Associations Among Digital Health Literacy, Lifestyle Factors, and Cardiovascular Health in Black and Hispanic Communities: Cross-Sectional Study.

Background: Black and Hispanic adults in the United States face a disproportionately high burden of cardiovascular disease (CVD). Digital health literacy (DHL) may influence CVD prevention and management, yet its role in these populations is not well understood. Objective: This study aimed to examine associations between DHL and cardiovascular-related lifestyle behaviors, CVD, and CVD risk factors among Black and Hispanic adults. Methods: This was an exploratory analysis of survey data from a cross-sectional study among adults in Maryland; Virginia; and Washington, DC (March 2024-June 2024). DHL was measured using items from the Digital Health Literacy Instrument, and outcomes included self-reported CVD and risk factor diagnoses and lifestyle behaviors (physical activity and fruit-, vegetable-, and sugar-sweetened beverage intake). Multivariable regression models were used to assess associations, adjusting for sociodemographic and health literacy factors. Results: Among 1221 participants, the mean age was 44 (SD 16) years; most were female (n=766, 62.7%), insured (n=1065, 87.2%), and non-Hispanic (n=840, 68.8%) and identified as Black or African American (n=778, 63.7%). Higher DHL was associated with greater vegetable intake (incidence rate ratio 1.08, 95% CI 1.01-1.15). Contrary to our hypothesis, DHL was positively associated with sugar-sweetened beverage consumption (incidence rate ratio 1.13, 95% CI 1.10-1.25). DHL showed a significant nonlinear association with fruit intake (P=.01). No significant associations were observed with CVD or its risk factors. Conclusions: The relationship between DHL and cardiovascular-protective behaviors was mixed, suggesting that DHL may not be sufficient to promote consistent health-protective behaviors. The findings highlight the need for interventions that strengthen DHL while also addressing broader contextual and structural factors such as targeted digital marketing of unhealthy food and beverages, as well as environmental barriers. Longitudinal and experimental studies are needed to clarify causal pathways and inform equitable CVD prevention strategies.