{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:00:24Z","timestamp":1787238024394,"version":"build-2736575974"},"reference-count":53,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T00:00:00Z","timestamp":1616803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Scientific Grant Agency of the Ministry of Education Science, Research and Sport of the Slovak Republic and the Slovak Academy of Sciences","award":["VEGA 1\/0427\/17"],"award-info":[{"award-number":["VEGA 1\/0427\/17"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: The aim of this study was to explore the associations between health literacy and symptoms for eating disorders among adolescents, taking into consideration age and gender and whether this association is mediated by body image. (2) Methods: We used data on 5054 adolescents (mean age = 13.9, 51.7% boys) from the Health Behaviour in School-Aged Children study conducted in 2018 in Slovakia. We used logistic regression models to examine associations between level of health literacy and symptoms for eating disorders mediated by body image. (3) Results: Adolescents with low and medium levels of health literacy had a higher occurrence of reporting two or more symptoms of eating disorders (odds ratio (OR)\/95% CI: 2.25\/1.78\u20132.84 and 1.37\/1.15\u20131.65). Adjustment for body image reduced the significance of association between low level of health literacy and symptoms for eating disorders by 26.4%, and association between medium level of health literacy and symptoms for eating disorders by 29.7%. (4) Conclusions: Adolescents who have a low health literacy level were found to have a higher probability of having symptoms for eating disorders, especially when they perceive themselves as fat. The study refers to potential theoretical frameworks for health literacy intervention that may provide guidelines for the intervention design and materials.<\/jats:p>","DOI":"10.3390\/ijerph18073482","type":"journal-article","created":{"date-parts":[[2021,3,28]],"date-time":"2021-03-28T22:09:01Z","timestamp":1616969341000},"page":"3482","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["What Role Does Body Image in Relationship between Level of Health Literacy and Symptoms of Eating Disorders in Adolescents?"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2239-0623","authenticated-orcid":false,"given":"Zuzana","family":"Boberov\u00e1","sequence":"first","affiliation":[{"name":"Institute of Biology and Ecology, Faculty of Science, Pavol Jozef \u0160af\u00e1rik University in Ko\u0161ice, M\u00e1nesova 23, 040-01 Ko\u0161ice, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8376-6922","authenticated-orcid":false,"given":"Daniela","family":"Hus\u00e1rov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Health Psychology and Methodology Research, Faculty of Medicine, Pavol Jozef \u0160af\u00e1rik University in Ko\u0161ice, Tr. SNP 1, 040-01 Ko\u0161ice, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,27]]},"reference":[{"key":"ref_1","unstructured":"World Health Organisation (WHO) (2017). Report of the commission on ending childhood obesity. Implement. Plan Exec. Summ., 19."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-018-5348-2","article-title":"Trends and correlates of unhealthy dieting behaviours among adolescents in the United States, 1999\u20132013","volume":"18","author":"Chin","year":"2018","journal-title":"BMC Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.jada.2011.04.012","article-title":"Dieting and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study","volume":"111","author":"Wall","year":"2011","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s00038-020-01469-1","article-title":"Smoking as a weight control strategy of Serbian adolescents","volume":"65","author":"Kilibarda","year":"2020","journal-title":"Int. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ojala, K., Tynj\u00e4l\u00e4, J., V\u00e4limaa, R., Villberg, J., and Kannas, L. (2012). Overweight adolescents\u2019 self-perceived weight and weight control behaviour: HBSC study in Finland 1994\u20132010. J. Obes., 2012.","DOI":"10.1155\/2012\/180176"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1007\/s12187-016-9424-9","article-title":"Relationship between subjective wellbeing and weight perception in children and adolescents: Gender and age differences","volume":"10","author":"Gaspar","year":"2017","journal-title":"Child Indic. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.jadohealth.2011.05.010","article-title":"Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass index","volume":"50","author":"Wall","year":"2012","journal-title":"J. Adolesc. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S70","DOI":"10.1016\/j.jadohealth.2020.03.008","article-title":"Weight reduction behaviors among european adolescents\u2014Changes from 2001\/2002 to 2017\/2018","volume":"66","author":"Dzielska","year":"2020","journal-title":"J. Adolesc. Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.chc.2014.08.003","article-title":"Adolescent eating disorders: Update on definitions, symptomatology, epidemiology, and comorbidity","volume":"24","year":"2015","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"ref_10","unstructured":"Association, A.P. (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1136\/archdischild-2015-309481","article-title":"Assessment and treatment of eating disorders in children and adolescents","volume":"101","author":"Mairs","year":"2016","journal-title":"Arch. Dis. Child."