The impact of digital health literacy on marriage-and-childbearing anxiety among Chinese youth of reproductive age.

Introduction: In the digital era, information on marriage and childbearing is predominantly accessed online, yet the coexistence of information overload and misinformation may amplify anxiety among reproductive-aged young adults. This study investigates the impact and underlying mechanisms of digital health literacy (DHL) on marriage-and-childbearing anxiety (MCA), aiming to provide empirical evidence for alleviating this growing concern. Methods: An empirical analysis was conducted using survey data from 748 reproductive-aged young adults. Multiple econometric methods were employed to ensure robustness: ordinary least squares (OLS) regression and ordered Probit models for baseline estimates, instrumental variable two-stage least squares (2SLS) to address endogeneity, and formal mediation tests to examine indirect effects. Results: First, DHL exhibits a significant negative effect on MCA, which remains stable after robustness checks and endogeneity correction. Second, information cognition, risk perception, and social support serve as three key mediating pathways linking DHL to MCA, with risk perception playing the most prominent role. Third, the protective effect of DHL against MCA shows significant heterogeneity across gender, household registration type, income level, urban classification tiers, and different dimensions of DHL. Discussion: These findings elucidate the mechanisms through which DHL influences MCA and provide targeted theoretical and empirical support for developing evidence-based interventions to reduce marriage-and-childbearing anxiety among young adults in the digital era.