Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.
Research Centre for Health Promotion, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
Eur J Public Health. 2022 Apr 1;32(2):182-187. doi: 10.1093/eurpub/ckab213.
To address social inequalities in adolescent substance use and consequent disparities in health, it is important to identify the mechanisms of the association between substance use and academic performance. We study the role of health literacy (HL) in the association between academic performance and weekly smoking, monthly alcohol use and cannabis ever-use among adolescents in Europe.
SILNE-R school survey data, which was collected in 2016-17 with paper-and-pencil-method from Hanover (GE), Amersfoort (NL) and Tampere (FI), were used (N = 5088, age 13-19). Health Literacy for School-aged Children instrument was used to assess students' HL. Logistic regression analyzed the association of substance use with academic performance and HL, separately and in the same model. Linear and multinomial logistic regression analyzed the association between academic performance and HL.
Poor academic performance compared with high was associated with smoking [odds ratio (OR) 3.94, 95% confidence interval (CI) 2.83-5.49], alcohol use (OR: 2.94, 95% CI: 2.34-3.68) and cannabis use (OR: 2.56, 95% CI: 1.89-3.48). Poor HL was also associated with each substance use (with ORs of 2.32, 1.85 and 1.29). HL was positively associated with academic performance (β = 1.04, 95% CI: 0.89-1.20). The associations between academic performance and substance use were only slightly attenuated after controlling for HL.
Academic performance and HL were both determinants of substance use, confirming their role in tackling the disparities in substance use. However, HL did not demonstrably mediate the association between academic performance and substance use. A wider set of factors needs to be tackled to address emerging social inequalities in adolescent substance use.
为了解决青少年物质使用中的社会不平等问题，以及由此导致的健康差距，确定物质使用与学业成绩之间关联的机制非常重要。我们研究了健康素养（HL）在欧洲青少年中，学业成绩与每周吸烟、每月饮酒和大麻使用之间的关联中的作用。
使用了 2016-17 年通过纸笔法在汉诺威（德国）、阿默斯福特（荷兰）和坦佩雷（芬兰）收集的 SILNE-R 学校调查数据（N=5088，年龄 13-19 岁）。使用儿童健康素养量表评估学生的 HL。使用逻辑回归分别和同一模型分析物质使用与学业成绩和 HL 的关联。线性和多项逻辑回归分析了学业成绩与 HL 之间的关联。
与高成绩相比，成绩差与吸烟（优势比[OR]3.94，95%置信区间[CI]2.83-5.49）、饮酒（OR：2.94，95%CI：2.34-3.68）和大麻使用（OR：2.56，95%CI：1.89-3.48）相关。HL 较差也与每种物质的使用相关（OR 分别为 2.32、1.85 和 1.29）。HL 与学业成绩呈正相关（β=1.04，95%CI：0.89-1.20）。在控制 HL 后，学业成绩与物质使用之间的关联仅略有减弱。
学业成绩和 HL 都是物质使用的决定因素，这证实了它们在解决物质使用中的差异方面的作用。然而，HL 并没有明显地介导学业成绩和物质使用之间的关联。需要解决更广泛的一系列因素，以解决青少年物质使用中出现的新的社会不平等问题。
