Abstract: Objective: To examine the influence relationships and mechanism among physical education teachers' health education literacy, the implementation quality of health education curriculum, and students' health literacy. Methods: A total of 614 valid questionnaires were collected from 640 middle school students at institutions designated as part of the first batch of national healthy school construction units approved by the Ministry of Education. Structural equation modeling (SEM) and the bias-corrected Bootstrap method were employed for data analysis. Results: Physical education teachers' health education literacy directly and positively influences both students' health literacy and the implementation quality of health education curriculum. The implementation quality of health education curriculum significantly and positively promotes students' health literacy. Furthermore, the implementation quality of health education curriculum exhibits a partial mediation effect between physical education teachers' health education literacy and students' health literacy. Conclusions: The implementation quality of health education curriculum plays a critical role when physical education teachers' health education literacy positively predicts students' health literacy. However, the implementation quality of health education curriculum is constrained by the level of pedagogical content knowledge (PCK) in health education possessed by physical education teachers. Therefore, it is imperative to accelerate the improvement of health education-related curriculum systems during the pre-service training stage for physical education teachers, strengthen thematic health education training during their in-service professional development, and establish evaluation standards and monitoring mechanisms for health education curricula to ensure the effective enhancement of students' health literacy levels.

Key words: physical education teachers, health education, health literacy, pre-service teachers, mediation effect