Health Literacy And Health Risk Behaviors Among Middle School Students In Chongqing

Objective To understand the overall health literacy of middle school students in Chongqing and the status of functional,interactive and critical dimensions of health literacy,and to explore the influencing factors.To obtain the basic data of health risk behaviors among middle school students in Chongqing,and to understand their prevalence and general characteristics.To explore the correlation between health literacy and health risk behaviors on the basis of health literacy and the incidence of health risk behaviors,so as to provide basis for health promotion.Methods From November to December in 2019,four districts(counties)in Chongqing were selected by stratified random cluster sampling.Two complete secondary schools were selected from each survey area(county),half from urban and rural areas,a total of 8.In each school,four classes were randomly selected from each grade from grade one to grade three,and all the students on the day of class selection were investigated by questionnaire.The data were collected by self-made questionnaire,adolescent health literacy assessment scale and adolescent health risk behavior questionnaire.A total of 9338 questionnaires were collected and 9072 valid questionnaires were included in the study.The enumeration data were described by the number of cases and percentage.Chi-square test was used to compare the differences in the rates of health literacy and the incidence of health risk behaviors among middle school students with different characteristics.Binary Logistic regression was used to analyze the influencing factors of health literacy,and to explore the relationship between health literacy level and the occurrence of various health risk behaviors.The clustering pattern and characteristics of health risk behaviors of male and female students were analyzed by two-step clustering method.Multivariate logistic regression analysis was used to explore the relationship between health literacy level and the clustering pattern of health risk behaviors.Results(1)The total health literacy attainment rate of middle school students in Chongqing was 67.66%,and the functional,interactive and critical health literacy attainment rates were 74.90%,50.29%and 71.80%,respectively.Multivariate logistic regression analysis showed that the respondents in Jiulongpo District(OR=1.187),junior high school students(OR=1.323),mothers with high school education or above(OR=1.176),good relationship with mothers(OR=1.421),good family economy(OR=1.254),good academic performance(OR=1.152),good relationship with teachers(OR=2.416),and health education courses with two or more sessions a week(OR=1.542)were more likely to have total health literacy(P<0.05),while those participants with doting parenting style(OR=0.762)were less likely to have total health literacy(P<0.05).The respondents in Jiulongpo district(OR=1.306),urban school(OR=1.124),good relationship with mothers(OR=1.630),and good relationship with teachers(OR=1.487)were more likely to have functional health literacy(P<0.05),while male students(OR=0.845),mothers with unknown educational level(OR=0.744),and mothers with authoritarian parenting style(OR=0.748)were less likely to have functional health literacy(P<0.05).The respondents in Qijiang District(OR=1.455),junior high school students(OR=2.133),male students(OR=1.397),mothers with high school education level or above(OR=1.187),good relationship with their fathers(OR=1.643),mothers with democratic parenting style(OR=1.302),good family economy(OR=1.572),medium academic performance(OR=1.126),good relationship with teachers(OR=2.552),and health education courses with two or more sessions a week(OR=1.790)were more likely to have interactive health literacy(P<0.05),while those in urban schools(OR=0.833)were less likely to have interactive health literacy(P<0.05).The results of multivariate analysis showed that the respondents in Jiulongpo District(OR=1.197),urban schools(OR=1.109),mothers with high school education level or above(OR=1.286),good family economy(OR=1.285),good academic performance(OR=1.215),good relationship with teachers(OR=2.184),and health education courses with two or more sessions a week(OR=1.387)were more likely to have critical health literacy,while the respondents in Banan District(OR=0.864)were less likely to have critical health literacy(P<0.05).(2)The incidences of unhealthy eating behavior,lack of exercise behavior,unintentional injury behavior,intentional injury behavior,substance addiction behavior and Internet addiction behavior were 77.39%,82.67%,38.22%,44.91%,14.21%and 5.16%respectively.According to the two-step clustering method,six types of health risk behaviors of male students were divided into three clustering models.The results showed that among 4320 male students,1346(31.16%)were in model 1(low-risk behavior group),1974(45.69%)were in model 2(medium risk behavior group),and 1000(23.15%)were in model 3(high-risk behavior group).According to the two-step clustering method,six types of health risk behaviors of female students were divided into three clustering models.The results showed that among 4752 female students,863(18.16%)were in model 1(low-risk behavior group),1781(37.48%)were in model 2(medium risk behavior group)and 2108(44.36%)were in model 3(high-risk behavior group).The results of univariate analysis showed that there were statistically significant differences in the constituent ratio of risk behavior aggregation models among boys with different levels of total health literacy(c~2=168.681),functional health literacy(c~2=19.373),interactive health literacy(c~2=368.715)and critical health literacy(c~2=133.006)(P<0.05).The results of univariate analysis showed that there were significant differences in the constituent ratio of risk behavior aggregation patterns among girls with different levels of total health literacy(c~2=71.892),interactive health literacy(c~2=149.643)and critical health literacy(c~2=71.598)(P<0.05).(3)The results of logistic regression analysis showed that middle school students with high total health literacy had lower risk of bad eating behavior(OR=0.477),lack of exercise behavior(OR=0.512),unintentional injury behavior(OR=0.596),intentional injury behavior(OR=0.594),substance addiction behavior(OR=0.685)and Internet addiction behavior(OR=0.465)(P<0.05);the students with high level of interactive health literacy had lower risk of bad eating behavior(OR=0.288),lack of exercise behavior(OR=0.345),unintentional injury behavior(OR=0.717),intentional injury behavior(OR=0.447),substance addiction behavior(OR=0.525)and Internet addiction behavior(OR=0.308)(P<0.05);the students with moderate critical health literacy had lower risk of bad eating behavior(OR=0.836)and unintentional injury behavior(OR=0.654)(P<0.05).The results of multiple logistic regression analysis showed that compared with model 3(high risk behavior group),boys with high total health literacy were 2.513 times more likely to belong to model 1(low risk behavior group)than those with low total health literacy,and boys with high total health literacy were 2.513 times more likely to belong to model 2(medium risk behavior group);boys with high level of interactive health literacy were 5.824 times more likely to belong to mode 1(low-risk behavior group)than those with low level of interactive health literacy,Boys with moderate level of interactive health literacy were 1.422 times more likely to belong to model 2(moderate risk behavior group)than those with low level of interactive health literacy(P<0.05).The results of multiple logistic regression analysis showed that compared with model 3(high-risk behavior group),girls with high total health literacy were 1.990times more likely to belong to model 1(low-risk behavior group),while girls with high total health literacy were 1.990 times more likely to belong to model 2(medium risk behavior group);girls with high level of interactive health literacy were 3.115 times more likely to belong to model1(low risk behavior group),and girls with high critical health literacy were1.280 times more likely to belong to model 2(moderate risk behavior group)than those with low critical health literacy(P<0.05).Conclusion The health literacy level of middle school students in Chongqing needs to be improved,especially the interactive health literacy rate is low.The prevalence of health risk behaviors among middle school students in Chongqing is serious,especially the incidence of unhealthy eating behaviors and lack of exercise behaviors is high,which should be paid attention to.Health literacy is an important influencing factor of all kinds of health risk behaviors and aggregation patterns of risk behaviors.Improving the level of health literacy may provide new ideas for the prevention and control of health risk behaviors.