title: Health literacy and medication adherence in adolescents.
abstract: OBJECTIVE
  To assess the relationship between health literacy levels and medication adherence in adolescents.
  
  
  METHODS
  A convenience sample of adolescents ages 12-21 years was recruited April-September 2011 at an urban adolescent health center. Health literacy and medication adherence was measured via the Rapid Estimate of Adult Literacy in Medicine-TEEN (REALM-TEEN) and Adherence to Refills and Medications Scale. The interrelated effects of age, sex, chronic illness, learning disability, health rating, and health literacy on adherence to medication were explored via the use of regression trees.
  
  
  RESULTS
  Of 138 adolescents surveyed, 112 (81%) were included in the analysis because they reported ever taking a medication and completed all survey questions. Median participant age was 16.1 years, 94% were African American, and 64% were female. Median REALM-TEEN score was 57 (6th-7th grade; range 0-66). Median ARMS score was 21 (poor; range 0-56). A positive correlation was found between worse adherence (greater ARMS scores) and self-report of a learning disability (P = .041), and between ARMS scores and having a chronic illness (P = .003). The ARMS and REALM-TEEN scores were not correlated (P = .069). Regression tree analysis indicated that adolescents with both a chronic illness and a learning disability had worse ARMS scores (median score 24), compared with adolescents having only a chronic illness (median score 22), independent of health literacy scores.
  
  
  CONCLUSIONS
  Almost one-quarter of adolescents reported having a learning disability and had worse medication adherence independent of health literacy levels. This finding suggests other cognitive factors, beyond reading, may play a role in medication adherence.
authors.affiliation: Division of Adolescent Medicine, Medical College of Wisconsin, Milwaukee, WI. Electronic address: sdharmap@mcw.edu.
authors.forename: Sadhana
authors.initials: S
authors.lastname: Dharmapuri
authors.affiliation: Department of Pediatrics, George Washington University, Washington, DC.
authors.forename: Dana
authors.initials: D
authors.lastname: Best
authors.affiliation: Department of Pediatrics, George Washington University, Washington, DC; Division of General and Community Pediatrics, Medical Education, Children's National Health System, Washington, DC.
authors.forename: Terry
authors.initials: T
authors.lastname: Kind
authors.affiliation: Department of Pediatrics, George Washington University, Washington, DC; Division of Adolescent Medicine, Children's National Health System, Washington, DC.
authors.forename: Tomas J
authors.initials: TJ
authors.lastname: Silber
authors.affiliation: Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
authors.affiliation: Department of Pediatrics, George Washington University, Washington, DC; Division of Adolescent Medicine, Children's National Health System, Washington, DC.
authors.forename: Lawrence
authors.initials: L
authors.lastname: D'Angelo
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring