Health Literacy and Tobacco Use: A Cross-Sectional Study of Associations Among Predominantly Low-Income Adults Motivated to Quit Smoking

Background/Objectives: Tobacco use remains the leading cause of preventable disease, with persistent health disparities for underserved populations. Health literacy may influence tobacco use and cessation. This study examined associations among health literacy, sociodemographic characteristics, and tobacco use behaviors among adults who smoke cigarettes. Methods: Baseline data were drawn from a clinical trial among adults who smoked cigarettes and wanted to quit. Participants (N = 498) completed the Brief Health Literacy Screener as well as sociodemographic and tobacco use behavior variables. T-tests, chi-square tests, and logistic regression analyses examined associations among health literacy, sociodemographic variables, and tobacco use. Results: Compared to participants with adequate health literacy, those with low health literacy were older (p < 0.001), had lower socioeconomic status (SES, p < 0.001), and were more likely to identify as African American (p = 0.005). In bivariate analyses, participants with low health literacy were more likely to smoke within 5 min of waking (p = 0.02), indicating higher nicotine dependence. Recent cigar or cigarillo co-use was more common among participants with low health literacy, although not statistically significant (p = 0.055). Participants with adequate health literacy were more likely to use electronic vapor products (p = 0.03), and this association remained significant after controlling for sociodemographic variables (p = 0.03). Conclusions: Low health literacy was associated with lower SES, with greater nicotine dependence observed in bivariate analyses. Electronic vapor product use was more common among participants with adequate health literacy. Findings underscore the intersection of health literacy, SES, and broader social determinants of health. Further research is needed to inform health literacy-responsive smoking cessation interventions.