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Aim: Identification of contributory factors in smoking and gaining insight into the roles played by each of these factors including health literacy (HL) may account for quitting or decreasing the prevalence of smoking. The aim of the current study was to identify the effects caused by different HL levels on smoking.
Methods: 347 students inhabiting the dormitories of Shahid Beheshti University of Medical Sciences were included in a cross-sectional correlational study. Random cluster sampling was used for the selection of participants. HELIA questionnaire (used for HL measurement in Iranian urban population between 18-65 years of age) and a researcher-made questionnaire (for determining the status of smoking in individuals) were used to collect information from the participants. All data were statistically analyzed by SPSS software.
Findings: The mean and standard deviation of HL score was 70.52±14.12 out of 100. The results indicated that among the university students, 59.7% (201 people) were non-smokers, 23.1% (78 people) were smokers, and 17.2% (58 people) had experienced smoking. These findings reveal that HL is significantly correlated with smoking in university students. Also different levels (insufficient, relatively sufficient, and sufficient) of HL show its significant correlation with smoking, meaning that less HL levels are accompanied by a higher chance of smoking.
Conclusion: The relatively high prevalence of smoking in university students and the impact of HL on smoking highlight the need to increase the level of HL in university students and develop an efficient tool for measuring smoking literacy in all age groups.

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Osteoporosis, which is known as a silent epidemic, the most common bone disease in humans, representing a major public health problem worldwide. At least, 1 in 3 women and 1 in 5 men over the age of 50 will suffer a fracture resulting by weak bones impacting the quality of life and the independence of millions of people. Osteoporosis is considered a health problem in the Middle East countries including Iran. The level of awareness about osteoporosis among people and health care professionals are estimated not enough in many countries. Considering the importance of awareness about prevention and self-care behaviors of osteoporosis and in order to promote people's health literacy about this issue, the World Osteoporosis Day (WOD) was launched on October 20 International Osteoporosis Foundation (IOF). The WOD marks the launch of a year-long campaign to raising health literacy and awareness of the prevention, diagnosis, and treatment of osteoporosis and metabolic bone disorder. It aims at putting bone health on the global health agenda and reaching out to policymakers, health providers and experts, the media, and the public. These campaigns involve patient societies around the world and have played an important role in raising public health literacy and awareness of bone health and the importance of preventing osteoporosis and fracture. Despite recording WOD in Iranian official calendar and public awareness programs regarding the prevention, self-care, diagnosis, and management of osteoporosis and fragility fractures of it in our country, they need to be strengthened.

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Aim: Currently, the issue of adolescents’ health literacy is particularly important because it is an essential component in improving their quality of life. Due to the lack of enormous studies on this issue, this study aimed to determine the level of health literacy and factors influencing it among high school students in Tehran, Iran.
Methods: This research is a cross-sectional and descriptive-analytic study, which was conducted on 400 male and female students studying in the second period of high school, who were selected using multi-stage random sampling. Data were collected through a questionnaire, which included personal characteristics, and the questionnaire of HELMA (Health Literacy Measure for Adolescents). The obtained data were analyzed using SPSS 20 and descriptive statistics as well as t-test and ANOVA tests.
Findings: The mean age of students was 17.01±0.87 years. 50% (n=200) of the participants were female, 50.5% (n=202) were from the North part of Tehran, and 34.5% (n=138) were in the third grade. 37.5% (n=150) had inadequate health literacy, 37% (n=148) relatively adequate health literacy, 22.5% (n=90) adequate health literacy, and 3% (n=12) excellent health literacy. Health literacy was correlated significantly with the level of education, parents’ education, source of information, the assessment of health status and interest in the issues of health (p<0.05).
Conclusion: The results indicated that most of the students had limited health literacy. Due to the role of health literacy in promoting the adolescence quality of life, it is necessary to pay more attention to promote health literacy and gain sufficient skills in order to make health information be practical and working.

