Acetaminophen is highly accessible yet potentially dangerous when used incorrectly. In attempts to address concerns about acetaminophen, The U.S. Food and Drug Administration (FDA) has identified gaps in evidence about unintentional misuse among adolescents. Therefore, our objectives were to assess: adolescents’: 1) health literacy; 2) knowledge about acetaminophen; 3) recent use of over-the-counter (OTC) medicines; 4) and use of medication dosing instructions to understand the medicine and how to use it (‘acetaminophen skills’).
Subjects and Setting: We conducted a cross-sectional survey of adolescents and young adults (ages 16–23 years) recruited from education settings and health care sites in Monroe County, New York, from 11/08–9/09. Measures: Using structured in-person interviews, we assessed acetaminophen knowledge and recent use of over-the-counter (OTC) medicines. We assessed participants’ ability to identify acetaminophen in OTC products and answer questions about instructions for acetaminophen use through role-plays of everyday health scenarios. We measured health literacy with the Rapid Estimate of Adult Literacy in Medicine (REALM) for participants >18, and the REALM-Teen for those <18.
Confusion about acetaminophen and its use was common. Limited health literacy was an independent risk factor for poor knowledge, misunderstanding, and potential unsafe use of acetaminophen-containing medicines, however, most participants at all health literacy levels erred dangerously in ‘unsafe’ understanding of acetaminophen use from label instructions.
Individuals with limited health literacy may face disproportionate risk of unsafe use of acetaminophen due to confusion and misunderstanding of label information. Better labeling, public health programs, and educational efforts could facilitate safer use of acetaminophen.
Health literacy; patient safety; adolescent medicine use; adolescents; young adults; acetaminophen knowledge; acetaminophen safety; OTC or over the counter medicines; safe use of medicines; acetaminophen risk; FDA Safe Use Initiative
Concerns have been raised about the quality of life and healthcare received by cancer patients at the end-of-life (EOL). Many patients die with pain and other distressing symptoms inadequately controlled, receiving burdensome, aggressive care that worsens quality of life and limits patient exposure to palliative care, such as hospice. Patient-physician communication is likely a very important determinate of EOL care. EOL discussions with physicians are associated with an increased likelihood of: 1. acknowledgement of terminal illness, 2. preferences for comfort care over life-extension, and 3. receipt of less intensive, life-prolonging and more palliative EOL care; while this appears to hold for white patients, it is less clear for black, advanced cancer patients. These results highlight the importance of communication in determining EOL cancer care and suggest that communication disparities may contribute to black-white differences in the EOL care. We review the pertinent literature and discuss areas for future research.
Audience segmentation is a useful tool for designing effective campaigns. Further, the efficiency promised in diffusion science rests to some degree on the existence of adopter categories that can be identified and used to strategically disseminate prevention innovations. This study investigates the potential to identify adopter categories in potential recipients (n = 127) of an innovation to prevent food shortages in Mozambique. A five-class model was found using latent class analysis, but it showed important differences from existing descriptions of adopter categories. Implications for theory and practice are discussed.
Audience segmentation; Adopter categories; Mozambique; Prevention
Scientists are taking advantage of web-based technology to work in new collaborative environments, a phenomenon known as Science 2.0. The National Cancer Institute (NCI) created a web-based tool called HINTS-GEM that allows a diverse group of stakeholders to collaborate in a virtual environment by providing input on content for the Health Information National Trends Survey (HINTS). This involved stakeholders providing new suggested content and commenting and rating on existing content. HINTS is a nationally-representative survey of the US non-institutionalized adult population (see Finney Rutten et al. [this journal] for more information about the HINTS program). This paper describes the conceptual development of HINTS-GEM and provides results of its use by stakeholders in creating an improved survey instrument.
