【目的】 目前我国尚没有统一的青少年健康素养测量工具，缺乏比较基础，因此本研究旨在将国外使用广泛，国内研究较少的 “最新关键指标量表（NVS）”进行汉化，验证其在中国青少年群体中的信效度，并用来评估青少年群体的健康素养水平及其影响因素，为开展相关横向纵向比较提供参考基础；进一步探讨青少年健康素养与体质指数（BMI）之间的关系以及零食摄入行为在其中的作用，为提升青少年健康素养、促进健康状况提供理论依据。 【方法】 获取量表授权后对原量表进行翻译和修改确定最终版量表内容。采用多阶段分 层随机抽样在四川省泸州市7个区（县）分别随机抽取4所学校，其中高中1所、 初中2所，小学1所，每所学校每个年级随机抽取1个班级（小学仅抽取5、6年级），每个班级等比例整群抽取学生共3910人，检验量表的内部一致性信度、重测信度以及结构效度和效标效度，结构效度中验证性因子分析使用 AMOS 21.0 进行。 选择其中 5-9 年级中小学生同时进行零食摄入行为和 BMI 调查，使用 SPSS 25.0 软 件进行统计分析，采用 t 检验，方差分析以及 χ² 检验进行组间比较，采用有序多分类 Logistic 回归分析青少年健康素养影响因素，健康素养与零食摄入行为得分以及 BMI 的相关性分析采用 Pearson 相关分析和多因素分析，并使用中介效应法分析三者间的关系，中介效应检验采用依次检验法以及Bootstrap法。 【结果】 本研究量表汉化与信效度检验部分回收有效问卷3754份，有效问卷率 96.0%。 中文版 NVS 量表各条目与总得分的相关系数r均在0.511~0.757之间；KMO 值为0.738，Bartlett 球性检验P＜0.001，探索性因子分析共提取出计算维度和阅读维度两个公因子，累计方差解释率63.694%，6个条目的因子载荷范围在 0.515~0.896，验证性因子分析，χ² /df=10.592，GFI=0.993，RMSEA=0.051，RMR=0.005，SRMR=0.021， CFI=0.087，NFI=0.985，NNFI=0.975，除 χ² /df 外均满足标准，结构效度较好；中文版 NVS 量表得分与中国居民健康素养调查得分呈正相关（r=0.506，P＜0.001），效标效度较好。内部一致性检验 NVS 总分、计算维度、阅读维度 Cronbach's α 分别为 0.748、0.726、0.708；间隔两周中文版 NVS 量表测量结果相关系数为 0.685，量表 总体信度结果较好。本研究量表应用部分回收有效问卷 2922 份，有效问卷率 93.6%。泸州市青少年健康素养得分均值为 2.38±1.936 分，具备足够健康素养水平比例为 31.2%，42.7% 健康素养水平不足。有序多分类 Logistic 回归结果显示住校、每周有零用钱的青少 年健康素养水平更高。泸州市青少年每天摄入水果和牛奶的比例分别为 36.0%和 19.7%，每天或经常摄入酸奶的比例为 33.9%，每天或经常摄入糖类及含糖饮料的比例在 11.7%~24.0%之间。泸州市青少年零食摄入总得分均值为 44.59±5.693 分，具备足够健康素养者得分高于健康素养不足者，零食摄入得分与健康素养得分相关系数 r=0.199；调整城乡、性别等变量，具备足够健康素养者零食摄入得分高的可能性 更高（OR=8.37，95% Cl：5.474~12.794），健康素养两个维度均得分越高，零食摄入 得分越高（OR_（计算）=1.53，95% Cl：1.138~1.758；OR_（阅读）=2.09，95% Cl：1.638~2.656）。 泸州市青少年 BMI 均值为 18.89±4.315，77.3%处于标准范围内，9.2%属于偏瘦范围，超重率为 4.5%，肥胖率为 9.0%，超重肥胖率 13.5%。具备足够健康素养者 BMI 处于标准范围的比例更高（73.6%），超重肥胖率更低（11.1%），BMI 与健康素养得 分呈负相关，相关系数 r=-0.062；调整城乡、性别、学段等变量，健康素养不足者 BMI 不在正常范围的比例更高（OR=1.52，95% Cl：1.201~1.916），健康素养两个维 度均得分越高，BMI 处于不正常的比例越低（OR_（计算）=0.92，95% Cl：0.857~0.997； OR_（阅读）=0.87，95% Cl：0.758~0.992）。中介效应分析显示，健康素养对 BMI 的直接效应值为-0.049，通过中介变量零食摄入对 BMI 的间接效应值为-0.014，零食摄入得分在健康素养对 BMI 的影响中起到部分中介作用，中介效应占总效应的 23.3%。 【结论】 中文版 NVS 量表在中国青少年群体中信效度检验结果较好，适用于测量青少年群体健康素养水平。泸州市 5-9 年级青少年健康素养水平低于发达国家和地区， 高于一般中低收入发展中国家。城乡、是否住校、每周是否有零用钱是青少年健康素养水平的影响因素。健康素养水平越高，青少年零食摄入行为越好，其体质指数 （BMI）处于标准范围的比例越高，其中零食摄入行为在健康素养和 BMI 之间存在部分中介效应。

Objective：At present, China does not have a unified health literacy measurement tool for adolescent, which lacks a basis for comparison. Therefore, the purpose of this study is to introduce "the Newest Vital Sign (NVS)", which is widely used abroad and less domestically studied, and verify its reliability and validity in Chinese adolescents. Then use the Chinese version to evaluate the health literacy level of the adolescents in Luzhou, Sichuan Province, and find its influencing factors, in order to carry out relevant horizontal and vertical comparisons. Then further explore the relationship between adolescents’ health literacy and body mass index (BMI) and the role of snacking behavior between the above two，in order to provide a theoretical basis for improving adolescents’ health literacy and promoting their physical health. Methods：After obtaining the scale authorization, translate and modify the original scale to determine the final version of the scale. Multi-stage stratified random sampling was used to randomly select 4 schools, including 1 high school, 2 junior high schools, and 1 elementary school (grades 5-6) in 7 districts (counties) of Luzhou City, Sichuan Province, and randomly sample 1 for each grade in each school Classes (Primary schools only take 5th and 6th grades). A total of 3,910 students are selected in groups in equal proportions in each class. The internal consistency reliability, test-retest reliability, structural validity and standard validity of the test scale were tested. The confirmatory factor analysis in the structural validity was carried out using AMOS 21.0. At the same time, the snack intake behavior and BMI of students in grades 5-9 were investigated. Use SPSS 25.0 software for statistical analysis, use t-test, analysis of variance, and χ² test for group comparisons, and use ordered multi-class Logistic regression to analyze the influencing factors of adolescents' health literacy. Use the Pearson correlation analysis and multi-factor analysis to analyze the relationship between Health literacy and snack intake behavior scores, and health literacy and BMI, then use the intermediary effect method to analyze the relationship between