The relationship between health literacy and correlates of adolescents' obesogenic and substance use behaviors

  • Author Footnotes
    1 Present address: CUNY Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, 55 W 125th St, New York, NY 10027.
    Sasha A. Fleary
    1 Present address: CUNY Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, 55 W 125th St, New York, NY 10027.
    Tufts University, Eliot-Pearson Department of Child Study and Human Development, 574 Boston Ave, Medford, MA 02155, USA
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  • Author Footnotes
    1 Present address: CUNY Graduate School of Public Health and Health Policy, Department of Community Health and Social Sciences, 55 W 125th St, New York, NY 10027.
Published:December 09, 2022DOI:


      • Health literacy is related to risk perception and self-efficacy for substance use.
      • Health literacy is related to risk perception for some obesity-related behaviors.
      • Health literacy affects the relationship between self-efficacy and substance use.
      • Health literacy affects the relationship between self-efficacy and diet.



      Risk perception (RP) and self-efficacy are targeted in adolescent health behavior interventions, however these variables have not been explored in relation to health literacy (HL). HL may affect how adolescents assess, prioritize, and integrate information when forming RP and self-efficacy and, ultimately, their health behaviors. This study assessed the relationship between functional, interactive, and critical HL and adolescents' behavior-specific RP and self-efficacy and health behaviors.

      Design and methods

      Cross-sectional data were collected from 380 adolescents attending high school via an online survey. Survey measures included demographics, functional, interactive, and critical HL, and substance use and obesogenic behavior-related beliefs, attitudes, and behaviors. Pearson correlations and regressions were estimated.


      The relationship between HL and RP, self-efficacy, and behaviors varied by behavior and HL type. Critical HL was related to obesogenic-specific RP and behaviors, while interactive and critical HL were related to self-efficacy. Interactive and critical HL were related to substance use-specific RP and self-efficacy while functional and interactive HL were related to substance use behaviors. HL moderated several RP/behavior and self-efficacy/behavior relationships.


      The significant relationships between HL and RP and self-efficacy highlight how HL may be an underlying factor or help shape adolescents' perceptions and beliefs adolescents have about behaviors and themselves, which ultimately influence their behaviors.

      Practical implications

      Adolescent interventions should be assessed to determine what underlying HL skills are needed for behavior change and assess and address HL directly as adolescents with low HL may be at a disadvantage for intervention uptake and outcomes.


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