Lindsay Rosenfeld

Beyond Reading Alone: The Relationship Between Aural Literacy And Asthma Management

OBJECTIVES to examine the relationship between literacy and asthma management with a focus on the oral exchange. METHODS study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression. RESULTS in bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR: 4.37, 95%CI: 1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management. CONCLUSION lower aural literacy skills seem to complicate asthma management capabilities. PRACTICE IMPLICATIONS greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management.

Literacy Skills and Calculated 10-Year Risk of Coronary Heart Disease

BackgroundCoronary heart disease (CHD) is a leading cause of morbidity and mortality. Reducing the disease burden requires an understanding of factors associated with the prevention and management of CHD. Literacy skills may be one such factor.ObjectivesTo examine the independent and interactive effects of four literacy skills: reading, numeracy, oral language (speaking) and aural language (listening) on calculated 10-year risk of CHD and to determine whether the relationships between literacy skills and CHD risk were similar for men and women.DesignWe used multivariable linear regression to assess the individual, combined, and interactive effects of the four literacy skills on risk of CHD, adjusting for education and race.ParticipantsFour hundred and nine English-speaking adults in Boston, MA and Providence, RI.MeasuresTen-year risk of coronary heart disease was calculated using the Framingham algorithm. Reading, oral language and aural language were measured using the Woodcock Johnson III Tests of Achievement. Numeracy was assessed through a modified version of the numeracy scale by Lipkus and colleagues.Key ResultsWhen examined individually, reading (p = 0.007), numeracy (p = 0.001) and aural language (p = 0.004) skills were significantly associated with CHD risk among women; no literacy skills were associated with CHD risk in men. When examined together, there was some evidence for an interaction between numeracy and aural language among women suggesting that higher skills in one area (e.g., aural language) may compensate for difficulties in another resulting in an equally low risk of CHD.ConclusionsResults of this study not only provide important insight into the independent and interactive effects of literacy skills on risk of CHD, they also highlight the need for the development of easy-to use assessments of the oral exchange in the health care setting and the need to better understand which literacy skills are most important for a given health outcome.

Are Neighborhood-Level Characteristics Associated with Indoor Allergens in the Household?

Background: Individual home characteristics have been associated with indoor allergen exposure; however, the influence of neighborhood-level characteristics has not been well studied. We defined neighborhoods as community districts determined by the New York City Department of City Planning. Objective: We examined the relationship between neighborhood-level characteristics and the presence of dust mite (Der f 1), cat (Fel d 1), cockroach (Bla g 2), and mouse (MUP) allergens in the household. Methods: Using data from the Puerto Rican Asthma Project, a birth cohort of Puerto Rican children at risk of allergic sensitization (n = 261), we examined associations between neighborhood characteristics (percent tree canopy, asthma hospitalizations per 1,000 children, roadway length within 100 meters of buildings, serious housing code violations per 1000 rental units, poverty rates, and felony crime rates), and the presence of indoor allergens. Allergen cutpoints were used for categorical analyses and defined as follows: dust mite: >0.25 μg/g; cat: >1 μg/g; cockroach: >1 U/g; mouse: >1.6 μg/g. Results: Serious housing code violations were statistically significantly positively associated with dust mite, cat, and mouse allergens (continuous variables), adjusting for mothers income and education, and all neighborhood-level characteristics. In multivariable logistic regression analyses, medium levels of housing code violations were associated with higher dust mite and cat allergens (1.81, 95%CI: 1.08, 3.03 and 3.10, 95%CI: 1.22, 7.92, respectively). A high level of serious housing code violations was associated with higher mouse allergen (2.04, 95%CI: 1.15, 3.62). A medium level of housing code violations was associated with higher cockroach allergen (3.30, 95%CI: 1.11, 9.78). Conclusions: Neighborhood-level characteristics, specifically housing code violations, appear to be related to indoor allergens, which may have implications for future research explorations and policy decisions.

Patient Activation and Advocacy: Which Literacy Skills Matter Most?

Attention to the effect of a patients literacy skills on health care interactions is relatively new. So, too, are studies of either structural or personal factors that inhibit or support a patients ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the United States increasingly requires a proactive stance. This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy—a component of health literacy itself—when faced with a hypothetical barrier to scheduling a medical appointment. Although all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.

Health Literacy: A New Area of Research With Links to Communication

The nascent but expanding field of health literacy research contributes to our understanding of the determinants of health. Over the past 10 years, health researchers, practitioners, and policymakers have been attentive to the links between a persons literacy skills and health outcomes, where lower literacy skills are most often associated with poorer health outcomes. However, there is growing attention to the substantial mismatch between existing literacy skills and the expectations of the health sector; this mismatch likely plays a part in such poor health outcomes. As researchers and practitioners in health literacy are examining efficacious actions, they are recognizing the need for collaborative work with those in education and in health communication. This article focuses on the developments in the field of health literacy studies and makes an argument for collaborative efforts among such professionals who have thus far charted relatively independent courses.

The New York City Puerto Rican Asthma Project: Study Design, Methods, and Baseline Results

Objective. We examined asthma risk factors among 274 Puerto Rican children born in New York to atopic mothers. Methods. We prospectively followed the cohort to measure aeroallergens in their homes and assess allergic sensitization. Baseline data are presented. Results. Maternal smoking was significantly higher among women born on the continental United States (25%) vs. those born elsewhere (11%). Cat ownership was more frequent among mainland-born women (15%) compared with those born in Puerto Rico (4%). While some aeroallergens were prevalent, few dust samples contained detectable dust mite allergens. Conclusions. By following this cohort, we hope to identify the roles that socio-cultural factors play in the process of allergic sensitization.

