Thank you, Rima, for addressing this topic! The data does support a great need for focusing on continued education for a much larger portion of our population than most people would assume necessary. The figures that struck me most relating to education were these:

Percentages of people scoring in the lowest level of HALS (Health Activity Literacy Scale):
48% of those who didn't complete high school
14% of high scool graduates
4% of those educated beyond high school

To what degree is this educational disparity the reason for the inequities of health literacy skills for Hispanics as compared to other minoritites and whites? Do Hispanics have a correspondingly low incidence of graduating from high school? 

All the best,
Julie

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> "Rima Rudd" <RRUDD at hsph.harvard.edu> 12/07/06 4:04 PM >>>

Hi,
This posting does not directly address all the issues Julie brings to the table. However, I do think the following is relevant to the discussion.
I bring your attention to the health literacy analysis done by Rudd, Kirsch, Yamamoto in 2004 - based on data from the NALS (1992). We focused on all (191) items and tasks on the 1992 NALS that related to health (health promotion, health protection, disease prevention, health care and maintenance, health systems navigation). You can link to this report [Literacy and Health in American, Educational Testing Services] via my web page: www.hsph.harvard.edu/healthliteracy under the policy button. 

The following paragraphs related to different population groups are from our 2004 analysis where we differentiated between US born and foreign born adults. Please recall that the scoring for the adult literacy surveys ranged from 0 to 500. The average score for high school graduates in the US in 1992 was ~273 [upper range of NALS Level 2]. Recall too that literacy scores did NOT improve between 1992 and 2003.


>From the report Literacy and Health in America:

++When nativity is considered, the average HALS proficiency for adults born in the United States is 278 compared to the overall average of 272.  HALS proficiency scores among non native-born adults are significantly below that of the native-born adult population.  The average proficiency of European Americans (White) on the HALS is significantly higher than are the average proficiency of African Americans (Black), Spanish Americans (Hispanic), and other groupings of adults living in America. African American adults have an average HALS score of 239 and Spanish American adults have an average of 217. However, among Spanish American adults born in the U.S., the average HALS score is 256. 

Findings indicate that adults with limited health literacy proficiencies are generally those who have not completed high school or obtained a GED, have health-related restrictions on their ability to attend school or work, are members of minority or marginalized population groups, and/or who have immigrated to the United States.  Furthermore, those with limited health literacy proficiencies are likely to report living in poverty with no income from savings, dividends, or retirement.++


I need to add that I am not terribly comfortable breaking out scores by “group” because doing so implies that we are talking about group characteristics. I feel strongly that we must first offer an historical context and discuss the biases and discriminatory practices in housing, schooling, and occupational opportunities related to various population groups in the US. In addition, we must consider issues related to immigration. Some immigrants come from countries where access to school is limited or completely denied.    

As you examine the report from the NAAL study, keep in mind that the NALS (1992) and the NAAL (2003) both followed the same basic schema for measuring literacy [adults’ proficiencies in the use of print materials to accomplish everyday tasks]. However, the findings are not directly comparable because of a number of changes that were made the sampling parameter, to the performance levels used to identify and characterize the participants, and in the level set for the probability of doing a task correctly. In brief, the analysis of the NAAL data does not include three percent of the population who were unable to answer a background questionnaire because of inability to read in English or in Spanish or because of a mental disability. Next, new performance levels, deemed more appropriate and useful for education policy, were used instead of the NALS 1 through 5 levels.  The new levels are labeled below basic, basic, intermediate, and proficient. These labels were developed to help adult education policy makers to identify performance levels and needed programs. In essence, the majority of US adults need additional schooling opportunities to become proficient in the use of everyday print materials (including those at the intermediate level). Finally, while the NALS mapped items to a performance level of 80 percent likelihood of getting an item correct, the NAAL used the 67 percent probability convention.

I hope this is useful,
Rima Rudd




Rima E. Rudd, ScD, MSPH
Department of Society, Human Development & Health
Harvard School of Public Health
677 Huntington Avenue
Boston MA 02115
Phone: 617 432 1135
fax:     617 432 3123
web:    www.hsph.harvard.edu/healthliteracy
www.hsph.harvard.edu/sisterstogether
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