Smoking quitlines, with their demonstrated efficacy and convenience, have become integral to tobacco control efforts in the United States. However, use of quitlines in smoking cessation remains low relative to their potential. To increase quitline use in the United States, a better understanding of current awareness of quitlines is needed. We analyzed data from the 2007 Health Information National Trends Survey (n =7,674) to identify factors associated with awareness and use of quitlines. Data were weighted to provide representative estimates of the adult U.S. population. Of those surveyed, approximately 50% were aware of quitlines (65% of current smokers) and 3.5% had called a quitline (9% of current smokers). Current and former smokers were significantly more likely to be aware of quitlines than never smokers (p < .01). Age, ethnicity, and education were significantly related to quitline awareness. Looking for health information (OR =1.40, CI =1.14–1.73) and having more trust in the government as a source of health information (OR =1.25, CI =1.05–1.48) were associated with awareness. Current smoking status was strongly associated with quitline use (OR =9.25, CI =3.18–26.85). Respondents who looked for health or medical information from any source, had a personal or family history of cancer, and reported psychological distress were more likely to have called a quitline. While awareness of quitlines appears to be high, quitline utilization is low. Implications and future research directions are discussed.
This article examines the relationship between literacy and colorectal cancer (CRC) screening knowledge, beliefs, and experiences, with a focus on fecal occult blood tests (FOBTs). Participants were 975 patients in 8 Louisiana federally qualified health centers. Participants were 50 years of age or older and not up to date with CRC screening; approximately half (52%) had low literacy (less than a 9th-grade level). Participants with low literacy were less likely than were those with adequate literacy to be aware of advertisements promoting CRC screening (58.7% vs. 76.3%, p < .0001) or to believe it was very helpful to find CRC early (74.5% vs. 91.9%, p < .0001). The majority of participants had positive beliefs about the benefits of CRC screening using FOBTs. Participants with low literacy had more perceived barriers to FOBT completion and were more likely to strongly agree or agree that FOBTs would be confusing, embarrassing, or a lot of trouble; however, none of these remained significant in multivariate analyses controlling for relevant covariates. Confidence in being able to obtain an FOBT kit was high among those with low and adequate literacy (89.8% vs. 93.1%, respectively, p = .20); yet multivariate analyses revealed a significant difference in regard to literacy (p = .04) with low-literacy participants indicating less confidence. There was no significant difference by literacy in ever receiving a physician recommendation for CRC screening (38.4% low vs. 39.0% adequate, p = .79); however, multivariate analyses revealed significant differences in FOBT completion by literacy (p = .036). Overall, findings suggest that literacy is a factor in patients’ CRC knowledge, beliefs, and confidence in obtaining a FOBT.
According to the Office of Minority Health, an estimated 4.9 million people living in the United States consider themselves American Indian or Alaska Native (AIAN), either alone or in combination with one or more races/ethnicities. AIAN are a racial/ethnic group experiencing serious health disparities, with very little if any improvement in health outcomes over the last several decades. This study was designed to explore use of the Internet as a health information source among American Indians in the Central Plains region of the United States. Nine hundred and ninety eight Natives in the region were recruited from May 2008 to December 2009 at pow wows, health fairs, through focus groups, career fairs and conferences, and other social and cultural events, and asked to complete a self-administered survey. Although compared with data from the general population, AIAN from our sample may seem heavier Internet users, their use of modern wireless devices is limited, and their usage of Internet to access health information is lower compared to the adult US population. Natives living in the Central Plains region face generational differences in both general and health-related use of the Internet. Inadequate availability of culturally appropriate health information websites may drive AIAN towards search engines and general information websites.
AIAN; health information; online; health disparities; generational divide
Theory-based research is needed to understand how maps of environmental health risk
information influence risk beliefs and protective behavior. Using theoretical concepts from multiple
fields of study including visual cognition, semiotics, health behavior, and learning and memory
supports a comprehensive assessment of this influence. We report results from thirteen cognitive
interviews that provide theory-based insights into how visual features influenced what participants
saw and the meaning of what they saw as they viewed three formats of water test results for private
wells (choropleth map, dot map, and a table). The unit of perception, color, proximity to hazards,
geographic distribution, and visual salience had substantial influences on what participants saw and
their resulting risk beliefs. These influences are explained by theoretical factors that shape what
is seen, properties of features that shape cognition (pre-attentive, symbolic, visual salience),
information processing (top-down and bottom-up), and the strength of concrete compared to abstract
information. Personal relevance guided top-down attention to proximal and larger hazards that shaped
stronger risk beliefs. Meaning was more local for small perceptual units and global for large units.