Which literacy skills are associated with smoking

Background Research has demonstrated associations between smoking and reading skills, but other literacy skills such as speaking, listening and numeracy are less studied despite our dependence on the use of numbers and the oral exchange to deliver information on the risks of smoking. Methods The authors used multivariable logistic regression to examine the effects of reading, numeracy, speaking and listening skills on: (1) becoming a regular smoker and (2) smoking cessation. Further, multivariable linear regression was used to examine the relation between literacy skills and amount smoked among current smokers. Models controlled for education, gender, age, race/ethnicity, income and, when relevant, age at which they became a regular smoker. Results For each grade equivalent increase in reading skills, the odds of quitting smoking increased by about 8% (OR=1.08, 95% CI 1.01 to 1.15). For every point increase in numeracy skills, the odds of quitting increased by about 24% (OR=1.24, 95% CI 1.06 to 1.46). No literacy skills were associated with becoming a regular smoker or current amount smoked. Conclusion The ability to locate, understand and use information related to the risks of smoking may impact ones decision to quit. Messaging should be designed with the goal of being easily understood by all individuals regardless of literacy level.

Implementation of Competitive Food and Beverage Standards in a Sample of Massachusetts Schools: The NOURISH Study (Nutrition Opportunities to Understand Reforms Involving Student Health)

BACKGROUND During 2012, Massachusetts adopted comprehensive school competitive food and beverage standards that closely align with Institute of Medicine recommendations and Smart Snacks in School national standards. OBJECTIVE We examined the extent to which a sample of Massachusetts middle schools and high schools sold foods and beverages that were compliant with the state competitive food and beverage standards after the first year of implementation, and complied with four additional aspects of the regulations. DESIGN Observational cohort study with data collected before implementation (Spring 2012) and 1 year after implementation (Spring 2013). PARTICIPANTS/SETTING School districts (N=37) with at least one middle school and one high school participated. MAIN OUTCOME MEASURES Percent of competitive foods and beverages that were compliant with Massachusetts standards and compliance with four additional aspects of the regulations. Data were collected via school site visits and a foodservice director questionnaire. STATISTICAL ANALYSES PERFORMED Multilevel models were used to examine change in food and beverage compliance over time. RESULTS More products were available in high schools than middle schools at both time points. The number of competitive beverages and several categories of competitive food products sold in the sample of Massachusetts schools decreased following the implementation of the standards. Multilevel models demonstrated a 47-percentage-point increase in food and 46-percentage-point increase in beverage compliance in Massachusetts schools from 2012 to 2013. Overall, total compliance was higher for beverages than foods. CONCLUSIONS This study of a group of Massachusetts schools demonstrated the feasibility of schools making substantial changes in response to requirements for healthier competitive foods, even in the first year of implementation.

How Do We Actually Put Smarter Snacks in Schools? NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Conversations with Food-Service Directors

OBJECTIVE In autumn 2012, Massachusetts schools implemented comprehensive competitive food and beverage standards similar to the US Department of Agricultures Smart Snacks in School standards. We explored major themes raised by food-service directors (FSD) regarding their school-district-wide implementation of the standards. DESIGN For this qualitative study, part of a larger mixed-methods study, compliance was measured via direct observation of foods and beverages during school site visits in spring 2013 and 2014, calculated to ascertain the percentage of compliant products available to students. Semi-structured interviews with school FSD conducted in each year were analysed for major implementation themes; those raised by more than two-thirds of participating school districts were explored in relationship to compliance. SETTING Massachusetts school districts (2013: n 26; 2014: n 21). SUBJECTS Data collected from FSD. RESULTS Seven major themes were raised by more than two-thirds of participating school districts (range 69-100 %): taking measures for successful transition; communicating with vendors/manufacturers; using tools to identify compliant foods and beverages; receiving support from leadership; grappling with issues not covered by the law; anticipating changes in sales of competitive foods and beverages; and anticipating changes in sales of school meals. Each theme was mentioned by the majority of more-compliant school districts (65-81 %), with themes being raised more frequently after the second year of implementation (range increase 4-14 %). CONCLUSIONS FSD in more-compliant districts were more likely to talk about themes than those in less-compliant districts. Identified themes suggest best-practice recommendations likely useful for school districts implementing the final Smart Snacks in School standards, effective July 2016.

Scoping Review: Social Determinants of Young Children’s Participation in the United States

Optimal child development is supported by services, policies, a social determinants of health (SDOH) frame, and meaningful participation (as defined by the International Classification of Functioning, Disability, and Health–Children and Youth [ICF-CY]). This scoping review describes the social determinants that may affect the participation of young children aged 0 to 3 years with developmental disabilities (DD) in the United States. Scoping review of studies including U.S. children with DD aged 0 to 3 years, from 2000 to 2016, were used. 5/979 studies met inclusion criteria. Two researchers independently coded studies to align them with both ICF-CY and SDOH. Studies found determinants of participation stemming from the child (e.g., individual) and multiple contexts: immediate, community, and policy. The emergent literature continues to primarily focus on child determinants but suggests participation of young children with DD is affected by social determinants stemming from the community and policy contexts. The literature underrepresents children from racial/ethnic minority backgrounds.