FOR MORE CLASSES VISIT www.tutorialoutlet.com Being literate in today’s society demands a myriad of functional abilities, which, when absent, can have dramatic health, economic, and social consequences. The purpose of this study was to develop a framework for defining literacy within an increasingly technological society, and to explore the experience of illiteracy among older adults.

1. Introductory Paragraph to Topic: ADULT
ILLITERACY. Write an introductory paragraph
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Being literate
in today’s society demands a myriad of functional abilities, which,
when absent,
can have dramatic health, economic, and social consequences. The
purpose of this
study was to develop a framework for defining literacy within an
increasingly
technological society, and to explore the experience of illiteracy
among older adults.
To examine these issues, qualitative data were gathered from an adult
literacy
program in Hamilton, Ohio. Data collected through these interactions
suggest that
the devastating effects of illiteracy are exacerbated throughout the
lifecourse,
resulting in significant disadvantage for older adults. In this time of
rapid technological advancement, opportunities abound
for innovation and the generation of knowledge. This so-called ‘‘age
of

2. information’’ has revolutionized every facet of society, including the
medical, industrial, and educational fields. Although this has resulted
in the proliferation of valuable data and technologies, the benefits of
these advancements are unevenly dispersed. In the wake of this surge
in innovation, a considerable portion of our population is being left
behind due to literacy issues. Disproportionately from lower
socioeconomic and minority groups, this country’s illiterate
population is
secluded from the aforementioned tools of innovation. As a result,
The author thanks Dr. Lisa Groger for her assistance in the
preparation of this paper.
Address correspondence to Sarah Poff Roman, Miami University,
Scripps Gerontology Center, Oxford, Ohio 45056. E-mail:
romansa@muohio.edu 79 80 S. P. Roman illiterate adults experience
poorer health outcomes, less financial
security, and lower life expectancies compared to the overall
population.
Literacy, which conceptually encompasses far more than the ability
to read, has become increasingly important as our society becomes
ever more dependent on technology. The purpose of this study was to
explore the effects that adult illiteracy has on both the individual and
society. First, a framework for developing a contemporary definition
of
literacy is presented. Then, the demographic prevalence of illiteracy
in
America is illustrated through the use of national literacy data sets. To

3. identify the consequences of these statistics, the individual and
societal implications of illiteracy are explored within the context of a
case
study from an adult literacy center in Hamilton, Ohio. Finally,
recommendations for addressing this social problem through policy
and program development are offered. DEFINING LITERACY
Literacy is a socially constructed concept whose definition varies
according to cultural and historical context (Center for Educational
Research and Innovation [CERI], 1992). In this sense, literacy is not a
state of being, but a reflection of the relative fit between the
individual’s
various competencies and the social and historical environment.
Literacy has not always held this holistic connotation. Until relatively
recently, literacy was defined according to easily quantifiable
measures, such as the ability to sign one’s name, and the number of
grades
completed in school (CERI, 1992). Now referred to as basic or
conventional, this traditional definition of literacy involves the ability
to read
written words, but says nothing about the understanding of those
words (Rassool, 1999). Literacy by this definition was actually the
exception, rather than the rule in early American society. Very few
individuals possessed basic literacy skills, because reading and
writing
were not necessary in early industrial and agricultural occupations
(Costa, 1988). Because literacy was uncommon, illiteracy was not
viewed as a social problem. This began to change as public education

4. became standard and society became increasingly industrialized. As a
result of these important developments, a gap began to develop
between the educated and non-educated with regard to income,
occupational security, and health (CERI, 1992). Once education
became the
norm, literacy began to be defined according to grade level attainment
(CERI, 1992). Because this type of data is readily available in most
countries, this definition facilitated the collection of easily
quantifiable
and cross-cultural data on literacy rates. Contemporary research has
shown, however, that grade level attainment is not always a good
Illiteracy and Older Adults 81 indicator of one’s ability levels. The
number of years completed in
school does not reflect the amount of education received, but rather
the
amount of education attempted (Baker, Parker, Williams, Clark,
&
Nurss, 1997). Although there is an uncontestable relationship between
educational attainment and literacy, education by itself is not a proxy
for ability level. To illustrate, it is not uncommon for poorly educated
people to score high on literacy tests, and for highly educated
individuals to rank poorly on the literacy scales. Thus, literacy seems
to be a
product of both educational attainment and life experience. Functional
Literacy
Recognizing the underlying complexity of individual literacy,
contemporary researchers have struggled to develop more appropriate
definitions of this multi-faceted concept. Our understanding of what

