Association between occupational health literacy and anxiety among furniture manufacturing workers: a cross-sectional study in Guangdong, China

Anxiety has become an increasing concern in occupational health. Furniture manufacturing workers face multiple risks that may heighten anxiety susceptibility, yet evidence linking occupational health literacy (OHL) to anxiety in this population remains scarce. This study examined the association between OHL and anxiety among furniture workers in Guangdong, China. A cross-sectional study was conducted using a stratified cluster random sampling design to select enterprises (4 large, 12 medium, 44 small/micro), and 2,666 workers were enrolled. OHL was assessed using the National Occupational Health Literacy Surveillance Questionnaire. Anxiety was evaluated using the 7-item Generalized Anxiety Disorder Scale (GAD-7), with a cut-off of ≥ 5 indicating anxiety. A sensitivity analysis was performed using a cut-off score of ≥ 10 to define moderate-to-severe anxiety. Binary logistic regression adjusted for confounders, with subgroup analyses and interaction tests for effect modification. The prevalence of adequate OHL was 45.7%, and anxiety prevalence was 17.9% (GAD ≥ 5). After adjusting for covariates, adequate OHL was significantly negatively associated with anxiety (adjusted odds ratio [aOR] = 0.633, 95% confidence interval [CI]: 0.511–0.784, P < 0.001). This inverse association remained significant in sensitivity analysis (GAD-7 ≥ 10, aOR = 0.646, 95% CI: 0.423–0.986, P = 0.043). Stronger inverse associations were observed among workers with ≤ 5 years of employment (OR = 0.52, 95% CI: 0.40–0.68), monthly incomes of 3,000 to < 5,000 yuan (OR = 0.71, 95% CI: 0.52–0.97) or 5,000 to < 7,000 yuan (OR = 0.51, 95% CI: 0.35–0.73), weekly working hours of ≤ 40 h (OR = 0.48, 95% CI: 0.31–0.72) or > 40–44 h (OR = 0.41, 95% CI: 0.24–0.68), and those without night work (OR = 0.64, 95% CI: 0.5–0.81). Working years and weekly working hours significantly modified the association between OHL and anxiety (both P < 0.05). OHL was significantly associated with anxiety among furniture manufacturing workers, particularly among those with ≤ 5 years of employment and those working ≤ 44 h per week. Strengthening OHL training for new employees and regulating working hours may inform targeted mental health promotion strategies in this occupational group.