Health Literacy and Internet Use Among Japanese Older Adults: A Gender-Stratified Cross-Sectional Analysis of the Moderating Effects of Neighborhood Relationships

<b>Background/Objectives</b>: Internet use positively impacts mental health in older adults, with health literacy (HL) playing a key role. While social networks may complement individual HL, the role of neighborhood relationships in this association, particularly by gender, remains unclear. This study examined how the association between HL and Internet use among older adults was modified by neighborhood relationships. <b>Methods</b>: Using baseline data from the Chofu-Digital-Choju project, a cross-sectional analysis was conducted on 1955 community-dwelling adults aged 65-84 (889 men and 1066 women). HL was assessed using the Communicative and Critical Health Literacy scale and dichotomized at four points. Neighborhood relationships were categorized as high (visiting/chatting with neighbors) or low (exchanging greetings/no relationship). Gender-stratified logistic regression analyses were performed with Internet use as the dependent variable, with HL, neighborhood relationships, and their interaction as independent variables. <b>Results</b>: Internet user proportion was 55.6% for men and 41.8% for women. HL was positively associated with Internet use in both genders, though patterns differed. Among men, the HL-Internet use association was consistent (OR = 3.09; 95% CI: 2.25-4.24) regardless of neighborhood relationship levels. For women, this association was significantly modified (interaction OR = 0.46, 95% CI: 0.24-0.87). Women with low HL but strong neighborhood relationships showed increased odds of Internet use (OR = 2.08, 95% CI: 1.32-3.26). <b>Conclusions</b>: Gender-specific patterns in HL and neighborhood relationships influence Internet use among older adults. Neighborhood relationships may compensate for low HL in women, underscoring the need for gender-sensitive strategies to promote digital HL.