Health literacy and its association with health outcomes among students in upper secondary education

Abstract Background Health literacy (HL) - as a broad range of health-related competencies and skills- has been recognized as a determinant of health outcomes, and suggested to be a modifiable health resource and a factor contributing to empowerment and equity. Thus, there is a need to identify the state of HL in various population groups. The aim of this study was to investigate HL levels and associations between HL, physical activity and subjective health among students in general upper secondary and vocational Swedish-language schools in Finland. Methods The study used cross-sectional data from the Finnish LIITU-study among students in Swedish-speaking general upper secondary and vocational schools (N = 887; age 16-20 years) conducted in the spring and autumn 2020, during the covid-19-pandemic. Students answered a web-based questionnaire during school hours. HL was measured with the 10-item Health Literacy for School-Aged Children (HLSAC) instrument. Data was analyzed with descriptive statistics and logistic regression analyses. Results According to preliminary findings, one third of students had high HL. HL was higher among female than male students, general upper secondary school students than vocational school students, and in spring than in autumn 2020. A higher proportion of students with high HL, as compared to students with low/medium HL, reached the national recommendations for physical activity, perceived their health to be excellent and, moreover, did not have recurrent psychological symptoms. Conclusions The findings confirm previous research findings on the importance of HL in promoting health outcomes. The pandemic year 2020 provided a unique perspective to the subject. It would be important to survey and discuss the role of schools in providing equal opportunities for the promotion of HL as this may contribute to decreasing health disparities in the population. Key messages • One third of students in upper secondary education (age 16-20 years) had high HL; there were differences between genders, students on different educational paths, and in spring and autumn 2020. • High HL was associated with better self-rated health, less psychological symptoms and reaching national recommendations for physical activity among students in upper secondary education.


Background:
Health literacy (HL) -as a broad range of health-related competencies and skills-has been recognized as a determinant of health outcomes, and suggested to be a modifiable health resource and a factor contributing to empowerment and equity. Thus, there is a need to identify the state of HL in various population groups. The aim of this study was to investigate HL levels and associations between HL, physical activity and subjective health among students in general upper secondary and vocational Swedish-language schools in Finland.

Methods:
The study used cross-sectional data from the Finnish LIITUstudy among students in Swedish-speaking general upper secondary and vocational schools (N = 887; age 16-20 years) conducted in the spring and autumn 2020, during the covid-19-pandemic. Students answered a web-based questionnaire during school hours. HL was measured with the 10-item Health Literacy for School-Aged Children (HLSAC) instrument. Data was analyzed with descriptive statistics and logistic regression analyses.

Results:
According to preliminary findings, one third of students had high HL. HL was higher among female than male students, general upper secondary school students than vocational school students, and in spring than in autumn 2020. A higher proportion of students with high HL, as compared to students with low/medium HL, reached the national recommendations for physical activity, perceived their health to be excellent and, moreover, did not have recurrent psychological symptoms.

Conclusions:
The findings confirm previous research findings on the importance of HL in promoting health outcomes. The pandemic year 2020 provided a unique perspective to the subject. It would be important to survey and discuss the role of schools in providing equal opportunities for the promotion of HL as this may contribute to decreasing health disparities in the population. Key messages: One third of students in upper secondary education (age 16-20 years) had high HL; there were differences between genders, students on different educational paths, and in spring and autumn 2020.
High HL was associated with better self-rated health, less psychological symptoms and reaching national recommendations for physical activity among students in upper secondary education.

Background:
Recently, it was established that more religious people tend to have less favorable views of vaccination. The aim of this study was to assess the relationship between the religiousness and attitudes towards COVID-19 vaccination and disease, in five Western Balkans countries.

Methods:
Using online questionnaire and convenience sampling procedure, data were obtained from 1605 respondents aged 18-75 years. Perceived COVID-19 vaccine safety and efficacy, and observed danger and susceptibility to disease were assessed by short five-point Likert scales. Religiousness was estimated using single item scale. Multivariate regression analysis was employed.

Results:
In Serbia, respondents who assessed themselves as more religious considered vaccine against COVID-19 as less safe (b = -.10, p<.01) and effective (b = -.12, p<.01), were more prone to the attitude that dangers of COVID-19 are not that serious (b = -.09, p<.01), and believed to a greater extent that they are less susceptible to the virus (b = -.07, p<.01). Similarly, in Bosnia and Herzegovina more religious individuals were less convinced that vaccine is effective (b = -.07, p<.05), less inclined to believe that danger of the virus is serious (b = -.07, p<.05), and assessed their susceptibility as lower (b = -.06, p<.05). More religious people in Montenegro (b = -.06, p<.05) regarded the vaccine as less safe, while in North Macedonia (b = .06, p<.05) and Albania (b = .08, p<.01) stronger religiosity was associated with more favorable attitudes towards vaccine safety.

Conclusions:
The relationship between religiosity and attitudes towards COVID-19 vaccination and disease is culturally conditioned. While in some Western Balkans societies religious beliefs render individual with a sense of lack of control triggering worry and anxiety, in some others they work as psychological shield against existential threats. Key messages: Religiosity should be considered as a relevant factor in vaccination campaigns implementation.
In the societies where negative attitudes towards vaccination prevail among the believers, religious leaders should be peculiarly educated and encouraged to participate in vaccination campaigns.