Differential associations of health literacy with Austrian adolescents' tobacco and alcohol use

Objectives

Tobacco use and alcohol use have their origin in adolescence, and risky use of these substances is amongst the leading preventable causes of morbidity and mortality. Health literacy (HL) encompasses the skills that are decisive to make appropriate health decisions in this context. Given the paucity of evidence on the link between HL and adolescents' health behaviors, the present study examined overall HL and different components of HL and their associations with smoking and alcohol use among 13 to 17-year-old Austrian students.
Study design

Data were obtained from a national survey carried out in Austria (N = 4219; 56% females) as part of the Health Behaviour in School-aged Children: World Health Organization (WHO) collaborative cross-national study.
Methods

We tested two structural equation models, one including the overall HL scale as the predictor and one with the three subscales of HL ‘finding,’ ‘understanding and appraising,’ and ‘applying’ health-related information as predictors of smoking and alcohol use.
Results

Although overall HL was related to all indicators of adolescents' smoking and drinking, the three HL components had differential effects on these behaviors. The easier it was for the participants to ‘understand and appraise’ and ‘apply’ health-related information, the less frequently they had smoked and drunk alcohol and the less was the amount of alcohol they had consumed. Contrarily, the easier it was for the participants to ‘find’ information, the more they had smoked and drunk alcohol.
Conclusions

Our results indicate that availability of health-related information may be insufficient on its own to prevent or reduce risky substance use. This is of particular importance for the development and improvement of primary prevention programs targeting adolescent populations.