The Health Literacy Of America's Adults
The Health Literacy ofAmerica’s AdultsResults From the 2003National Assessmentof Adult LiteracyU.S. Department of EducationNCES 2006–483
The Health Literacy ofAmerica’s AdultsResults From the 2003National Assessmentof Adult LiteracyU.S. Department of EducationNCES 2006–483September 2006Mark KutnerElizabeth GreenbergYing JinChristine PaulsenAmerican Institutesfor ResearchSheida WhiteProject OfficerNational Center forEducation Statistics
U.S. Department of EducationMargaret SpellingsSecretaryInstitute of Education SciencesGrover J. WhitehurstDirectorNational Center for Education StatisticsMark SchneiderCommissionerThe National Center for Education Statistics (NCES) is the primary federal entity for collecting, analyzing, and reporting datarelated to education in the United States and other nations. It fulfills a congressional mandate to collect, collate, analyze, andreport full and complete statistics on the condition of education in the United States; conduct and publish reports and specialized analyses of the meaning and significance of such statistics; assist state and local education agencies in improvingtheir statistical systems; and review and report on education activities in foreign countries.NCES activities are designed to address high-priority education data needs; provide consistent, reliable, complete, and accurate indicators of education status and trends; and report timely, useful, and high-quality data to the U.S. Department ofEducation, the Congress, the states, other education policymakers, practitioners, data users, and the general public. Unlessspecifically noted, all information contained herein is in the public domain.We strive to make our products available in a variety of formats and in language that is appropriate to a variety of audiences.You, as our customer, are the best judge of our success in communicating information effectively. If you have any commentsor suggestions about this or any other NCES product or report, we would like to hear from you. Please direct your commentstoNational Center for Education StatisticsInstitute of Education SciencesU.S. Department of Education1990 K Street NWWashington, DC 20006–5651September 2006The NCES World Wide Web Home Page address is http://nces.ed.gov.The NCES World Wide Web Electronic Catalog is http://nces.ed.gov/pubsearch.Suggested CitationKutner, M., Greenberg, E., Jin, Y., and Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From the 2003 NationalAssessment of Adult Literacy (NCES 2006–483). U.S. Department of Education. Washington, DC: National Center for EducationStatistics.For ordering information on this report, write toU.S. Department of EducationED PubsP.O. Box 1398Jessup, MD 20794–1398or call toll free 1–877–4ED–Pubs or order online at http://www.edpubs.org.Content ContactSheida White(202) 502-7473sheida.white@ed.gov
Literacy LevelsDemographic Characteristicsand Health LiteracyExecutive SummaryThe 2003 National Assessment of AdultLiteracy (NAAL) assessed the English literacy of adults in the United States. Includedin the assessment were items designed to measurethe health literacy of America’s adults. The assessment was administered to more than 19,000 adults(ages 16 and older) in households or prisons. Unlikeindirect measures of literacy, which rely on selfreports and other subjective evaluations, the assessment measured literacy directly through tasks completed by adults.Overall Health, HealthInsurance Coverage, andSources of Information AboutHealth IssuesThe health literacy scale and health literacy taskswere guided by the definition of health literacy usedby the Institute of Medicine and Healthy People2010 (a set of national disease prevention and healthpromotion objectives led by the U.S. Department ofHealth and Human Services). This definition statesthat health literacy is:The degree to which individuals have thecapacity to obtain, process, and understandbasic health information and services needed tomake appropriate health decisions. (HHS 2000and Institute of Medicine 2004)These health literacy tasks represent a range of literacy activities that adults are likely to face in theirdaily lives. Health literacy is important for all adults.Adults may read an article in a magazine or a pamphlet in their doctor’s office about preventive healthpractices; they may need to fill a prescription, selectiii
The Health Literacy of America’s Adultsand buy an over-the-counter medication, or understand health insurance forms. Parents must managetheir children’s health care, including getting themimmunized, taking them for physicals, and havingtheir illnesses treated. Adult children are often facedwith the responsibility of managing their own parents’ health care. Older adults must make decisionsabout Medicare supplementary insurance and prescription drug benefits. Adults without medicalinsurance may need to determine whether they, theirchildren, or their parents qualify for any public programs. Adults living in older houses and apartmentsmay need to make decisions about the dangers oflead paint or asbestos. All these activities require, orare facilitated by, the ability to read and understandwritten and printed information.The health tasks for the 2003 assessment were developed to fit into the NAAL’s prose, document, orquantitative scales but were distinguished from theother tasks on those scales by their health content. The prose