Health literacy and adolescents: a framework and agenda for future research

Using the "Newest Vital Sign" to assess health literacy in children

INTRODUCTION

The purpose of this study was to explore the feasibility, utility, and validity of using the Newest Vital Sign (NVS) tool to assess health literacy in children.

METHOD

Forty-seven parent-child dyads individually completed the NVS and a Home Literacy Environment single-item screening question (No. of children's books in the home).

RESULTS

The majority (72%; n = 34) of parent-child dyads had adequate health literacy (NVS scores ≥4), with no significant differences (p = .95) between children's NVS scores (M = 4.8, SD = 1.5) and parents (M = 4.8, SD = 1.6). A moderate, positive correlation was found between children's and parents' NVS scores (rs = .35, p = .017). Of note was that all of the parents (n = 4) and children (n = 6) who reported having only 10 or fewer children's books in their homes had NVS scores less than 4, indicating inadequate health literacy.

DISCUSSION

The NVS is a quick screening mechanism for identifying households that have adequate health literacy levels. Asking children the Home Literacy Environment single-question screening item (No. of children's books) provided additional insight that confirmed and extended findings from the NVS.

Health literacy among young adults: a short survey tool for public health and health promotion research

Health literacy (HL) is context-specific. In public health and health promotion, HL in the private realm refers to individuals' knowledge and skills to prevent disease and to promote health in everyday life. However, there is a scarcity of measurement tools explicitly geared to private realm contexts. Our aim was to develop and test a short survey tool that captures different dimensions of HL in the context of family and friends. We used cross-sectional data from the Swiss Federal Surveys of Adolescents from 2010 to 2011, comprising 7983 males and 366 females between 18 and 25 years. HL was assessed through a set of eight items (self-reports). We used principal component analysis to explore the underlying factor structure among these items in the male sample and confirmatory factor analysis to verify the factor structure in the female sample. The results showed that the tested item set represented dimensions of functional, interactive and critical HL. Two sub-dimensions, understanding versus finding health-relevant information, denoted functional HL. Interactive and critical HL were each represented with two items. A sum score based on all eight items (Cronbach's α: 0.64) showed expected positive associations with own and parental education among males and females (p < 0.05). The short item set appears to be a feasible measurement tool to assess HL in the private realm. Its broader application in survey studies may help to improve our understanding of how this form of HL is distributed in the general population.

Exploring prostate cancer literacy and family cancer awareness in college students: getting ahead of the curve in cancer education

Cancer literacy and family cancer experiences have not been widely researched from the perspective of young adults. This study examined health literacy related to prostate cancer and family cancer awareness among a sample of 146 male and female college students. Results supported conventional wisdom that males would be more knowledgeable about the anatomical location of the prostate as compared to females. More notably, across the sample participants had limited knowledge of comprehensive prostate cancer screening but were generally aware of the prostate specific antigen blood test, as well as age and diet as risk factors for prostate cancer. Emerging associations between sexual health history and prostate cancer risk were not widely known by the sample as a whole and perceived availability of prostate health education in college was low. Finally, gender differences in family communication about cancer and racial differences in the number of family members with cancer were observed, which could have implications for perpetuating existing gender and racial gaps in health literacy and cancer awareness. A lifespan approach to cancer education research is suggested to identify ways to promote lifelong learning about cancer, promote prevention behaviors and informed screening in young adulthood, and beyond and better prepare adults to face a family or personal cancer diagnosis should that occur in the future.

Social Theory Applied to Body Image and Chronic Illness in Youth

Changes in appearance and functional limitations of youth with chronic illness place them at greater risk for negative body image and poor psychosocial and medical outcomes compared with their healthy peers. Sociocultural pressures from the media, family, and peers, as well as social comparison processes to some extent explain the development of negative or positive body image in young people. This article discusses social theories applied to body image in young people with chronic illness, an overlooked population. A review of risk and protective factors of body dissatisfaction in this population and suggested treatment strategies/interventions in the prevention of body dissatisfaction are also considered. Reported findings may help health care providers become more aware of body image issues their young patients with chronic illness face, and posit the importance of regularly monitoring their psychosocial well-being in the efforts to curtail development of body dissatisfaction and consequential poor health outcomes.

