The relationship between health literacy and health outcomes among male young adults: exploring confounding effects using decomposition analysis

  • René RüeggEmail author
  • Thomas Abel
Original article



Previous studies indicate substantial correlations between low health literacy and poor health outcomes. However, empirical findings remain inconsistent and are theoretically challenging. In this study, we conceptually place health literacy within an established model of health inequality. Studying multiple pathways, we estimate the associations between health literacy and six health outcomes and decompose these associations with health literacy’s covariates.


Cross-sectional data from the Young Adult Survey Switzerland was used for the analyses (n = 5959, age = 18–25). Logistic regression and KHB decomposition analyses were applied to estimate health literacy’s coefficients and confounding percentages.


Eleven covariates were associated with health literacy (p < 0.001). Ten covariates reduced the naïve health literacy coefficient when included in the regression models (confounding percentages: 36.7–86.9%). In three out of six models, the confounding effects led to non-significant health literacy coefficients.


We found that health literacy’s associations with health outcomes are confounded by socioeconomic, material, psychosocial, and health-related factors. More investigations on the causal importance of health literacy, respectively, on its potential to health promotion are required.


Health literacy Determinants of health Health status Health behavior Decomposition analysis Young adults 



No external funding involved.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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© Swiss School of Public Health (SSPH+) 2019

Authors and Affiliations

  1. 1.Department of Social WorkBern University of Applied SciencesBernSwitzerland
  2. 2.Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland

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