Abstract
Limited health literacy is a significant predictor of engaging in unhealthy behaviors. However, the literature regarding the association between health literacy and smoking in university students is very limited. Thus, this study was conducted to examine the association between university students' health literacy and smoking habits. A cross-sectional design was used. A sample of university students (N = 327) was recruited to conduct this study. Data collection was performed using a demographics questionnaire and the health literacy questionnaire. AMOS was used to conduct data analysis using structural equation modeling analysis with maximum likelihood estimation. Different versions of the structural model were compared and evaluated based on specific fit indices criteria. The results showed that 30% of the participants were current smokers. Smoking cigarettes was the most common type of smoking in this study, and 23.1% of the participants were current users of two or more types of smoking (e.g., cigarettes and hookah). The structural model with three latent variables (health literacy, smoking status and type, and smoking frequency and duration) was the one that best fit the data; the model fit indices were X2 = 305.84, df = 102, p < .001; RMSEA = .068; CFI = .95; CMIN/df = 2.51; TLI = .929; and AIC = 355.75. A single standard deviation increase of health literacy causes .38 decrease in smoking status and type and .13 decrease of smoking frequency and duration. The results showed that health literacy is negatively associated with smoking in a sample of Jordanian university students.
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Data Availability
The data that support the findings of this study are available from Jordan University of Science and Technology, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Jordan University of Science and Technology.
References
Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 80. https://doi.org/10.1186/1471-2458-12-80
World health Organization. (2022). Tobacco. Retrieved from https://www.who.int/news-room/fact-sheets/detail/tobacco#:~:text=Over%2080%25%20of%20the%20world's,7.8%25%20of%20the%20world's%20women.
Nutbeam, D., McGill, B., & Premkumar, P. (2018). Improving health literacy in community populations: A review of progress. Health Promotion International, 33(5), 901–911. https://doi.org/10.1093/heapro/dax015
Urstad, K. H., Andersen, M. H., Larsen, M. H., Borge, C. R., Helseth, S., & Wahl, A. K. (2022). Definitions and measurement of health literacy in health and medicine research: A systematic review. British Medical Journal Open, 12(2), e056294. https://doi.org/10.1136/bmjopen-2021-056294
Hansen, H. R., Shneyderman, Y., & Belcastro, P. A. (2015). Investigating the association of health literacy with health knowledge and health behavior outcomes in a sample of urban community college undergraduates. American Journal of Health Education, 46(5), 274–282. https://doi.org/10.1080/19325037.2015.1055016
Walters, R., Leslie, S. J., Polson, R., Cusack, T., & Gorely, T. (2020). Establishing the efficacy of interventions to improve health literacy and health behaviours: A systematic review. BMC Public Health, 20(1), 1–17. https://doi.org/10.1186/s12889-020-08991-0
Aygun, O., & Cerim, S. (2021). The relationship between general health behaviors and general health literacy levels in the Turkish population. Health Promotion International, 36(5), 1275–1289. https://doi.org/10.1093/heapro/daaa151
Clendennen, S. L., Loukas, A., Creamer, M. R., Pasch, K. E., & Perry, C. L. (2019). Longitudinal patterns of multiple tobacco and nicotine product use among Texas college students: A latent transition analysis. Prevention Science, 20(7), 1031–1042. https://doi.org/10.1007/s11121-019-01031-3
Centers for Disease Control and Prevention. (2021). Global Tobacco Control. Retrieved from https://www.cdc.gov/tobacco/global/index.htm?s_cid=osh-stu-home-nav-007#core1
Ministry of Health. (2019). Jordan National Stepwise Survey (STEPs) for Noncommunicable Diseases Risk Factors 2019. Retrieved from https://kaa.moh.gov.jo/Echobusv3.0/SystemAssets/aa28955c-cdef-4f8b-8b30-8f2f82ab3203.pdf
Brandt, L., Schultes, M. T., Yanagida, T., Maier, G., Kollmayer, M., & Spiel, C. (2019). Differential associations of health literacy with Austrian adolescents’ tobacco and alcohol use. Public Health, 174, 74–82. https://doi.org/10.1016/j.puhe.2019.05.033
Nasser, A. M., Geng, Y., & Al-Wesabi, S. A. (2020). The prevalence of smoking (cigarette and waterpipe) among university students in some Arab countries: A systematic review. Asian Pacific Journal of Cancer Prevention APJCP, 21(3), 583.