Three aspects of color were important: pre-attentive “incremental risk” meaning of
sequential shading, symbolic safety meaning of stoplight colors, and visual salience that drew
attention. The lack of imagery, geographic information, and color diminished interest in table
information. Numeracy and prior beliefs influenced comprehension for some participants. Results
guided the creation of an integrated conceptual framework for application to future studies. Ethics
should guide the selection of map features that support appropriate communication goals.
risk communication; visual communication; visual cognition; environmental health; health behavior; hazard proximity
Patients with rare illnesses may use medication information sources that are appreciably different from those used by patients with more common illnesses. This article's purpose is to describe vasculitis patients' most frequently used medication information sources, determine which sources patients perceive as credible, and explore gender differences in source use and perceived credibility. Using an online questionnaire, patients (n=232) indicated how often they obtained medication information from 12 sources during the previous year and rated the credibility of 6 sources. The authors used multivariate analysis of covariance and follow-up contrasts to test for gender differences in source use and conducted t tests to compare patients' perceived credibility ratings. Patients used physicians and the Internet most often to obtain medication information and rated them as the most credible sources. Male patients used their spouse/partner more often and rated them as more credible than did female patients. Female patients were more likely to use medication package inserts and the Internet and were less likely to use nurses than were male patients. There appear to be similarities and differences between the information-seeking behaviors of vasculitis patients and other patient populations. Because male patients view their spouse/partner as a credible information source, providers may want to involve the spouse/partner in prescription decision making.
Dating abuse is a prevalent adolescent health problem with substantial public health consequences. As many as 1 in 10 high school students in the US reports being “hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend” in the past year. We used the Rihanna-Chris Brown dating abuse incident of 2009 as a case study to conduct what is, to our knowledge, the first assessment of media framing of dating abuse. We reviewed the 20 leading U.S. single copy sales magazines published February–April, 2009 and identified 48 relevant articles which were all printed in seven “tabloid” magazines. We conducted a content analysis of the media frames of the articles using five frame categories: (1) Abuse is objectionable; (2) Victim-blaming; (3) Abuse is sexualized/romanticized; (4) Myths about abuse perpetration; and (5) Abuse is normalized. “Abuse is objectionable” was the dominant frame of 40% of articles, “victim-blaming” in 36%. Although the vast majority of articles reviewed (83%) made at least passing reference to the idea that abuse is wrong, a minority (40%) used a dominant frame that condemned abuse. Instead, the majority of articles communicated “mixed messages” about dating abuse, and many minimized the seriousness of partner abuse perpetration. Advocacy is needed to improve future tabloid media framing of dating abuse incidents.
The HEALTHY Study was a 3-year school-based intervention designed to change the behaviors of middle school students to reduce their risk for developing type 2 diabetes mellitus. This report examines the relation between exposure to communications campaign materials and behavior change among students in the HEALTHY intervention schools. Using data from campaign tracking logs and student interviews, the authors examined communications campaign implementation and exposure to the communications campaign as well as health behavior change. Campaign tracking documents revealed variability across schools in the quantity of communications materials disseminated. Student interviews confirmed that there was variability in the proportion of students who reported receiving information from the communication campaign elements. Correlations and regression analysis controlling for semester examined the association between campaign exposure and behavior change across schools. There was a significant association between the proportion of students exposed to the campaign and the proportion of students who made changes in health behavior commensurate with study goals. The results suggest that, in the context of a multifaceted school-based health promotion intervention, schools that achieve a higher rate of exposure to communication campaign materials among the students may stimulate greater health behavior change.
