Racial Disparities in Cancer-Related Health   Literacy and Communication SkillsRoblin DW1, Mazor KM2, 3, Cutrona S2, 3, To...
Background• Competence in verbal and print literacy has important  implications for:   – Patient-provider communication   ...
Objectives• Primary objectives   – Ascertain the independent effects of oral and print literacy by race     and level of e...
Conceptual Model• Educational disadvantage has historically burdened  African Americans relative to Caucasians in the US. ...
Conceptual Model• Higher levels of educational attainment, however, mitigate  earlier effects of disparities in the learni...
Methods• Data were obtained from 2-hour in-person assessments  conducted at Kaiser Permanente Georgia (KPGA) in 2010   – S...
Methods• Literacy measures   – Health literacy – Oral: 45 items summarized into a single scale     scored from 0 (low) to ...
Methods• Linear analyses of variance of oral literacy, print literacy,  and REALM scores   – Primary independent variables...
Methods• Logistic analyses of variance of frequent internet use,  preference for hearing vs. reading, difficulty  understa...
Results• Within levels of educational attainment, greatest  differences in average health-related literacy by race were  a...
Results• Education had a significant, graded association with oral  and print literacy and REALM scores [a(1) path]• Afric...
Results• Low levels of education, oral or print literacy, and  REALM scores were significantly associated with less  frequ...
Conclusions• Adults with lower levels of educational attainment  (particularly HS education or less) have lower levels of ...
Conclusions• Limitations:   – Small sample size   – Limited number of covariates       • Educational quality       • Famil...
Acknowledgements• Funding   – NCI, 5U19CA079689 for the HMO Cancer Research Network     (EH Wagner, PI) and subproject 3 “...
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Disparities in Cancer Related Health Literacy Between African American and Caucasian Adults ROBIN

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Disparities in Cancer Related Health Literacy Between African American and Caucasian Adults ROBIN

