Background: Health literacy has become an important health policy and health promotion agenda item in recent years. It had been seen as a means to reduce health disparities and a critical empowerment strategy to increase people's control over their health. So far, most of health literacy studies mainly focus on adults with few studies investigating associations between child health literacy and health status. This study aimed to investigate the association between health literacy and body weight in Taiwan's sixth grade school children. Methods: Using a population-based survey, 162,209 sixth grade (11-12 years old) school children were assessed. The response rate at school level was 83 %, with 70 % of all students completing the survey. The Taiwan child health literacy assessment tool was applied and information on sex, ethnicity, self-reported health, and health behaviors were also collected. BMI was used to classify the children as underweight, normal, overweight, or obese. A multinomial logit model with robust estimation was used to explore associations between health literacy and the body weight with an adjustment for covariates. Results: The sample consisted of 48.9 % girls, 3.8 % were indigenous and the mean BMI was 19.55 (SD = 3.93). About 6 % of children self-reported bad or very bad health. The mean child health literacy score was 24.03 (SD = 6.12, scale range from 0 to 32). The overall proportion of obese children was 15.2 %. Children in the highest health literacy quartile were less likely to be obese (12.4 %) compared with the lowest quartile (17.4 %). After controlling for gender, ethnicity, self-rated health, and health behaviors, children with higher health literacy were less likely to be obese (Relative Risk Ratio (RRR) = 0.94, p < 0.001) and underweight (RRR = 0.83, p < 0.001). Those who did not have regular physical activity, or had sugar-sweetened beverage intake (RRR > 1.10, p < 0.0001) were more likely to report being overweight or obese. Conclusions: This study demonstrates strong links between health literacy and obesity, even after adjusting for key potential confounders, and provides new insights into potential intervention points in school education for obesity prevention. Systematic approaches to integrating a health literacy curriculum into schools may mitigate the growing burden of disease due to obesity.

Purpose: To investigate the change in the prevalence of reduced visual acuity (VA) in Taiwanese school children after a policy intervention promoting increased time outdoors.Design: Prospective cohort study based on the Taiwan School Student Visual Acuity Screen (TSVAS) by the Ministry of Education in Taiwan.Participants: All school children from grades 1 through 6 were enrolled in the TSVAS from 2001 through 2015.Methods: The TSVAS requires each school in Taiwan to perform measurements of uncorrected VA (UCVA) on all students in grades 1 through 6 every half year using a Tumbling E chart. Reduced VA was defined as UCVA of 20/25 or less. Data from 1.2 to 1.9 million primary school children each year were collected from 2001 through 2015. A policy program named Tian-Tian 120 encouraged schools to take students outdoors for 120 minutes every day for myopia prevention. It was instituted in September 2010. To investigate the impact of the intervention, a segmented regression analysis of interrupted time series was performed.Main Outcome Measures: Prevalence of reduced VA. Results: From 2001 to 2011, the prevalence of reduced VA of school children from grades 1 through 6 increased from 34.8% (95% confidence interval [CI], 34.7%e34.9%) to 50.0% (95% CI, 49.9%e50.1%). After the implementation of the Tian-Tian 120 outdoor program, the prevalence decreased continuously from 49.4% (95% CI, 49.3%e49.5%) in 2012 to 46.1% (95% CI, 46.0%e46.2%) in 2015, reversing the previous long-term trend. For the segmented regression analysis controlling for gender and grade, a significant constant upward trend before the intervention in the mean annual change of prevalence was found (þ1.58%; standard error [SE], 0.08; P < 0.001). After the intervention, the trend changed significantly, with a constant decrease by e2.34% annually (SE, 0.23; P < 0.001).Conclusions: Policy intervention to promote increased time outdoors in schools was followed by a reversal of the long-term trend toward increased low VA in school children in Taiwan. Because randomized trials have demonstrated outdoor exposure slowing myopia onset, interventions to promote increased time outdoors may be useful in other areas affected by an epidemic of myopia. Ophthalmology 2020;-:1e8 ª 2020 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).

Objective: This study assessed school principals’ understanding, attitudes and willingness to influence the implementation of the health-promoting schools (HPS) programme in Taiwan and teachers’ willingness to sustain it. Method: In 2014, a total of 1,140 school principals and 1,110 teachers (HPS coordinators) completed questionnaires concerning their perspectives on implementation and sustainability. Results: Compared with teachers, school principals reported higher levels of willingness to sustain HPS implementation. School principals’ levels of understanding of HPS and willingness to sustain it were significantly associated with higher levels of HPS implementation and an increase in teachers’ willingness to sustain HPS implementation. Conclusion: School principals’ understanding and willingness to support are central to the effective implementation and sustainability of initiatives such as HPS.