literacy scale measured the knowledge and skills needed to search, comprehend,and use information from texts that wereorganized in sentences or paragraphs. The document literacy scale measured theknowledge and skills needed to search, comprehend, and use information from noncontinuoustexts in various formats. The quantitative scale measured the knowledgeand skills needed to identify and perform computations using numbers embedded in printedmaterials.The NAAL health tasks included on the assessmentwere distributed across three domains of health andhealth care information and services: clinical, prevention, and navigation of the health system.ivThis report describes how health literacy variesacross the population and where adults with differentlevels of health literacy obtain information abouthealth issues.The analyses in this report examine differences related to literacy that are based on selfreported background characteristics among groupsin 2003. This report discusses only findings that arestatistically significant at the .05 level.Literacy LevelsThe National Research Council’s Board on Testingand Assessment (BOTA) Committee on PerformanceLevels for Adult Literacy recommended a set of performance levels for the prose, document, and quantitative scales. The Committee on Performance Levelsfor Adult Literacy recommended that new literacylevels be established for the 2003 assessment instead ofusing the same reporting levels used for the 1992National Adult Literacy Survey (Hauser et al. 2005).Differences between the 1992 and 2003 levels are discussed by the Committee. Drawing on the committee’s recommendations, the U.S. Department ofEducation decided to report the assessment results byusing four literacy levels for each scale: Below Basic,Basic, Intermediate, and Proficient.The health literacy tasks were analyzed together andwere used to create a health literacy scale. Eachhealth literacy task was also classified as a prose, document, or quantitative task and was included on oneof those scales.The BOTA Committee did not recommend performance levels for the health scale. Because everyhealth literacy task was included on the prose, document, or quantitative scale in addition to the healthscale, it was mapped to a performance level (BelowBasic, Basic, Intermediate, or Proficient) on one of thosescales.Tasks were mapped to each scale at the point onthe scale where an adult would have a 67 percent
Executive Summaryprobability of doing the task correctly. Cut-points forthe performance levels on the health scale were set sothat each task was classified into the same category onthe health scale as on the other scale (prose, document,or quantitative) with which the task was associated.high school had Below Basic health literacy,compared with 15 percent of adults who endedtheir education with a high school diploma and3 percent of adults with a bachelor’s degree. Demographic Characteristics and HealthLiteracy The majority of adults (53 percent) hadIntermediate health literacy. An additional12 percent of adults had Proficient health literacy.Among the remaining adults, 22 percent hadBasic health literacy, and 14 percent had BelowBasic health literacy.Women had higher average health literacy thanmen; 16 percent of men had Below Basic healthliteracy compared with 12 percent of women. White and Asian/Pacific Islander adults hadhigher average health literacy than Black,Hispanic, American Indian/Alaska Native, andMultiracial adults. Hispanic adults had loweraverage health literacy than adults in any otherracial/ethnic group. Adults who spoke only English before startingschool had higher average health literacy thanadults who spoke other languages alone orother languages and English. Adults who were ages 65 and older had loweraverage health literacy than adults in youngerage groups. The percentage of adults in the 65and older age group who had Intermediate andProficient health literacy was lower than the comparable percentage of adults in other age groups. Starting with adults who had graduated fromhigh school or obtained a GED, average healthliteracy increased with each higher level of educational attainment. Some 49 percent of adultswho had never attended or did not completeAdults living below the poverty level had loweraverage health literacy than adults living abovethe poverty threshold.Overall Health, Health Insurance Coverage,and Sources of Information About HealthIssues At every increasing level of self-reported overall health, adults had higher average health literacy than adults in the next lower level. Adults who received health insurance coveragethrough their employer or a family member’semployer or through the military or who privately purchased health insurance had higheraverage health literacy than adults whoreceived Medicare or Medicaid and adults whohad no health insurance coverage. Amongadults who received Medicare or Medicaid,27 percent and 30 percent, respectively, hadBelow Basic health literacy. A lower percentage of adults with Below Basichealth literacy than adults with Basic,Intermediate, or Proficient health literacy gotinformation about health issues from any written sources, including newspapers, magazines,books or brochures, and the Internet. A higherpercentage of adults with Below Basic and Basichealth literacy than adults with Intermediate andProficient health literacy received a lot of information about health issues from radio and television. With each increasing level of health literacy, a higher percentage of adults got information about health issues from family members, friends, or coworkers.v
