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Literacy and Health in America

Rudd, Rima; Kirsch, Irwin S.; Yamamoto, Kentaro
Publication Year:
ETS Policy Information Center Report
Document Type:
Page Count:
Subject/Key Words:
Health Activities Literacy Scale (HALS), Adult Literacy, Health, Senior Citizens, Harvard School of Public Health, National Adult Literacy Survey (NALS), Gitomer, Drew H., Eastland, Julie K., Coley, Richard J., Wang, Minwhei, Von Davier, Matthias, International Adult Literacy Survey (IALS), General Education Development (GED), Socioeconomic Influences, Gender Differences, Health Care, National Assessment of Educational Progress (NAEP), Item Response Theory (IRT), Programme for International Student Assessment (PISA), Human Capital and Education


This Policy Information Report seeks to further illuminate the relationship between literacy and health using data from large-scale surveys of adult literacy — the National Adult Literacy Survey (NALS) and the International Adult Literacy Survey (IALS) — conducted by ETS for the U.S. Department of Education. Included in these assessments were a variety of health-related materials on topics such as drugs and alcohol, disease prevention and treatment, safety and accident prevention, first aid, emergencies, and staying healthy. Survey respondents were asked to perform different literacy tasks based on these materials. The survey also gathered extensive background information about respondents' demographic and socioeconomic characteristics, as well as their health status, literacy practices, and civic participation. For the current study, researchers analyzed performance results for the 191 health-related tasks included in the large-scale literacy assessments. In doing so, they were able to create a new Health Activities Literacy Scale (HALS) linked to the NALS database. The HALS is a 0 to 500 scale that reflects a progression of health-related literacy skills from low (Level 1) to high (Level 5). Using the new HALS scale, the authors estimate the distribution of literacy on health-related tasks among U.S. adults, describe the health literacy skills of at-risk or vulnerable population groups, and demonstrate how health-related literacy is connected to health status, wealth, and civic engagement.

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