The amount of cancer-related information available in the media and other sources continues to increase each year. We wondered how people make use of such content in making specific health decisions. We studied both the information they actively seek (“seeking”) and that which they encounter in a less purposive way (“scanning”) through a nationally representative survey of adults aged 40–70 years (n=2,489) focused on information use around three prevention behaviors (dieting, fruit and vegetable consumption and exercising) and three screening test behaviors (prostate-specific antigen, colonoscopy, mammogram). Overall, respondents reported a great deal of scanning and somewhat less seeking (on average 62% versus 28% for each behavior), and used a range of sources including mass media, interpersonal conversations and the Internet, alongside physicians. Seeking was predicted by female gender; age of 55–64 vs. 40–44; higher education; Black race and Hispanic ethnicity and being married. Scanning was predicted by older age, female gender and education. Respondents were fairly consistent in their place on a typology of scanning and seeking across behaviors. Seeking was associated with all six behaviors and scanning was associated with three of six behaviors.
Cancer; information seeking; scanning
Text messaging programs on mobile phones have shown some promise in helping people quit smoking. Text2Quit is an automated, personalized and interactive mobile health program that sends text messages and emails timed around a participant’s quit date over the course of 3 months. The text messages include pre- and post-quit educational messages, peer ex-smoker messages, medication reminders and relapse messages, as well as multiple opportunities for interaction. Study participants were university students (n=23) enrolled in the Text2Quit program. Participants were surveyed at baseline and at 2 and 4 weeks post-enrollment. The vast majority of participants agreed that they liked the program at 2 and 4 weeks post-enrollment (90.5% and 82.3%, respectively). Support for text messages was found to be moderate, and higher than that of the email and web components. Seventy-five percent of participants reported reading most or all of the texts. On average, users made 11.8 responses to the texts over a 4 week period, although responses declined following the quit date. The interactive feature for tracking cigarettes was the most used interactive feature, followed by the craving trivia game. This pilot test provides some support for the Text2Quit program. A future iteration of the program will include additional tracking features in both the pre-quit and post-quit protocol and an easier entry into the not-quit protocol. Future studies are recommended that identify the value of the interactive and personalized features that characterize this program.
Companies need to maintain a good reputation to do business; however, companies in the infant formula, tobacco, and processed food industries have been identified as promoting disease. Such companies use their websites as a means of promulgating a positive public image, thereby potentially reducing the effectiveness of public health campaigns against the problems they perpetuate. The author examined documents from the websites of Philip Morris, Kraft, and Nestlé for issue framing and analyzed them using Benoit’s typology of corporate image repair strategies. All three companies defined the problems they were addressing strategically, minimizing their own responsibility and the consequences of their actions. They proposed solutions that were actions to be taken by others. They also associated themselves with public health organizations. Health advocates should recognize industry attempts to use relationships with health organizations as strategic image repair and reject industry efforts to position themselves as stakeholders in public health problems. Denormalizing industries that are disease vectors, not just their products, may be critical in realizing positive change.
Little research has examined the antecedent characteristics of patients most likely to seek online cancer information. This study employs the Cognitive-Social Health Information Processing (C-SHIP) model as a framework to understand what psychosocial characteristics precede online cancer-related information seeking among rural breast cancer patients who often have fewer healthcare providers and limited local support services. Examining 144 patients who were provided free computer hardware, Internet access and training for how to use an Interactive Cancer Communication System, pre-test survey scores indicating patients’ psychosocial status were correlated with specific online cancer information seeking behaviors. Each of the factors specified by the C-SHIP model had significant relationships with online cancer information seeking behaviors with the strongest findings emerging for cancer-relevant encodings and self-construals, cancer-relevant beliefs and expectancies and cancer-relevant self-regulatory competencies and skills. Specifically, patients with more negative appraisals in these domains were more likely to seek out online cancer information. Additionally, antecedent variables associated with the C-SHIP model had more frequent relationships with experiential information as compared to didactic information. This study supports the applicability of the model to discern why people afflicted with cancer may seek online information to cope with their disease.