5. true literacy entails has changed significantly since the days when
signing your name was the only prerequisite. Today, the definition of
literacy is based on what is called functional literacy. That is,
someone
is literate if they are able to function properly within society (Rassool,
1999). This definition can include (but is not limited to) possessing
skills in reading and writing. In other words, literacy is no longer
viewed as a well-defined set of technical skills, but as a
multidimensional concept that is linked to one’s ability to process and
generate information from his or her surroundings (Rassool, 1999).
Today, literacy is defined as ‘‘the ability to read, write and speak
English proficiently, to compute and solve problems, and to use
technology in order to become a life-long learner and to be effective
in the
family, in the workplace and in the community’’ (Literacy Volunteers
of
America [LVA], no date, para. 1). The concept of functional literacy
has
made the definition of literacy infinitely more complicated. Primarily,
because functional literacy involves utilizing a diverse array of skills
in various combinations, literacy is not an ‘‘all or nothing’’ attribute
(CERI, 1992). Rather, literacy is commonly described as a continuum.
This has made the assessment of literacy skills much more
challenging for adult educational centers because there are no
absolute stages
of literacy. However, this conceptualization also has had positive

6. effects in that it has led to the development of highly effective and
individualized tutoring approaches. Health Literacy
The definition of literacy also has expanded to include what is
commonly called health literacy. This concept refers to one’s ability
to read 82 S. P. Roman and understand materials encountered in the
health care setting and
to obtain knowledge necessary for positive health outcomes (Nurss,
1998). This concept has emerged as a critical component of functional
literacy with arguably the most severe consequences for both the
individual and society. MEASURING LITERACY
As illiteracy has become an issue of concern to society at large,
various
techniques for measuring its prevalence have been developed.
Generally, these techniques can be categorized as tools for measuring
either individual or population literacy. Individual Literacy
Tools for measuring individual literacy are used primarily by
educators and the health care community to gauge comprehension and
reading skills. Most of these systems categorize respondents into
multiple levels of literacy according to cumulative scores on a variety
of skill tests. Examples of tools for assessing individual literacy
include the Test of Adult Basic Education (TABE), the Adult Basic
Literacy Examination (ABLE), the Wide Range Achievement
TestRevised (WRAT-R), and the Test of English as a Foreign
Language
(TOEFL) (Nurss, 1998). These tests, although highly used by adult
education centers, have been criticized for being inadequate at testing

7. functional literacy skills. The focus of these tests is on reading ability,
with little to no attention on comprehension or practical utility (Nurss,
1998). Various tools have been developed to address these
shortcomings and approach literacy assessment from a functional
perspective. Two of the most widely used tools are the Test of
Functional
Health Literacy in Adults (TOFHLA) and the Rapid Estimate of
Adult
Literacy in Medicine (REALM) (Nurss, 1998). Although designed for
use in health care settings, both tests have been found to have wider
applicability because of their focus on functional literacy. Population
Literacy
The primary mechanism used to measure population literacy in this
country is the National Adult Literacy Survey (NALS), which is
funded by the U.S. Department of Education and administered by the
Educational Testing Service (Kirsch, Jungeblut, Jenkins, &
Kolstad,
2001). This survey, which was last conducted in 1992, elicits a wide
range of data on literacy rates including ethnic background, Illiteracy
and Older Adults 83 socioeconomic status, work history, family
trends, age ranges, and
gender composition of the population. Rather than focusing on
educational attainment as a measure of literacy, the NALS tests
people
according to their performance on tasks relating to everyday life. The
structure of this survey involves three main categories of testing
(prose, document, and quantitative literacy) that are used to garner a

