Health literacy and injury prevention behaviors among caregivers of infants

Neighborhood child opportunity is associated with hospital length of stay following pediatric burn injury

INTRODUCTION

Pediatric burns are associated with socioeconomic disadvantage and lead to significant morbidity. The Child Opportunity Index (COI) is a well-validated measure of neighborhood characteristics associated with healthy child development. We sought to evaluate the relationship between COI and outcomes of burn injuries in children.

METHODS

We performed a single-institution retrospective review of pediatric (<16 years) burn admissions between 2015 and 2019. Based on United States residential zip codes, patients were stratified into national COI quintiles. We performed a multivariate Poisson regression analysis to determine the association between COI and increased length of stay.

RESULTS

2095 pediatric burn admissions occurred over the study period. Most children admitted were from very low (n = 644, 33.2 %) and low (n = 566, 29.2 %) COI neighborhoods. The proportion of non-Hispanic Black patients was significantly higher in neighborhoods with very low (44.5 %) compared to others (low:28.8 % vs. moderate:11.9 % vs. high:10.5 % vs. very high:4.3 %) (p < 0.01). Hospital length of stay was significantly longer in patients from very low COI neighborhoods (3.6 ± 4.1 vs. 3.2 ± 4.9 vs. 3.3 ± 4.8 vs. 2.8 ± 3.5 vs. 3.2 ± 8.1) (p = 0.02). On multivariate regression analysis, living in very high COI neighborhoods was associated with significantly decreased hospital length of stay (IRR: 0.51; 95 % CI: 0.45-0.56).

CONCLUSION

Children from neighborhoods with significant socioeconomic disadvantage, as measured by the Child Opportunity Index, had a significantly higher incidence of burn injuries resulting in hospital admissions and longer hospital length of stay. Public health interventions focused on neighborhood-level drivers of childhood development are needed to decrease the incidence and reduce hospital costs in pediatric burns.

TYPE OF STUDY

Retrospective study LEVEL OF EVIDENCE: Level III.

Child safety seat checks in Salt Lake County: protective and risk factors

BACKGROUND

Older children are at an increased risk of injury due to less commonly being in an appropriate child safety seat (CSS). Proper installation and consistent use of CSSs can significantly reduce child and infant automobile injuries. While research exists around parent behaviours concerning CSS use (or lack), little research takes place at the county level to identify normative beliefs as they contribute to risk factors.

METHODS

Through a mixed-methods approach, this evaluation retrospectively determines the Salt Lake County Health Department's impact on CSS usage, as well as identify normative parent behaviours that impact CSS usage.

RESULTS

Results indicated that parents' level of education and being in the car with family/friends was significantly associated with overall CSS usage.

DISCUSSION

More research is needed to specify parent normative beliefs around CSS use (or lack).

The Injury Prevention Program to Reduce Early Childhood Injuries: A Cluster Randomized Trial

BACKGROUND AND OBJECTIVES

The American Academy of Pediatrics designed The Injury Prevention Program (TIPP) in 1983 to help pediatricians prevent unintentional injuries, but TIPP's effectiveness has never been formally evaluated. We sought to evaluate the impact of TIPP on reported injuries in the first 2 years of life.

METHODS

We conducted a stratified, cluster-randomized trial at 4 academic medical centers: 2 centers trained their pediatric residents and implemented TIPP screening and counseling materials at all well-child checks (WCCs) for ages 2 to 24 months, and 2 centers implemented obesity prevention. At each WCC, parents reported the number of child injuries since the previous WCC. Proportional odds logistic regression analyses with generalized estimating equation examined the extent to which the number of injuries reported were reduced at TIPP intervention sites compared with control sites, adjusting for baseline child, parent, and household factors.

RESULTS

A total of 781 parent-infant dyads (349 TIPP; 432 control) were enrolled and had sufficient data to qualify for analyses: 51% Hispanic, 28% non-Hispanic Black, and 87% insured by Medicaid. Those at TIPP sites had significant reduction in the adjusted odds of reported injuries compared with non-TIPP sites throughout the follow-up (P = .005), with adjusted odds ratios (95% CI) of 0.77 (0.66-0.91), 0.60 (0.44-0.82), 0.32 (0.16-0.62), 0.26 (0.12-0.53), and 0.27 (0.14-0.52) at 4, 6, 12, 18, and 24 months, respectively.

