Objective To evaluate the intervention effect of peer education on the health literacy of junior high school students, and to explore new pathways for enhancing adolescent health literacy. Methods From May 2023 to May 2024, a multi-stage stratified cluster sampling method was used to select 3 403 students from grades 7 and 8 across eight schools in two districts (counties) of Chongqing as the study subjects for a baseline survey. Based on convenience sampling, the eight schools were divided into an intervention group and a control group. A total of 133 eligible students were selected and trained as peer educators to implement a two-month health literacy-themed intervention in the intervention classes. The Adolescent Health Literacy Assessment Scale was used to obtain health literacy scores. A generalized estimating equation model was applied to analyze changes in health literacy scores before the intervention (T0), immediately after the intervention (T1), and six months after the intervention (T2). Results A total of 2 817 subjects were included in the final analysis, with 1 364 in the intervention group and 1 453 in the control group. There were no statistically significant differences in demographic characteristics and baseline health literacy levels between the two groups(all P>0.05). In the intervention group, overall health literacy and functional health literacy showed a continuous upward trend (both P<0.001). Interactive health literacy at T2 was significantly higher than at T0 and T1 (all P<0.001). The intervention group had significantly higher scores in overall health literacy, interactive health literacy, and critical health literacy at T1, as well as in interactive health literacy and critical health literacy at T2, compared to the control group (all P<0.05). Analysis using the generalized estimating equation model revealed that the improvement in overall health literacy and the three health literacy dimensions from T1 to T0 were significantly greater in the intervention group than in the control group (all P<0.05). However, there was no statistically significant difference in the improvement at T2 compared to T0 between the two groups (all P>0.05). Conclusion Peer education has produced a clear and immediate improvement effect on the health literacy of junior-high school students, but the long-term effects require further verification.

Objective To explore the independent effects and gender differences of multi-dimensional health literacy on the co-occurrence of Non-Suicidal Self-Injury (NSSI) and Suicide Attempts (SA) (NSSI + SA) among junior high school students, to provide evidence for developing targeted intervention strategies for self-injurious behaviors. Methods From May to June 2023, a multi-stage stratified cluster sampling method was used to select 7 317 junior high school students from three districts/counties in Chongqing as the study subjects. Questionnaires including the Adolescent Health Literacy Assessment Scale, the suicide-related section of the Chinese Adolescent Health-related Behavior Questionnaire (Junior High School Version), the Adolescent Non-suicidal Self-injury Assessment Questionnaire (ANSAQ), and the Center for Epidemiologic Studies-Depression Scale (CES-D) were administered. Data were analyzed using the chi-square test and multivariate logistic regression. Results The detection rates of NSSI, SA, and NSSI + SA among junior high school students were 19.1%, 4.6%, and 3.5%, respectively. The rates of possessing total health literacy, functional health literacy, interactive health literacy, and critical health literacy were 62.6%, 66.6%, 54.2%, and 72.7%, respectively. Multivariate logistic regression analysis revealed that junior high school students lacking interactive health literacy had a significantly higher risk of NSSI+SA (OR=1.54, 95%CI=1.06-2.23). After stratifying by gender, the association between lacking interactive health literacy and NSSI+SA remained significant only among females (OR=1.78, 95%CI=1.12-2.81). Conclusions Among junior high school students, interactive health literacy is a significant factor influencing the co-occurrence of NSSI and SA, with this association demonstrating gender-specific variations. This suggests that future interventions targeting co-occurring self-injury patterns in adolescents could achieve more precise prevention by implementing gender-differentiated strategies aimed at enhancing health literacy.

