Objective: To understand the association of healthrelated quality of life of middle school students with parental companionship, so as to provide a reference for school and family health education. Methods: From September to November 2023, 4 594 middle school students were selected through convenient sampling from four economic zones in China (Liaoning Province, Beijing City, Sichuan Province, Shanxi Province). Structured questionnaires were used to evaluate healthrelated quality of life among middle school students. The ttest, variance analysis and linear regression were used to analyze the relationship between healthrelated quality of life with parental companionship among middle school students. Results: The average score of healthrelated quality of life among middle school students was (140.99±21.38). There were statistically significant differences in the scores of healthrelated quality life among middle school students in different regions, genders, educational stages, grades, whether they live on campus and parental companionship(F/t=20.73, 8.62,16.71,105.70, -9.51, 52.29, P<0.01). Linear regression analysis showed that students who were living in eastern region, boys, with higher selfevaluation of academic performance, with higher subjective family socioeconomic status, with parental companionship (β=3.19, 4.96, 2.19, 6.11, 3.19), and older students had lower healthrelated quality of life levels (β=-2.34)(P<0.01). Conclusions There are significant regional differences in the healthrelated quality of life levels among middle school students. It is necessary to strengthen the popularization of school health education and focus on students who do not live with their parents on a daily basis to provide more psychological support for them.

Objective: To preliminarily develop Health Literacy Scale for pupils, providing a tool for dynamic monitoring and related health literacy research among pupils. Methods: Through policy and literature review, the health literacy evaluation index system of pupils was established. Through two rounds of expert consultation, the evaluation index system and scale item pool of three levels in primary school were formed, and "Evaluation Scale 1.0" was developed. Through two panel discussions, health education experts, teachers and students were invited to provide advices on the content, expression and structure of scale 1.0, turning it into "Evaluation Scale 2.0", and completing the preliminary development of the scale. Results: The health literacy assessment index system of primary school students includes three levels，including level-1 was Grade 1-2, level-2 was Grade 3-4,level-3 was Grade 5-6, covering two level indexes. The scale for primary school students contained five horizontal dimensions and four vertical dimensions. In the Delphi consultation, the response rate was 100%, and the authority coefficient was 0.85. After item selection and modification, the final version of level-1, level-2 and level-3 scales contained 36, 44 and 50 items respectively. Conclusion The development of Health Literacy Evaluation Scale for pupils has high applicability and practical value.