1. Does Parental Health Literacy Mediate the Relationship Between Parental Education Attainment and CLUSTERING OF CVD RISK FACTORS AMONG Young Adults By
Nithiah Thangiah
University of Malaya, Malaysia
4th AHLA International Health Literacy Conference
7th – 9th November 2016, Haiphong, Vietnam

2. Presentation Outline Background of Study Problem Statement
Research Objectives and Questions
Methodology
Results
Conclusion

3. CARDIOVASCULAR DISEASES (CVD) IN MALAYSIA
BACKGROUND OF STUDY :
CARDIOVASCULAR DISEASES (CVD) IN MALAYSIA
NON-COMMUNICABLE DISEASES (NCD)
CANCER
CARDIOVASCULAR DISEASE
Disorder of heart & blood vessels ie:- CHD(heart attack), cerebrovascular disease (stroke), heart failure
RESPIRATORY DISEASES
NCD
Non-infectious disease do not spread from one person to another
34 millions deaths worldwide and CVD account for 17.1 million
Most challenging and highest NCD deaths are cardiovascular diseases
Non-infectious disease do not spread from one person to another through direct or indirect contact and may be a result of sedentary lifestyle or behaviour (Goldberg & McGee, 2011)
CVD
Heart and vessels related diseases (Memon & Nelson, 1997)
DIABETES

4. CARDIOVASCULAR DISEASES (CVD) IN MALAYSIA
BACKGROUND OF STUDY :
CARDIOVASCULAR DISEASES (CVD) IN MALAYSIA
NCD
Non-infectious disease do not spread from one person to another
34 millions deaths worldwide and CVD account for 17.1 million
Most challenging and highest NCD deaths are cardiovascular diseases
Non-infectious disease do not spread from one person to another through direct or indirect contact and may be a result of sedentary lifestyle or behaviour (Goldberg & McGee, 2011)
CVD
Heart and vessels related diseases (Memon & Nelson, 1997)

5. BACKGROUND OF STUDY : CVD RISK FACTORS
Modifiable
Lifestyle : Unhealthy dietary intake, Physical inactivity
Behavioural : Smoking, Alcohol consumption
Biological : Hypertension, Diabetes, Hypercholesterolimia, Obesity, Physical fitness
Non-modifiable
Age, Gender, Ethnicity, Genetic, Family History
CLUSTERS
Biological CVD risk factors tend to occur more commonly together and have a multiplicative effect
These risk factors can be divided into clusters of high risk, medium risk and low risk groups
A score of 1 is given if the subject belonged to the “high risk” quartile or cut-off of the particular biological risk factor
All high risk biological risk factors that occur in a particular subject are accumulated
Each biological risk factor is related as an independent variable to other biological risk factors. Chances of a high risk quartile of a particular predicting risk factor to also be in the high risk quartile of the outcome risk factor.
STABILITY
The relationship (correlation) between early measurements and measurements later in life or the maintenance of a relative position within a distribution of values in the observed population over time
Stability in the number of accumulated risk factors over time

6. HEALTH LITERACY, SOCIOECONOMIC INEQUALITY & CVD RISK FACTORS
BACKGROUND OF STUDY :
HEALTH LITERACY, SOCIOECONOMIC INEQUALITY & CVD RISK FACTORS
Common SES
Different level of HL
SOCIOECONOMIC STATUS
ACCESS
UNDERSTAND
APPRAISE
APPLY
To make informed health decisions
HEALTH LITERACY
Reduce effects of clustering
CLUSTERING OF BIOLOGICAL CVD RISK FACTORS
Health Literacy
People’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course (Sorensen et al., 2012)
Health literacy indicators are access to, ability to understand, ability to appraise and ability to apply information related to health care, disease prevention and health promotion
How is Health Literacy related to socioeconomic inequality & the clustering of CVD risk factors?
Clustering of CVD risk factors may differ even between people from common socioeconomic backgrounds
High possibility that health literacy could be the main reason for the difference
Health Literacy is more applicable as it may be impossible (or rather time consuming) to change the socioeconomic status of an individual but it’s highly possible to improve the health literacy of a person
Health Literacy should be the main focus in mitigating the clustering effect of biological CVD risk factors among the unequal distribution of SES of parents

7. Clustering of CVD Risk Factors among Adolescents
PROBLEM STATEMENT : RISING STATISTICS
Clustering of CVD Risk Factors among Adolescents
Leading cause of death in Malaysia (highest incidence rate of obesity
and elevated blood sugar levels compared to other countries in the
ASEAN region in 2010 (Alwan, 2011)
CVD risk factors are rising at an alarming rate (NHMS,1996 – 2015)
Diabetes : 8.3% in1996 to 17.5% in 2015
Hypercholesterolemia : 20.7% in 2006 to 47.7% in 2015
Obesity : 29.1% in 2006; 29.4% in 2011 and 32.0% in 2015
Clustering has multiplicative effect & portrays higher risk of CVD
Onset of CVD begins in childhood but often is not manifested until adult
Loss of productivity - future adult working population
Higher expenditure & cost for healthcare
CVD is the leading cause of death in Malaysia (GBD 2013 Mortality and
Causes of Death Collaborators, 2014). Onset of CVD begins in
childhood or adolescence but often is not manifested until adulthood.
CVD risk factors are rising at an alarming rate (NHMS II, 1996;
NHMS III, 2006; NHMS IV, 2011; NHMS, 2015).
- Incidences of risk factors among adults in Malaysia :
Diabetes : 8.3% in1996 to 17.5% in 2015
Hypercholesterolemia : 20.7% in 2006 to 47.7% in 2015
Obesity : 29.1% in 2006; 29.4% in 2011 and 32.0% in 2015
- Malaysia had the highest incidence rate of obesity, overweight
and elevated blood sugar levels compared to other countries in
the ASEAN region in 2010 (Alwan, 2011).
Clustering of CVD risk factors tend to occur more frequently together.
Clustering has multiplicative effect portray higher risk of CVD

