Health literacy, alcohol expectancies, and alcohol use behaviors in teens

Objective: Expectancies are beliefs that specific positive or negative outcomes will follow certain behaviors. In teens, alcohol expectancies have consistently been shown to predict alcohol use behaviors. Expectancies are developed, in part, through exposure to health messages, the understanding of which may be influenced by health literacy. This study explores the relationships among health literacy, alcohol expectancies, and alcohol use behaviors in teens and examines whether disparities in health literacy influence disparities in alcohol expectancies and alcohol use behaviors. Methods: Alcohol expectancies and alcohol use behaviors in the past six months were assessed via questionnaires given to youths aged 14-19 who were recruited from two adolescent medicine clinics in Ohio and Pennsylvania. Health literacy was assessed using the REALM-Teen. Bivariate relationships were examined using the chi-squared test. A multivariate logistic regression model was used to test the role of health literacy as a moderator of the relationship between expectancies and use behaviors. Results: Of the 293 teens in the study, 45% reported use of alcohol in the past six months. Use behaviors were positively associated with higher health literacy and positive alcohol expectancies. 24% of respondents had less than adequate health literacy. Health literacy limitations were significantly higher in African-American youths compared with whites (32.0% vs. 16.5%).  Our moderation model found that health literacy significantly moderated the relationship between expectancies and use, with the expectancy/use relationship being significantly stronger in higher literacy teens. Conclusion: Alcohol prevention messages designed to reduce use behaviors by reducing positive expectancies may be less effective in low literacy populations which are disproportionately African American.