Asthma medication device skills in high-risk African American adolescents

OBJECTIVE

To describe the asthma medication device skills of high-risk African American adolescents and associations between skills and other components of illness management,

METHODS

170 African American adolescents, with at least one hospitalization or two emergency department visits in the last year, demonstrated how they use their asthma quick-relief and controller medication devices. Observations were scored using an in vivo observation asthma skills checklist. To assess other areas of asthma management, adolescents and their primary caregiver were interviewed using the Family Asthma Management System Scales,

RESULTS

Only 5% of adolescents correctly demonstrated all controller skills, and none of the adolescents correctly showed all quick-relief inhaler skills (5% showed between 90 and 95% of skills). Several components of asthma management predicting controller medication skills were attendance at an asthma specialty clinic, collaboration with provider, medication adherence, and quick-relief medication skills. These variables accounted for a total of 24% of the variance in controller medication skills,

CONCLUSIONS

Results indicate the need for interventions directly targeting observed asthma management skills and the importance of relationship with providers.

Health knowledge among the millennial generation

The Millennial Generation, also known as Generation Y, is the demographic cohort following Generation X, and is generally regarded to be composed of those individuals born between 1980 and 2000. They are the first to grow up in an environment where health-related information is widely available by internet, TV and other electronic media, yet we know very little about the scope of their health knowledge. This study was undertaken to quantify two domains of clinically relevant health knowledge: factual content and ability to solve health related questions (application) in nine clinically related medical areas. Study subjects correctly answered, on average, 75% of health application questions but only 54% of health content questions. Since students were better able to correctly answer questions dealing with applications compared to those on factual content contemporary US high school students may not use traditional hierarchical learning models in acquisition of their health knowledge.

Health literacy and substance use in young Swiss men

OBJECTIVES

The purpose of the present study was to describe health literacy and its association with substance use among young men.

METHODS

The present study was part of the Cohort Study on Substance Use Risk Factors that included 11,930 Swiss males participating in initial screening from August 2010 to July 2011. Self-completed questionnaires covered use of three substances and three components of health literacy.

RESULTS

Roughly 22 % reported having searched the Internet for health information and 16 % for information on substances over the past 12 months. At-risk and not at-risk users of alcohol (adjusted odds ratio (AOR) = 2.50 and 1.46), tobacco (AOR = 2.51 and 1.79) and cannabis (AOR = 4.86 and 3.53) searched for information about substances significantly more often via the Internet than abstainers. Furthermore, at-risk users reported better knowledge of risks associated with substance use and a marginally better ability to understand health information than abstainers.

CONCLUSIONS

Substance users appear to be more informed and knowledgeable about the risks of substance use than non-users. Consequently, interventions that focus only on information provision may be of limited benefit for preventing substance use.

The relationship between oral health education and quality of life in adolescents

BACKGROUND

There is no study on the association between oral health education and oral health quality of life (OHQoL).

AIM

To assess the relationship between oral health education activities integrated into primary care services and OHQoL in adolescents.

DESIGN

A retrospective observational survey was conducted on 300 randomly selected 12-14 years-of-age adolescents living in two publicly funded health service administrative areas in Manaus, Brazil. Between 2006 and 2008, dental treatment and oral health education were offered in one area (DT/OHE group), whereas in the other area, only dental treatment was provided (DT group). Collected data included socio-demographic characteristics, health services use, health-related behaviours, dental pain, dental caries and Child-OIDP. Independent variables were compared between groups by Mann-Whitney and chi-square tests. The association between one or more OIDP (Child-OIDP ≥ 1) and DT group tested using multivariate logistic regression.

RESULTS

Caries, use of dental services and health-related behaviours did not differ between groups (P > 0.05). Child-OIDP ≥ 1 was higher in DT group (90.0%) compared with DT/OHE group (79.3%) (P = 0.01). Child-OIDP ≥ 1 was independently associated with DT group [OR = 4.4 (1.1; 17.0)].

CONCLUSIONS

Adolescents living in an area where OHE and DT were provided had better OHRQoL than those living in an area where only DT was provided.