CONCLUSIONS

In this cluster-randomized trial with predominantly low-income, Hispanic, and non-Hispanic Black families, TIPP resulted in a significant reduction in parent-reported injuries. Our study provides evidence for implementing the American Academy of Pediatrics' TIPP in routine well-child care.

Education on Preventing Early Childhood Injuries Using a Video Game: The VirtualSafeHome Platform

Poisonings and household injuries are frequent events among toddlers. We developed VirtualSafeHome (VSH)-a novel self-contained, Internet-based home-safety learning tool-to improve awareness of household hazards. Study aims were to investigate VSH usage characteristics. A prototype, screen-based VSH kitchen was built in Unity and delivered through the web using 3DVista and Wix. Players spot and click 21 embedded hazards. A unique feature is the ability to capture the "child's perspective" in identifying hazards. We recruited a convenience sample of adults in 2021-2022. Outcomes included number of hazards discovered, session duration, and pretest/posttest knowledge scores. Twenty-four adults identified a median 15.5 hazards; median playing time was 1022 seconds. Players reported satisfaction with ease of navigation and game features. Mean pretest/posttest knowledge scores rose from 2.0 to 2.79 (P < .035). A web-enabled video game can provide easily accessed, enjoyable training on home safety.

Health literacy and parenting infants at home: protocol for a qualitative systematic review of parents' experiences

OBJECTIVE

This systematic review will identify and synthesize the available qualitative evidence regarding parents' experiences of health literacy in parenting infants at home.

INTRODUCTION

Parental health literacy, which is essential for parents' and children's health, is associated with parents' health knowledge, parenting practices, and children's health outcomes. Parents face difficulties pertaining to their health literacy skills in daily health education and health care for their infants; therefore, understanding their parenting experience with infants from a health literacy perspective is important for health professionals. This review will evaluate and integrate qualitative evidence regarding parental experiences of health literacy in daily parenting of infants at home.

INCLUSION CRITERIA

This review will include qualitative data from empirical studies describing parents' experiences of health literacy in parenting infants at home. Parents of infants (0-1 year of age) living at home in Organisation for Economic Co-operation and Development member countries will be included.

METHODS

This review will follow the JBI approach for qualitative systematic reviews. The following databases will be searched for published and unpublished studies: MEDLINE (EBSCOhost), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), and ProQuest Health and Medical Collection (in English and Japanese); Open Access Theses and Dissertations (in English); and Ichushi-Web, CiNii, and the Institutional Repositories Database (in Japanese). Study selection, data extraction, and critical appraisal of the methodological quality of studies will be undertaken by 2 reviewers independently. Data synthesis will be conducted using the meta-aggregation approach, and the synthesized findings will be assessed using the ConQual approach.

REVIEW REGISTRATION

PROSPERO CRD42022345187.

Burn Prevention in Spanish: Assessment of Content Accuracy, Website Quality, and Readability of Online Sources

Burn prevention information may be inadequate or inaccessible to communities with non-English language preference. Our objective was to systematically analyze the content accuracy, website quality, and readability of online Spanish information for burn prevention in the home and compare it to English websites. We collected the top ten burn prevention results from a search on Google, Bing, and Yahoo using a list of Spanish key terms. Using recommendations from national organizations and a burn care expert team, content accuracy was evaluated for each website. We assessed website quality following the "Health on the Net" Code of Conduct. Readability was scored by averaging five validated readability tests for the Spanish language. After using the same protocol, a comparison was made with English websites as a control. Once duplicates and non-relevant search results were removed, 23 Spanish websites were assessed. Out of 21 possible points for content accuracy, the top website scored 14 (67%) and the average score was 6.6 (31%). For website quality, the average score was 50%. The average grade level needed to read the websites was 8.6. Compared to English, Spanish websites were less accurate (31% vs 41%), harder to read (9.8 vs 7.8), but were of higher website quality (50% vs 43%). Online burn prevention information in Spanish is often inaccurate, incomplete, and inferior to available English language websites. We propose a call to action to increase the quality of online burn prevention material available in Spanish.

