Factors Influencing the Improvement of Environmental Health Literacy in Shanghai Residents: Three Rounds of Cross-sectional Studies from 2020 to 2022

Abstract Background In 2019, the Chinese State Council issued the "Healthy China Initiative (2019–2030)", in which the section of " Action for the promotion of a Healthy Environment " explicitly calls for the levels of environmental and health literacy (EHL) of the residents to reach more than 15% and 25% in 2022 and 2030, respectively. Objective In order to identify weaknesses in the popularization of environmental health knowledge and make targeted improvements, Shanghai has conducted three rounds of environmental health literacy (EHL) surveys from 2020 to 2022. Methods Multi-stage random sampling method was used in the three rounds of cross-sectional studies. A total of 8348 valid participants aged from 15 to 69 were assessed by The Core Questionnaire for Assessing the EHL of Chinese residents (Trial Implementation). Factors influencing EHL levels were analyzed using χ 2-test, Kruskal-Wallis test, generalized linear model (GLM), and multivariate logistic regression. Results The mean score of EHL for all participants was (58.93 ± 16.35) points, which was below the reference value of 70 points. Compared with the first round of the survey in 2020 (55.28 ± 15.64 points), the scores were significantly promoted (P < 0.001) in 2021 and 2022, with (61.77 ± 15.92 points) and (62.13 ± 17.14 points), respectively. The results showed that the EHL significantly increased from 18.74% in 2020 to 33.22% in 2022. The generalized linear model suggested that survey year, residential area, education level, occupation and income were also influential factors of EHL. For educational attainment, the largest increase of 11.937 points was observed in the postgraduate and above group compared with the control group (primary school and below). The results of the multivariate logistic regression model were consistent with those of GLM: residents had higher EHL in the groups of third round survey [OR: 2.71, 95%CI: 2.23–3.13], high education [OR: 3.73, 95%CI: 2.40–5.86], high income [OR: 1.61, 95%CI: 1.26–2.06], and student occupation [OR: 3.09, 95%CI: 2.06–4.65]. Conclusions Education attainment was a crucial factor influencing the EHL of Shanghai residents. The popularization and promotion of environmental health knowledge can significantly improve the EHL of Shanghai residents.