BACKGROUND: Health literacy is defined as the ability to understand and utilize health information. South Korea exhibits a significant sex difference in smoking rate among OECD countries. This study aimed to analyze the factors associated with health literacy among smokers and non-smokers, with a focus on sex differences.
METHODS: This study used the 2023 KNHANES database in South Korea. The analysis was based on the four determinant domains described in the Lalonde Report. We analyzed data from 2086 South Korean adults. Descriptive statistics and generalized linear regression with complex sampling design were performed using SAS 9.4.
RESULTS: Overall, a high education level was positively associated with high health literacy. For non-smokers, age and marital status were significantly associated with health literacy in both sexes. Among female non-smokers, the absence of unmet healthcare needs and positive subjective health status were significantly associated with high health literacy. For smokers, performing strength exercises at least twice a week was positively associated with high health literacy exclusively among male smokers. Additionally, male smokers with positive subjective health status and female smokers who were widowed, separated, or divorced were less likely to have high health literacy.
CONCLUSIONS: This study explored differences in health literacy by sex and smoking status. Male smokers showed higher health literacy with increased physical activity, likely reflecting sex differences in activity levels. Smokers recognized the benefits of exercise despite engaging in health-risk behaviors. Male smokers with positive subjective health status were less likely to seek health information, possibly due to positive health perceptions. Female smokers who were divorced, widowed, or separated showed lower health literacy, likely influenced by life transitions, and diminished social support. This study highlights the need for health information intervention that considers sex differences, potentially contributing to smoking cessation interventions.