and reproductive health literacy needs: a sub-national level assessment in Ghana.

This study assessed young adolescents' access and literacy challenges to sexual and reproductive health information and knowledge gaps in the Effutu Municipality in the Central Region of Ghana. We used a narrative design and a focus group discussion method to glean data from 52 in-school adolescents, aged 11-15. Focus group discussions were conducted using a discussion guide and data were processed using QDA Miner (version 6.0). We analyzed data thematically using an iterative process of data validation, coding and recording. The participants had poor knowledge of the concepts of sexual and reproductive health and its essential domains. Abstinence was the predominant sexual and reproductive health goal of the participants. Yet, many males admitted to having sexual partners. There was difficult linguistic and physical access to structured and safe information. Personal hygiene, signs of sexual maturation and abstinence were the predominant contents available to young adolescents. A revision of adolescent health policies and strategies to embrace actions for improving unrestricted access to easy-to-read educational materials and adolescent health literacy is essential. Creating adolescent corners and introducing peer education in schools within Effutu and other municipalities in the Central Region will be useful.