[Study on the relationship between smoking behavior and health literacy among grade 4-6 primary students in Shandong province]. 
Objective: To investigate the associations between smoking and literacy on health among 4-6 grade primary school students.  Methods: A questionnaire survey was conducted to research on health literacy and smoking among 4-6 grade pupils in Shandong province, through a multi-stage stratified cluster random sampling method.  Sociodemographic characteristics, health literacy level and smoking rate were collected from respondents.  Binary logistic regression analysis was used to evaluate the association of smoking and health literacy.  Results: A total of 9 240 questionnaires were distributed, with the rate of valid response as 99.7%.  The current smoking rate of the students was 2.6%, on higher in boys (3.1%) than in girls (2.0%).  60.8% of 4-6 grade students were found to have adequate health literacy level.  Levels of literacy health in both boy and girl school students appeared 56.7% and 64.9%, respectively.  Results indicated that health literacy in smokers (14.4%) was lower than that in non-smokers (62.0%).  Results from the binary logistic regression analysis showed that the independent influencing factors would include grade, father's education level, economic situation of the family, self-assessment on the school record and literacy on health (P<0.01).  After controlling the other independent variables, the smoking rate was 8.62 (1/0.116) times in students with low literacy level on health, than those with high literacy level.  Conclusions: Literacy on health was significantly associated with smoking in the 4-6 grade pupils of Shandong province.