8. cumulative score (Kirsch et al., 2001). This cumulative score places
the
individual in one of five literacy levels, one being the lowest, and five
being the highest. Level one includes those with minimal reading
skills who cannot complete simple literacy tasks such as filling out an
application, reading a food label, or reading a children’s book (LVA,
no
date). The second level of adult literacy includes the ability to
compare, contrast, and integrate small chunks of information, but
excludes the ability to complete more complex problem-solving tasks
(LVA, no date). This is the level that Steve, the case study who is
presented in a following section, tested into during a preliminary
literacy assessment. The last three literacy levels (levels three through
five) are characterized by an increasing ability to solve ever more
complex tasks (LVA, no date). DEMOGRAPHIC PREVALENCE
Findings of the NALS
According to the results of the NALS, 23% of adults in this country
are
functioning at the lowest level of literacy. This translates into roughly
44 million adults who lack the basic skills to function and thrive
(Weiss & Coyne, 1997). Of this population, 62% did not
complete high
school; more than 30% were over the age of 65; 25% were
immigrants;
and 26% had physical, mental, or other debilitating health conditions
(Kirsch et al., 2001). The study also revealed that 25–28% of the adult

9. population (or 45–50 million individuals) have level two literacy
skills.
Taken together, this means that more than half of the adults in
America have reading skills well below the 8th grade level (Weiss
&
Coyne, 1997).
Perhaps most striking are the findings reported on the highest literacy
levels. In 1992, only 3% of adults surveyed exhibited level five
literacy skills (Kirsch et al., 2001). While these figures are generally
accepted, the ambiguous definition of literacy has resulted in
numerous contested estimates of the magnitude of our national
literacy
crisis. Some statistics place the rate of illiteracy in this country much
higher than the NALS, depending on the definition of literacy
employed. For example, estimates offered by the Laubach Literacy 84
S. P. Roman Organization suggest that as many as 90 million
Americans suffer
from limited literacy skills (Byers, 1993). Although the statistics
generated through the NALS have been contested, the results have
provided invaluable insight into the characteristics of the illiterate
population. Several predictors or variables related to literacy have
been identified, including age, ethnicity, and socioeconomic status.
Older Adults
Age seems to be highly correlated to literacy among the American
population. As a group, older adults have higher rates of illiteracy

10. than any other age bracket. Data collected through the NALS
classified 44% of adults over the age of 65 as functionally illiterate
(Baker
et al., 2002). It is likely that this predominance in the older population
is a cohort effect rather than age-related. Because these cohorts grew
up in a time when literacy was not a common value, many older
adults
lack the functional skills that have become necessary in today’s
society. On average, adults over the age of 65 test a full level below
adults aged 40–54 years old (Kirsch et al., 2001). Ethnic Background
Largely a product of economic, social, and educational inequalities,
literacy rates in America follow distinct demographic trends.
Although
illiteracy is present in every demographic group, African Americans
exhibit the highest prevalence of illiteracy, followed by Hispanics,
Native Americans, and Whites of lower socioeconomic status (Sissel,
1996). Although the rates of illiteracy are highest among African
American and Hispanic populations, the numerical majority of
illiterate adults are white (Weiss & Coyne, 1997). The incidence
of illiteracy also seems to vary according to geographic location, with
the
highest prevalence of literacy problems occurring in rural
communities. While rural residents only make up about 28% of the
U.S.
population, they account for some 42% of all functionally illiterate
adults (Byers, 1993). Challenges in Recognizing Illiteracy
One of the greatest challenges in fighting illiteracy is recognizing it.