  1. 1. Racial Disparities in Cancer-Related Health Literacy and Communication SkillsRoblin DW1, Mazor KM2, 3, Cutrona S2, 3, Torres-Stone R2, Robinson BE1, Williams AE4, Gaglio B5, Wagner J3 3. Center for Health Research / Southeast, Kaiser Permanente Georgia 4. University of Massachusetts Medical School 5. Meyers Primary Care Institute 6. Center for Health Research / Hawai’i, Kaiser Permanente Hawai’I 7. Division of Research, Kaiser Permanente Mid-Atlantic States HMO Research Network Annual Conference Seattle, WA May 2, 2012 1
  2. 2. Background• Competence in verbal and print literacy has important implications for: – Patient-provider communication – Treatment adherence – Health outcomes.• On average, African American adults have lower health literacy than Caucasians. – Comparisons of average literacy levels by race are confounded by lower levels of education achieved by African Americans. – Average literacy increases with higher levels of educational achievement. 2
  3. 3. Objectives• Primary objectives – Ascertain the independent effects of oral and print literacy by race and level of education – Ascertain if race moderates the relationship between education and literacy• Secondary objectives – Ascertain the independent effects of race and education or literacy on communication skills (frequent internet use, preference for listening vs. reading of new health information, difficulty understanding rapid speech) – Ascertain if race moderates the relationship between education or literacy and communication skills 3
  4. 4. Conceptual Model• Educational disadvantage has historically burdened African Americans relative to Caucasians in the US. – Under-resourcing of public schools – Under-resourcing of the domestic learning environment• Implications of public under-resourcing of public education on educational achievement compounded by domestic under-resourcing and support of learning. – Personal selection and institutional selection leading to lower levels of educational attainment – Lower quality of learning environment for equal levels of educational attainment 4
  5. 5. Conceptual Model• Higher levels of educational attainment, however, mitigate earlier effects of disparities in the learning environment. – Selection: Motivation of students who progress to higher levels – Resourcing: Resourcing differentials less associated with race• Implications – Disadvantaged students are less likely to progress to higher levels of education than advantaged students. – Performance gap between disadvantaged and advantaged students narrows with higher levels of educational achievement. 5
  6. 6. Methods• Data were obtained from 2-hour in-person assessments conducted at Kaiser Permanente Georgia (KPGA) in 2010 – Study goal: Develop psychometrically valid scale of oral (i.e. verbal or spoken) cancer-related health literacy – 40-70 year old enrollees (N=279 completed) – KPGA enrollees selected using a stratified random sample • Strata defined by area-based race and educational attainment – Item construction • Oral assessment: “Same” or “different” responses to paraphrased statements following viewing of 1-3 minute videoclips • Print assessment: “Same” or “different” responses to paraphrased statements following reading of 1-3 paragraph vignettes 6
  7. 7. Methods• Literacy measures – Health literacy – Oral: 45 items summarized into a single scale scored from 0 (low) to 100 (high) – Health literacy – Print: 21 items summarized into a single scale scored from 0 (low) to 100 (high) – REALM (Rapid Estimate of Adult Literacy in Medicine): number of 66 items pronounced correctly (ranged from 10 to 66 in the study population)• Communication skills measures – “Frequent” internet use: 5-7 days per week vs. 0-4 days – Preference for hearing vs. reading new information on cancer prevention – Difficulty understanding rapid speech 7
  8. 8. Methods• Linear analyses of variance of oral literacy, print literacy, and REALM scores – Primary independent variables: self-reported race, education, and their interaction Race b(1) c(1) Literacy: -- Oral Education a(1) -- Print --REALM 8
  9. 9. Methods• Logistic analyses of variance of frequent internet use, preference for hearing vs. reading, difficulty understanding rapid speech – Primary independent variables: self-reported race, education/literacy, and their interaction Race b(2) c(2) Education Communication Skills: Literacy: -- Frequency of Computer Use -- Oral -- Preference for Spoken vs. a(2) Printed Words -- Print -- Ability to Understand Rapid -- REALM Speech 9
  10. 10. Results• Within levels of educational attainment, greatest differences in average health-related literacy by race were at the lower levels. – Differences decreased, but did not disappear, at higher levels of education. 10
  11. 11. Results• Education had a significant, graded association with oral and print literacy and REALM scores [a(1) path]• African Americans had significantly lower oral health literacy [b(1) path]• Race moderated the relationship between education and oral and print literacy and REALM scores [c(1) path] – HLO: -8.9 for HS or less (p=0.05) – HLP: -11.0 for some college (p=0.02) – REALM: -4.1 for HS or less (p=0.06) 11
  12. 12. Results• Low levels of education, oral or print literacy, and REALM scores were significantly associated with less frequent weekly computer use [a(2) path] – Race had no significant independent [b(2) path] or moderating [c(2)] effects• Low levels of education and REALM scores were significantly associated with more difficulty understanding rapid speech – Race had no significant independent or moderating effects• No significant associations of education, oral or print literacy, REALM scores or race with preference for hearing vs. reading materials on new cancer prevention services. 12
  13. 13. Conclusions• Adults with lower levels of educational attainment (particularly HS education or less) have lower levels of health-related literacy. – With comparable levels of educational attainment, African Americans have lower levels of health-related literacy than Caucasians. • Legacy costs of educational disparities • “Education policy is also health policy”.• Educational attainment and health literacy, to some extent, are related to communication skills. – Adjusting for education, race has no association. – Low educational attainment or literacy particularly affected internet use. 13
  14. 14. Conclusions• Limitations: – Small sample size – Limited number of covariates • Educational quality • Family history – Selection effects • Individuals with history of cancer, personal or familial, likely to have participated• Strengths: – Unique dataset with batteries of validated measures – Systematically developed computer-based assessment ensuring high quality data 14
  15. 15. Acknowledgements• Funding – NCI, 5U19CA079689 for the HMO Cancer Research Network (EH Wagner, PI) and subproject 3 “Health Literacy and Cancer Prevention: Do People Understand What They Hear?” (KM Mazor, PI)• Project Team – UMass / MPCI: Kathleen Mazor, Terry Field, Joann Wagner, Mary Costanza, Rosalie Torres-Stone, Sarah Cutrona – KPGA: Douglas Roblin, Jody Calvi, Brandi Robinson – KPHI: Andrew Williams, Vinutha Vijayadeva – KPCO: Bridget Gaglio 15

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