Health knowledge gaps among high school students: evidence from a regional school-based survey

Background

Health knowledge (HK) in adolescence may shape prevention, risk perception, and everyday health choices, contributing to longer-term differences in health behavior. Although health education starts earlier, the upper-secondary period is important for consolidating knowledge before adulthood. Students may nevertheless differ by educational pathway, health literacy (HL), and information environment. This study identified factors associated with HK among high school students.

Methods

A web-based survey was conducted among 1,031 students aged 15–19 years in southern Poland. Schools were randomly selected from the Board of Education list to reflect general and technical secondary schools, and large-city and smaller-town settings. HK was assessed with 24 multiple-choice questions based on the health education curriculum introduced in 2025. Multivariable linear regression examined associations with HL, educational pathway, sociodemographic background, health-related factors, and digital behavior.

Results

The mean HK score was 10.54 (SD = 3.16). The model was significant (F(34,996)=7.95, p < 0.001; adjusted R²=18.7%). Higher HL was associated with HK (B = 0.13, 95%CI: 0.09–0.17). Technical school students scored lower than general secondary school students (B=−2.47, 95%CI: -2.97 to -1.98). Compared with fourth-year students, lower scores were observed in years 1–3 (B from -1.45 to -0.53) and higher scores were observed in year 5 (B = 0.81, 95%CI: 0.17–1.45). Residence in medium-sized or large cities and daily gaming for 1–2 hours were also negatively associated with HK.

Conclusions

HK should be viewed as the result of cumulative educational and informational experiences, not only current curriculum exposure. A brief assessment may help tailor teaching to students’ needs and topic priorities. Upper-secondary health education should combine content delivery with activities that strengthen understanding, application, and critical use of health knowledge.

Key messages

• Health knowledge among high school students was strongly patterned by school type and health literacy, not by overall Internet time.

• School health education should better support technical school students and adolescents with lower health literacy.