Objective To explore the correlations between health literacy and dental caries among eighth graders in Zhongshan, and to provide a scientific basis for developing school-based dental caries prevention and control strategies centered on improving health literacy. Methods In November 2024, a cross-sectional study was conducted using a cluster sampling method. Data from on-site health literacy questionnaires and annual routine physical examination (dental check-up) of 8 592 eighth graders from 101 secondary schools in Zhongshan were analyzed. Health literacy was assessed across six dimensions, and a score of ≥80% was defined as possessing basic health literacy. The chi-square test was used to compare differences in dental caries prevalence among students with different characteristics, and a multivariate logistic regression model was employed to analyze the correlations between health literacy and dental caries. Results The overall possession rate of basic health literacy among eighth graders in Zhongshan was 49.52%, and the prevalence of dental caries was 27.58%. Multivariate logistic regression analysis showed that after adjusting for factors such as gender, accommodation status, father’s education level, and health education frequency, students with basic health literacy had a lower risk of dental caries than those without (OR=0.90, 95%CI: 0.82-0.99). Students possessing the dimensions of “Health Behaviors and Lifestyles” (OR=0.89, 95%CI: 0.80-0.98) and “Growth and Development & Adolescent Health-care” (OR=0.84, 95%CI: 0.75-0.93) had a lower risk of dental caries than those without. Conclusions Eighth graders in Zhongshan with basic health literacy have a lower risk of dental caries than those without, especially those competent in the dimensions of “Health Behaviors and Lifestyles” and “Growth and Development & Adolescent Health-care”. Therefore, comprehensively enhancing students’ health literacy, particularly strengthening literacy in dimensions such as “Health Behaviors and Lifestyles” and “Growth and Development & Adolescent Health-care”, is conducive to preventing the occurrence of dental caries.

Objective To investigate the health literacy level and its influencing factors among secondary school students in Guangdong Province, and to provide a scientific basis for targeted health education interventions. Methods From October to November 2022, a total of 18 230 secondary school students in Guangdong Province were selected using a multistage stratified cluster random sampling method for a health literacy survey. The possession rates of overall and six-dimensional health literacy (growth and development & adolescent health-care, healthy behaviors and lifestyles, disease prevention, mental health, safety emergency &risk avoidance, medical knowledge & rational medical health-care) were calculated and compared among students with different characteristics. Multivariate logistic regression was employed to identify the independent influencing factors related to students’ health literacy. Results The overall possession rates of health literacy among secondary school students in Guangdong Province was 28.8%. The possession rates of six-dimensional health literacy, from high to low, were safety emergency & risk avoidance (63.2%), healthy behaviors and lifestyles (44.4%), disease prevention (43.0%), mental health (41.9%), growth and development & adolescent health-care (19.9%), and medical knowledge & rational medical health-care (9.1%). Multivariate logistic regression analysis showed that being in senior high school, female gender, being an only child, parental education level of junior college/bachelor’s degree or above, and receiving health education ≥3 times per month were positively correlated with the overall health literacy level of secondary school students (P<0.05). Schools located in non-Pearl River Delta regions (Eastern, Western, and Northern Guangdong), vocational school students, and daily use of mobile electronic devices for more than 4 hours were negatively correlated with the overall health literacy level of secondary school students (P<0.05). Conclusions The overall health literacy level among secondary school students in Guangdong Province is suboptimal and unevenly distributed across dimensions, influenced by multiple factors at the individual, family, and school levels. It is recommended that relevant authorities strengthen education in underdeveloped areas, such as growth and development & adolescent health-care, and medical knowledge & rational medical health-care, and formulate differentiated intervention strategies guided by the aforementioned influencing factors.

Objective To preliminarily develop a health literacy assessment tool covering all educational stages of primary and secondary schools and to test its reliability and validity, providing a reliable basis for the scientific evaluation of students’ health literacy levels. Methods A preliminary indicator system was constructed through systematic literature and policy review. Following revisions based on two rounds of expert consultation, an indicator system was formed covering five grade levels, 6 domains, 26 indicators, and either 36 or 66 items. Based on this system, four parallel questionnaires (A/B/C/D versions) were developed for each grade level. In October 2024, a pilot assessment was conducted using convenience sampling among primary and secondary school students in Zhongshan City. Reliability was assessed using Cronbach’s α coefficient, split-half reliability, and test-retest reliability. Validity was assessed using content validity and confirmatory factor analysis. Results The positive coefficient for both rounds of expert consultation was 100% and the expert authority coefficient was>0.7. The Kendall’s W coefficient in the second-round expert consultation was statistically significant (P<0.05). The pilot assessment showed that the mean scores for the four parallel questionnaires across the five grade levels were 82.66±9.76, 82.54±6.99, 83.64±7.30, 73.86±10.46, and 81.92±7.84 points, respectively. No statistically significant differences were found among the four questionnaires within each grade level (P>0.05). Regarding reliability, the questionnaire Cronbach’s α coefficient (0.871-0.960), split-half reliability (0.841-0.921), and test-retest reliability (0.637-0.818) all met acceptable standards. For validity, content validity correlations were significant. Confirmatory factor analysis indicated acceptable χ2/df and RMSEA values, but CFI and TLI did not reach 0.9. Conclusion The preliminarily developed overall health literacy scale for primary and secondary school students demonstrates good reliability, while its structural validity requires further improvement.

