| Objective:At present,China does not have a unified health literacy measurement tool for adolescent,which lacks a basis for comparison.Therefore,the purpose of this study is to introduce "the Newest Vital Sign(NVS)",which is widely used abroad and less domestically studied,and verify its reliability and validity in Chinese adolescents.Then use the Chinese version to evaluate the health literacy level of the adolescents in Luzhou,Sichuan Province,and find its influencing factors,in order to carry out relevant horizontal and vertical comparisons.Then further explore the relationship between adolescents’health literacy and body mass index(BMI)and the role of snacking behavior between the above two,in order to provide a theoretical basis for improving adolescents’ health literacy and promoting their physical health.Methods:After obtaining the scale authorization,translate and modify the original scale to determine the final version of the scale.Multi-stage stratified random sampling was used to randomly select 4schools,including 1 high school,2 junior high schools,and 1 elementary school(grades 5-6)in 7 districts(counties)of Luzhou City,Sichuan Province,and randomly sample 1 for each grade in each school Classes(Primary schools only take 5th and 6th grades).A total of 3,910 students are selected in groups in equal proportions in each class.The internal consistency reliability,test-retest reliability,structural validity and standard validity of the test scale were tested.The confirmatory factor analysis in the structural validity was carried out using AMOS 21.0.At the same time,the snack intake behavior and BMI of students in grades 5-9 were investigated.Use SPSS 25.0 software for statistical analysis,use t-test,analysis of variance,and χ2 test for group comparisons,and use ordered multi-class Logistic regression to analyze the influencing factors of adolescents’ health literacy.Use the Pearson correlation analysis and multi-factor analysis to analyze the relationship between Health literacy and snack intake behavior scores,and health literacy and BMI,then use the intermediary effect method to analyze the relationship between the three.The intermediary effect test uses the sequential test method and the Bootstrap method.Results:In the first part of this study,3754 valid questionnaires were collected,the valid questionnaire rate was 96.0%.The correlation coefficient between each item of the NVSCH and the total score is between 0.511 and 0.757,KMO=0.738,the Bartlett spheroidity test P<0.001.The exploratory factor analysis has abstracted two factors and explained 63.694%of total variance.The factor loading range of each item is 0.515～0.896.Name the two factors as calculated dimensions and reading dimensions.Confirmatory factor analysis showed that almost all indicators satisfy the standard,the model was acceptable:χ2/df=10.592,GFI=0.993,RMSEA=0.051,RMR=0.005,SRMR=0.021,CFI=0.087,NFI=0.985,NNFI=0.975.The scores of the NVS-CH scale were positively correlated with the scores of the Chinese Citizens’Health Literacy Survey(r=0.506,P<0.001).The Cronbach’s a of total score,calculation dimension,and reading dimension was 0.748,0.726,0.708 respectively.The retest reliability of NVS-CH scale was 0.685,so the overall reliability of the scale was good.In the second part of this study,2922 valid questionnaires were collected,the valid questionnaire rate was 93.6%.The average health literacy score of Luzhou adolescents was 238±1.936 points,31.2%had adequate health literacy,and 42.7%had insufficient health literacy.The results of Ordered Multi-class Logistic regression showed that the adolescents who lived in school and had pocket money each week had higher health literacy levels.The proportion of adolescents who consume fruit and milk every day is 36.0%and 19.7%,respectively,the proportion of daily or regular intake of yogurt is 33.9%,and the proportion of daily or regular intake of sugar and sugar-sweetened beverages is 11.7%-24.0%between.The average total snack intake score of Luzhou adolescents is 44.59±5.693 points,and those with adequate health literacy score higher than those with insufficient health literacy.The correlation coefficient between snack intake score and health literacy score is 0.199.Adjusting urban and rural areas,gender,etc,those with adequate health literacy are more likely to have higher snack intake score(OR=8.37,95%Cl:5.474-12.794).And the higher the score on both dimensions of health literacy,the higher the snack intake score they have(ORccalculation)=1.53,95%Cl:1.138～1.758;OR(reading)=2.09,95%Cl:1.638～2.656).The average BMI of Luzhou adolescents was 18.89±4.315,77.3%were within the standard range,9.2%were lean,the overweight rate was 4.5%,the obesity rate was 9.0%,and the overweight and obesity rate was 13.5%.Those with adequate health literacy levels have a higher proportion of BMI in the standard range(73.6%),and a lower rate of overweight and obesity(11.1%).There is a negative relationship between BMI and health literacy(r=-0.062).Adjusting urban and rural areas,gender,school level etc,people with insufficient health literacy have a higher proportion of abnormal BMI level(OR=1.52,95%Cl:1.201～1.916),and the higher the scores on both dimensions of health literacy,the lower the proportion of abnormal BMI level(OR(calculation)=0.92,95%Cl:0.857～0.997;OR(reading)=0.87,95%Cl:0.758～0.992).The mediating effect analysis showed that the direct effect of health literacy on BMI was-0.049.The indirect effect of the intermediate variable(snack intake behavior)on BMI was-0.014,and accounted for 23.3%of the total effect.Conclusions:The Chinese version of the NVS scale has good reliability and validity among Chinese adolescents,and is suitable for measuring the health literacy level of Chinese adolescents.The health literacy level of adolescents in grades 5-9 in Luzhou is lower than in developed countries and regions,and higher than in general low-income developing countries.Urban and rural areas,living in school,and having pocket money every week are the influencing factors of the health literacy level of adolescents.The higher the level of health literacy,the better adolescents’ snack intake behavior,and the higher the proportion of their body mass index(BMI)within the standard range.Among them,snack intake behavior has a partial mediating effect between health literacy and BMI. |
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