11. Identifying literacy problems among older adults is a difficult task
because many of them hide their illiteracy and have a lifetime of
practice in doing so (Weiss & Coyne, 1997). One older
gentleman who
sought literacy training at the site for this study had kept his illiteracy
Illiteracy and Older Adults 85 a secret from everyone, including his
wife of 50 years. Studies have
found that up to 70% of illiterate adults have not told their spouse and
over 50% have not told their children about their literacy problems
(Nurss, 1998). This poses a significant challenge with regard to
addressing our literacy crisis. INDIVIDUAL IMPLICATIONS OF
ILLITERACY
My goal’s in life first get my GED learn computers and spend time
with
my keds. Little do they know they are my strenth. Also give more
time to
God. Give him all thanks and prays (Steve, Journal entry, March 1,
2002). Shame and Frustration
I began tutoring Steve twice a week through the local YWCA’s adult
literacy program (all names have been changed). Consistent with
demographic trends, Steve is an African American who dropped out
of
high school due to the birth of his first son. Now, his illiteracy has
begun to jeopardize his career. This has motivated him to try again for
his GED. When we first met, I was immediately struck by his
enveloping sense of embarrassment and frustration. As he struggled to
tell

12. me why he had sought tutoring and what he hoped to achieve, he
expressed shame towards his past and doubt towards his future.
Steve’s story illustrates that illiteracy affects the individual on
numerous levels, including at the workplace, as a consumer, as a
parent, and in social situations (Heathington, 1987). Poverty and
Unemployment
One of the most serious implications of illiteracy for the individual is
the inability to obtain employment and receive competitive wages.
Researchers have found that there is a positive relationship between
literacy level and employment stability and income. As workers,
illiterate adults are at a serious disadvantage in today’s workplace. It
is estimated that 75% of adults who are unemployed have limited
literacy skills (Family Literacy, no date). Not only do illiterate adults
have trouble with the application and interview processes, but their
employment status is often jeopardized by changes in company
policies
and regulations (Heathington, 1987). Steve is a prime example of how
problems with literacy can pose challenges to securing and
maintaining employment. Steve was driven to the program at the
YWCA
out of necessity when he was disqualified for a promotion due to his
technological illiteracy. Although he was given the chance to take a
86 S. P. Roman computer course that would qualify him for the
position, Steve’s course
application was denied due to his lack of a high school degree.

13. Unfortunately, Steve’s story is not uncommon; adults with low
literacy
skills are frequently unemployed, work fewer weeks annually, and
earn lower wages than individuals with high literacy skills (Kirsch
et al., 2001). According to the NALS, average incomes among adults
scoring at the lowest levels were less than one-third of the average
incomes of those scoring at the highest level on the literacy scale.
Adults with level one literacy skills earned an average of $240 per
week, compared to $681 for those at the highest level (National
Institute for Literacy [NIL], 1998). Almost half of the adults who
scored in the lowest level were living in poverty, compared to only
4–8% of those in the two highest levels (NIL, 1998). Health
Outcomes
As consumers, adults with low literacy struggle to obtain health
services, buy groceries, take medications, and pay bills, among
numerous
other daily tasks (Heathington, 1987). Perhaps the most serious
implication of illiteracy is the barrier that is created between illiterate
adults and the health care community. Studies have found that adults
with literacy problems have poorer health, are more likely to take
medications incorrectly or not at all, are less likely to have regular
medical examinations, are more likely to work in hazardous
occupations, have poor health habits, and are more likely to lack
health
insurance (Baker et al., 1997; Sissel, 1996). The link between health

14. and literacy is of particular concern with regard to the older
population. Not only does this population have the highest rates of
illiteracy,
it also has the highest rates of chronic disease and health-related
complications (Baker et al., 2002). The implications of this are
evident
in data gathered through the Robert Wood Johnson Literacy and
Health Care Project (Preston, 1995). Results of this study found that
among older patients, 41.6% could not read instructions on how to
take
medications, 26% could not read or understand when their next
appointment was scheduled, 59.5% could not understand a standard
consent form, and 36.9% could not understand the application forms
for the Medicaid program (Preston, 1995). Studies have also found
that literacy offers some protective effects against memory decline in
old age. The most well-known of these studies is David Snowdon’s
longitudinal ‘‘nun study,’’ in which he analyzed the thought processes
of a group of nuns throughout their life course. He discovered that the
women who exhibited the most simple writing patterns in early
adulthood were the most likely to develop Alzheimer’s disease in old
Illiteracy and Older Adults 87 age (Fotuhi, 2003). Similar results were
found in a collaborative study
of the Rush Alzheimer’s Disease Center (Chicago), and the
University
of Pennsylvania. This study found that highly educated individuals
have heightened resistance to the progression of Alzheimer’s disease.