Development of Mothers' Health Literacy: Findings From the KUNO-Kids Study

BACKGROUND AND OBJECTIVE

The aim of this study was to analyze the longitudinal development of health literacy (HL) in a large cohort of new mothers in Germany and to investigate which determinants are associated with the initial HL level and with change over time.

METHODS

Longitudinal data from 1,363 mothers participating with their child in the KUNO-Kids Health Study was used; data were collected at birth of the child (baseline), after 6 and 12 months, using interviews and self-report questionnaires. The HL of mothers was assessed with the health care scale of the European Health Literacy Survey Questionnaire, which has 16 items on accessing, understanding, appraising, and applying health information in the health care setting. Latent growth curve models were used to analyze average trajectories and predictors of HL in the total sample and in the subgroup of first-time mothers.

KEY RESULTS

HL values increased from baseline (M = 35.46, standard deviation [SD] = 7.34) over 6 months (M = 37.31, SD = 7.31) to 12 months (M = 38.01, SD = 7.41). The increase was statistically significant in the total sample (1.188, standard error [SE] = 0.087, p < .001) and in the subgroup of first-time mothers (1.357, SE = 0.113, p <. 001), with a steeper trajectory for mothers with lower HL at baseline. Several personal and situational variables were associated with HL at baseline (e.g., education, child health) and with its development (e.g., number of children).

CONCLUSION

Overall, new mothers became slightly more health literate during their child's first year of life. However, some groups of mothers could benefit from support in developing HL skills even before childbirth. [HLRP: Health Literacy Research and Practice. 2023;7(1):e39-e51.] Plain Language Summary: We investigated how health literacy (that is the ability to find, understand, and apply health information) develops in new mothers in Germany. Mothers told us that this ability slightly improved during the child's first year of life. Some mothers still have difficulties in dealing with health information; these mothers should be supported even before childbirth.

Functional status impairment at six-month follow-up is independently associated with child physical abuse mechanism

BACKGROUND

Children with abusive injuries have worse mortality, length-of-stay, complications, and healthcare costs compared to those sustaining an accidental injury. Long-term functional impairment is common in children with abusive head trauma but has not been examined in a cohort with heterogeneous body region injuries.

OBJECTIVE

To assess for an independent association between child physical abuse and functional impairment at discharge and six-month follow-up.

PARTICIPANTS AND SETTING

Seriously injured children (<15 years) treated at seven pediatric trauma centers.

METHODS

Functional status was compared between child physical abuse and accidental injury groups at discharge and six-month follow-up. Functional impairment was defined at discharge ("new domain morbidity") as a change from pre-injury ≥2 points in any of the six domains of the Functional Status Scale (FSS), and impairment at six-month follow-up as an abnormal total FSS score.

RESULTS

Children with abusive injuries accounted for 10.5% (n = 45) of the cohort. New domain morbidity was present in 17.8% (n = 8) of child physical abuse patients at discharge, with 10% (n = 3) of children having an abnormal FSS at six-months. There were no differences in new domain morbidity at hospital discharge between children injured by abuse and or accidental injury. However, children injured by physical abuse were 4.09 (2.15, 7.78) times more likely to have functional impairment at six months.

CONCLUSIONS

Child physical abuse is an independent risk factor for functional impairment at six-month follow-up. Functional status measurement for this high-risk group of children should be routinely measured and incorporated into trauma center quality assessments.

