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RESEARCH PRODUCT

Adolescent health literacy in 3 European cities and its association with smoking and smoking beliefs

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Abstract Background Beliefs about smoking have been found to be associated with smoking behaviour. Similarly, health literacy (HL) as a competence to make health-related decisions has been identified as an independent factor to explain differences in smoking. However, little is known about adolescents’ HL in different countries, and how HL is associated with health behaviour and health-related beliefs. The aim of this study is to describe the levels of HL in three European cities, and how HL is associated with smoking and beliefs about smoking consequences. Methods In 2016 as part of SILNE-R study, 5,088 adolescents aged 14 to 16 years answered a school survey in Amersfoort (NL), Hanover (GE) and Tampere (FI). Health Literacy for School-aged Children (HLSAC) covering five components (theoretical knowledge, practical knowledge, critical thinking, self-awareness and citizenship) was used. Questions on smoking and five statements on beliefs about smoking consequences were asked. The analyses were conducted with multinomial logistic regression, and with generalised linear mixed models. Results HL was the highest in Tampere (Finland), then in Amersfoort (the Netherlands), and the lowest in Hanover (Germany). HL was not associated with smoking, but it was positively associated with beliefs about smoking consequences, overall and when stratified by city. Conclusions Health literacy level was the highest in Tampere (FI), which may be due to Health Education as a curriculum-based school subject. In other cities, the education on health is not offered so systematically. Highly health literate students also know more about smoking consequences, but it does not affect their smoking behaviour. Systematic and compulsory health education in schools can be recommended in order to enhance adolescents HL. Key messages Adolescents’ high health literacy was associated with more accurate believes on smoking consequences. Health literacy was not associated with smoking behavior.