8. Association of Health Literacy in Socioeconomic Inequality of
PROBLEM STATEMENT
Association of Health Literacy in Socioeconomic Inequality of
Clustering CVD Risk Factors among Adolescents
Low health literacy reduces the accessibility to and the effectiveness
of medical care
Reduces the likelihood that individuals are adequately informed and
activated with regard to healthy behaviours
Increases a person’s stress in addressing the challenges of navigating
through daily life
Diminishes an individual’s self efficacy (ie : the ability to exert control
over one’s life)

9. Research objective & RESEARCH QUESTIONS
To investigate the mediating effect of parental health literacy between parental educational attainment and the clustering of biological CVD risk factors among adolescents in Malaysia
Does parental health literacy mediate the relationship between SES and clustering of CVD risk factors?
To determine the association of parental health literacy with the socioeconomic inequality in the clustering of CVD risk factors.

10. METHODOLOGY

11. METHODOLOGY : DATA SOURCE
MALAYSIAN HEALTH AND ADOLESCENTS LONGITUDINAL RESEARCH STUDY (MyHeARTs) & HLS-ASIA-Q : MEASUREMENT OF HEALTH LITERACY IN ASIA
HLS-ASIA-Q
Parents of adolescents from baseline and 2ND-WAVE
Source of data : MyHeARTs (Malaysian Health and Adolescents Longitudinal Research Study)
Longitudinal study investigating the longitudinal relation of multiple risk factors for chronic non-communicable diseases among adolescents.
2012
MyHeARTs I
13 years old
BASELINE

12. METHODOLOGY : STUDY AREA
SELANGOR
KUALA LUMPUR
PUTRAJAYA
PERAK

13. METHODOLOGY : SAMPLING DESIGN
Northern & Central Region
Perak (n=238)
Selangor (n=261)
Kuala Lumpur (n=96)
Urban
Rural
Multi-stage stratified cluster sampling
First stage : PPS (larger clusters have bigger probability of being sampled)
Second Stage : PPS
Third Stage : Random Sampling from Sampling Frame
Fourth Stage : Defined Study Population
# Secondary
# Secondary
Total number of schools
is 15
…..
…..
Total # of students: % of target is achieved
School k
School q
Defined Study Population : Selection of n students (aged 13 yo with consent)

14. METHODOLOGY : DATA COLLECTION
SELF-ADMINISTERED STUDENT & HLS-ASIA-Q QUESTIONNAIRE
CLINICAL BLOOD TESTS (10 tests)
ANTHROPOMETRIC AND BLOOD PRESSURE MEASUREMENTS
7-DAYS DIET HISTORY INTERVIEW
PHYSICAL FITNESS TEST

15. METHODOLOGY : STATISTICAL ANALYSIS
K-MEANS CLUSTERING USING SPSS
&
MEDIATION USING AMOS
NCD
Non-infectious disease do not spread from one person to another
34 millions deaths worldwide and CVD account for 17.1 million
Most challenging and highest NCD deaths are cardiovascular diseases
Non-infectious disease do not spread from one person to another through direct or indirect contact and may be a result of sedentary lifestyle or behaviour (Goldberg & McGee, 2011)
CVD
Heart and vessels related diseases (Memon & Nelson, 1997)

16. RESULTS & CONCLUSION

17. RESULTS & CONCLUSION : PARENTAL EDUCATION AND HEALTH LITERACY

18. RESULTS & CONCLUSION : CLUSTERING OF BIOLOGICAL CVD RISK FACTORS
Diabetes
Fasting Plasma Glucose
Hypercholesterolemia
Total Cholesterol
HDL-C
LDL-C
TC : HDL -C
Triglyceride
Hypertension
Systolic BP
Diastolic BP
Obesity
BMI (boys/girls)
WC (boys/giirls)
Body Fat (boys/girls)
Physical fitness
Physical Fitness Score (HRR) T1
HIGH
CLUSTERS
Biological CVD risk factors tend to occur more commonly together and have a multiplicative effect
These risk factors can be divided into clusters of high risk, medium risk and low risk groups
A score of 1 is given if the subject belonged to the “high risk” quartile or cut-off of the particular biological risk factor
All high risk biological risk factors that occur in a particular subject are accumulated
Each biological risk factor is related as an independent variable to other biological risk factors. Chances of a high risk quartile of a particular predicting risk factor to also be in the high risk quartile of the outcome risk factor.
STABILITY
The relationship (correlation) between early measurements and measurements later in life or the maintenance of a relative position within a distribution of values in the observed population over time
Stability in the number of accumulated risk factors over time
MEDIUM
LOW

19. CVD RISK FACTORS AMONG ADOLESCENTS
RESULTS & CONCLUSION : MEDIATOR USING AMOS
PARENTAL EDUCATION
CLUSTERING
CVD RISK FACTORS AMONG ADOLESCENTS
PARENTAL HEALTH LITERACY

20. RESULTS & CONCLUSION : SUMMARY OF ESTIMATES
Before Mediator (Parental Health Literacy) is entered into model
After Mediator (Parental Health Literacy) is entered into model

21. CONCLUSION
Parental health literacy mediates the relationship between parental education attainment and clustering CVD risk factors of young adolescents
Parental health literacy contributes to disparities associated with parental education attainment and children’s health outcome

22. Thank You VERY MUCH FOR LISTENING 