Pathways linking parental health literacy with health behaviours directed at the child: a scoping review

Health literacy (HL) is thought to be crucial for the management of the manifold demands relating to child health which parents are faced with. Albeit many studies have investigated parental HL and health behaviours (HBs) directed at the child, knowledge about the pathways which link parental HL with HB is scarce. The aim of this scoping review was to identify and comprehensively describe the variety of pathways linking parental HL with HBs directed at the child which were empirically analysed in previous studies. Following established scoping review methods database searches were conducted in MEDLINE, EMBASE, PsycINFO and WebofScience on 5 March 2020. Eligibility criteria included primary, empirical studies assessing parental HL and HB directed at the child in the general parent population. Titles and abstracts were screened independently by six reviewers for potentially relevant publications and data were extracted using standardized data extraction forms. The search identified 6916 articles for title and abstract screening. After full-text review, 50 studies were included in this review. Most studies (N = 24) assumed a direct association between HL and HBs and only few studies (N = 4) used more complex models investigating different pathways or mediation and/or moderation models. Overall, the evidence on the underlying pathways linking parental HL and HBs directed at the child is mixed and fairly limited. Therefore, hypothesis-driven research and integration of results into theoretical frameworks is needed for advancing both the research on HL and public health practice.

Pediatric Health Care Provider Perspectives on Injury Prevention Counseling in Acute and Primary Care Settings

The objective of this study was to characterize how pediatric primary care and emergency medicine health care providers and trainees engage in injury prevention counseling and assess perceptions toward injury prevention resources. We surveyed physicians, advanced practice providers, and trainees in the Emergency Department, Primary Care Network, and Pediatric Residency Program at Children's Hospital of Philadelphia from September to November 2019. Of the 578 eligible participants, 208 (36.0%) completed the survey. When asked to rank the suitability of alternative personnel for providing counseling, 63.0% of the participants selected an injury prevention specialist as best suited. Seventy-six percent of the providers considered a tablet or mobile device used before a patient encounter to be a helpful resource. Variability existed in provider comfort, knowledge, and frequency of counseling by injury topic. Free-text responses cited time as a barrier to counseling. Opportunities exist to improve the provision of injury education through the utilization of novel resources and personnel.

Reducing inequities among adult female migrants at higher risk for drowning in Australia: The value of swimming and water safety programs

ISSUE ADDRESSED

Drowning is a global public health challenge with a need to ensure equity to drowning prevention information and interventions. In Australia, people born overseas are identified as being at greater risk of drowning. This paper presents findings from a community-based qualitative evaluation of swimming and water safety (SWS) programs delivered to adults from migrant backgrounds in Sydney, Australia.

METHODS

A qualitative study was conducted in November-December 2019 among 35 female participants of SWS programs targeted to adult migrants. While offered to all SWS program participants, no males took part in the study. Focus groups and interviews were recorded, transcribed and thematically analysed using a deductive approach. The domains of enquiry were guided by the health belief model and the theory of planned behaviour.

RESULTS

Study participants were ≥25 years, first generation and most had lived in Australia for ≥10 years. Most were nonswimmers and were fearful of water prior to the program. Key themes were: direct SWS program outcomes, health and well-being; enablers and barriers to participation including: motivation, a program coordinator, fear and settlement priorities.

CONCLUSION

Findings suggest that in order to increase SWS participation among migrant communities, the broader determinants of health need to be considered. Culturally appropriate strategies are required to enable both men and women equal opportunities to access SWS programs.

SO WHAT

SWS programs provide multiple benefits for adult migrants; however, the impact on reducing inequities is limited, with broader multi-strategic health promotion approaches and policies required for inclusion and sustainability.

Exploring the Relationship between Maternal Health Literacy, Parenting Self-Efficacy, and Early Parenting Practices among Low-Income Mothers with Infants

OBJECTIVE

To explore the association of maternal health literacy (MHL), parenting self-efficacy and early parenting practices among low-income mothers with infants.

DESIGN

A cross-sectional, descriptive correlational design.

PARTICIPANTS

Low-income mothers (N=186) with infants.

METHODS

Face-to-face interviews were conducted using English and Spanish versions of questionnaires by trained bilingual research assistants. The Newest Vital Sign (NVS) screening tool was used to measure MHL.

