{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:03:14Z","timestamp":1770897794631,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"FCT\u2014Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia, I.P.","award":["UIDB\/05380\/2020"],"award-info":[{"award-number":["UIDB\/05380\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Purpose: Higher health literacy is associated with better health behaviors and better overall well-being; however, the contribution of relational and socio-economic factors to this association remains insufficiently explored. The present study aimed to examine the relationships between health literacy, well-being, social support, and stress among adolescents. In particular, the mediating roles of social support (family, peers, and teachers) and stress in the association between health literacy and well-being were analyzed. Participants and Methods: Data were drawn from the 2022 wave of the Health Behaviour in School-aged Children (HBSC) study, an international survey conducted every four years in collaboration with the World Health Organization (WHO) and implemented according to a standardized protocol. The sample comprised 7643 students from the 6th, 8th, 10th, and 12th grades of Portuguese public schools. Of the participants, 53.9% were female, and the mean age was 15.05 years (SD = 2.36). Gender-based comparisons indicated statistically significant differences for all study variables, with the exception of health literacy. Results: Mediation analysis reveals an effect of health literacy on well-being. After the inclusion of the mediating variables, the direct effect of health literacy on lack of well-being remained negative. All four mediators showed statistically significant indirect effects, accounting for the difference between the total and direct effects. These findings indicate that the association between health literacy and lack of well-being was partially mediated by family support, peer support, relationships with teachers, and stress. Health literacy influenced lack of well-being both directly and indirectly through these mediating pathways, with stress emerging as the strongest indirect contributor. Conclusions: The findings support an ecological interpretation of health literacy and well-being, as these constructs are embedded within multiple interacting systems. Individual adolescent characteristics, such as gender, age, and stress management, are interconnected with interpersonal contexts, including relationships with family members, peers, and teachers. In addition, adolescents\u2019 socio-economic circumstances appear to play a relevant role in shaping both health literacy and perceptions of well-being.<\/jats:p>","DOI":"10.3390\/pediatric18010029","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T09:48:34Z","timestamp":1770889714000},"page":"29","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mediation and Moderation Effect of Psychosocial Factors on the Relationship Between Health Literacy and Well-Being in Adolescents"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9616-0441","authenticated-orcid":false,"given":"Tania","family":"Gaspar","sequence":"first","affiliation":[{"name":"Digital Human-Environment Interaction Labs (HEI-LAB), Lus\u00f3fona University, Campo Grande, 1749-024 Lisbon, Portugal"},{"name":"CHRC, Lisbon NOVA University, 1169-056 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1784-5240","authenticated-orcid":false,"given":"Marina","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Aventura Social, Institute of Environment Health (ISAMB), University of Lisbon, 1649-004 Lisbon, Portugal"},{"name":"Instituto Superior Manuel Teixeira Gomes, 8500-656 Portim\u00e3o, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9183-9121","authenticated-orcid":false,"given":"Miguel","family":"Arriaga","sequence":"additional","affiliation":[{"name":"Dire\u00e7\u00e3o-Geral da Sa\u00fade, 1049-005 Lisbon, Portugal"}]},{"given":"Barbara","family":"Sousa","sequence":"additional","affiliation":[{"name":"Digital Human-Environment Interaction Labs (HEI-LAB), Lus\u00f3fona University, Campo Grande, 1749-024 Lisbon, Portugal"},{"name":"Aventura Social-Associa\u00e7\u00e3o, SPIC, 1675-184 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2114-2350","authenticated-orcid":false,"given":"Margarida","family":"Gaspar-Matos","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Aventura Social, Institute of Environment Health (ISAMB), University of Lisbon, 1649-004 Lisbon, Portugal"},{"name":"Faculdade de Ci\u00eancias Humanas, Catholic University, 1649-023 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S258","DOI":"10.1097\/PHH.0000000000001324","article-title":"Updating health literacy for healthy people 2030: Defining its importance for a new decade in public health","volume":"27","author":"Santana","year":"2021","journal-title":"J. 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