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Breast cancer prevention and control efforts serve as priorities in Iran, as breast cancer is, the common leading cause of death women in the country. It seems effective communication can play important role in increasing Breast cancer screening. On the other hand, health literacy is increasing recognized as a critical factor affecting communication across the continuum of breast cancer screening behavior. A goal outlined in healthy people 2020 call for improving health literacy by the use of health communication (1, 2). Health literacy is the capacity to obtain, process, and understand breast cancer information and services needed to make appropriate health care decisions (3).
Women with poor health literacy have a complex set of problems with written and oral communication that may their understanding of breast cancer screening and of symptoms of breast cancer, adversely affecting their stage at early diagnosis (4). In addition, these barriers destroy communication and discussion about the risks and benefits of prevention and treatment options, and women understanding of informed consent for routine procedures and clinical trials, more research is required to identify successful methods for educating and communicating with women who have limited and low health literacy. Individuals with low health literacy may be limited in their ability to access and navigate the breast cancer care system, make appropriate health decisions, and practice on health care information understanding the factors that contribute to miscommunication is important in solving the difficulties included by low health literacy.

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Aim: One of the most significant outcomes of health education is health literacy (HL) so that it must be widely applied for achieving health promotion. The aim of this study was assessing HL and its relationship with using cell phone in adolescents in Mashhad City.
Methods: In this analytic-descriptive research, 445 high school adolescents selected with cluster sampling were assessed. For assessing HL, the Newest Vital Sign (NVS) was used. Cell phone use assessment tool was used for assessing the use of using cell phone. Data were analyzed by SPSS version 16.
Findings: Based on the obtained results, 82.1% and 86.2% of the female and male adolescents had not adequate HL, respectively. There was a negative correlation between the adolescents’ HL and using cell phone (p<0.0001).
Conclusion: Most of the adolescents had limited HL, and the adolescents with higher rate of using cell phone had worse HL score. In fact, adequate HL has a significant role for promoting health in the society. Therefore, policy makers are suggested to design useful educational programs for adolescents, especially in non-medical settings such as schools, was most of the day, adolescents spend their time over there.

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Aim: Health literacy means having basic health information and services needed to make appropriate health decisions. The aim of this study was to assess the relationship between health literacy and knowledge in rural patients with type 2 diabetes mellitus.
Methods: This descriptive-analytic study was performed on 120 patients with type 2 diabetes patients in 2016 in two health homes of Hossein Abad and Kaghazi villages of Aran and Bidgol City in Isfahan Province. Sampling was done by census. Data were gathered by three questionnaires. They were valid and standard questionnaires including demographic, knowledge and HELIA. The data were analyzed by SPSS16 software using descriptive statistics, T-test, correlation coefficient and ANOVA.
Findings: In this study, the participants were 66.7% women, 29/2% worker, 5/8% employee, 4/2% retired, 5% unemployed, and the rest were housewives. The mean score of health literacy and knowledge was 13/82±2/20 and 114±23/21, respectively. The mean age of the participants was 48/88±9/57 years, the mean score of knowledge and health literacy of the participants was 13/82±2/20, 114±23/21, respectively. There was a significant relationship between health literacy and knowledge (p=0.007) and between health literacy and educational level (p<0.05). Also there was a significant difference in health literacy between men and women (p=0.001).
Conclusion: According to the results of the study on the relationship between health literacy and educational level, this study suggests that since the women have an axial role in family health, in order to improve the level of knowledge, the formal education level in rural women diabetic patients must be increased.

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Aims: Health literacy becomes increasingly important in understanding the prenatal perception of risk by pregnant women. Maternal understanding of and perception of risk may have an impact on mothers’ willingness to follow antenatal recommendations. This study aimed at investigating correlation between maternal health literacy and dietary self-efficacy in pregnant mothers.
Instruments & Methods: In this cross-sectional descriptive-analytical study, 120 pregnant mothers were selected from health centers in Mashhad city, Iran in 2016. The subjects were selected through multi-stage cluster random sampling method. Data were collected using Maternal Health Literacy and Pregnancy outcomes Questionnaire and Perceived Dietary Self-efficacy Questionnaire. The obtained data were analyzed by SPSS 15 software and using descriptive statistics (mean, standard deviation, and frequency) and analytical statistical tests (independent t-test, ANOVA, Turkey’s Post hoc test and Pearson correlation test).
Findings: There was a positive and significant correlation between maternal health literacy and dietary self-efficacy (r=0.29; p=0.001). Significant relationships were found between maternal health literacy and educational level, incomes, and living place (p<0.05). But dietary self-efficacy had only a significant relationship with incomes (p<0.05). 
Conclusion: There are the significant correlation between maternal health literacy and self-efficacy in pregnant mothers.

