Andres, Neil--

	I want to pick up on both your comments.

	The unit of analysis it seems to me can be the community, or in rural  
areas, the region. We are talking about complex public health issues.   
An example, which some of you doubtless know about--at the Boston  
Medical Center, help to the health of the family goes through the  
child, first by giving the child a story book at each visit, then by  
having on the team doctors and lawyers who can judge whether or not the  
child's apartment is itself healthy--does it meet code standards.  If  
it doesn't, then legal pressure is applied.


Andrea




On Sep 18, 2007, at 10:41 PM, Neil Izenberg wrote:


> May I add another dimension to this interesting discussion?

>  

> We at the Nemours Foundation Center for Children's Health Media have  

> been pondering the concept of health literacy as it applies to  

> children and adolescents for some time. Although we're part of an  

> academic pediatric clinical program (based at the Alfred I. duPont  

> Hospital for Children], we tend to take a practical approach, looking  

> at the issue of health literacy more as a matter of health (and  

> science) comprehension rather than as a strict "literacy" issue. It's  

> really an understandability issue - and that can be complex.

>  

> [As backgrounder, for the past 15 years, we create KidsHealth.org,  

> which has separate areas for adults, adolescents, and kids. Much of  

> the English-language site's content is also in Spanish at the three  

> levels, as well. The site gets about 120 million visits/year and is  

> the most visited site about children's health and one of the top dozen  

> health sites online. To date we've had over a half billion visits].

>  

> From time to time we're asked about the "literacy levels" of the site  

> (by which the questioner usually means what "grade level" score would  

> pop up were the site to be analyzed with the various rapid tools  

> available that emphasize such things as sentence length, number of  

> polysyllabic words, etc). Such measurements, though satisfyingly  

> simple, can be somewhat deceptive, since part of the goal of the  

> content can be to include, define, and explain such polysyllabic words  

> - putting them into context. Good content development might take  

> something seeminly complex and explain in a systematic way.  In  

> addition, lower grade level content does not necessarily mean that the  

> process is well explained - or even accurate for that matter.

>  

> Add into the mix that explanations need ideally to take into account  

> age-related developmental, emotional, and experential issues of  

> children and you really have a nice challenge.

>  

> Neil Izenberg

>  

> Neil Izenberg, M.D.

> Chief Executive

> Nemours Center for Children's Health Media

> Nemours Foundation

> Editor-in-Chief, KidsHealth.org

> Pediatrician, Alfred I. duPont Hospital for Children, Wilmington, DE

> Professor, Pediatrics

> Jefferson Medical School, Philadelphia

>  

>  

>  

>  

>  

>

>  

>> ----- Original Message -----

>> From: Andrea Wilder

>> To: The Health and Literacy Discussion List

>> Sent: Tuesday, September 18, 2007 5:17 PM

>> Subject: [HealthLiteracy 1224] Re: (no subject)

>>

>> Hi again, Mark,

>>

>> What about low literate adults whose first language is English? How  

>> are increases in literacy related to their health? Why I ask--in some  

>> cultures there has been measured a direct (causal) relationship  

>> between literacy in women and lower fertility, that is, fewer  

>> children and more of them survive to adulthood.

>>

>> In this country, do you see any direct relationships such as this  

>> between literacy and health? I am thinking of "health" in a public  

>> health manner--health outcomes which affect the whole community. If  

>> there is not a direct relationship, is there a literacy variable that  

>> would plug into a regression equation, as one factor among several,  

>> that leads to socially desired outcomes? --as: fewer children,  

>> healthier children, higher income, and so on.

>>

>> Thanks very much.

>>

>> Andrea

>>

>>

>>

>> On Sep 18, 2007, at 9:41 AM, Kutner, Mark wrote:

>>

>>

>>> There is a close relationship between health and literacy, just as  

>>> there is a close relationship between literacy and income, which I  

>>> imagine does not surprise any of us.

>>>  

>>>

>>> I very much enjoyed your characterization of the relationship  

>>> between health and literacy as a "distinction without a  

>>> difference."  To me this distinction without a difference  

>>> underscores the need to incorporate health literacy-related  

>>> materials within our adult education and literacy programs,  

>>> especially in ESL programs.  The NAAL data really documents the  

>>> challenges faced by adults whose first language is not English.