15. Highly educated people showed little to no sign of memory loss at
time
of death, despite high densities of plaques and tangles in their brain
tissue, while less educated individuals showed significant memory
loss
with far fewer plaques and tangles present (Fotuhi, 2003). As a result
of the barriers between illiterate adults and the health care
community, they are more likely to find themselves needing hospital-
level
care. Because protocols for health maintenance and prevention
strategies are often misunderstood by this population, the hospital is
often
the first line of health care, which is not only costly but often too little
too late. A study of Medicare managed care enrollees found that those
with inadequate literacy skills had a significantly higher risk of
hospitalization than those with adequate literacy skills (Baker et al.,
2002). Even when adjustments are made for other sociodemographic
variables (age, income, and self-reported health), adults with the
lowest literacy are more likely to be admitted to a hospital, have
higher healthcare costs, and poorer overall health than those with
adequate literacy (Baker et al., 2002; Weiss & Coyne, 1997).
SOCIETAL IMPLICATIONS OF ILLITERACY
The Bigger Picture of Illiteracy
While illiteracy poses significant threats to the individual, there also
are numerous societal implications. Illiteracy has adverse effects on
families, the economy, and society at large. It has long been
recognized

16. that illiteracy is an intergenerational trend that is passed on from
parent to child (Costa, 1988). Children whose parents did not
complete
school or have trouble with literacy skills are more likely to be
illiterate themselves, and are more than five times as likely to drop out
of
high school as other children (Pages, no date). Illiteracy also imposes
a
considerable burden on the family or support system of the individual
in question, as illiterate adults are highly dependent on others to
function and survive. Family members often must do the grocery
shopping, pay the bills, fill out forms and documents, and manage the
financial affairs of illiterate relatives (Costa, 1988). Economic Impact
Illiteracy also affects society at large through the financial burden
that it imposes via lost productivity and increased taxes for welfare 88
S. P. Roman programs, prisons, and crime prevention programs
(Pages, no date).
Almost 50% of adults on welfare do not have a high school diploma
or
their GED (Pages, no date). Not only is this population more likely to
need welfare, but they are often dependent for longer periods of time.
There also seems to be a link between literacy levels and
incarceration. Studies have found that seven out of 10 inmates
perform in the
lowest two literacy levels (NIL, 1998). Over half of these individuals
cannot read or write at all and have not graduated from high school.
Nowhere is the economic impact of illiteracy greater than on the

17. health care system. As illustrated in the previous section, low literacy
is associated with poor health, poverty, and a heightened risk of
hospitalization. Because the hospital is often the first line of health
care
for individuals with literacy issues, and the majority are impoverished
and uninsured, there is a significant strain on the healthcare system
(Baker et al., 2002). People with low literacy skills are more likely to
receive health care through public services, and the cost is often much
higher. A study of Medicaid patients found that those who read at a
3rd grade level or less had average health care costs four times higher
than the overall Medicaid population (Center for Health Care
Strategies [CFHCS], no date). Considering the prevalence of illiteracy
among the older population, and the impending growth in this
segment of our society, the financial implications are astounding. It is
estimated that the price tag of illiteracy in America is in the billions as
a result of health care costs, low productivity in the workplace, and
strains on the welfare system (Baker et al., 1997). DISCUSSION
AND RECOMMENDATIONS
As uncovered in the current study, there are several areas that warrant
further research and development. Significant strides towards
eradicating illiteracy and diminishing its effects could be made by
changing our definition of literacy, the way we teach adult learners,
and the standard of communication between the health care system
and consumers. Individualized Instruction
To make instruction in adult literacy more effective, more
personalized

18. or consumer-oriented materials are needed (Literacy Research Centers
[LRC], 2001). Steve made frequent reference to his former tutor’s
teaching methods that, according to Steve, would have made him take
‘‘ten years to get [his] GED.’’ This instructor had simply followed the
Illiteracy and Older Adults 89 manual produced by the literacy center,
and took no initiative to
respond to Steve’s personal interests and goals. Tutoring needs to be
made relevant