Findings toward a multidimensional measure of adolescent health literacy

OBJECTIVE

To explore a multidimensional measure of health literacy that incorporates skills necessary to manage one's health environment.

METHODS

We designed a questionnaire to assess variation in an expanded understanding of health literacy among publicly insured adolescents in California (N = 1208) regarding their health care experiences and insurance.

RESULTS

Factor loading and item clustering patterns reflected in the exploratory principal components factor analysis suggest that the data are parsimoniously described by 6 domains.

CONCLUSION

This multidimensional measure becomes relevant in an era of health care reform in which many will for the first time have health insurance requiring them to navigate a system that uses a managed care model.

Effects of responsibility attribution and message source on young adults' health attitudes and behaviors

This study investigated the effect of message attributes on responses to health messages. The authors examined 3 variables--responsibility attribution (individual vs. social), source (personal blog vs. online magazine), and illness (stigmatized vs. nonstigmatized)--for effects on young adults' health-related attitudes and behaviors. Responsibility attributions influenced attitudes about individual responsibility for health but did not alter participants' behavioral intentions. Further, individuals exposed to a story from a health magazine exhibited stronger intentions to communicate about health than individuals exposed to a personal health blog. Although women's attitudes regarding social responsibility for health did not differ by illness type or responsibility attribution, men's attitudes did.

Contextualizing an expanded definition of health literacy among adolescents in the health care setting

The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and practices relevant when managing one's health environment. It is an emerging area of inquiry especially among adults and those with chronic conditions; however, it has been less studied among adolescent populations. To begin operationalizing this concept in a manner appropriate for teens in a health systems context, we explored knowledge, attitudes and practices related to health and preventive health care in 12 focus groups with publicly insured adolescents (N = 137), aged 13-17 years, as well as eight key informant interviews with physicians who serve publicly insured teens. Five dimensions emerged that provide a preliminary framework for an expanded definition of health literacy among adolescents. These include: (i) navigating the system, (ii) rights and responsibilities, (iii) preventive care, (iv) information seeking and (v) patient-provider relationship. This robust definition of health literacy contextualizes the concept in a health environment where individuals must be informed and skilled health care consumers.

Older Adolescents' Experiences Living with a Parent Who is a Transplant Patient

This descriptive qualitative study using telephone interviews and surveys explored how parental transplant status affected older adolescents. A sample of 8 adolescents (62% female) between 15 and 20 years old participated. Findings revealed “a normal life.” Other themes were feeling the impact, worrying, coping, and keeping healthy. Parental transplant status had positive and negative effects. No evidence was found of signs or symptoms of depression. Transplant candidates' children worried about “something going wrong”; recipients' children worried about organ rejection. Most stated that parental transplant status did not influence career plans, jobs, or friends. Strategies and recommendations for practice and future research are discussed.

Mechanisms underlying the relationship between health literacy and glycemic control in American Indians and Alaska Natives

OBJECTIVE

Research suggests that health literacy (HL) is associated with clinical outcomes. Few studies, however, have examined the mechanisms accounting for this relationship. To understand why HL is related to outcomes, we tested a theoretical framework proposing that diabetes-related knowledge and behavior mediate (explain) the relationship between HL and glycemic control (i.e., A1c).

METHODS

Analyses used baseline data from the Special Diabetes Program for Indians Healthy Heart Project (N=2594), an intervention to reduce cardiovascular risk among American Indians/Alaska Natives (AI/ANs) with diabetes. Three nested structural equation models tested the theoretical framework.

RESULTS

Model 1 demonstrated that participants with stronger HL skills had better glycemic control. Model 2 tested whether diabetes-related behaviors accounted for this relationship. Self-monitoring of blood glucose significantly mediated the HL-A1c relationship. Model 3 examined the role of diabetes knowledge, showing that it mediated the relationship between HL and dietary behavior. When knowledge was included, behavior was no longer a significant mediator, suggesting that knowledge was the main driver of the relationship between HL with A1c.

CONCLUSION

Interventions to improve knowledge may be particularly important in enhancing outcomes among AI/ANs with diabetes.