Objective To compare the diagnostic values of Body Mass Index (BMI), Waist Circumference (WC), Hip Circumference (HC), Waist-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR), Body Adiposity Index (BAI) and Body Roundness Index (BRI) in identifying hypertension among children and adolescents, and to provide references for the early intervention of hypertension among children and adolescents. Methods From September 2022 to June 2023, a random cluster sampling method was adopted to select 4 963 students aged 6-15 years from 5 primary and secondary schools in Zhengzhou Economic Development Zone and Zhongmu County for physical examination (e.g., height, weight, and WC), as well as blood pressure measurements. The area under the receiver operating characteristic curve (AUC) was used to compare the value of each obesity indicator in identifying hypertension. Results Based on non-consecutive three-day measurements, the detection rate of hypertension in children and adolescents was 3.22%. The detection rate of hypertension in boys (3.89%) was significantly higher than that in girls (2.45%). After adjusting for age, residence and other covariates, the risks of hypertension in boys increased with the increase of each obesity indicator. In girls, except for WHR, the other indicators showed a corresponding increasing trend with the risk of hypertension. Both WHtR and BRI were the best indicators for identifying hypertension in boys (AUC=0.847, 95% CI: 0.809-0.885) and girls (AUC=0.709, 95%CI: 0.627-0.790), followed by BMI. Conclusion WHtR and BRI are the best obesity indicators for identifying hypertension among children and adolescents.

Objective To investigate the screening status of myopia and the impact of reading-writing habits on myopia among third- to fourth-graders in Yangpu, Shanghai, and to provide evidence for formulating corresponding myopia prevention and control measures. Methods In 2023, a cross-sectional study with stratified random cluster sampling was conducted among 2 242 third- and fourth-graders from 10 primary schools in Yangpu. Visual acuity and non-cycloplegic refraction examinations were performed, and questionnaires on reading and writing habits were completed by students and their parents. Logistic regression analysis was used to assess the influence of reading and writing habits on myopia. Results The screening myopia prevalence among third- and fourth-graders in Yangpu was 36.93%. The screening myopia prevalence was higher in girls than in boys (χ2=7.934, P=0.005), and higher in fourth graders than in third graders (χ2=28.251, P<0.001). Myopia prevalence increased with age (χ2trend=25.578, P<0.001), showing statistically significant differences. Logistic regression analysis indicated that being female (OR=1.223, 95%CI:1.020-1.466) and reading with the eyes-book distance<30 cm (OR=1.597, 95%CI:1.327-1.915) were risk factors for myopia. Having a father without myopia (OR=0.475, 95%CI:0.393-0.574), mother without myopia (OR=0.677, 95%CI:0.563-0.813), grandfather without myopia (OR=0.713, 95%CI:0.536-0.950), and having learned the correct pen-holding posture (OR=0.608, 95%CI:0.478-0.774) were protective factors against myopia. Conclusions This study found that the screening myopia prevalence among third- to fourth-graders in Yangpu, Shanghai remains at a relatively high level. Myopia is susceptible to the effects of factors such as gender, age, parental myopia status, eye-book distance, and whether students have mastered the correct pen-holding posture. Therefore, targeted intervention measures should be implemented for myopia prevention and control in this targeted population.