RESULTS

Nearly three-quarters (72%) of mothers were rated as having low MHL. In the bivariate analysis, MHL was positively correlated with education, household income, language, social support, parenting self-efficacy, and early parenting practices, but negatively correlated with number of children. The study findings demonstrate that parenting self-efficacy had a mediating effect on MHL and early parenting practices among mothers with infants.

CONCLUSION

Results suggest that future research is needed to advance MHL in low-income mothers and to inform potential HL interventions for this target population.

The impact of caregiver health literacy on healthcare outcomes for low income minority children with asthma

Objectives: The aim of this exploratory study was to assess the impact of caregiver health literacy (HL) on health care outcomes for their child with asthma.Methods: Caregiver dyads across two different healthcare delivery systems completed a battery of validated asthma outcome instruments, including the Newest Vital Sign™ as a measure of HL for the caregivers of children ages 7-18 y. Utilization history was obtained through the electronic medical record. Descriptive analysis with bivariate associations was conducted.Results: There was no direct relationship between HL and asthma outcomes in the 34 Hispanic and African American caregiver-child dyads. However, caregiver health literacy was significantly related to language (p = 0.02). African American English-speaking caregivers, seen in an urban emergency department, demonstrated adequate health literacy. Hispanic Spanish-speaking caregivers, seeking care in a mobile asthma van, showed limited health literacy. There was no significant association between caregivers' HL and routine asthma care visits when language and child age were controlled.Conclusions: Assessing patient factors can identify persons at risk who need additional support to negotiate the healthcare system when providing care for a child with asthma.

Associations between Parents' Health Literacy and Sleeping Hours in Children: A Cross-Sectional Study

Background: Sleep in preschool children is an important factor for their health and active lives. The lack of adequate sleep in preschool children is a serious public problem in Japan. The relationship between health literacy (HL) and health status is well recognized. The purpose of this study was to investigate the association between the sleep duration of preschool children and the HL of their parents. Methods: In the present study, participants were preschool children (3–6 years) and their parents. We assessed the HL of the parents with the 14-item Health Literacy Scale (HLS-14) questionnaire. Sleep duration of the children was reported by their parents. We divided parents into two groups according to HLS-14 score and analyzed children’s sleeping time separately. Results: Data from 279 parents and their children were ultimately analyzed. The high HL group comprised 210 families (75.3%) and the low HL group comprised 69 families (24.7%). Average children’s sleep duration was significantly longer in the high HL group (9.5 ± 0.9 h) than in the low HL group (9.1 ± 1.1 h) (p = 0.013). A positive correlation was found in the low HL group between parents’ HL and their children’s sleeping times (p < 0.01, r = 0.32) but the difference was not significant in the high HL group (p = 0.98, r = −0.0009). Conclusion: The HL of parents appears to affect their children’s sleep duration, suggesting that parental HL may be an appropriate target for interventions aiming to lengthen children’s sleeping time.

Psychometric testing of the Turkish version of the Health Literacy for School-Aged Children Scale

This study aimed to assess the validity and reliability of the Turkish version of the Health Literacy for School-Aged Children (HLSAC-T) scale. This study was a cross-sectional and methodological design. The sample consisted of 563 sixth and ninth grade students in Izmir, Turkey. Data were collected with the socio-demographic characteristics questionnaire, HLSAC-T, and Turkish version of the Adolescent Lifestyle Profile. Cronbach's α for the scale was .77 and item-total correlations were between .49 and .61 ( p < .001). The model fit indices were determined to be the root mean square error of approximation at .035, the goodness of fit index at .99, and the comparative fit index at .99. The concordance validity and convergent validity were supported and the discriminant validity suggested that the scale successfully discriminated students who cared about healthy lifestyle from the students who did not. The HLSAC-T showed an adequate reliability and validity for determining the subjective health literacy of Turkish school-aged children. The results showed promise that the scale could be translated into other languages.

Health literacy among caregivers of patients with heart failure: A multicentre cross-sectional survey

AIMS AND OBJECTIVES

To assess the levels of health literacy of Italian caregivers of patients with heart failure.

BACKGROUND

Health literacy is related to patients' health outcomes. Low health literacy has been found in older people with heart failure, and less is known on the health literacy of caregivers whose patients are suffering from heart failure.

