Objective  To examine the level and associates of health literacy (HL) among primary and high school students in Nanjing city of Jiangsu province and to provide evidences for developing targeted interventions on HL in the students.

  Methods  Using two-stage random cluster sampling, we recruited 4 498 students aged 9 – 17 years at 36 primary and high schools in all administrative districts of Nanjing municipality and conducted a self-administered questionnaire survey during May – June, 2018. Chi-square test and the multivariate logistic regression model were adopted to explore the influencing factors of HL.

  Results  Among the 4 401 students completing the survey, 85.7% were assessed with adequate HL and the proportions of the students with adequate HL were 73.7%, 90.3%, and 95.1% for the grade 4 – 6 pupils, junior high school students, and senior high school students, respectively. The results of multivariate logistic regression analysis demonstrated that the students with following characteristics were more likely to have adequate HL: girl students (versus boy students: odds ratio OR = 1.56, 95% confidence interval 95% CI: 1.30 – 1.87); upper grade students (OR = 4.29, 95% CI: 3.45 – 5.33 for junior high school vs. primary school and OR = 8.29, 95% CI: 6.24 – 11.01 for senior high school vs. primary school); reporting better self-rated academic performance (OR = 1.86, 95% CI: 1.48 – 2.34 for normal vs. poor and OR = 3.07, 95% CI: 2.42 – 3.89 for good vs. poor); and higher parental educational attainment (versus lower: OR = 1.78, 95% CI: 1.42 – 2.24).

  Conclusion  Among primary and high school students in Nanjing city, the health literary is at a relatively high level and mainly influenced by gender, schooling grade, self-rated academic performance, and parental educational attainment.