Environmental Health Literacy Prevalence and Profiles among Shanghai Residents - Shanghai, China, 2020-2024

In 2019, the Chinese State Council launched the "Healthy China Initiative (2019-2030)", establishing explicit targets for residents' environmental and health literacy (EHL): reaching to 15% by 2022, to 25%, and over 2030. To identify knowledge gaps and guide targeted interventions, Shanghai implemented five consecutive EHL surveys between 2020 and 2024.

We employed a multi-stage random sampling design across five cross-sectional surveys. Associations with EHL levels were examined using χ ² tests, one-way analysis of variance, generalized linear models, and multivariate logistic regression analyses.

Among 11,220 residents aged 15-69 years assessed using the Core Questionnaire for Assessing the EHL of Chinese Residents, mean EHL scores demonstrated steady improvement. Scores increased from 55.28±15.64 points in 2020 to 61.77±15.92 points (2021), 62.13±17.14 points (2022), 62.03±16.97 points (2023), and 63.14±18.21 points (2024) (P<0.001). The proportion achieving adequate EHL (≥70 points) increased correspondingly, with age-adjusted rates rising from 18.78% in 2020 to 30.18% (2021), 33.22% (2022), 33.84% (2023), and 42.88% (2024). Among the three primary dimensions, knowledge showed the greatest improvement, increasing from 7.12% to 39.93%. Participants surveyed in 2024 had 3.50-fold higher odds of achieving adequate EHL compared with those in 2020 (odds ratio=3.50; 95% confidence interval: 3.07, 4.00).

Although educational attainment remained the primary determinant of EHL, targeted public health education campaigns significantly improved EHL among Shanghai residents between 2020 and 2024.