eHealth Literacy and Adolescent Health in Japanese Female High School Students in Sendai: Cross-Sectional Study (Preprint)

BACKGROUND In the digital age, adolescents increasingly rely on online sources for health-related information. eHealth literacy—defined as the ability to find, evaluate, and apply online health information—plays a crucial role in health outcomes. However, limited research exists on eHealth literacy among Japanese high school students, particularly on its association with menstrual health and psychological well-being. OBJECTIVE This study aimed to assess the eHealth literacy of Japanese female high school students and examine its association with premenstrual symptoms, psychological distress, loneliness, and self-esteem. METHODS A cross-sectional, web-based survey was conducted in December 2024 among 1607 female students from 2 public high schools in Sendai, Japan. A total of 909 students with regular menstrual cycles completed all survey items. The survey included the eHealth Literacy Scale (eHEALS), Premenstrual Symptoms Questionnaire, Kessler Psychological Distress Scale (K6), Revised UCLA Loneliness Scale, Rosenberg Self-Esteem Scale, and a numerical rating scale for menstrual pain. Statistical analyses, including Student t tests, chi-square tests, correlation analyses, and logistic regression analyses, were used to examine the relationships between eHealth literacy and various health outcomes. RESULTS The mean eHEALS score was 22.8 (SD 7.3), with 32.1% (292/909) of participants classified as having high eHealth literacy (eHEALS≥26). Students with higher eHealth literacy reported significantly lower levels of loneliness and higher self-esteem. The severity of premenstrual symptoms, particularly feeling overwhelmed, was significantly lower in the high eHealth literacy group. Additionally, interpersonal difficulties related to premenstrual symptoms were less prevalent among students with high eHealth literacy. Pearson correlation analysis indicated negative associations between the eHEALS score and psychological distress (K6) and loneliness, whereas a positive association was observed with self-esteem. Logistic regression analysis showed that high self-esteem was significantly associated with high eHealth literacy. CONCLUSIONS This study highlights the importance of eHealth literacy in adolescent health care. Higher eHealth literacy is linked to lower levels of loneliness, higher self-esteem, and reduced premenstrual symptom severity, particularly feeling overwhelmed. Although the cross-sectional design limits causal conclusions, these findings suggest that higher eHealth literacy is associated with better mental and reproductive health in adolescents. Future research should adopt longitudinal designs, include more diverse populations—such as male adolescents—and explore additional contributing factors to better elucidate these associations.