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IntroductionSocial deprivation is a known determinant of health and related behaviors. Many studies have linked socioeconomic status to secondhand smoke (SHS) exposure. However, no studies have examined the relationship between social deprivation and SHS exposure. This study examined whether social deprivation has any independent effect on SHS exposure at both individual and regional levels among Chinese residents.MethodsA cross-sectional multistage sampling design was utilized to interview subjects from 6 selected cities in China. A standardized questionnaire was used to tap demographic characteristics, social deprivation and SHS exposure. Multilevel logistic regression models were used to assess the association between social deprivation and SHS exposure.Results5,782 valid questionnaires were collected in this study. Of 2,930 non-smokers, the SHS exposure prevalence was 21.9% (95% CI 19.5, 24.30). Multilevel logistic regression showed a negative association between family income, regional GDP and SHS exposure, and positive associations between social deprivation and SHS exposure, respectively. ConclusionsFindings support the central proposition that social deprivation influences SHS exposure messages. Our research underscores the importance of reducing health inequality in controlling SHS exposure. ImplicationsThe information from this study should be helpful when considering effective SHS exposure control policies and interventions among urban residents in China. Targeted interventions for SHS exposure should help reduce health inequities across social class. With this in mind, SHS exposure control for socially deprived groups should be paid attention.

Background The COVID-19 vaccine is an essential means to establish group immunity and prevent the spread of the pandemic. However, the public's hesitation has created major difficulties to the promotion of the vaccine. By investigating the relationship between health literacy and COVID-19 vaccine hesitancy, as well as the potential moderating role of stress, the present study would provide critical insights for tailoring vaccine-promotion strategies. Objective The two-fold research purpose is: i) address the effect of health literacy on people's attitude toward COVID-19 vaccine, ii) clarify the role of stress in this effect. Method With structured questionnaires, an online survey was conducted to evaluate general public's COVID-19 vaccine hesitancy, health literacy, and perceived stress. In total, 560 responses were collected, and moderated regression analysis was conducted to test the effect of health literacy on vaccine hesitancy among people with different levels of stress. Results A total of 560 participants aged over 18 years were included in this study. About 39.8% of the respondents reported vaccine hesitancy, and this rate is higher among those aged 20-30 years old (83%) and female (71.3%). The results showed people with higher level of health literacy are less likely to have vaccine hesitancy . However, this effect was only among those with lower to moderate level of stress , among the people with high stress, no significant effect of health literacy was found . Conclusions By focusing on the effect of health literacy on COVID-19 vaccine hesitancy, the findings showed education program increasing individual's health literacy may also effectively reduce the public's vaccine hesitancy and promote accepting attitude. However, for people with high level of stress, other health programs need to be developed to enhance their positive attitude toward the COVID-19 vaccine. In conclusion, promotion strategies should be tailored for different populations, with considering individual factors such as health literacy and stress. Keywords vaccine hesitancy; health literacy; stress; moderation

BACKGROUND The COVID-19 vaccine is an essential means to establish group immunity and prevent the spread of the pandemic. However, the public’s hesitation has created major difficulties to the promotion of the vaccine. By investigating the relationship between health literacy and COVID-19 vaccine hesitancy, as well as the potential moderating role of stress, the present study would provide critical insights for tailoring vaccine-promotion strategies. OBJECTIVE The two-fold research purpose is: i) address the effect of health literacy on people’s attitude toward COVID-19 vaccine, ii) clarify the role of stress in this effect. METHODS With structured questionnaires, an online survey was conducted to evaluate general public’s COVID-19 vaccine hesitancy, health literacy, and perceived stress. In total, 560 responses were collected, and moderated regression analysis was conducted to test the effect of health literacy on vaccine hesitancy among people with different levels of stress. RESULTS A total of 560 participants aged over 18 years were included in this study. About 39.8% of the respondents reported vaccine hesitancy, and this rate is higher among those aged 20-30 years old (83%) and female (71.3%). The results showed people with higher level of health literacy are less likely to have vaccine hesitancy (β = -2.00, 95%CI= [-3.00~ -0.99]). However, this effect was only among those with lower to moderate level of stress (β =-3.43, p<0.001), among the people with high stress, no significant effect of health literacy was found (β =-0.53, p>0.05). CONCLUSIONS By focusing on the effect of health literacy on COVID-19 vaccine hesitancy, the findings showed education program increasing individual’s health literacy may also effectively reduce the public’s vaccine hesitancy and promote accepting attitude. However, for people with high level of stress, other health programs need to be developed to enhance their positive attitude toward the COVID-19 vaccine. In conclusion, promotion strategies should be tailored for different populations, with considering individual factors such as health literacy and stress.