DESIGN

Observational, multicentre, cross-sectional study.

METHODS

From July 2015-May 2016, caregivers were recruited in five hospitals from Central and Southern Italy. To assess health literacy, the Italian version of the Short Test of Functional Health Literacy tool was used.

RESULTS

A total of 173 caregivers participated in the research, the majority being females (60.1%), aged between 46-60 years (52.6%) and 96 (55.5%) were from Central Italy. 33.5% of caregivers were patients' children, and 16.2% were paid caregivers of foreign origins. The average level of health literacy was adequate; however, lower levels were found among patients' spouses and those of older age.

CONCLUSION

Our results, in contrast with previous studies, showed adequate health literacy levels of caregivers. However, caregivers older in age and with a low education level showed the lowest health literacy, emphasising the need for healthcare workers, to check caregivers' health literacy, before entrusting them with the care of patients.

RELEVANCE TO CLINICAL PRACTICE

As this research gives, for the first time, an overview on Italian caregivers' levels of health literacy, its results may be used to improve Italian healthcare professionals' knowledge of caregivers' health literacy, before entrusting them with the care of patients.

Racial and Ethnic Differences in Injury Prevention Behaviors Among Caregivers of Infants

INTRODUCTION

African American and Latino children experience higher rates of traumatic injury and mortality, but the extent to which parents of different races and ethnicities disparately enact injury prevention behaviors has not been fully characterized. The objective of this study is to evaluate the association between caregiver race/ethnicity and adherence to injury prevention recommendations.

METHODS

This was a cross-sectional analysis of caregiver-reported baseline data from the Greenlight study, a cluster-randomized pediatric obesity prevention trial. Data were collected between 2010 and 2012 in four academic pediatric practices and analyzed in 2015. Non-adherence to injury prevention recommendations was based on five domains: car seat safety, sleeping safety, fire safety, hot water safety, and fall prevention.

RESULTS

Among 864 caregiver-infant pairs (17.7% white, non-Hispanic; 49.9% Hispanic; 27.7% black, non-Hispanic; 4.7 % other, non-Hispanic), mean number of non-adherent injury prevention behaviors was 1.8 (SD=0.9). In adjusted regression, Hispanic caregivers had higher odds of non-adherence to car seat safety (AOR=2.1, 95% CI=1.2, 3.8), and lower odds of non-adherence with fall prevention (AOR=0.4, 95% CI=0.3, 0.7) compared with whites. Black, non-Hispanic caregivers had higher odds of non-adherence to car seat safety (AOR=2.4, 95% CI=1.3, 4.4) and sleeping safety (AOR=2.1, 95% CI=1.3, 3.2), but lower odds of fall prevention non-adherence (AOR=0.5, 95% CI=0.3, 0.8) compared with whites.

CONCLUSIONS

A high prevalence of non-adherence to recommended injury prevention behaviors is common across racial/ethnic categories for caregivers of infants among a diverse sample of families from low-SES backgrounds.

Parent Health Literacy, Depression, and Risk for Pediatric Injury

BACKGROUND

Population-wide research on the impact of parent health literacy to children's health outcomes is limited. We assessed the relationship of low parent health literacy to a range of pediatric health risks within a large cohort of primary care patients.

METHODS

Data were from 17 845 English- and Spanish-speaking parents of children aged ≤7 years presenting for well-child care. We used a 3-item screener to measure health literacy. Outcomes included secondhand smoke exposure, asthma treatment nonadherence, parent depression, child-rearing practices, injury prevention, and parent first-aid knowledge. We summarized study variables with descriptive statistics and then performed multivariable logistic regression to identify associations between low parent literacy and our dependent measures.

