Critical thinking and health literacy as drivers of healthy choices: The SUNRISE adolescent cohort

Background

Health decision-making among adolescents depends on navigating complex information. The SUNRISE project aims to promote primary cancer prevention through a digitally enhanced program. This study explores the baseline relationship between critical capacity and adolescent lifestyle choices.

Methods

Baseline data from a multi-center trial involving 1,978 adolescents aged 12-18 from eight European countries were analyzed. Health literacy, persuasion knowledge and active critical thinking were assessed and examined in relation to ultra-processed food (UPF) intake, breakfast frequency and physical activity using correlation analyses and group comparisons.

Results

Analysis showed that 16.9% of adolescents report low persuasion knowledge and 8.4% exhibit low health literacy. These capacities were strongly interrelated (rS= .58, p< .001). Higher health literacy was significantly associated with reduced ultra-processed food intake (rS = -.17, p< .001) and more frequent breakfast consumption; adolescents with high literacy reported breakfast on 5.44 days/week compared with 3.79 days/week in the low-literacy group (p< .001). Active critical thinking was associated with lower UPF consumption (rS= -.11, p<.001) and positively linked to physical activity (rS= .16, p<.001) and vigorous exercise (rS= .18, p< .001) suggesting that the habit of questioning media messages generalizes to broader health-promoting behaviors.

Conclusions

These baseline findings suggest that critical capacity is a relevant factor linked to adolescent health behaviors. The observed gaps in breakfast frequency and the link with UPF intake support the potential of the SUNRISE approach. Integrating the habit of questioning health information and building resilience against digital persuasion appears as a promising strategy for supporting primary cancer prevention in the digital ecosystem.

EU funded (101136829)

Key messages

• Critical capacity as prevention: Health literacy and critical thinking are essential for primary cancer prevention, as they promote healthy habits in adolescents.

• Better knowledge, better choices: Strengthening health knowledge empowers adolescents to make better lifestyle decisions, supporting cancer prevention through improved diet and activity.