Research from several fields has explored health literacy as a multidimensional construct. The authors’ multimethod study, “The Impact of Cultural Differences on Health Literacy and Chronic Disease Outcomes,” assessed health literacy and chronic disease self-management among 296 patients from four ethnic groups (Vietnamese, African American, White, Latino) at a Massachusetts community health center between 2006 and 2010. Health literacy was assessed using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Adult Literacy in Medicine (REALM), and the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA) measures. Qualitative research methods, including in-depth interviews (n = 34), home visits (n = 12), chronic disease diaries (n = 15), and focus groups (n = 47), were completed with a subset of participants. Qualitative interviews indicated a wide range of interpretations of S-TOFHLA questions in which participants substituted their own illness or health care experiences for the abstract examples offered in the instrument, at times leading to incorrect responses. Situating these responses in a broader social and cultural context, this article describes examples of the wide range of chronic disease self-management abilities among participants with limited education and/or low health literacy. It also discusses the culturally variable health beliefs identified among participants interviewed that may play important roles in their chronic disease self-management practices.
After hospital discharge, patients commonly suffer potentially avoidable adverse events and hospital readmissions. As hospitals implement interventions to improve discharge transitions, it is important to understand patients’ perspectives on which intervention components are most beneficial. We examined a sample of 125 patients randomized to the intervention arm of the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study who completed a telephone survey about the helpfulness of different components of the PILL-CVD intervention, which included medication reconciliation, inpatient counseling, simple adherence aids, and telephone follow-up. The majority of patients indicated it was “very helpful” to speak with a pharmacist about their medications before discharge (72.8%), particularly about how to take the medications, and how to prevent and manage side effects. Receiving an illustrated medication list (69.6%) and follow-up phone call after discharge (68.0%) were also considered very helpful. Patients with limited health literacy indicated the greatest benefit. Patients also reported feeling more comfortable speaking with their outpatient providers about their medications after receiving the intervention. In conclusion, patients – particularly those with limited health literacy – found a hospital pharmacist-based intervention to be very helpful and empowering.
care transitions; hospital discharge; health literacy; pharmacist
Inadequate health literacy and limited English proficiency are associated with poor health care access and outcomes. Despite what appears to be an interaction phenomenon—whereby the rate of inadequate health literacy is particularly high among limited English proficiency populations—researchers in health literacy and limited English proficiency rarely collaborate. As a result, few health literacy instruments and interventions have been developed or validated for smaller linguistic populations. Interventions to improve health outcomes for people with low health literacy and limited English proficiency show great potential to alleviate many of the health disparities currently experienced by some of the most disenfranchised individuals in our health care system, those from smaller linguistic minority groups, including Deaf American Sign Language users. It is critical for health literacy and limited English proficiency researchers to work together to understand how culture, language, literacy, education, and disabilities influence health disparities and health outcomes. It is important to ensure that research is collaborative and inclusive in order to broaden the reach of future interventions to smaller linguistic minority populations.
Most health literacy assessments evaluate literacy skills including reading, writing; numeracy and interpretation of tables, graphs, diagrams and charts. Some assess understanding of health systems, and the ability to adequately apply one’s skills to specific health-related tasks or demands in health situations. However, to achieve functional health literacy, the ability to “obtain, process, and understand basic health information and services needed to make appropriate health decisions,” other health literacy dimensions should be assessed: a person’s knowledge and attitudes about a health issue affects his or her ability to and interest in participating in his or her own care. In patient care settings, the abilities to listen, ask questions and check one’s understanding are crucial to making appropriate decisions and carrying out instructions. Although literacy is a skill associated with educational attainment and therefore difficult to change in a short time, health education interventions can address health literacy domains such as knowledge, attitudes and oral communication skills. For this reason, an instrument that can assess these constructs is a valuable part of a health educator’s toolbox. The authors describe the development and process and outcomes of testing a novel instrument targeted to assess HPV and cervical cancer health literacy competencies, TALKDOC, including its validation with the Health Activities Literacy Scale.