Objective To investigate and analyze the status and changing trends of teaching environments in primary and secondary schools of Binhai, Tianjin, and to provide a scientific basis for formulating teaching environment intervention measures. Methods A multistage sampling method was adopted. From 2021 to 2025, no less than 20% of schools were selected annually from all primary and secondary schools in Binhai, Tianjin. In each selected school, 6-12 classrooms were randomly selected per grade for teaching environment monitoring. Eight indicators were served as the monitoring indicators, such as per capita classroom area and noise, etc. Results From 2021 to 2025, a total of 1 106 classrooms in 183 schools were monitored for teaching environment. The overall compliance rates of 8 monitoring indicators were as follows: noise (98.1%), average illuminance of desk surface (92.9%), illuminance uniformity of desk surface (90.6%), illuminance uniformity of blackboard surface (88.5%), average illuminance of blackboard surface (87.0%), blackboard size (73.8%), blackboard reflectance ratio (61.8%), and per capita classroom area (58.0%). The compliance rates of the 8 monitoring indicators differed among different years. Among them, compliance rates of per capita classroom area (χ2trend=124.219, P<0.001), blackboard size (χ2trend=59.866, P<0.001), average illuminance of blackboard surface (χ2trend=36.833, P<0.001), illuminance uniformity of blackboard surface (χ2trend=7.594, P=0.006), and average illuminance of desk surface (χ2trend=11.879, P=0.001) increased over the years. The compliance rate of blackboard reflectance decreased over the years (χ2trend=226.148, P<0.001), while the compliance rate of illuminance uniformity of desk surface showed no upward or downward trend (χ2trend=0.530, P=0.467). Conclusions Some indicators of teaching environments in Binhai had relatively high compliance rates, but the rates of per capita classroom area and blackboard reflectance were relatively low. Effective measures should be taken to gradually improve the teaching environment by targeting weak links.

Objective To investigate the influencing factors of overweight/obesity in children at 5 years old who were admitted to Neonatal Intensive Care Unit (NICU), and to provide a basis for preventing childhood overweight/obesity. Methods A retrospective cohort study was conducted and neonates hospitalized in the NICU of Hunan Children’s Hospital from August 1, 2018 to October 31, 2019 were enrolled. General conditions, family situations, maternal pregnancy conditions, and perinatal factors affecting overweight/obesity at admission were collected. Height and weight at 5 years old were recorded via telephone follow-up, and children were divided into normal group and overweight/obesity group. Logistic regression analysis was used to identify influencing factors of overweight/obesity in preschool age. Results A total of 293 neonates admitted to NICU were finally included, including 211 preterm infants (72.0%) and 167 infants with birth weight<2 500 g (57.0%). The overweight/obesity rate at 5 years old by telephone follow-up was 12.3%. Multivariate logistic regression analysis showed that male gender (OR=2.892, 95%CI: 1.190-7.033) and birth weight (OR=1.002, 95%CI: 1.001-1.003) were risk factors for overweight/obesity in preschool children, while gestational age (OR=0.729, 95%CI: 0.576-0.923) was a protective factor. Conclusions The incidence of overweight/obesity at 5 years old in NICU children is relatively high. Male gender, higher birth weight, and lower gestational age are more likely to lead to overweight/obesity in NICU children at 5 years old.

Objective To explore the characteristics and trends of mortality among primary and secondary school students in Wulong from 2015 to 2024, and to provide a scientific basis for implementing effective interventions to reduce mortality. Methods Data on deaths occurring between January 1, 2015, and December 31, 2024, were retrieved from the mortality surveillance system. Descriptive analysis, χ2 test, and Joinpoint regression analysis were employed to examine mortality patterns among students aged 6-18 years, including gender-, age group-, and cause-specific mortality rates, monthly distribution of deaths, and the Average Annual Percentage Change (AAPC). Results The average mortality rate among students aged 6-18 years in Wulong (2015-2024) was 25.40 per 100 000, with boys showing significantly higher rates (29.80/100 000) than girls (20.74/100 000) (χ2=4.040, P=0.044). Injury-related mortality (16.48/100 000) exceeded disease-related mortality (8.93/100 000) (χ2=9.820, P=0.002). The highest mortality rate was observed in the 15-18-year age group (36.27/100 000), while the lowest was in the 6-<10-year age group (19.30/100 000). Annual mortality rates fluctuated during 2015-2024, with an AAPC of -4.27%, though the trend was not statistically significant. Among injury-related deaths, drowning was the leading cause (mortality rate: 7.32 per 100 000), with male drowning mortality (10.68 per 100 000) being 2.83 times that of females (3.77 per 100 000). The leading disease-related cause of death was malignant tumors (2.72 per 100 000). The highest proportional mortality occurred in January, July, and November, accounting for 45.05% of all deaths. Conclusions Injuries, particularly drowning, were the leading causes of death among students aged 6-18 years in Wulong. Prevention efforts should prioritize drowning control through enhanced safety measures along water bodies and targeted water safety education for students. Parents should strengthen supervision, while relevant authorities should promote life-value education and increase awareness of healthy living and safety precautions among students.

