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Social support mediates the association of health literacy and depression among racially/ethnically diverse smokers with low socioeconomic status

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Abstract

Nearly half of U.S. adults have health literacy (HL) difficulties, and lack the ability to effectively obtain, process, and understand health information. Poor HL is associated with depression, yet mechanisms of this relation are unclear. This study examined whether social support mediated the relation between HL and depressive symptoms in 200 low-socioeconomic status (SES), racially/ethnically diverse smokers enrolled in cessation treatment. Mediation analyses were conducted using bootstrapping and controlling for SES and nicotine dependence. In simple mediation models, social support [Interpersonal Support Evaluation List (ISEL) total, subscales (Appraisal, Belonging, Tangible)] mediated the effect of HL on depression, such that lower HL was associated with lower perceived support, which predicted higher depressive symptoms (ps < .05). A multiple mediation model, with ISEL subscales entered simultaneously as mediators, was significant (p < .05) but only the Belonging subscale demonstrating independent significance (p < .05). Thus, social support may be a critical factor underlying the HL–depression relationship in low-SES, racially/ethnically diverse smokers.

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Acknowledgments

This research is supported in part by Grants from the Centers for Disease Control and Prevention (K01CD000193), the National Cancer Institute (R25T CA57730), and the University of Texas MD Anderson’s Cancer Center Support Grant CA016672, and the Latinos Contra el Cancer Community Networks Program Center Grant U54CA153505. This work was also supported by the Center for Clinical and Translational Sciences, which is funded by National Institutes of Health Clinical and Translational Award UL1 RR024148 from the National Center for Research Resources. Lastly, this work was supported in part by a faculty fellowship from the University of Texas MD Anderson Cancer Center Duncan Family Institute for Cancer Prevention and Risk Assessment.

Conflict of interest

Authors Diana W. Stewart, Lorraine R. Reitzel, Virmarie Correa-Fernández, Miguel Ángel Cano, Claire E. Adams, Yumei Cao, Yisheng Li, Andrew J. Waters, David W. Wetter, and Jennifer Irvin Vidrine declare that they have no conflict of interest.

Animal and Human Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Health Disparities Research, Unit 1440, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230-1402, USA

    Diana W. Stewart, Virmarie Correa-Fernández, Miguel Ángel Cano, David W. Wetter & Jennifer Irvin Vidrine

  2. Department of Educational Psychology, The University of Houston, 491 Farish Hall, Houston, TX, 77204-5209, USA

    Lorraine R. Reitzel

  3. Department of Psychology, The Catholic University of America, 327 O’Boyle Hall, Washington, DC, 20064, USA

    Claire E. Adams

  4. Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Suite 01Y, Houston, TX, 77021, USA

    Yumei Cao

  5. Department of Biostatistics, Unit 1411, The University of Texas MD Anderson Cancer Center, Houston, TX, 77230-1402, USA

    Yisheng Li

  6. Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814-4799, USA

    Andrew J. Waters

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Stewart, D.W., Reitzel, L.R., Correa-Fernández, V. et al. Social support mediates the association of health literacy and depression among racially/ethnically diverse smokers with low socioeconomic status. J Behav Med 37, 1169–1179 (2014). https://doi.org/10.1007/s10865-014-9566-5

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