RESULTS

Mean child age was 4.8 years (SD 3.7); 36.5% of parent respondents had low health literacy. In models adjusted for child gender, race/ethnicity, insurance, age, and parent language preference, low parent health literacy was related to a range of pediatric health risks, including parent depression (adjusted odds ratio [AOR] 1.32; 95% confidence interval 1.18-1.48), firearm access (AOR 1.68; 1.49-1.89), not having a working smoke detector (AOR 3.54; 2.74-4.58), and lack of first-aid knowledge about choking (AOR 1.67; 1.44-1.93) and burns (AOR 1.45; 1.29-1.63). Children of parents with low health literacy were also more likely to watch >2 hours of television per day (AOR 1.27; 1.17-1.36).

CONCLUSIONS

Low parent health literacy is independently and significantly related to parent depression, child television viewing, and at-risk family behaviors associated with child injury. Use of low-literacy approaches to health-behavior interventions may be essential to address common child morbidities.

Pediatric injury information seeking for mothers with young children: The role of health literacy and ehealth literacy

BACKGROUND

An understanding of preferred sources of injury information among parents is needed to develop best practices for information dissemination. Yet, almost no research examines injury information seeking for a national sample of mothers.

METHODS

A cross-sectional online survey was conducted in 2013 with 1081 mothers in the United States (U.S.) with at least one child <6 years. We measured self-report health literacy with the Morris Single-Item Screener (18% low), and eHealth literacy using the eHEALS (28% low).

RESULTS

The internet was the most preferred source for injury information (76%), followed by health providers (44%), and family/friends (35%). Most mothers selected the internet as the first choice for information about bicycle helmets (65%) and car seats (63%). For poison prevention, preferences were mixed; 48% internet compared with 41% health providers. Mothers with low health literacy were more likely to have discussed injury prevention with their doctors (P = 0.022) and searched for injury information (P = 0.001), but less likely to report the internet as a top source (P < .0001). Mothers with low eHealth literacy were less likely to search for injury information (P < 0.0001) and report the internet as a top source (P < 0.0001), and slightly more likely to rely on health providers for information (P = 0.028).

CONCLUSIONS

Findings suggest the internet is a common source of injury prevention information, but health providers remain a valuable resource for mothers, especially those with lower literacy skills. Despite widespread internet use, health providers should be sure to communicate injury prevention information to mothers, especially those at risk for low health literacy and eHealth literacy.

Health literacy and the determinants of obesity: a population-based survey of sixth grade school children in Taiwan

BACKGROUND

Health literacy has become an important health policy and health promotion agenda item in recent years. It had been seen as a means to reduce health disparities and a critical empowerment strategy to increase people's control over their health. So far, most of health literacy studies mainly focus on adults with few studies investigating associations between child health literacy and health status. This study aimed to investigate the association between health literacy and body weight in Taiwan's sixth grade school children.

METHODS

Using a population-based survey, 162,209 sixth grade (11-12 years old) school children were assessed. The response rate at school level was 83%, with 70% of all students completing the survey. The Taiwan child health literacy assessment tool was applied and information on sex, ethnicity, self-reported health, and health behaviors were also collected. BMI was used to classify the children as underweight, normal, overweight, or obese. A multinomial logit model with robust estimation was used to explore associations between health literacy and the body weight with an adjustment for covariates.

RESULTS

The sample consisted of 48.9% girls, 3.8% were indigenous and the mean BMI was 19.55 (SD = 3.93). About 6% of children self-reported bad or very bad health. The mean child health literacy score was 24.03 (SD = 6.12, scale range from 0 to 32). The overall proportion of obese children was 15.2%. Children in the highest health literacy quartile were less likely to be obese (12.4%) compared with the lowest quartile (17.4%). After controlling for gender, ethnicity, self-rated health, and health behaviors, children with higher health literacy were less likely to be obese (Relative Risk Ratio (RRR) = 0.94, p < 0.001) and underweight (RRR = 0.83, p < 0.001). Those who did not have regular physical activity, or had sugar-sweetened beverage intake (RRR > 1.10, p < 0.0001) were more likely to report being overweight or obese.

CONCLUSIONS

This study demonstrates strong links between health literacy and obesity, even after adjusting for key potential confounders, and provides new insights into potential intervention points in school education for obesity prevention. Systematic approaches to integrating a health literacy curriculum into schools may mitigate the growing burden of disease due to obesity.