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Risk for physical inactivity due to inadequate health literacy among middleaged Japanese adults: a cross-sectional study† Cover

Risk for physical inactivity due to inadequate health literacy among middleaged Japanese adults: a cross-sectional study†

By:  and    
Open Access
|Mar 2026

Figures & Tables

Table 1.

Descriptivestatistics of health literacy, sociodemographic factors, stages of health behavior change, and physical inactivity among 3742 middle-aged Japanese adults.

Variablesn (%) or Mean ± SD
Health literacy*
   High health literacy group1281 (34.2)
   Medium health literacy group1473 (39.4)
   Low health literacy group988 (26.4)
   Mean CCHL scale score (points)3.5 ± 0.8
Age (years)
   60–64859 (23.0)
   50–591657 (44.3)
   40–491226 (32.8)
   Mean age (years)53.2 ± 6.7
Gender
   Male1718 (45.9)
   Female2024 (54.1)
Education level
   >12 years1747 (46.7)
   9–12 years1995 (53.3)
Occupation
   Presence3202 (85.6)
   Absence540 (14.4)
Economic status
   Very good and good680 (18.2)
   Average829 (22.2)
   Poor and very poor2233 (59.7)
Living alone
   No3244 (86.7)
   Yes498 (13.3)
Stages of health behavior change
   Non-precontemplation stage2496 (66.7)
   Precontemplation stage1246 (33.3)
   Physical inactivity2621 (70.0)

1 Note: CCHL, communicative and critical health literacy; SD, standard deviation.

1* Participants were classified into 3 groups (low, medium, and high health literacy groups) by the tertiles of the CCHL scale score: low health literacy group with 1.0–3.0 points, medium health literacy group with 3.1–3.9 points, and high health literacy group with 4.0–5.0 points.

Table 2.

Differences in physical inactivity according to health literacy, sociodemographic factors, and stages of health behavior change among 3742 middle-aged Japanese adults.

VariablesPercentage (%) of physical inactivityP
Health literacy<0.001
   High health literacy group64.5
   Medium health literacy group71.9
   Low health literacy group74.5
Age (years)<0.001
   60–6464.1
   50–5970.6
   40–4973.4
Gender<0.001
   Male66.2
   Female73.3
Education level0.794
   >12 years69.8
   9–12 years70.2
Occupation0.021
   Presence69.3
   Absence74.3
Economic status<0.001
   Very good and good62.5
   Average68.4
   Poor and very poor73.0
Living alone0.474
   No70.3
   Yes68.7
Stages of health behavior change0.315
   Non-precontemplation stage69.5
   Precontemplation stage71.1

1 Note: Dichotomous and categorical data were analyzed with chi-squared tests and shown.

Table 3.

Risk for physical inactivity due to inadequate health literacy among 3742 middle-aged Japanese adults.

VariablesMultivariable-adjusted OR (95% CI) for physical inactivityP
Health literacy
   High health literacy group1.0 (reference)
   Medium health literacy group1.36 (1.16–1.59)<0.001
   Low health literacy group1.70 (1.36–2.11)<0.001
   Covariates in the same model
Age (years)
   60–641.0 (reference)
   50–591.39 (1.16–1.67)<0.001
   40–491.63 (1.34–1.98)<0.001
Gender
   Male1.0 (reference)
   Female1.55 (1.34–1.80)<0.001
Education level
   >12 years1.0 (reference)
   9–12 years0.95 (0.82–1.10)0.472
Occupation
   Presence1.0 (reference)
   Absence1.30 (1.05–1.61)0.016
Economic status
   Very good and good1.0 (reference)
   Average1.22 (0.98–1.52)0.077
   Poor and very poor1.52 (1.26–1.84)<0.001
Living alone
   No1.0 (reference)
   Yes0.95 (0.77–1.17)0.616
Stages of health behavior change
   Non-precontemplation stage1.0 (reference)
   Precontemplation stage1.05 (0.90–1.22)0.548

1 Note: A logistic regression model was used to estimate the multivariable-adjusted ORs and 95% CIs for physical inactivity according to health literacy. Health literacy, age, gender, education level, occupation, economic status, living alone, and stages of health behavior change were included in the same model; CIs, confidence intervals; ORs, odds ratios.

Table 4.

Risk for physical inactivity due to inadequate health literacy among 3742 middle-aged Japanese adults: age-stratified analysis.

Variablesn (%)Percentage (%) of physical inactivityMultivariable-adjusted OR (95% CI) for physical inactivityP
60–64 years
   High health literacy group289 (7.7)58.11.0 (reference)
   Medium health literacy group327 (8.7)64.81.25 (0.90–1.75)0.188
   Low health literacy group243 (6.5)70.41.57 (1.08–2.28)0.019
50–59 years
   High health literacy group565 (15.1)64.41.0 (reference)
   Medium health literacy group669 (17.9)73.21.46 (1.14–1.87)0.003
   Low health literacy group423 (11.3)74.71.57 (1.18–2.10)0.002
40–49 years
   High health literacy group427 (11.4)68.91.0 (reference)
   Medium health literacy group477 (12.7)74.81.35 (1.01–1.81)0.041
   Low health literacy group322 (8.6)77.31.55 (1.10–2.19)0.012

1 Note: Logistic regression models were used to estimate the multivariable-adjusted ORs and 95% CIs for physical inactivity according to health literacy. Health literacy, gender, education level, occupation, economic status, living alone, and stages of health behavior change were included in the same model; CIs, confidence intervals; ORs, odds ratios.

DOI: https://doi.org/10.2478/FON-2026-0006 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368
Language: English
Page range: 43 - 49
Submitted on: Jan 3, 2025
Accepted on: Mar 11, 2025
Published on: Mar 24, 2026
Published by: Shanxi Medical Periodical Press
In partnership with: Paradigm Publishing Services

© 2026 Nao Sonoda, Akiko Morimoto, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution 4.0 License.