AcknowledgmentsThe National Assessment of Adult Literacy(NAAL) is a complex project whose successful completion is due to the work ofcountless individuals from many organizations. We,at the American Institutes for Research (AIR),especially want to thank the staff at the NationalCenter for Education Statistics (NCES) who havesupported the project. Sheida White, the NAALproject officer, has provided substantive guidanceand direction to all aspects of the assessment. Herintellectual contributions are reflected throughoutthe assessment, analyses, and report. AndrewKolstad, the project’s senior technical advisor andproject officer of the 1992 National Adult LiteracySurvey, provided both technical guidance and aninstitutional memory throughout the project andhelped us reflect on all statistical and technicalissues. Steven Gorman also played a key role inguiding all aspects of the assessment, especially thoserelated to the statistical aspects of the assessment.Peggy Carr, NCES Associate Commissioner forAssessment, provided the project and team memberswith ongoing support, recommendations, andencouragement.We are very grateful for her leadership. William Tirre and Arnold Goldstein of NCESplayed invaluable roles in reviewing the report andguiding it through the review process. Theirefforts are very much appreciated. We also thankMarilyn Seastrom, NCES Chief Statistician,and members of the NCES/Education Statisticsvii
The Health Literacy of America’s AdultsServices Institute(ESSI) Technical Review Team,Kevin Bromer, LaTisha Jones, Alison Slade, AparnaSundaram, and Jed Tank, who reviewed the report andmade many suggestions that have improved the finalproduct. Other government reviewers who providedthoughtful comments are Tom Snyder and John Wirt,from NCES, and Cheryl Keenan, Director, Division ofAdult Education and Literacy in the Office ofVocational and Adult Education (OVAE), and RicardoHernandez of OVAE. We also want to thank JalehSoroui of the ESSI for her ongoing substantive contributions to the NAAL.Young Chun, Linda Shafer, andAlan Vanneman of National Assessment of EducationalProgress (NAEP)-ESSI reviewed the report andprovided important comments and suggestions.Cynthia Baur, Office of Disease Prevention andHealth Promotion, Office of Public Health andScience, Office of the Secretary of the Departmentof Health and Human Services, played a pivotal rolein conceptualizing, planning, designing, and reporting on the health literacy component of NAAL.TheNAAL health literacy component is based on herintellectual contributions and perseverance. RonPugsley, former Director of the Division of AdultEducation and Literacy in the Office of Vocationaland Adult Education, played a key role in the earlyplanning stages of the health literacy report. DanSherman from AIR also provided invaluable guidance to the health literacy analyses and report.Our colleagues at Westat, Inc., planned, developed,and implemented the complex sampling and weighting necessary for the successful completion of theassessment. Westat also planned and carried out allphases of the data collection, and was responsible fortraining and managing a group of 400 field data collection staff.This study could not have been successful without the outstanding work of the Westat project director, Martha Berlin, and the Westat team,including Michelle Amsbary, Leyla Mohadjer, andJacquie Hogan.viiiMany staff at AIR made substantial contributions tothe health literacy report, often under tight timelines.Stéphane Baldi and Justin Baer, senior members ofthe AIR NAAL team, provided invaluable substantive and technical contributions throughout theduration of the project. Bridget Boyle and Yungchen Hsu conducted analyses for the authors whenever requested. Rachel Greenberg and ElizabethMoore provided ongoing research and technical support in developing the assessment, preparing the dataand text, and shepherding the report through therevision and review process.We are especially appreciative of the skills and contributions by Holly Baker, who edited the reportthrough multiple revisions, and by Heather Block,who designed and redesigned the report. We aregrateful for their dedication and in awe of their ability to work under often seemingly impossible timeconstraints. Also, Janan Musa provided the AIR teamwith invaluable guidance and administrative andlogistical support throughout the project.We also want to acknowledge the essential contributions of three other individuals. Archie Lapointe wasan active member of the AIR team during the earlystages of the NAAL, and the project greatly benefited from his experience and wisdom.Another formermember of the AIR team, Eugene Johnson, whodirected the assessment’s psychometrics and preliminary analysis activities, played an essential role in theproject. We also want to acknowledge the contributions of Richard Venezky, who provided invaluableguidance, support, and friendship, and whose memory we cherish.Thousands of adults participated in the assessment.Their willingness to spend time answering the background questions and assessment items was essentialto ensuring that meaningful data about the literacy ofAmerica’s adults could be obtained.This study wouldnot have been possible without their participation.
CONTENTSExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiLiteracy Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ivDemographic Characteristics and Health Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vOverall Health, Health Insurance Coverage, and Sources of Information AboutHealth Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiList of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiList of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xivChapter 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Defining and Measuring Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Interpreting Literacy Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Conducting the Survey. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Interpretation of Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Cautions in Interpretation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Organization of the Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Chapter 2: Demographic Characteristics and Health Literacy. . . . . . . . . . . . . . . 9Total Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Gender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Race and Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Language Spoken Before Starting School . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Highest Level of Educational Attainment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Poverty Threshold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Chapter 3: Overall Health, Health Insurance Coverage, and Sources ofInformation About Health Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Self-Assessment of Overall Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Health Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17ix
The Health Literacy of America’s AdultsSources of Information About Health Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Appendix A: Sample Health Literacy Assessment Question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23Appendix B: Definitions of All Subpopulations and Background Variables Reported . . . . . . . . . . . . . . . . . . . . . . . .27Appendix C: Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Appendix D: Standard Errors for Tables and Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39Appendix E: Additional Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59x
ContentsList of D2-4.D2-5.D2-6.Overview of the literacy levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5Average health literacy scores of adults, by language spoken before starting school: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Average health literacy scores of adults, by poverty threshold: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14Weighted and unweighted household response rate, by survey component: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Weighted and unweighted prison response rate, by survey component: 2003. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Estimates and standard errors for Figure 2-1. Percentage of adults in each health literacy level: 2003 . . . . . . . . . . . . . . . . . . 40Estimates and standard errors for Figure 2-2. Average health literacy scores of adults, by gender: 2003 . . . . . . . . . . . . . . . . .40Estimates and standard errors for Figure 2-3. Percentage of adults in each health literacy level, by gender: 2003 . . . . . . . . .40Estimates and standard errors for Figure 2-4. Average health literacy scores of adults, by race/ethnicity: 2003 . . . . . . . . . . .40Estimates and standard errors for Figure 2-5. Percentage of adults in each health literacy level, by race/ethnicity: 2003 . . .41Estimates and standard errors for Table 2-1. Average health literacy scores of adults, by language spoken beforestarting school: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41Estimates and standard errors for Figure 2-6. Average health literacy scores of adults, by age: 2003 . . . . . . . . . . . . . . . . . . . .41Estimates and standard errors for Figure 2-7. Percentage of adults in each health literacy level, by age: 2003 . . . . . . . . . . . .42Estimates and standard errors for Figure 2-8. Average health literacy scores of adults, by highest educationalattainment: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42Estimates and standard errors for Table 2-2. Average health literacy scores of adults, by poverty threshold: 2003 . . . . . . . . .43Estimates and standard errors for Figure 2-9. Percentage of adults in each health literacy level, by highest educationalattainment: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43Estimates and standard errors for Figure 3-1. Average health literacy scores of adults, by self-assessment of overallhealth: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44Estimates and standard errors for Figure 3-2. Percentage of adults in each health literacy level, by self-assessmentof overall health: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44Estimates and standard errors for Figure 3-3. Average health literacy scores of adults, by type of health insurancecoverage: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44Estimates and standard errors for Figure 3-4. Percentage of adults in each health literacy level, by type of healthinsurance coverage: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45Estimates and standard errors for Figure 3-5. Percentage of adults who got information about health issues fromprinted and written media: newspapers, magazines, books or brochures, and the Internet, by health literacy level: 2003 . .45Estimates and standard errors for Figure 3-6. Percentage of adults who got information about health issues fromnonprint media: radio and television, by health literacy level: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46Estimates and standard errors for Figure 3-7. Percentage of adults who got information about health issues frompersonal contacts: family, friends, or coworkers; or health care professionals, by health literacy level: 2003 . . . . . . . . . . . . . .46Average health literacy scores of adults, by occupational group: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48Average health literacy scores of adults, by self-assessment of overall health and gender: 2003 . . . . . . . . . . . . . . . . . . . . . . D3-5.D3-6.D3-7.E-1.E-2.xi