the three. The intermediary effect test uses the sequential test method and the Bootstrap method. Results：In the first part of this study, 3754 valid questionnaires were collected, the valid questionnaire rate was 96.0%. The correlation coefficient between each item of the NVS-CH and the total score is between 0.511 and 0.757, KMO=0.738, the Bartlett spheroidity test P<0.001. The exploratory factor analysis has abstracted two factors and explained 63.694% of total variance. The factor loading range of each item is 0.515~0.896. Name the two factors as calculated dimensions and reading dimensions. Confirmatory factor analysis showed that almost all indicators satisfy the standard, the model was acceptable: χ²/df=10.592, GFI=0.993, RMSEA=0.051, RMR=0.005, SRMR=0.021, CFI=0.087, NFI=0.985，NNFI=0.975. The scores of the NVS-CH scale were positively correlated with the scores of the Chinese Citizens’ Health Literacy Survey (r=0.506, P＜0.001). The Cronbach's α of total score, calculation dimension, and reading dimension was 0.748, 0.726, 0.708 respectively. The retest reliability of NVS-CH scale was 0.685, so the overall reliability of the scale was good. In the second part of this study, 2922 valid questionnaires were collected, the valid questionnaire rate was 93.6%. The average health literacy score of Luzhou adolescents was 2.38±1.936 points, 31.2% had adequate health literacy, and 42.7% had insufficient health literacy. The results of Ordered Multi-class Logistic regression showed that the adolescents who lived in school and had pocket money each week had higher health literacy levels. The proportion of adolescents who consume fruit and milk every day is 36.0% and 19.7%, respectively, the proportion of daily or regular intake of yogurt is 33.9%, and the proportion of daily or regular intake of sugar and sugar-sweetened beverages is 11.7%~24.0% between. The average total snack intake score of Luzhou adolescents is 44.59±5.693 points, and those with adequate health literacy score higher than those with insufficient health literacy. The correlation coefficient between snack intake score and health literacy score is 0.199. Adjusting urban and rural areas, gender, etc, those with adequate health literacy are more likely to have higher snack intake score (OR=8.37, 95% Cl: 5.474~12.794). And the higher the score on both dimensions of health literacy, the higher the snack intake score they have (OR_{(calculation)}=1.53, 95% Cl: 1.138~1.758; OR_(reading)=2.09, 95% Cl: 1.638~2.656). The average BMI of Luzhou adolescents was 18.89±4.315, 77.3% were within the standard range, 9.2% were lean, the overweight rate was 4.5%, the obesity rate was 9.0%, and the overweight and obesity rate was 13.5%. Those with adequate health literacy levels have a higher proportion of BMI in the standard range (73.6%), and a lower rate of overweight and obesity (11.1%). There is a negative relationship between BMI and health literacy (r=-0.062). Adjusting urban and rural areas, gender, school level etc, people with insufficient health literacy have a higher proportion of abnormal BMI level (OR=1.52, 95% Cl: 1.201~1.916), and the higher the scores on both dimensions of health literacy, the lower the proportion of abnormal BMI level (OR_{(calculation)} = 0.92, 95% Cl: 0.857~0.997; OR_(reading)= 0.87, 95% Cl: 0.758~0.992). The mediating effect analysis showed that the direct effect of health literacy on BMI was -0.049. The indirect effect of the intermediate variable (snack intake behavior) on BMI was -0.014, and accounted for 23.3% of the total effect.   Conclusion：The Chinese version of the NVS scale has good reliability and validity among Chinese adolescents, and is suitable for measuring the health literacy level of Chinese adolescents. The health literacy level of adolescents in grades 5-9 in Luzhou is lower than in developed countries and regions, and higher than in general low-income developing countries. Urban and rural areas, living in school, and having pocket money every week are the influencing factors of the health literacy level of adolescents. The higher the level of health literacy, the better adolescents' snack intake behavior, and the higher the proportion of their body mass index (BMI) within the standard range. Among them, snack intake behavior has a partial mediating effect between health literacy and BMI.