By Iris Smith, Ph.D.

Data from the 2022 National Survey on Drug Use and Health estimated that 48.7 million people in the U.S. aged 12 and older had a substance use disorder (SUDS).¹ Drug and alcohol misuse among adolescents is particularly concerning.

In 2023, 22% of high school students drank alcohol in the past 30 days, 17% used marijuana and 10% used illicit drugs in the past 30 days and 4% reported having misused prescription opioid drugs. ² Developmentally, adolescence is a period of transition when there may be an imbalance in the brain’s emotional, reward and cognitive control systems causing the emotional reward system to dominate the brain functions that control attention, planning, and impulse control. This makes adolescents more likely to engage in risky behaviors without considering the consequences of those behaviors.³ Family and peer influences, social media, and the portrayal of substance use in entertainment media (TV, cinema, and video games) all influence adolescent beliefs and attitudes about substance use. Decision making is further complicated by their ability (or inability) to navigate multiple sources of influence, access, understand, and act on health knowledge. The three core competencies of health literacy include:

• Functional skills (reading, writing and numeracy).
• Communicative/interaction skills (interacting with multiple sources of information, interpreting and acting on information).
• Critical skills that enable the individual to engage in individual and socio-political advocacy for health.¹

Research on the relationship between health literacy and health behavior in adults has found that it is positively associated with prevention behaviors such as vaccination, healthy eating, and regular visits to the doctor.  Some studies have found low health literacy in adolescents is related to fewer health-promoting behaviors and lower quality of life.⁴ 

 A recent scoping review of adolescent health literacy and substance use identified 16 studies out of 1,767 English language studies published prior to September 21, 2023, that examined and reported on the relationship between substance use and health literacy in adolescents.  Higher health literacy was associated with lower rates of substance use including alcohol, tobacco, and electronic vapor product use. However, only one study on the relationship between health literacy and cannabis and one on amphetamines/methamphetamines use were found. Higher health literacy was associated with greater negative expectancies of alcohol use, greater risk perception of substance use, and self-efficacy for avoiding substance use. The researchers noted that there is a need for additional research on the relationship of health literacy and substance use, including a better understanding of its role as a mediator or moderator in decisions about substance use in general as well as regarding specific drugs.  There is also a need to better understand  how it is influenced by socio-economic conditions, geography, and culture.  Despite these limitations of the research, it is clear that attention to health literacy may be a useful adjunct to substance misuse prevention programming for adolescents.

References

Alho J, Gutvilig M, Niemi R, et al. Transmission of Mental Disorders in Adolescent Peer Networks. JAMA Psychiatry. Published online May 22, 2024. doi:10.1001/jamapsychiatry.2024.1126

Engel, E., Gell, S., Heiss, R., & Karsay, K. (2024). Social media influencers and adolescents' health: A scoping review of the research field. Social science & medicine (1982), 340, 116387. https://doi.org/10.1016/j.socscimed.2023.116387

Fleary SA. Development and Validation of the Adolescent Media Health Literacy Scales: Rasch Measurement Model Approach. JMIR Pediatr Parent. 2022 Apr 15;5(2):e35067. doi: 10.2196/35067. PMID: 35436219; PMCID: PMC9055475. https://pmc.ncbi.nlm.nih.gov/articles/PMC9055475/

Fleary SA, Rastogi S,Fenton T, Zaire A. (2024).  Health Literacy and Adolescents’ Substance Use Behaviors and Correlates:  A Scoping Review.  Health Promotion International 39. https://doi.org/10.1093/heapro/daae074

Kaňková, J., Binder, A., & Matthes, J. (2024). Health-Related Communication of Social Media Influencers: A Scoping Review. Health Communication, 1–14. https://doi-org.proxy.library.emory.edu/10.1080/10410236.2024.2397268

Larsen B, Veenstra R (2021). Toward Understanding the Functions of Peer Influence:  A Summary and Sythesis of Recent Empirical Research.  Journal of Research on Adolescence 31(4); pg. 889-907.

Lojszczyk, A., Wilson, R., Wood, J., & Hutton, A. (2023). Motivational Characteristics of Recreational Drug use among emerging adults in social settings: an integrative literature review. Frontiers in public health, 11, 1235387. https://doi.org/10.3389/fpubh.2023.1235387

¹ SAMHSA .  Highlights for the 2022 National Survey on Drug Use and Health.

² Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023 . U .S . Department of Health and Human Services; 2024

³ Fleary SA, Rastogi S,Fenton T, Zaire A. (2024).  Health Literacy and Adolescents’ Substance Use Behaviors and Correlates:  A Scoping Review.  Health Promotion International 39. https://doi.org/10.1093/heapro/daae074

⁴ Fleary SA, Joseph P, Pappagianopoulos JE (2018).  Adolescent Health Literacy and Health Behaviors:  A Systematic Review; Journal of Adolescence 62; pg. 116-127.