>>>

>>> From: healthliteracy-bounces at nifl.gov  

>>> [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Andrea Wilder

>>> Sent: Monday, September 17, 2007 1:29 PM

>>> To: The Health and Literacy Discussion List

>>> Subject: [HealthLiteracy 1201] Re: (no subject)

>>>

>>> Hi Mark,

>>>

>>> first, I apologize for not ahvng at my fingertips more information  

>>> about the NAAL, but here goes:

>>>

>>> 1) is there a relationship between health and literacy?

>>> 2) If so, what is it?

>>>

>>> 3) What is the relationship between health literacy and literacy? (A  

>>> distinction without a difference?)

>>>

>>> Thanks.

>>>

>>> Andrea

>>>

>>>

>>> On Sep 17, 2007, at 12:05 PM, Kutner, Mark wrote:

>>>

>>>> Good morning all.  Cynthia Baur and I are very much looking forward  

>>>> to answering any questions or issues that you might have related to  

>>>> the health literacy component and report!of the National Assessment  

>>>> of Adult Literacy (NAAL).  Just as way of introduction, from 1999  

>>>> through last December I was the project director for the design,  

>>>> analysis, and reporting component of NAAL.  In that role, I worked  

>>>> with Cynthia in developing the health literacy component of NAAL.   

>>>> The health literacy items also had to be prose, document, and  

>>>> quantitative items so that they could also be placed on the NAAL  

>>>> scale.  The health literacy items were field tested before being  

>>>> included on the national study.  As we discuss the health literacy  

>>>> component, it is important to remember that the NAAL was  

>>>> administered in the homes of individuals, not in a doctor's office  

>>>> or emergency room.

>>>> In case folks are shy, I want to pose a couple of questions to all  

>>>> of you: 

>>>> 1. As an individual who has been involved in adult literacy and  

>>>> assessment for almost 20 years, I am curious to hear you  

>>>> perspectives about the difference between measuring literacy and  

>>>> health literacy, especially when the definition of health literacy  

>>>> (which we used from HHS) does not indicate any prior substantive  

>>>> knowledge of health-related issues (such as I take aspirin for  

>>>> headaches). 

>>>> 2. Also, NAAL highlights the challenges of improving health  

>>>> literacy for adults whose first language is not English.  What  

>>>> evidence do we have about successful approaches to ensure that the  

>>>> health literacy for these adults improves?

>>>>

>>>> As we begin these discussions, I want to clearly acknowledge that  

>>>> there would never have been a health literacy component of NAAL if  

>>>> it was not for the hard work, perseverance,  stubbornness of  

>>>> Cynthia Baur. For me, working with Cynthia on the health literacy  

>>>> component has been a real joy.  The field is quite fortunate to be  

>>>> able to benefit from her leadership!.

>>>>

>>>> ----------------------------------------------------

>>>> National Institute for Literacy

>>>> Health and Literacy mailing list

>>>> HealthLiteracy at nifl.gov

>>>> To unsubscribe or change your subscription settings, please go to  

>>>> http://www.nifl.gov/mailman/listinfo/healthliteracy

>>>> Email delivered to

>>>> andreawilder at comcast.net-------------------------------------------- 

>>>> --------

>>> National Institute for Literacy

>>> Health and Literacy mailing list

>>> HealthLiteracy at nifl.gov

>>> To unsubscribe or change your subscription settings, please go to  

>>> http://www.nifl.gov/mailman/listinfo/healthliteracy

>>> Email delivered to  

>>> andreawilder at comcast.net--------------------------------------------- 

>>> -------

>> National Institute for Literacy

>> Health and Literacy mailing list

>> HealthLiteracy at nifl.gov

>> To unsubscribe or change your subscription settings, please go to  

>> http://www.nifl.gov/mailman/listinfo/healthliteracy

>> Email delivered to  

>> izenberg at kidshealth.org----------------------------------------------- 

>> -----

> National Institute for Literacy

> Health and Literacy mailing list

> HealthLiteracy at nifl.gov

> To unsubscribe or change your subscription settings, please go to  

> http://www.nifl.gov/mailman/listinfo/healthliteracy

> Email delivered to andreawilder at comcast.net

-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: text/enriched
Size: 11996 bytes
Desc: not available
Url : http://www.nifl.gov/pipermail/healthliteracy/attachments/20070919/953ab85e/attachment.bin