Generic health literacy of adolescents in Germany: Results of a nationwide cross-sectional survey

Abstract

Objective: There is no European Union (EU) health system but there is an EU health policy and this health policy is rapidly changing due to the COVID-19 responses of the EU and Member States. The aim of this panel discussion is to analyze and put into context the rapid evolvement of EU health policy during the pandemic. This panel discussion will therefore focus on 1) EU public health policy 2) EU action for health 3) the EU Market shaping health 4) the fiscal governance 5) the institutions, processes and powers. Background: EU health policy has often been overlooked and was never on the political agenda. COVID-19 and the pandemic response, however, changed this dramatically. EU-health policy has become centre stage followed by bold investments and new regulatory initiatives. Obvious examples are the EU4Heatlth programme, the Recovery and Resilience fund, the new agency HERA, the new remit for the European Medicines Agency and the European Center for Disease Control. There are also new European Commission mechanisms with regards to the purchase of personal protective equipment, supplies, medicines including vaccines and medical technologies. But will the new EU health policy strengthen health systems of Member States or just focus on stronger emergency responses? Will the constitutional asymmetry between health and internal market be addressed? Will EU-health policy remain after the crisis a centre-piece of European Integration? This panel is based on the COVID-19 update of the EU-health policy handbook 'Everything you always wanted to know about European Union health policies but were afraid to ask' Interactivity: There will be a high level of interactivity. After an introductory presentation, attendees can use the chat-box to choose specific topics from the aforementioned five themes. These topics will be presented in a table. The chair will then pass the questions and topics to the panelists. Enhancing health literacy of children and adolescents is a critical means for health promotion and sustainable development. This is mainly because childhood and adolescence represent key stages for addressing health, social, cognitive, emotional and educational development and influencing health behavior and healthy lifestyles over the life-course. The education sector is particularly important, and schools represent a critical setting to facilitate health literacy teaching and learning, for example in health education classes or whole-of-school approaches. Regarding the question of what makes health literacy so important for children and adolescents these days, there are three key themes and recent developments which amplified the meaning and relevance of health literacy for public health and societies: (i) A globalizing world: Globalization and digitalization change the ways in which health is negotiated and promoted, including that today health information is almost limitlessly accessible in everyday life. (ii) The information overload: The overload of information-a.k.a. infodemic (short for information epidemic)-makes health literacy a critical skill-set in managing the overabundance of information that is available through digital communication channels; while at the same time children and adolescents are increasingly turning to the Internet and social media as sources of health information and for communication about health issues with their peers or social contacts. (iii) The COVID-19 pandemic: The pandemic has once again underlined how important health literacy is not only for understanding public health recommendations , applying health behaviours, avoiding unnecessary risks, and protecting individual, family, and population health, but also to learn about the importance of vaccination, to become knowledgeable and skilled in navigating the infodemic, and to identifying fake news and disinformation about COVID-19. The purpose of this workshop is to bring together five contemporary projects on health literacy from Germany in and with schools that reflect the above issues: (i) A cross-sectional pen-and-paper survey in primary schools on children's health literacy; (ii) A survey on adolescents health literacy; (iii) The development of a toolbox for health literacy interventions in schools; (iv) An intervention for improving adolescent's mental health literacy in schools, (v) A whole school approach and organizational health literacy in schools. Each project will be given ample time to present their findings, which will be followed by Q&A and an open discussion with the audiences. This workshop offers a forum for researchers, practitioners and policymakers interested in school related health literacy and school health promotion. By dialogue and two-way communication, vivid interaction will be ensured, allow building synergies, and facilitate networking and capacity building. Background: The WHO describes Health literacy (HL) as a critical determinant of health, and a number of studies among adults link low HL to adverse health outcomes. However, little research has been conducted on HL and health outcomes in younger populations. Thus, this study describes the relationship between HL, health behaviors, and health status among children in primary schools. Methods: A cross-sectional pen-and-paper survey was conducted in a convenience sample of 4th-graders in the federal state of North Rhine-Westphalia, Germany. Self-report measures were used for subjective HL, health behaviors (freq. of brushing teeth, eating fruit, exercising, screen time), and health status (subj. health, chronic condition, freq. of doctor visits, feeling ill). Correlations and binary logistic regression for the outcome ''at least one adverse health behavior'' (e.g. brushing teeth <2x a day; not eating fruit every day) are reported. Sex, age, family affluence, background of migration, numeracy, literacy, and health knowledge are included in the regression model. Results: In our sample of n = 899 children (mean age 9,56 years), HL is significantly correlated with subj. health (=.262 ÃÃ) doctor visits (=.086 Ã), feeling ill (=-.078 Ã), brushing teeth (=.116 ÃÃ), eating fruit (=.191 ÃÃ) exercising (=.124 ÃÃ) and screen time (=-.096 ÃÃ). Logistic regression (X 2 =29.237; p=.001, n = 648) shows that the relative risk for !1 adverse health behaviour is higher for boys (OR: 1.4; 95%-CI [1.016-1.927]) and children with lowest family affluence (1.7 [1.097-2.694]). Also, for one unit increase in HL (range 1-4), risk decreases by about 50% (0.472 [.298-.748]). Conclusions: Already at a young age (9-10 years), HL is linked to a number of health outcomes. Further, HL has been found to be a potential predictor of adverse health behaviors after controlling for confounders.Thus, the promotion of HL might play an important role in mitigating adverse health behaviors early in the life course.