The Potential Benefit of Improving Health Literacy to Reduce Socioeconomic Inequities in Adolescent Health and Educational Outcomes (original) (raw)

Background: Exposure to early socioeconomic disadvantage is associated with a range of adverse health and educational outcomes in later life, leading to substantial social and economic costs. Health literacy, as a personal asset to maintain and protect good health, has the potential to reduce socioeconomic inequities in these adverse outcomes. This study aimed to estimate the extent to which improving health literacy could reduce socioeconomic inequities in adolescents' health and educational outcomes. Methods: A cross-sectional study was conducted with 650 students (54.9% male and 45.1% female) in Years 7 to 9 from four secondary schools in Beijing. Socioeconomic disadvantage was assessed by the Family Affluence Scale. Health literacy was measured by the 8-item skills-based Health Literacy Assessment Tool overall and by three domains: functional, interactive and critical. Outcomes included self-report global health status, health behaviours (breakfast eating, teeth brushing, cigarette smoking, alcohol drinking, physical activity, two or more health-compromising behaviours), patient-provider communication, and academic achievement. An interventional effects approach to causal mediation analysis was conducted. Results: Improving disadvantaged adolescents' health literacy to the level of their non-disadvantaged peers could reduce 15.3%, 12.0%, 15.2% and 11.4% of socioeconomic differences in global health status, two or more health-compromising behaviours, patient-provider communication, and academic achievement, respectively. There were varying benefits of improving health literacy in each domain, depending on the outcome measured. Conclusion: Improving health literacy could contribute to reducing socioeconomic inequities in adolescents' health and educational outcomes. Health literacy interventions should be considered within a broader, multifaceted and sustained strategy via collaborations between schools, families and communities.