# Exploring the factors associated with health literacy among adolescents in Hong Kong

## TL;DR

This study explores factors affecting health literacy in Hong Kong adolescents, identifying groups needing targeted interventions to improve health outcomes.

## Contribution

The study identifies specific demographic and behavioral factors linked to health literacy in Hong Kong adolescents.

## Key findings

- Higher health literacy is associated with older age, higher socioeconomic status, healthy eating, and mental toughness.
- Smoking, alcohol use, excessive screen time, and male gender are linked to lower health literacy.
- Mental toughness strongly correlates with all health literacy sub-domains.

## Abstract

Health literacy is crucial for promoting healthy behaviors and is linked to improved health outcomes among adolescents, yet global levels remain suboptimal. In Hong Kong, where rising rates of obesity and related health issues among adolescents are of increasing concern, understanding health literacy in this population is essential. However, current interventions of health literacy face challenges in effectively addressing the differences between the target groups. Therefore, this study aims to investigate factors associated with health literacy among adolescents in Hong Kong, to provide evidence for identifying groups for intervention implementation. This is a cross-sectional study conducted in Hong Kong. Secondary school students from grades 1 to 4 in Hong Kong were recruited to complete a 98-item survey measuring socio-demographic information, socioeconomic status (SES), health behaviors, mental toughness, and health literacy. Group differences were analyzed using t-tests and ANOVA. Univariable and multivariable linear regression models examined factors associated with adolescent health literacy. A total of 1423 adolescents were included in this study. The mean health literacy score was 57.24 (SD = 17.04) in the adolescents. Multivariable regression showed that aged over 14 years (β = 3.79), medium SES (β = 2.91), high SES (β = 4.80), adequate vegetable intake (β = 0.041), adequate fruit intake (β = 3.13), and mental toughness (β = 10.69) were positively related to overall health literacy. Smoking (β = − 7.38), alcohol drinking (β = − 4.03), excessive electronic game screen time (β = − 2.06), and male gender (β = − 3.86) were negatively associated with overall health literacy. Mental toughness (β = 4.27–12.43) showed a strong positive association across all health literacy sub-domains. This study identified high-risk groups with regard to health literacy among adolescents, including younger individuals, males, those with lower socioeconomic status, poor dietary habits, lower levels of mental toughness, and those engaging in risky behaviors. Future policies and interventions should specifically target these groups to optimize the effectiveness of subsequent initiatives.

The online version contains supplementary material available at 10.1038/s41598-025-28900-y.