Objective To explore the college students’ HPV vaccination willingness in western China and its influencing factors, and to provide a reference basis for improving the HPV vaccination rate in this targeted population. Methods In February 2025, a questionnaire survey was conducted among 2 505 students at a certain university in western China using a convenience sampling method. The survey covers personal information, family background, and the student’s HPV vaccination willingness. The data were analyzed to examine HPV vaccination willingness and its influencing factors. Results Among the surveyed students, 1 680 (67.1%) expressed willingness to receive the HPV vaccine. The willingness rate was 73.2% among female students and 43.1% among male students. Multivariate logistic regression analysis showed that female students [OR=3.031, 95%CI (2.421-3.795)], those who had heard of HPV [OR=2.240, 95%CI (1.794-2.796)], and those who had heard of the HPV vaccine [OR=2.718, 95% CI (1.923-3.843)] were more willing to be vaccinated. Students with a monthly living expense of 1 000-<1 500 yuan [OR=0.894, 95%CI (0.772-0.997)] and those who had never engaged in sexual activity[OR=0.695, 95%CI (0.190-2.547)] showed lower vaccination willingness. Conclusions These students surveyed in western China exhibit low HPV vaccination willingness, with female students showing higher vaccination willingness. It is recommended to focus on promoting HPV-related knowledge and providing policy support for HPV vaccination among male students, those who have never engaged in sexual activity, and students from low-income families.

Objective To investigate the tobacco hazard awareness and anti?smoking information approach channels among college students, and to provide scientific basis for anti?smoking propaganda in universities. Methods In 2021, a total of 4 715 college students from 9 universities in Hunan were surveyed for investigating the current smoking rate and awareness of tobacco hazards. SPSS 25.0 and χ2 test were used for data analysis and processing. Results The findings indicate that college students in Hunan have a high awareness of the fact that smoking and second?hand smoke may lead to respiratory diseases. However, the awareness of the hazards of low?tar cigarettes and e?cigarettes were relatively low, accounting for 31.9% and 39.5%, respectively. In the aspects of understanding the tobacco hazard and second?hand smoking, students with different characteristics showed significant differences (P<0.05), while no statistically significant difference in the awareness of the hazards of low?tar cigarettes and e?cigarettes (P>0.05). The Internet (75.7%), bulletin boards (66.4%) and school health courses (64.1%) were ranked the top three for approaching anti?smoking information. There were statistically significant differences (P<0.05) in the channels for approaching anti?smoking information among college students with different genders, grades, and school types; while no statistically significant difference (P>0.05) between medical and non?medical students. Conclusion College students in Hunan have limited understanding of the hazards of tobacco use, and medical students need to further improve their understanding of tobacco hazards and anti?smoking information approach.

Objective To understand the current status of myopia among children and adolescents in Taizhou in 2024, and to provide a scientific basis for myopia prevention and control. Methods A stratified random cluster sampling method was used to conduct distance visual acuity examination and refractive testing among children and adolescents in 48 schools (kindergartens) in Taizhou City in 2024, and data were analyzed for myopia detection status and severity. Results A total of 13 950 children and adolescents were surveyed, and 8 745 were diagnosed with myopia, corresponding to an overall prevalence of 62.69%. The prevalence of myopia was significantly higher in girls (64.04%) than in boys (61.45%), and higher in urban areas (66.14%) than in suburban areas (58.33%) (both P<0.05). The prevalence of myopia in kindergartens, primary schools, junior high schools, senior high schools, and vocational high schools was 9.20%, 46.03%, 85.02%, 93.09%, and 87.01%, respectively. For both boys and girls, the prevalence of myopia demonstrated a significant upward trend with grade progression (both P<0.001). The prevalence of mild, moderate, and severe myopia in kindergarten was 8.92%, 0.19%, and 0.09% in kindergarten; in primary school, 32.33%, 11.73%, and 1.24%; in junior high school, 32.06%, 41.76%, and 10.24%; and in senior high school, 22.04%, 49.45%, and 20.82%. A significant trend of increasing myopia severity with advancing educational stage was observed (χ2 trend=1 560.214, P<0.001). Conclusions The myopia situation among children and adolescents in Taizhou is relatively severe, with myopia rates increasing with educational stage and severity worsening. Scientific protective measures should be taken to prevent myopia in younger children and delay the progression from mild to moderate or severe myopia.