PRACTICE IMPLICATIONS

Strategies known to enhance patient comprehension may enable low-literate patients to develop needed diabetes knowledge.

Clinicians poorly assess health literacy-related readiness for transition to adult care in adolescents with inflammatory bowel disease

BACKGROUND & AIMS

To prepare for the transition from pediatric to adult-oriented health care systems, adolescents must develop the ability to obtain, process, and understand basic health information; make appropriate health decisions; and interact effectively with health care professionals. However, physicians use subjective methods to determine patients' readiness for this transition. We investigated health care literacy-related readiness for transition of children and adolescents with inflammatory bowel disease (IBD) to identify determinants and compare actual levels with clinicians' opinions.

METHODS

The study included 74 pediatric patients with IBD ≥10 years old who were recruited from a pediatric hospital-based clinic. We evaluated their functional and interactive health literacy and recorded clinicians' perceptions of literacy and readiness for transition among pediatric patients. Relationships between health literacy measures, demographic variables, and clinician perceptions were determined.

RESULTS

Health literacy-related readiness for transition was observed in 11% of the patients analyzed. However, clinicians found 47% of the cohort ready for the transition, on the basis of literacy standards. Health literacy-related readiness for transition was associated with older age (P < .01), white race (P = .03), and low income (P < .02). Agreement was poor between measures-defined and clinician-defined levels of health literacy-related readiness for transition (P = .18).

CONCLUSIONS

Clinicians inadequately judge the health literacy-related readiness for transition to adult care of pediatric IBD patients. Improved awareness of health literacy issues among adolescents with IBD is needed among health care providers and health care systems.

Social cognitive factors and perceived social influences that improve adolescent eHealth literacy

While adolescents are increasingly using the Internet for health information, little research has been done to assess and improve their "eHealth literacy"-the abilities to find, evaluate, and apply online health information. This study examines the extent to which adolescents' levels of eHealth literacy can be improved by known determinants such as social cognitive factors and perceived social influences, either independently or jointly. Among 182 middle-schoolers, an eHealth literacy intervention was carried out. It involved qualitative and quantitative baseline research, three online training sessions, and a postintervention survey. According to hierarchical regression model results, social cognitive factors of outcome expectations and involvement, but not health motivation, significantly improved eHealth literacy, and all the perceived social influence variables significantly improved eHealth literacy. However, no joint effect of social cognitive factors and perceived social influences was found. In light of these findings, educators need to make eHealth literacy programs personally relevant to adolescents and reinforce local social norms about the importance of seeking health information online.

Health literacy and public health: a systematic review and integration of definitions and models

Background

Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy.

Methods

A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model.

Results

The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively.

Conclusions

Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

Health literacy and public health: a systematic review and integration of definitions and models

BACKGROUND

Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy.

METHODS

A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model.

RESULTS

The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively.

CONCLUSIONS

Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

The health literacy skills framework

Although there are a variety of models and frameworks that describe factors that are associated with health literacy skills, few illustrate the full pathway from development and moderators of health literacy skills, their application, and the outcomes that result all in one framework or model. This article introduces the Health Literacy Skills conceptual framework that does encompass this full continuum. To develop the framework, the authors reviewed and built upon existing health literacy frameworks. The Health Literacy Skills framework hypothesizes the relations between health literacy and health-related outcomes and depicts how health literacy functions at the level of the individual. The framework also reflects how factors external to the individual (e.g., family, setting, community, culture, and media) influence the constructs and relations represented in the framework. The framework is organized into 4 primary components: (a) factors that influence the development and use of health literacy skills; (b) health-related stimuli; (c) health literacy skills needed to comprehend the stimulus and perform the task; and (d) mediators between health literacy and health outcomes. Previous theoretical frameworks lend support to the proposed causal pathways it illustrates. The authors hope this conceptual framework can serve as a springboard for further discussion and advancement in operationalizing this complex construct. The Health Literacy Skills framework could also be used to guide the development of interventions to improve health literacy. Future research should be conducted to fully test the relations in the framework.