While low health literacy and suboptimal medication adherence are more prevalent in racial/ethnic minority groups than Whites, little is known about the relationship between these factors in adults with diabetes, and whether health literacy or numeracy might explain racial/ethnic disparities in diabetes medication adherence. Previous work in HIV suggests health literacy mediates racial differences in adherence to anti-retroviral treatment, but no study to date has explored numeracy as a mediator of the relationship between race/ethnicity and medication adherence. This study tested whether health literacy and/or numeracy were related to diabetes medication adherence, and whether either factor explained racial differences in adherence. Using path analytic models, we explored the predicted pathways between racial status, health literacy, diabetes-related numeracy, general numeracy and adherence to diabetes medications. After adjustment for covariates, African American race was associated with poor medication adherence (r=−0.10, p<0.05). Health literacy was associated with adherence (r=.12, p<0.02), but diabetes-related numeracy and general numeracy were not related to adherence. Furthermore, health literacy reduced the effect of race on adherence to non-significance, such that African American race was no longer directly associated with less medication adherence (r=−0.09, p=.14). Diabetes medication adherence promotion interventions should address patient health literacy limitations.
Health literacy; numeracy; diabetes; medication adherence; disparities
Despite the benefits and growing availability of online cancer support groups, many breast cancer patients still do not actively participate in the support groups. To better understand cancer patients’ online information and support seeking behaviors, this study explores how various social and psychological characteristics predict different levels of engagement with an online breast cancer support group: posters, lurkers, and non-users. The study sample included 231 recently diagnosed breast cancer patients. Data included baseline survey scores of demographic, disease-related, and psychosocial factors and automatically collected discussion group use data over the 4-month intervention. Patterns of engagement with the cancer support group differed according to the patients’ characteristics, suggesting that (1) cancer patients have very different orientations to and engagement with an online support group, and (2) ‘deficits’ in social and psychological resources may not be barriers to participation in a cancer support group, but rather motivators to interact with other patients. Theoretical and practical implications of the findings are discussed.
Internet use is widespread, but little is known about Internet use for cancer information among Latinos, especially those who rely on safety net clinics. The authors investigated access to and intended use of the Internet for cancer information among low income, immigrant Latinos predominately from Central and South America. A cross-sectional study of 1,273 Latinos 21 years and older attending safety net clinics or health fairs was conducted from June 2007 to November 2008. The authors used logistic regression models to evaluate associations of age, acculturation, psychosocial factors and other covariates with Internet access and intended use of the Internet for cancer information among those with access. Of the sample, 44% reported Internet access. Higher information self-efficacy and greater trust in the Internet were independently associated with Internet access (p= .05 and p < .001, respectively). Among those with access, 53.8% reported they intended to seek cancer help online if they needed information. Those with younger age and higher acculturation, education and self-efficacy had higher odds of intended Internet use for cancer information, considering covariates. In addition, those with high (vs. low) perceived risk of cancer (OR = 1.76; 95% CI [1.14, 2.73]; p = .01) and higher levels of trust in online health information (OR = 1.47 per one-point increase; 95% [CI 1.19, 1.82]; p = .0004) were more likely to intend to seek cancer information online. These findings that Internet access is fairly high in the immigrant Latino population and that the Internet is a trusted source of cancer information suggest that the Internet may be a channel for cancer control interventions.
Social support in computer-mediated settings is an important variable in health communication research, yet little is known about the factors that influence the amount of social support one gives and receives in online support groups. To shed some light on this issue, the authors examined demographics, disease-related factors, psychosocial factors, and strategies for coping with breast cancer as potential determinants of which patients provide support to others and which ones consume it. Data collected from 177 participants in the Comprehensive Health Enhancement Support System “Living With Breast Cancer” program revealed that individuals who are younger, have higher levels of positive reframing, and lower levels of self-blame are more likely to provide emotional support in online settings. In contrast, individuals who are more educated, have less perceived availability of social support, and have lower levels of religious coping are more likely to receive emotional support from others. The authors discuss the theoretical and practical implications for providing effective psychosocial support for women with breast cancer.