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Instruments and Methods: This cross sectional descriptive-analytical study was conducted on 225 women in reproductive age (15-49) with breast cancer and having a mastectomy referred to Sina Hospital-breast surgery clinic, Breast Research Center, and Mahdieh Hospital from 2014 to 2015. A simple random sampling method as well as 4 questionnaires including the Health Literacy for the Iranian Adults (HELIA), Standard questionnaire of the European Organization for Research and Treatment of Cancer (EORTC version 3.0), special edition of Breast Cancer (QLQ-BR 23), and a Special questionnaire for body images was used. The data were analyzed by SPSS 21 software, using Spearman's correlation coefficient and one way ANOVA test.

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Aims: The present study was conducted to review the relationship between health literacy and self-care of diabetic patients.
Information & Methods: This study is a systematic review based on the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was implemented systematically through an electronic search in Iran Medex, SID, Magiran databases, Web of Science, PubMed, Scopus, Google Scholar, and Science Direct from January 2011 to April 2020. The terms were used, including health literacy, self-care, diabetes and their combinations. To maximize the comprehensiveness of the search in Persian references, general and general Persian keywords, including health literacy, self-care, diabetes self-care, health literacy, and self-care, health literacy, and diabetes and their possible combinations in the abstract, title, and keywords were used “AND” and “OR” operators were used for this purpose. For the English equivalent of Latin and MESHE, the words were searched, including “Health literacy”, “diabetes”, “self-care”, “Diabetes self-care”, and a combination of the “AND” and “OR” operators.
Findings: The results showed that in most studies there is a significant relationship between health literacy and self-care in patients with diabetes.
Conclusion: Health literacy plays an important and key role in promoting self-care behaviors in diabetic patients. It requires paying attention to health literacy and adopting strategies to improve the health literacy of diabetic patients.
 

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Aims: Health literacy has gained increasing attention in public health. It was aimed to assess health literacy and the related determinants among mothers with children under 6 years old.
Instrument & Method: In this population-based cross-sectional study, 1483 mothers were included through stratified random sampling. The study included demographic variables and socioeconomic status based on asset variables. Data was collected through Health Literacy for Iranian Adults questionnaire. The analysis was conducted in SPSS 16.0 and STATA 12.0 software using the principal component and adjusted linear regression models
Findings: The mean age of the children was 2.1±1.5. The mean score of health literacy was 70.2±17.5 in mothers. There was a significant association between the mother’s and her husband’s permanent jobs and socioeconomic status and total health literacy (p<0.05). Minimum and maximum scores of health literacy were obtained in the appraisal and understanding subscales, respectively. Totally, 36.4% of the participants had adequate health literacy.
Conclusion: The health literacy of the mothers was relatively high.

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Aims: Health literacy is considered a fundamental ability needed when making difficult health-related decisions. Also, people with nutrition literacy can convert nutrition messages into knowledge and tend to make healthier eating choices. This systematic review aimed to summarize the literature on nutrition and health literacy to enhance the medical students’ knowledge about the importance of health and nutrition literacy.
Information & Methods: In this study systematic review, research articles published in English were reviewed using relevant terms in PubMed, CINAHL, Web of Science, EMBASE, Scopus, and CINAHL databases. The articles were selected based on the inclusion and exclusion criteria, repetition, purpose, and relevance to the topic. Furthermore, the “Consensus-based Standards for the selection of health Measurement Instruments” checklist was used to select and evaluate the reviewed articles.
Findings: A total of 2978 articles were reviewed. Ultimately, 15 articles were approved and included in the study. Six studies were conducted on nursing students, six were on students of pharmacy and other clinical fields, and three studies examined medical students. The average nutrition and food literacy scores were sufficient, whereas the nutrition knowledge score was moderate.
Conclusion: In the reviewed studies, nutrition literacy is evaluated to be at a low to medium level. Most students have insufficient nutrition knowledge.

