Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12–16 years old population, Nanning, China, 2012

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Abstract

Background

The problem of overweight and obesity in children and adolescents is considered an epidemic in both developed and developing world by the WHO. There has been little study on the relationship between health literacy and body weight among adolescents.

This epidemiological study aims to investigate the association between low health literacy and overweight and obesity among a population of Chinese adolescents aged 12–16 years in the city of Nanning, China in 2012.

Methods

This study was a population-based cross-sectional health survey utilising a two-stage random cluster sampling design. The sample consisted of high school students aged between 12–16 years with the total student population attending high schools in a large city as the sample frame. Health literacy was measured by the Chinese version of the short form of the Test of Functional Health Literacy translated for and validated among Taiwanese adolescents. Overweight and obesity were assessed in accordance to the recommendation of the World Health Organization (WHO) Global Database of Body Mass Index classification methods. Data were analysed using logistic regression modelling techniques with adjustment to the cluster sampling effect.

Results

A total of 1035 students responded to the survey providing usable information with 628 (48.1%) respondents classified as high, 558 (42.8%) moderate, and 119 (9.1%) low levels of health literacy. After adjusting for potential confounding factors and the cluster sampling effect, low health literacy was significantly associated with overweight and obesity (OR = 1.84, 95% C.I. = 1.13-2.99).

Conclusion

Results suggested that low health literacy level was associated with many aspects of adolescence health including their body weight. These results have public health implications on an important global problem of adolescence body weight. Enhancing the health literacy should be considered as part of the strategies in combating adolescence weight problem.

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Most cited references 14

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The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability

Nancy Morris, Charles MacLean, Lisa Chew … (2006)

Background Reading skills are important for accessing health information, using health care services, managing one's health and achieving desirable health outcomes. Our objective was to assess the diagnostic accuracy of the Single Item Literacy Screener (SILS) to identify limited reading ability, one component of health literacy, as measured by the S-TOFHLA. Methods Cross-sectional interview with 999 adults with diabetes residing in Vermont and bordering states. Participants were randomly recruited from Primary Care practices in the Vermont Diabetes Information System June 2003 – December 2004. The main outcome was limited reading ability. The primary predictor was the SILS. Results Of the 999 persons screened, 169 (17%) had limited reading ability. The sensitivity of the SILS in detecting limited reading ability was 54% [95% CI: 47%, 61%] and the specificity was 83% [95% CI: 81%, 86%] with an area under the Receiver Operating Characteristics Curve (ROC) of 0.73 [95% CI: 0.69, 0.78]. Seven hundred seventy (77%) screened negative on the SILS and 692 of these subjects had adequate reading skills (negative predictive value = 0.90 [95% CI: 0.88, 0.92]). Of the 229 who scored positive on the SILS, 92 had limited reading ability (positive predictive value = 0.4 [95% CI: 0.34, 0.47]). Conclusion The SILS is a simple instrument designed to identify patients with limited reading ability who need help reading health-related materials. The SILS performs moderately well at ruling out limited reading ability in adults and allows providers to target additional assessment of health literacy skills to those most in need. Further study of the use of the SILS in clinical settings and with more diverse populations is warranted.

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Development of a brief test to measure functional health literacy.

D. W. Baker, M V Williams, R M Parker … (1999)

We describe the development of an abbreviated version of the Test of Functional Health Literacy in Adults (TOFHLA) to measure patients' ability to read and understand health-related materials. The TOFHLA was reduced from 17 Numeracy items and 3 prose passages to 4 Numeracy items and 2 prose passages (S-TOFHLA). The maximum time for administration was reduced from 22 minutes to 12. In a group of 211 patients given the S-TOFHLA, Cronbach's alpha was 0.68 for the 4 Numeracy items and 0.97 for the 36 items in the 2 prose passages. The correlation (Spearman) between the S-TOFHLA and the Rapid Estimate of Adult Literacy in Medicine (REALM) was 0.80, although there were important disagreements between the two tests. The S-TOFHLA is a practical measure of functional health literacy with good reliability and validity that can be used by health educators to identify individuals who require special assistance to achieve learning goals.

