(1) Background: There is a need for studies on population-level health literacy (HL) to identify the current state of HL within and between countries. We report comparative findings from 10 European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) on adolescents' HL and its associations with gender, family affluence (FAS), and self-rated health (SRH). (2) Methods: Representative data (N = 14,590; age 15) were drawn from the HBSC (Health Behavior in School-Aged Children) study. The associations between HL, gender, FAS, and SRH were examined via path models. (3) Results: The countries exhibited differences in HL means and in the range of scores within countries. Positive associations were found between FAS and HL, and between HL and SRH in each country. Gender was associated with differences in HL in only three countries. HL acted as a mediator between gender and SRH in four countries, and between FAS and SRH in each country. (4) Conclusions: The findings confirm that there are differences in HL levels within and between European countries, and that HL does contribute to differences in SRH. HL should be taken into account when devising evidence-informed policies and interventions to promote the health of adolescents.

Department of Humanization in Medicine and Sexology Collegium Medicum University of Zielona Gora and Institute of Mother and Child in Warsaw 65 729 Zielona Góra Poland

Department of Recreation and Leisure Studies Faculty of Physical Culture Palacky University Olomouc 779 00 Olomouc Czechia

Department of Teacher Education University Of Jyväskylä 40014 Jyväskylä Finland

Faculty of Sport and Health Sciences Research Center for Health Promotion University of Jyväskylä 40014 Jyväskylä Finland

Institute of Biology and Ecology Faculty of Science Pavol Jozef Safarik University 040 01 Košice Slovakia

Institute of Sport Science Education and Health Research Eberhard Karls University Tübingen 72074 Tübingen Germany

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