title: The association of health literacy with cervical cancer prevention knowledge and health behaviors in a multiethnic cohort of women.
abstract: OBJECTIVE
  Our purpose was to describe the relationship between health literacy, ethnicity, and cervical cancer screening practices and to evaluate physician recognition of low literacy.
  
  
  METHODS
  We studied a prospective cohort of English-speaking patients > or =18 years (n = 529) in ambulatory women's clinics. Univariate and multivariate analyses were used to evaluate demographics, health practices and beliefs, and knowledge regarding cervical cancer screening and prevention. Physicians' assessments of patient reading skills were obtained.
  
  
  RESULTS
  Low health literacy (<9th grade) was found among 40% of participants. Minority women were half as likely to know the purpose of the Papanicolaou test (9% vs 21%; P <.03) and were significantly more likely to have low literacy levels compared with white women (46% vs 15%; P <.05). Literacy was the only factor independently associated with knowledge related to cervical cancer screening (adjusted odds ratio, 2.25; 95% CI, 1.05-4.80). Physicians detected only 20% of the lowest readers.
  
  
  CONCLUSIONS
  Poor health literacy was a better predictor of cervical cancer screening knowledge than ethnicity or education, yet physicians infrequently recognized low literacy. Improved physician awareness and development of low literacy interventions may improve cervical cancer screening, particularly for the most vulnerable women.
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University Medical School, the University of Chicago Robert Wood Johnson Clinical Scholars Program, Ill 60637, USA.
authors.forename: Stacy T
authors.initials: ST
authors.lastname: Lindau
authors.forename: Cecilia
authors.initials: C
authors.lastname: Tomori
authors.forename: Tom
authors.initials: T
authors.lastname: Lyons
authors.forename: Lizbet
authors.initials: L
authors.lastname: Langseth
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Patricia
authors.initials: P
authors.lastname: Garcia
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D008913:Minority Groups; D065006:Papanicolaou Test; D011315:Preventive Medicine / Q000193:education*; D011446:Prospective Studies; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*; D014626:Vaginal Smears; D044465:White People