Correlates of sexual risk behaviors among high school students in Colorado: analysis and implications for school-based HIV/AIDS programs

Objectives of this study are to examine correlates of antecedent sexual risk exposures associated with HIV/AIDS infection among adolescents participating in the 2005 Colorado Youth Behavioral Risk Survey (CYBRS), and to determine gender differences associated with these exposures since previous studies have produced mixed findings. Variables assessing these relationships were drawn from CYBRS, 2005. We used χ2 to assess bivariate relationships and multinomial logistic regression to evaluate associations among dependent variables (sexual risk behaviors, age at first sex, and number of sexual partners in the past 3 months) and independent variables (in-school HIV/AIDS education, use of illegal substances, physically forced sex, and alcohol use). We found no significant effect of having received in-school HIV/AIDS education on all outcome measures. Compared with females, males were more likely to initiate sex at a relatively younger age, report unprotected sex with multiple partners, and drink alcohol before sexual intercourse. Among females, using 2 illegal substances increased the odds of early sexual debut by 12 times, while using ≥3 substances increased the same odds to 44-fold. Likewise, binge drinking was also associated with higher odds of having multiple partners. Hispanic ethnicity and physically forced sex variables were consistently associated with high risk sexual behaviors, early sexual initiation, and increased number of sexual partners. Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender- and racial/ethnic-specific risk exposures among this population group, including risk behaviors linked with lifetime physically forced sex. The need to re-examine the role of in-school HIV prevention programs to build adequate competencies among students, parents and community leaders to reduce risk exposures associated with HIV/AIDS infection among youth is emphasized.

Responding to adolescent women's reproductive health concerns: empowering clients through health literacy

Adolescents have particular needs in health care that are often not met. Health care providers can help overcome barriers that hinder adolescents' effective use of health services by incorporating health literacy strategies that are developmentally and contextually appropriate, and that actively involve adolescents in their own learning. Based on extensive practice and research experience in Canada with rural and urban high school adolescent women, we offer suggestions for how health care providers can respond to adolescent women's reproductive health concerns by teaching these young women how to increase their skills in functional, communicative/interactive, and critical health literacy.

Health literacy, self-reported status and health promoting behaviours for adolescents in Taiwan

AIM AND OBJECTIVE

The objective of this study was to analyse the associations between health literacy, health status and health-promoting behaviours among Taiwan adolescents.

BACKGROUND

Limited health literacy is associated with poor health outcomes such as low use of preventive services, poor self-reported health conditions and absence of health-promoting behaviours in adults. However, these factors have not been analysed in adolescents. The associations between health literacy and health outcome in adolescents provide helpful insights in conducting health education programmes for health professionals.

DESIGN

A cross-sectional survey.

METHODS

The survey analysed a purposive sample of 1601 senior/vocational high school students from six counties in Taiwan. Data for health literacy and health-promoting behaviours were collected by the Chinese version (short form) of the Test of Functional Health Literacy in Adolescents (c-sTOFHLAd) and health-promoting behaviour scale with subscales for the following health-promoting behaviours: nutrition, exercise, stress management, interpersonal relations, health responsibility and self-actualisation.

RESULTS

Adolescents with low health literacy were less likely to perceive good health status [adjusted odd ratio, (AOR) = 0·59, 95%CI = 0·41-0·86] and less likely to exhibit health-promoting behaviours (AOR = 0·58, 95%CI = 0·39-0·86) than those with high health literacy were, especially in nutrition (AOR = 0·62, 95%CI = 0·43-0·89) and interpersonal relations (AOR = 0·61, 95%CI = 0·43-0·87) subscales. Adolescents with high and low health literacy did not significantly differ in the following health-promoting behaviours: exercise, stress management, health responsibility and self-actualisation.

CONCLUSION

Health literacy is vital for promoting health in adolescents, especially in the domains of nutrition and interpersonal relations.

RELEVANCE TO CLINICAL PRACTICE

Health professionals should conduct health literacy assessments for adolescents prior to designing health education programmes for those with low health literacy to develop health literacy skills as to perform health promoting behaviours.