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.jaac.2015.05.009","article-title":"Adolescent eating disorders predict psychiatric, high-risk behaviors and weight outcomes in young adulthood","volume":"54","author":"Micali","year":"2015","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.copsyc.2017.08.023","article-title":"Eating disorders and suicidality: What we know, what we don\u2019t know, and suggestions for future research","volume":"22","author":"Smith","year":"2018","journal-title":"Curr. Opin. Psychol."},{"key":"ref_14","unstructured":"World Health Organization (WHO) (2016, January 21\u201324). Promoting health in the SDGs. Proceedings of the 9th Global Conference, Shanghai, China."},{"key":"ref_15","unstructured":"World Health Organization Regional Office for Europe (2019). Draft WHO European Roadmap for Implementation of Health Literacy Initiatives Through the Life Course, World Health Organization Regional Office for Europe."},{"key":"ref_16","first-page":"1","article-title":"What is the meaning of health literacy?","volume":"8","author":"Liu","year":"2020","journal-title":"A systematic review and qualitative synthesis. Fam. Med. Community Health"},{"key":"ref_17","unstructured":"WHO (1998). The World Health Organization (WHO) Health Promotion Glossary, WHO."},{"key":"ref_18","first-page":"1","article-title":"Health literacy in childhood and youth: A systematic review of definitions and models","volume":"17","author":"Okan","year":"2017","journal-title":"BMC Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.adolescence.2017.11.010","article-title":"Adolescent health literacy and health behaviors: A systematic review","volume":"62","author":"Fleary","year":"2018","journal-title":"J. Adolesc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-018-5054-0","article-title":"Generic health literacy measurement instruments for children and adolescents: A systematic review of the literature","volume":"18","author":"Okan","year":"2018","journal-title":"BMC Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1093\/eurpub\/ckz011","article-title":"Does health literacy explain the link between structural stratifiers and adolescent health?","volume":"29","author":"Paakkari","year":"2019","journal-title":"Eur. J. Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1093\/her\/cyr007","article-title":"Media Health Literacy (MHL): Development and measurement of the concept among adolescents","volume":"26","author":"Lemish","year":"2011","journal-title":"Health Educ. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/j.1365-2702.2009.03181.x","article-title":"Health literacy, self-reported status and health promoting behaviours for adolescents in Taiwan","volume":"20","author":"Chang","year":"2011","journal-title":"J. Clin. Nurs."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.jadohealth.2009.11.195","article-title":"Relationship between health literacy, reading comprehension, and risk for sexually transmitted infections in young women","volume":"46","author":"Needham","year":"2010","journal-title":"J. Adolesc. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/j.1746-1561.2010.00555.x","article-title":"Smoking media literacy in vietnamese adolescents","volume":"81","author":"Page","year":"2010","journal-title":"J. Sch. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.pec.2014.07.019","article-title":"Health literacy, alcohol expectancies, and alcohol use behaviors in teens","volume":"97","author":"Chisolm","year":"2014","journal-title":"Patient Educ. Couns."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Paakkari, L., Torppa, M., Mazur, J., Boberova, Z., Sudeck, G., Kalman, M., and Paakkari, O. (2020). A comparative study on adolescents\u2019 health literacy in europe: Findings from the HBSC study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17103543"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"234","DOI":"10.21101\/cejph.a5172","article-title":"Low health literacy and excess body weight: A systematic review","volume":"26","author":"Michou","year":"2018","journal-title":"Cent. Eur. J. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-016-2879-2","article-title":"Health literacy and the determinants of obesity: A population-based survey of sixth grade school children in Taiwan","volume":"16","author":"Shih","year":"2016","journal-title":"BMC Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2049-3258-72-11","article-title":"Is low health literacy associated with overweight and obesity in adolescents: An epidemiology study in a 12\u201316 years old population, Nanning, China, 2012","volume":"72","author":"Lam","year":"2014","journal-title":"Arch. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e257","DOI":"10.1016\/j.pedn.2020.05.012","article-title":"Health literacy and predictors of body weight in Turkish children","volume":"55","year":"2020","journal-title":"J. Pediatr. Nurs."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000357601","article-title":"Adolescent overweight, obesity and chronic disease-related health practices: Mediation by body image","volume":"7","author":"Farhat","year":"2014","journal-title":"Obes. Facts"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpsyg.2016.00083","article-title":"Am I overweight? A longitudinal study on parental and peers weight-related perceptions on dietary behaviors and weight status among adolescents","volume":"7","author":"Zarychta","year":"2016","journal-title":"Front. