Introduction:
Understanding health literacy is important for formulating health policies and conducting public health interventions. We aimed to evaluate the status quo and influencing factors of teenager dietary behavior and health literacy in China, to provide insights into the coping strategies of teenager health.

Material and methods:
Between March 1, 2021 and May 15, 2021, teenagers in four high schools in Bengbu, China were selected. The Interactive Health Literacy Questionnaire for Chinese Teenagers (IHLQCT) was used for assessing health literacy. Mixed linear models were used to analyze the relationships among dietary behavior patterns, IHLQCT and individual characteristics.

Results:
A total of 1920 teenagers were included. The average score of the IHLQCT was (72.45 ±8.99). Mixed linear analyses showed that parents’ educational level (β = –0.11, 95% CI: –0.19, 0.05), monthly family income (β = 0.08, 95% CI: 0.02, 0.16), and IHLQCT scores (β = 0.15, 95% CI: 0.10, 0.23) were associated with risky dietary behavior patterns in teenagers (all p < 0.05). Being an only child (β = –0.12, 95% CI: –0.35, –0.09), parents’ educational level (β = 0.49, 95% CI: 0.13, 0.95) monthly family income (β = 0.14, 95% CI: 0.08, 0.38), and IHLQCT scores (β = 0.45, 95% CI: 0.24, 0.69) were associated with the protective dietary behavior patterns (all p < 0.05). Being an only child (β = –0.16, 95% CI: –0.41, –0.07), parents’ educational level (β = 0.49, 95% CI: 0.11, 0.82), monthly family income (β = 0.17, 95% CI: 0.10, 0.41), risky dietary behavior patterns (β = 0.34, 95% CI: 0.14, 0.83), and protective dietary behavior patterns (β = 0.22, 95% CI: 0.07, 0.51) were associated with the IHLQCT (all p < 0.05).

Conclusions:
Teenager dietary behavior is closely associated with health literacy. There are differences in the dietary behaviors of teenagers under different family characteristics in China.