{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:10:38Z","timestamp":1790143838847,"version":"4.0.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Physical inactivity among Chinese adolescents remains a pressing public health concern, with pronounced urban\u2013rural disparities. School sports environments serve as a critical determinant of adolescent physical activity (PA), yet the conditions under which this relationship strengthens or weakens remain insufficiently understood. Digital health literacy (DHL) has emerged as a potential moderator that may amplify or buffer environmental influences on PA behavior.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional survey was conducted among 2,531 adolescents (M\n                      <jats:sub>age<\/jats:sub>\n                      \u202f=\u202f15.2\u202f\u00b1\u202f1.8\u202fyears; 51.3% male) recruited through stratified cluster sampling from 18 secondary schools in Hubei Province, China (9 urban, 9 rural). Participants completed validated Chinese versions of the Questionnaire Assessing School Physical Activity Environment (Q-SPACE-Chi), the eHealth Literacy Scale (eHEALS), and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Structural equation modeling with a latent interaction term tested the moderating role of DHL, and multigroup analysis examined urban\u2013rural differences. Reporting followed the STROBE guideline.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      School sports environment was positively associated with PA levels (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.34,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). DHL significantly moderated this pathway (interaction\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003), such that the environment-PA association was stronger among adolescents with higher DHL. Multigroup analysis revealed a significantly stronger environmental effect in urban (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.38) than in rural schools (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.29;\n                      <jats:italic>z<\/jats:italic>\n                      = 2.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.004); the DHL moderation was significant in urban (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.14,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.008) but not rural schools (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.14), and the between-group difference in the moderation effect was not significant (\n                      <jats:italic>z<\/jats:italic>\n                      = 0.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.32). The model demonstrated acceptable fit (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \/df\u202f=\u202f3.12, CFI\u202f=\u202f0.94, TLI\u202f=\u202f0.93, RMSEA\u202f=\u202f0.045, SRMR\u202f=\u202f0.041).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DHL amplifies the translation of favorable school sports environments into actual PA engagement, and the environment-PA association was stronger in urban schools. These findings suggest a potential pathway through which digital inequities may contribute to PA disparities, a possibility that requires longitudinal confirmation, and underscore the need for integrated school-based and digital literacy interventions to advance health equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1967478","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:49:44Z","timestamp":1790142584000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital health literacy moderates the school sports environment and physical activity pathway among Chinese adolescents: a health equity perspective"],"prefix":"10.3389","volume":"14","author":[{"given":"Bing","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Physical Education, Huanggang Normal University","place":["Huanggang, Hubei, 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Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1732510","DOI":"10.3389\/fpubh.2026.1732510","article-title":"Prevalence of insufficient daily physical activity and its association with health indicators among Chinese primary and secondary school students: a cross-sectional study","volume":"14","author":"Qin","year":"2026","journal-title":"Front Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1146\/annurev.publhealth.27.021405.102100","article-title":"An ecological approach to creating active living communities","volume":"27","author":"Sallis","year":"2006","journal-title":"Annu Rev Public Health"},{"key":"ref6","doi-asserted-by":"crossref","DOI":"10.4159\/9780674028845","volume-title":"The Ecology of Human Development: Experiments by Nature and Design","author":"Bronfenbrenner","year":"1979"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1111\/obr.12425","article-title":"The school environment and adolescent physical activity and sedentary behaviour: a mixed-studies systematic review","volume":"17","author":"Morton","year":"2016","journal-title":"Obes Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1080\/10913670701294088","article-title":"Development of a questionnaire assessing school physical activity environment","volume":"11","author":"Robertson-Wilson","year":"2007","journal-title":"Meas Phys Educ Exerc Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2348","DOI":"10.1186\/s12889-025-23571-w","article-title":"Redevelopment and examination of the psychometric properties of school physical activity environment in Chinese","volume":"25","author":"Leung","year":"2025","journal-title":"BMC Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1534843","DOI":"10.3389\/feduc.2025.1534843","article-title":"Development and validation of the Chinese school environment influencing physical activity habits scale","volume":"10","author":"Dai","year":"2025","journal-title":"Front Educ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.2196\/jmir.8.4.e27","article-title":"eHEALS: the eHealth literacy scale","volume":"8","author":"Norman","year":"2006","journal-title":"J Med Internet Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"20552076261456577","DOI":"10.1177\/20552076261456577","article-title":"The association between digital health literacy and healthy lifestyle behaviors among youth: systematic review of cross-sectional studies","volume":"12","author":"Xu","year":"2026","journal-title":"Digit Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1080\/08870449808407422","article-title":"Health promotion from the perspective of social cognitive theory","volume":"13","author":"Bandura","year":"1998","journal-title":"Psychol Health"},{"key":"ref14","first-page":"106","article-title":"Validation of Chinese version of eHealth literacy scale and analysis of influencing factors among high school students","volume":"29","author":"Guo","year":"2013","journal-title":"Zhongguo Jiankang Jiaoyu"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s12966-025-01866-w","article-title":"Physical activity interventions among children and adolescents in China: a scoping review through an equity lens","volume":"23","author":"Li","year":"2025","journal-title":"Int J Behav Nutr Phys Act"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"429","DOI":"10.2190\/986L-LHQ6-2VTE-YRRN","article-title":"The concepts and principles of equity and health","volume":"22","author":"Whitehead","year":"1992","journal-title":"Int J Health Serv"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational 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coefficients","volume":"36","author":"Paternoster","year":"1998","journal-title":"Criminology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1027\/1614-2241.1.3.86","article-title":"Sufficient sample sizes for multilevel modeling","volume":"1","author":"Maas","year":"2005","journal-title":"Methodology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1207\/S15328007SEM0902_5","article-title":"Evaluating goodness-of-fit indexes for testing measurement invariance","volume":"9","author":"Cheung","year":"2002","journal-title":"Struct Equ Model Multidiscip J"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.psychsport.2018.11.009","article-title":"Social cognitive theory and physical activity: mechanisms of behavior change, critique, and legacy","volume":"42","author":"Beauchamp","year":"2019","journal-title":"Psychol Sport 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