Education-based differences in alcohol health literacy in Germany.

Introduction: Alcohol health literacy is critical for informed consumer decision making but has yet received limited attention in public health research. We therefore seek to measure alcohol health literacy and its educational distribution in Germany.

Methods: In this cross-sectional study, we developed and applied a brief nine-item questionnaire on alcohol health literacy in an adult convenience sample (n = 391; February to April 2023). The association of educational attainment with 'insufficient' alcohol health literacy was tested in adjusted logistic regression models.

Results: Insufficient alcohol health literacy was recorded in 47.8% of men and 41.1% of women in our sample. While most respondents correctly identified common misconceptions and wrong beliefs about alcohol and were able to specify low-risk drinking limits for women and women during pregnancy, only few correctly identified all alcohol-related health conditions, especially respiratory and infectious diseases. Respondents with low education were 1.35 (risk ratio [RR], 95% confidence interval 1.09-1.50, p = 0.014) times more likely to have been classified as having insufficient alcohol health literacy than high-educated respondents. There was no statistically significant difference between respondents with medium versus high education (RR = 1.22, 95% confidence interval 0.99-1.43, p = 0.060).

Discussion and conclusions: Educational gaps in alcohol health literacy question a policy rationale that is fundamentally based on the premise of informed consumer choice. Strategies to raise alcohol health literacy must ensure that they reach all population groups, for instance, by providing health warning labels on alcohol containers.