title: Lower health literacy predicts smoking relapse among racially/ethnically diverse smokers with low socioeconomic status.
abstract: BACKGROUND
  Nearly half of U.S. adults have difficulties with health literacy (HL), which is defined as the ability to adequately obtain, process, and understand basic health information. Lower HL is associated with negative health behaviors and poor health outcomes. Racial/ethnic minorities and those with low socioeconomic status (SES) are disproportionately affected by poor HL. They also have higher smoking prevalence and more difficulty quitting smoking. Thus, lower HL may be uniquely associated with poorer cessation outcomes in this population.
  
  
  METHODS
  This study investigated the association between HL and smoking cessation outcomes among 200, low-SES, racially/ethnically diverse smokers enrolled in smoking cessation treatment. Logistic regression analyses adjusted for demographics (i.e., age, gender, race/ethnicity, relationship status), SES-related characteristics (i.e., education, income), and nicotine dependence were conducted to investigate associations between HL and smoking relapse at the end of treatment (3 weeks post quit day).
  
  
  RESULTS
  Results indicated that smokers with lower HL (score of < 64.5 on the Rapid Estimate of Adult Literacy in Medicine [REALM]) were significantly more likely than those with higher HL (score of ≥ 64.5 on the REALM) to relapse by the end of treatment, even after controlling for established predictors of cessation including demographics, SES, and nicotine dependence (OR = 3.26; 95% CI = 1.14, 9.26).
  
  
  CONCLUSIONS
  Findings suggest that lower HL may serve as an independent risk factor for smoking relapse among low-SES, racially/ethnically diverse smokers enrolled in treatment. Future research is needed to investigate longitudinal relations between HL and cessation outcomes and potential mechanisms of this relationship.
authors.affiliation: The Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. DWStewart@mdanderson.org.
authors.forename: Diana W
authors.initials: DW
authors.lastname: Stewart
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Cano
authors.forename: Virmarie
authors.initials: V
authors.lastname: Correa-Fernández
authors.forename: Claire Adams
authors.initials: CA
authors.lastname: Spears
authors.forename: Yisheng
authors.initials: Y
authors.lastname: Li
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Waters
authors.forename: David W
authors.initials: DW
authors.lastname: Wetter
authors.forename: Jennifer Irvin
authors.initials: JI
authors.lastname: Vidrine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005006:Ethnicity; D005260:Female; D015438:Health Behavior; D057220:Health Literacy; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D015995:Prevalence; D044469:Racial Groups; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000208:ethnology; D016540:Smoking Cessation / Q000208:ethnology; D012923:Social Class; D014029:Tobacco Use Disorder / Q000208:ethnology; D014481:United States; D055815:Young Adult