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Childhood predictors of adult obesity: a systematic review.

Richard C. Summerbell, Nicola S Logan, Michael Parsons … (1999)

To identify factors in childhood which might influence the development of obesity in adulthood. The prevalence of obesity is increasing in the UK and other developed countries, in adults and children. The adverse health consequences of adult obesity are well documented, but are less certain for childhood obesity. An association between fatness in adolescence and undesirable socio-economic consequences, such as lower educational attainment and income, has been observed, particularly for women. Childhood factors implicated in the development of adult obesity therefore have far-reaching implications for costs to the health-services and economy. In order to identify relevant studies, electronic databases--Medline, Embase, CAB abstracts, Psyclit and Sport Discus-were searched from the start date of the database to Spring 1998. The general search structure for electronic databases was (childhood or synonyms) AND (fatness or synonyms) AND (longitudinal or synonyms). Further studies were identified by citations in retrieved papers and by consultation with experts. Longitudinal observational studies of healthy children which included measurement of a risk factor in childhood (<18 y), and outcome measure at least 1 y later. Any measure of fatness, leanness or change in fatness or leanness was accepted. Measures of fat distribution were not included. Only studies with participants from an industrialized country were considered, and those concerning minority or special groups, e.g. Pima Indians or children born preterm, were excluded. Risk factors for obesity included parental fatness, social factors, birth weight, timing or rate of maturation, physical activity, dietary factors and other behavioural or psychological factors. Offspring of obese parent(s) were consistently seen to be at increased risk of fatness, although few studies have looked at this relationship over longer periods of childhood and into adulthood. The relative contributions of genes and inherited lifestyle factors to the parent-child fatness association remain largely unknown. No clear relationship is reported between socio-economic status (SES) in early life and childhood fatness. However, a strong consistent relationship is observed between low SES in early life and increased fatness in adulthood. Studies investigating SES were generally large but very few considered confounding by parental fatness. Women who change social class (social mobility) show the prevalence of obesity of the class they join, an association which is not present in men. The influence of other social factors such as family size, number of parents at home and childcare have been little researched. There is good evidence from large and reasonably long-term studies for an apparently clear relationship for increased fatness with higher birth weight, but in studies which attempted to address potential confounding by gestational age, parental fatness, or social group, the relationship was less consistent. The relationship between earlier maturation and greater subsequent fatness was investigated in predominantly smaller, but also a few large studies. Again, this relationship appeared to be consistent, but in general, the studies had not investigated whether there was confounding by other factors, including parental fatness, SES, earlier fatness in childhood, or dietary or activity behaviours. Studies investigating the role of diet or activity were generally small, and included diverse methods of risk factor measurement. There was almost no evidence for an influence of activity in infancy on later fatness, and inconsistent but suggestive evidence for a protective effect of activity in childhood on later fatness. No clear evidence for an effect of infant feeding on later fatness emerged, but follow-up to adulthood was rare, with only one study measuring fatness after 7y. Studies investigating diet in childhood were limited and inconc

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Author and article information

Contributors

Lawrence T Lam

Li Yang

Journal

Journal ID (nlm-ta): Arch Public Health

Journal ID (iso-abbrev): Arch Public Health

Title: Archives of Public Health

Publisher: BioMed Central

ISSN (Print): 0778-7367

ISSN (Electronic): 2049-3258

Publication date Collection: 2014

Publication date (Electronic): 1 April 2014

Volume: 72

Issue: 1

Page: 11

Affiliations

[1 ]Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia

[2 ]Department of Health and Physical Education, The Hong Kong Institute of Education, Hong Kong SAR, Hong Kong, China

[3 ]School of Public Health, Guangxi Medical University, Nanning, Guangxi, China

Article

Publisher ID: 2049-3258-72-11

DOI: 10.1186/2049-3258-72-11

PMC ID: 3994214

PubMed ID: 24685203

SO-VID: 41966002-37f0-409d-a05b-7a4b93003406

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12–16 years old population, Nanning, China, 2012

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Chinese Journal of School Health

Most cited references 14

The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability

Development of a brief test to measure functional health literacy.

Childhood predictors of adult obesity: a systematic review.

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