The Health Literacy of America’s -23.E-24.E-25.xiiAverage health literacy scores of adults, by self-assessment of overall health and race/ethnicity: 2003 . . . . . . . . . . . . . . . . .49Average health literacy scores of adults, by self-assessment of overall health and age: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . .49Average health literacy scores of adults, by self-assessment of overall health and highest educational attainment:2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49Average health literacy scores of adults, by type of health insurance coverage and gender: 2003 . . . . . . . . . . . . . . . . . . . . . .50Average health literacy scores of adults, by type of health insurance coverage and race/ethnicity: 2003 . . . . . . . . . . . . . . . .50Average health literacy scores of adults, by type of health insurance coverage and age: 2003 . . . . . . . . . . . . . . . . . . . . . . . . .50Average health literacy scores of adults, by type of health insurance coverage and highest educational attainment:2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Average health literacy scores of adults who got information about health issues from newspapers, magazines,and books or brochures, by gender: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51Average health literacy scores of adults who got information about health issues from the Internet, by gender: 2003 . . . .52Average health literacy scores of adults who got information about health issues from newspapers, magazines,and books or brochures, by race/ethnicity: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Average health literacy scores of adults who got information about health issues from the Internet, by race/ethnicity:2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53Average health literacy scores of adults who got information about health issues from newspapers, magazines,and books or brochures, by age: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53Average health literacy scores of adults who got information about health issues from the Internet, by age: 2003 . . . . . . .54Average health literacy scores of adults who got information about health issues from newspapers, magazines,and books or brochures, by highest educational attainment: 2003 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54Average health literacy scores of adults who got information about health issues from the Internet, by highesteducational attainment: 2003 . . . .
The health literacy scale and health literacy tasks were guided by the definition of health literacy used by the Institute of Medicine and Healthy People 2010 (a set of national disease prevention and health promotion objectives led by the U.S.Department of Health and Human Services).This definition states that health literacy is:
May 02, 2018 · D. Program Evaluation ͟The organization has provided a description of the framework for how each program will be evaluated. The framework should include all the elements below: ͟The evaluation methods are cost-effective for the organization ͟Quantitative and qualitative data is being collected (at Basics tier, data collection must have begun)
Silat is a combative art of self-defense and survival rooted from Matay archipelago. It was traced at thé early of Langkasuka Kingdom (2nd century CE) till thé reign of Melaka (Malaysia) Sultanate era (13th century). Silat has now evolved to become part of social culture and tradition with thé appearance of a fine physical and spiritual .
On an exceptional basis, Member States may request UNESCO to provide thé candidates with access to thé platform so they can complète thé form by themselves. Thèse requests must be addressed to esd rize unesco. or by 15 A ril 2021 UNESCO will provide thé nomineewith accessto thé platform via their émail address.
̶The leading indicator of employee engagement is based on the quality of the relationship between employee and supervisor Empower your managers! ̶Help them understand the impact on the organization ̶Share important changes, plan options, tasks, and deadlines ̶Provide key messages and talking points ̶Prepare them to answer employee questions
Dr. Sunita Bharatwal** Dr. Pawan Garga*** Abstract Customer satisfaction is derived from thè functionalities and values, a product or Service can provide. The current study aims to segregate thè dimensions of ordine Service quality and gather insights on its impact on web shopping. The trends of purchases have
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Chính Văn.- Còn đức Thế tôn thì tuệ giác cực kỳ trong sạch 8: hiện hành bất nhị 9, đạt đến vô tướng 10, đứng vào chỗ đứng của các đức Thế tôn 11, thể hiện tính bình đẳng của các Ngài, đến chỗ không còn chướng ngại 12, giáo pháp không thể khuynh đảo, tâm thức không bị cản trở, cái được
Le genou de Lucy. Odile Jacob. 1999. Coppens Y. Pré-textes. L’homme préhistorique en morceaux. Eds Odile Jacob. 2011. Costentin J., Delaveau P. Café, thé, chocolat, les bons effets sur le cerveau et pour le corps. Editions Odile Jacob. 2010. Crawford M., Marsh D. The driving force : food in human evolution and the future.
