Adolescent health literacy: sociodemographic determinants and its relationship with substance use avoidance

Adolescence is a critical period for health literacy (HL) development and for decision-making regarding substance use behaviors. Little is known about which sociodemographic factors are related to the three major components of HL (i.e. functional, interactive, critical HL) and the extent to which these components of HL moderate the relationship between sociodemographic determinants of substance use avoidance and avoidance for adolescents. This study aimed to identify sociodemographic determinants of functional, interactive, critical and composite HL among adolescents, and to assess HL's role as a determinant and moderator of substance use avoidance. Data were collected from 675 adolescents (mean age = 15.5 years, ~53% girls, ~32% Hispanic/Latine) through Qualtrics survey panels and in school settings. Participants completed surveys on social and demographic factors, HL, and substance use. Binary and multinomial logistic regressions were used to address the study aims. In adjusted analyses, adolescents who were girls, Hispanic/Latine (vs. White), food secure, English proficient, had private communications with health providers, and those without impaired decision-making had higher odds of having high HL. Having higher functional, interactive and composite HL increased the odds of substance use avoidance and moderated the effect of age, with younger adolescents with higher HL (vs. low HL) having greater odds of substance use avoidance. Our findings suggest that HL may act as a protective factor against the initiation of substance use in younger adolescents. Thus, HL may be a good intervention strategy to delay substance use initiation for younger adolescents.