Al-Sawalha, N. A., Almomani, B. A., Mokhemer, E., Al-Shatnawi, S. F., & Bdeir, R. (2021). E-cigarettes use among university students in Jordan: Perception and related knowledge. PLoS ONE, 16(12), e0262090. https://doi.org/10.1371/journal.pone.0262090
Khatatbeh, M. M., Alkhaldi, S., Khader, Y., Momani, W., Al Omari, O., Kheirallah, K., & Al-Taani, G. (2019). Prevalence of nicotine dependence among university students in Jordan: A cross-sectional study. Epidemiology, Biostatistics, and Public Health. https://doi.org/10.2427/13075
Al-Balas, H., Al-Balas, M., Al-Balas, H. I., Khamees, A. A., Talafha, M., & Nuseir, A. (2021). Electronic smoking behavior among adult males in Jordan. Journal of Community Health, 46(4), 803–807. https://doi.org/10.1007/s10900-020-00953-2
Al-Sheyab, N. A., Alyahya, M. S., Almomani, F., & Tazlat, A. M. (2021). Risk perception of waterpipe smoking among undergraduate medical and nursing students in Jordan. Journal of Substance Use, 26(4), 397–403. https://doi.org/10.1080/14659891.2020.1841843
Clifford, J. S., Lu, J., Blondino, C. T., Do, E. K., & Prom-Wormley, E. C. (2022). The association between health literacy and tobacco use: Results from a nationally representative survey. Journal of Community Health, 47(1), 63–70. https://doi.org/10.1007/s10900-021-01019-7
Panahi, R., Niknami, S., Ramezankhani, A., Tavousi, M., & Osmani, F. (2015). Is there a relationship between low health literacy and smoking? Health Education and Health Promotion, 3(3), 43–52.
Panahi, R., Osmani, F., Javanmardi, K., Ramezankhani, A., Dehghankar, L., Amini, R., & Hosseini, N. (2021). The relationship between different levels of health literacy and smoking prevention among medical sciences students. International Journal of Preventive Medicine. https://doi.org/10.4103/ijpvm.IJPVM_460_20
Marx, J. M., Miller, A., Windsor, A., Locke, J., & Frazier, E. (2021). Perceptions of cigarettes and e-cigarettes: Does health literacy matter? Journal of American College Health. https://doi.org/10.1080/07448481.2021.1979008
Atri, S. B., Sahebihagh, M. H., Jafarabadi, M. A., Behshid, M., Ghasempour, M., & Abri, F. (2018). The relationship between health literacy and stages of change in smoking behavior among employees of educational health centers of Tabriz University of Medical Sciences (2016). International journal of preventive medicine. https://doi.org/10.4103/ijpvm.IJPVM_259_17
Panahi, R., Hosseini, N., Ramezankhani, A., Anbari, M., Amjadian, M., Dehghankar, L., & Niknami, S. (2022). Measuring the structures of the health belief model integrated with health literacy in predicting university students’ adoption of smoking preventive behaviors. Journal of Preventive Medicine and Hygiene, 63(1), E51.
Kline, R. B. (2015). Principles and practice of structural equation modeling. Guilford Publications.
Osborne, R. H., Batterham, R. W., Elsworth, G. R., Hawkins, M., & Buchbinder, R. (2013). The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health, 13(1), 1–17. https://doi.org/10.1186/1471-2458-13-658
Rababah, J. A., Al-Hammouri, M. M., & Aldalaykeh, M. (2022). Validation and measurement invariance of the Arabic Health Literacy Questionnaire. Heliyon, 8(4), e09301. https://doi.org/10.1016/j.heliyon.2022.e09301
Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2014). Pearson new international edition. Multivariate data analysis (7th ed.). Pearson Education Limited Harlow.
Vozikis, A., Pollalis, Y., Armoutaki, A., & Kyriazis, I. (2020). The association between smoking and health risk behaviours among university students in Greece. International Journal of Caring Sciences, 13, 783–790.
Darawad, M. W., Rezk-Hanna, M., Alhussami, M., Lee, J., Mostafa, A., Abu-Rmeileh, N., & Salloum, R. (2020). Poly-tobacco use among young adult waterpipe smokers: Insights from university students in three eastern Mediterranean countries. Substance use & misuse, 55(13), 2099–2108. https://doi.org/10.1080/10826084.2020.1790010
Pardavila-Belio, M. I., Ruiz-Canela, M., & Canga-Armayor, N. (2019). Predictors of smoking cessation among college students in a pragmatic randomized controlled trial. Prevention Science, 20(5), 765–775. https://doi.org/10.1007/s11121-019-01004-6
Ministry of Health. (2008). Public Health Law No (47) for year 2008 and its changes. Retrieved from https://www.moh.gov.jo/ebv4.0/root_storage/en/eb_list_page/public_health_law_no_(47)_for_year_2008_and_its_changes.pdf
Acknowledgements
The authors are gratefully thankful to the Deanship of Research at Jordan University of Science and Technology for facilitating the process of conducting this research. We would also like to thank the participants for their commitment throughout the course of conducting this study.
Funding
This study was fully supported by the Deanship of Scientific Research, Jordan University of Science and Technology (Grant ID: 20190480).
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JR: conception of the research idea, building the overall study design, and supervising the data collection. He performed the data analysis and prepared this manuscript. MA: contributed to the conception of the main idea, made substantial contribution toward preparing the data collection tools, and assisted with the data analysis. Both authors read and approved the final manuscript.
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The approval of the institutional review board (IRB) was obtained from Jordan University of Science and Technology prior to conducting this study (ID #: 40/126/2019).
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Rababah, J.A., Al-Hammouri, M.M. Health Literacy and Smoking Habits Among a Sample of Jordanian University Students. J Community Health 48, 30–37 (2023). https://doi.org/10.1007/s10900-022-01139-8
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DOI: https://doi.org/10.1007/s10900-022-01139-8