Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL).
In the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources) contribute to understanding disparities in health literacy.



We analyze data on respondents 18 years of age and older (N = 14,592) from the 2003 National Assessment of Adult Literacy (NAAL) restricted access data set. A series of weighted Ordinary Least Squares (OLS) regression models estimate the association between respondent's demographic characteristics, socioeconomic status (SES), relational social class, social resources and an Item Response Theory (IRT) based health literacy measure.



Our findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use) are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels.



Relational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering) are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.
Department of Media & Information, Michigan State University, 409 Comm Arts, 404 Wilson Road, East Lansing, MI, 48824, USA. rvrikard@msu.edu.
R V
0000-0003-2201-553X
RV
Rikard
Department of Sociology & Anthropology, North Carolina State University, Raleigh, NC, USA.
Maxine S
MS
Thompson
McKinney Health Literacy Services, Cambridge, MA, USA.
Julie
J
McKinney
Deakin Population Health SRC, Faculty of Health, Deakin University, Melbourne, VIC, Australia.
Alison
A
Beauchamp
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012923:Social Class; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult