Association between health literacy and the time to first cigarette among daily smokers in Zhejiang Province, China

Health literacy exhibits an independent, protective association against nicotine dependence among daily smokers in this predominantly male sample, with effects becoming pronounced above the adequacy threshold. These findings suggest that integrating tobacco control objectives within China's existing health literacy promotion framework may enhance smoking cessation efforts and reduce nicotine dependence, particularly in regions like Zhejiang Province that continue to face high male smoking prevalence despite active tobacco control policies.