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s11199-010-9894-z","article-title":"Promoting positive body image in males and females: Contemporary issues and future directions","volume":"63","author":"Grogan","year":"2010","journal-title":"Sex Roles"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1108\/09654281211203411","article-title":"Health literacy as a learning outcome in schools","volume":"112","author":"Paakkari","year":"2012","journal-title":"Health Educ."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Zuair, A.A., and Sopory, P. (2020). Effects of media health literacy school-based interventions on adolescents\u2019 body image concerns, eating concerns, and thin-internalization attitudes: A systematic review and meta-analysis. Health Commun., 1\u20139.","DOI":"10.1080\/10410236.2020.1813954"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1016\/j.ijnurstu.2009.04.007","article-title":"Uncovering hidden eating disorders using the SCOFF questionnaire: Cross-sectional survey of adolescents and comparison with nurse assessments","volume":"46","author":"Hautala","year":"2009","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1080\/08039488.2017.1300322","article-title":"Identification of eating disorder symptoms in Danish adolescents with the SCOFF questionnaire","volume":"71","author":"Lichtenstein","year":"2017","journal-title":"Nord. J. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jpsychores.2004.06.005","article-title":"Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care","volume":"59","author":"Lou","year":"2005","journal-title":"J. Psychosom. Res."},{"key":"ref_40","first-page":"19","article-title":"The SCOFF questionnaire and clinical interview for eating disorders in general practice: Comparative study psychia","volume":"325","author":"Luck","year":"2002","journal-title":"JSTOR"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1093\/eurpub\/cky229","article-title":"The cross-national measurement invariance of the health literacy for school-aged children (HLSAC) instrument","volume":"29","author":"Paakkari","year":"2019","journal-title":"Eur. J. Public Health"},{"key":"ref_42","unstructured":"Inchley, J., Currie, D., Cosma, A., and Samdal, O. (2018). Health Behaviour in School-Aged Children (HBSC) Study Protocol: Background, Methodology and Mandatory Items for the 2017\/18 Survey 2018, St Andrews."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.20960\/nh.1778","article-title":"The risk of eating disorders and academic performance in adolescents: DADOS study","volume":"35","author":"Pastor","year":"2018","journal-title":"Nutr. Hosp."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1023\/B:NERV.0000028081.40907.de","article-title":"The role of cognitive deficits in the development of eating disorders","volume":"14","author":"Lena","year":"2004","journal-title":"Neuropsychol. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1108\/HE-02-2017-0014","article-title":"Subjective health literacy among school-aged children","volume":"118","author":"Paakkari","year":"2018","journal-title":"Health Educ."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5694\/j.1326-5377.1997.tb140071.x","article-title":"\u201cMental health literacy\u201d: A survey of the public\u2019s ability to recognise mental disorders and their beliefs about the effectiveness of treatment","volume":"166","author":"Jorm","year":"1997","journal-title":"Med. J. Aust."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Skre, I., Friborg, O., Breivik, C., Johnsen, L.I., Arnesen, Y., and Wang, C.E.A. (2013). A school intervention for mental health literacy in adolescents: Effects of a non-randomized cluster controlled trial. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-873"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1080\/09638237.2020.1713996","article-title":"Eating disorders \u201cmental health literacy\u201d: A scoping review","volume":"29","author":"Bullivant","year":"2020","journal-title":"J. Ment. Health"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Simovska, V., and McNamara, P.M. (2015). Three approaches to school health education as a means to higher levels of health literacy. Schools for Health and Sustainability, Springer.","DOI":"10.1007\/978-94-017-9171-7"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1007\/s10984-008-9042-7","article-title":"A model of metacognition, achievement goal orientation, learning style and self-efficacy","volume":"11","author":"Coutinho","year":"2008","journal-title":"Learn. Environ. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpsyg.2019.03039","article-title":"The influence of sports participation on body image, self-efficacy, and self-esteem in college students","volume":"10","author":"Ouyang","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.acap.2013.04.011","article-title":"Accuracy of child and adolescent weight perceptions and their relationships to dieting and exercise behaviors: A NHANES study","volume":"13","author":"Chung","year":"2013","journal-title":"Acad. Pediatr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40337-020-00330-3","article-title":"Body mass index and self-reported body image in German adolescents","volume":"8","author":"Sarrar","year":"2020","journal-title":"J. Eat. Disord."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3482\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:53:09Z","timestamp":1760363589000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/7\/3482"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,27]]},"references-count":53,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["ijerph18073482"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18073482","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,27]]}}}