Roles of interpersonal and media socialization agents in adolescent self-reported health literacy: a health socialization perspective

This study proposes a health socialization model and applies it to examine direct, relative and mediating roles of interpersonal and media health socialization agents in predicting adolescent self-reported health literacy. We conducted a paper-and-pencil survey among 452 seventh graders in rural and urban school districts. Our regression analysis results show that both interpersonal and media socialization agents are significantly and positively related to adolescent health literacy. Media socialization agents seem to play a strong role in health literacy orientation, not much weaker than those of interpersonal socialization agents. The proposed health socialization model could contribute to the literature on how adolescents acquire health-related information and channels through which they are most receptive.

Health-related behaviour, knowledge, attitudes, communication and social status in school children in Eastern Germany

Enhancing health literacy is a keystone in health promotion. Yet, most studies on health literacy are limited to functional literacy levels. Furthermore, little evidence is available from children. Based on Nutbeam's outcome model for health promotion, this study aims (i) to elaborate a set of short scales to measure important health literacy domains in children and (ii) to analyse their associations among each other, with health behaviour as an intermediate health outcome, subjective health, social status and gender. The sample comprised 852 school children in fifth grade, aged 9-13 years, in Western Pomerania, Germany. Items were taken from the child's questionnaire to form short scales for health-related knowledge, attitudes, communication and behaviour. The internal consistencies of the communication and attitude scales were 0.73 and 0.57, respectively. Unidimensional scalability of the knowledge and behaviour scales was supported by item response models. Associations between health scales were modest. In regression analyses, social status and gender predicted only health knowledge and communication but not health behaviours, attitudes and self-efficacy. Health knowledge was not associated with any other scale. Our results suggest that targeting one specific component of health literacy in children is likely to exert only small effects on health status and health behaviour.

Developing and evaluating a relevant and feasible instrument for measuring health literacy of Canadian high school students

Health literacy has come to play a critical role in health education and promotion, yet it is poorly understood in adolescents and few measurement tools exist. Standardized instruments to measure health literacy in adults assume it to be a derivative of general literacy. This paper reports on the development and the early-stage validation of a health literacy tool for high school students that measured skills to understand and evaluate health information. A systematic process was used to develop, score and validate items. Questionnaire data were collected from 275, primarily 10th grade students in three secondary schools in Vancouver, Canada that reflected variation in demographic profile. Forty-eight percent were male, and 69.1% spoke a language other than English. Bivariate correlations between background variables and the domain and overall health literacy scores were calculated. A regression model was developed using 15 explanatory variables. The R(2) value was 0.567. Key findings were that lower scores were achieved by males, students speaking a second language other than English, those who immigrated to Canada at a later age and those who skipped school more often. Unlike in general literacy where the family factors of mother's education and family affluence both played significant roles, these two factors failed to predict the health literacy of our school-aged sample. The most significant contributions of this work include the creation of an instrument for measuring adolescent health literacy and further emphasizing the distinction between health literacy and general literacy.

High school health curriculum and health literacy: Canadian student voices

This study explores the relevance of health literacy, and its development through a health curriculum, as a necessary but insufficient component to facilitate healthy living among adolescents through comprehensive school health models. This paper presents qualitative findings from focus groups with students (N = 33) in four schools toward the end of their experience in a health class that focused on topics related to healthy living, healthy relationships, health information and decision-making. Students reported mostly negative experiences citing repetitive course content, routinely delivered by teachers and passively received by students. As well, students described their experiences of using health information sources beyond the classroom, such as the media. The findings suggest that the curriculum, and particularly its implementation, have had limited effect on health literacy: students' abilities to access, understand, communicate and evaluate health information. The paper concludes with recommendations for improving health education.

A social ecological conceptual framework for understanding adolescent health literacy in the health education classroom

With the rising concern over chronic health conditions and their prevention and management, health literacy is emerging as an important public health issue. As with the development of other forms of literacy, the ability for students to be able to access, understand, evaluate and communicate health information is a skill best developed during their years of public schooling. Health education curricula offer one approach to develop health literacy, yet little is known about its influence on neither students nor their experiences within an educational context. In this article, we describe our experience applying a social ecological model to investigating the implementation of a health education curriculum in four high schools in British Columbia, Canada. We used the model to guide a conceptual understanding of health literacy, develop research questions, select data collection strategies, and interpret the findings. Reflections and recommendations for using the model are offered.