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Aims: Teenagers experience hearing loss due to exposure to loud noises. This study aimed to explore the effect of educational intervention on hearing health literacy in boy students.
Materials & Methods: This research was conducted experimentally on high school boy students in Sanandaj, Iran, in 2021. Using multi-stage cluster sampling, eight schools with 40 students were randomly selected for each group. Data were collected using a researcher-made questionnaire with 42 questions assessing hearing-related health literacy. The intervention group received six sessions of 50-65 minutes of virtual education. Measures were administered prior to the intervention and at a two-week follow-up. The educational content was designed based on reliable sources and according to general, specific, and behavioral goals. Data were analyzed using SPSS version 23.
Findings: Before the intervention, there was no significant difference between the intervention and control groups in their average scores in the domains of ear and hearing-related health literacy. After the educational program, the ear and hearing-related health literacy scores of the intervention group significantly improved (p<0.05) as follows: mean comprehension and evaluation skills (from 43.8±18.6 to 81.3±10.6), communicating skills (from 49.8±8.9 to 66.3±6.9), and the ability to apply hearing health information (from 25.6±14.5 to 56.9±11.9).
Conclusion: Virtual education is effective in increasing ear and hearing-related health literacy among school students.
 

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Aims: Health literacy includes a range of critical skills that allow individuals to empower themselves to promote health behaviors. This study aimed to review the articles related to health literacy in the last 20 years and explain the factors associated with health literacy or predict it.
Information & Methods: This systematic review examined quantitative research articles published from 2002 to 2022 and indexed in Scopus, PubMed, and Web of Science databases. 887 articles were retrieved, and based on inclusion/exclusion criteria, 55 articles were reviewed.
Factors with the most frequent were reported and discussed. The role (prediction or association) was determined based on the highest frequency. The PRISMA 2009 framework was used to conduct a transparent process.
Findings: Younger people, white people, females, people with higher education levels, good social status, occupation, especially lifetime main occupations, higher individual income, higher knowledge level, and healthy people had high levels of health literacy. Also, the factors that had a significant relationship with health literacy (predictive or related) were different in patients and healthy people.
Conclusion: Health literacy includes various constructs and is related to different factors (as predictors or associated with health literacy). It may differ based on socio-economic and demographic characteristics in different communities.
 

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Aims: Obesity in adolescent is associated with several negative outcomes. This study aimed to determine factors associated with obesity among female students during the COVID-19 pandemic.
Instrument & Methods: In this descriptive correlational study, a convenience sample of female adolescent students of high schools in Tabriz, Iran (322 students who were classified as obese or overweight) was selected between January and May 2021. An online self-administered questionnaire was distributed through the Shad platform. The survey package included socio-demographic questions, health literacy measures for adolescents, an inventory of determinants of obesity-related behaviors in adolescents, and mother's nutritional literacy. Multiple regression analysis examined associated factors with obesity using SPSS 133. The study adhered to the STROBE guidelines for reporting.
Findings: The mean score of obesity-related behaviors was moderate (124.18±22.35). Participants' mean scores in the domains of lack of support, unhealthy nutrition, physical inactivity, and perceived inability were more than average. Adolescents' health literacy mean score was moderate (167.43±20.06). Mother’s occupation (β=15.73; 95% CI: 7.54 to 23.92; p<0.001) and mother's nutritional literacy (β=-0.88; 95% CI: -1.50 to -0.27; p=0.005) were statistically significant predictors of the obesity-related behavior.
Conclusion: Mothers' nutritional literacy plays a pivotal role in shaping adolescents' behaviors related to obesity; thus, empowering mothers with appropriate knowledge and skills in the field of healthier lifestyles and improving the overall well-being of adolescents is essential.