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

• Alcohol use behaviors in teens are positively correlated with health literacy.
• The relationship between alcohol expectancy and use is moderated by health literacy.
• Expectancy-based prevention messages may be more effective in high literacy teens.

ObjectiveAlcohol 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.MethodsWe studied alcohol use behaviors in the past six months in youths aged 14–19 recruited from two adolescent medicine clinics. We assessed covariate-adjusted bivariate relationships between HL, expectancies, and four measures of alcohol use and tested health literacy as a moderator of the relationship between expectancies and use.ResultsOf the 293 study teens, 45 percent reported use of alcohol in the past six months. Use behaviors were positively associated with higher health literacy and positive expectancies. Our moderation model suggested that health literacy moderates the relationship between expectancies and use, with the expectancy/use relationship being significantly stronger in higher literacy teens.ConclusionFindings suggest that health literacy can influence alcohol expectancies and behaviors.Practice implicationsHealth literacy should be explicitly considered in the design of alcohol prevention messages.