Objective To analyze the influencing factors of suicidal behavior in patients with Bipolar Disorder (BD) in China, with a meta-analysis method. Methods Eight databases (PubMed/MedLine, Embase, Cochrane, Web of Science, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Medical Network, VIP Journals) were retrieved from the inception to June 4, 2025. Fourteen eligible studies with Chinese BD patients involving 6 431 participants were included. Both Review Manager 5.4 software and Stata 18.0 software were performed to analyze the associations between suicidal behavior and the potential influencing factors in BD patients, such as gender, age, family history or previous history of mental illness, history of depression, mixed episodes, typical initial symptoms, and typical suicidal concepts or previous attempted suicide behaviors. The sources of heterogeneity were explored. Results The influences of gender, history of depression, mixed episodes, typical suicidal concepts or previous attempted suicide behaviors on the suicidal behaviors of patients were statistically significant (P<0.05). Female patients (OR=1.738), those with a family history or past history of mental illness (OR=1.501), those with a history of depression (OR=1.981), those with mixed episodes (OR=2.864), those with typical initial symptoms (OR=2.025), and those with typical suicidal ideas or past attempted suicide behaviors (OR=4.064) exhibited higher risks of suicide. The heterogeneity results indicated substantial heterogeneity for age, family history or past history of mental illness, history of depression, typical initial symptoms, typical suicidal concepts or previous attempted suicide behaviors (P<0.001). The subgroup analysis showed that the effects of each influencing factor in different subgroups were not statistically significant (P>0.05). Conclusion BD patients who are female, with a family history or past history of mental illness, a history of depression, mixed episodes, typical initial symptoms, typical suicidal ideas or previous attempted suicide behaviors have a relatively higher risk of suicidal behavior.

Objective Dental caries is a common multifactorial disease among children, severely affecting oral health. With the acceleration of urbanization, the scale of rural left-behind children has been expanding. Due to the absence of parent-child relationships and lack of oral health knowledge, dental caries among left-behind children has attracted widespread social attention. This study aimed to comprehensively understand the current status of dental caries prevalence among rural left-behind children in China and provide scientific strategies for improving their oral health. Methods A systematic search was conducted in Chinese databases (CNKI, Wangfang Data, VIP) and English databases (PubMed, Medline) for studies on dental caries prevalence among left-behind children. Meta-analysis was performed on the included literature data. Results A total of 16 studies were included, involving 7 458 participants, of whom 4 366 had dental caries. The overall prevalence of dental caries among left-behind children was 63.5% (95%CI: 51.9%-75.1%). Subgroup analysis showed that the pooled prevalence of dental caries was higher in female left-behind children than in males, at 62.4% (95%CI: 43.1%-81.8%) and 58.3% (95%CI: 39.4%-77.2%), respectively. The prevalence in preschool left-behind children was higher than that in school-aged children, at 70.1% (95%CI: 50.2%-90.0%) and 55.1% (95%CI: 42.8%-67.3%), respectively. The prevalence in South China was significantly higher than that in East China, Central China, and Southwest China, at 67.5% (95%CI: 48.8%-86.2%). Conclusions The prevalence of dental caries among rural left-behind children in China is relatively high, with significant differences in prevalence across gender, age, and region. Targeted oral health education and preventive measures should be strengthened for left-behind children with different characteristics. Due to the limited information on family and other basic factors mentioned in the included studies, future high-quality cross-sectional studies on influencing factors are needed.