title: A life course approach to health literacy: the role of gender, educational attainment and lifetime cognitive capability.
abstract: social inequalities in health are believed to arise in part because individuals make use of social and economic resources in order to improve survival. In recent years, health literacy has received increased attention as a factor that can help explain differences in health outcomes. However, examination of life course predictors of health literacy has been limited.
  
  
  
  life course data from the Wisconsin Longitudinal Study 1957-2011 were used to examine predictors of health literacy in old age (N = 2,122), using the Newest Vital Sign. Generalised structural equation modelling was used to model pathways to health literacy.
  
  
  
  predictors of health literacy included educational attainment, and adolescent cognitive and non-cognitive skills, and, in men, rate of cognitive decline from middle to later life.
  
  
  
  numerous studies have documented health literacy issues among older adults, and recommendations have been made for ways to improve health literacy for this population. This study reports on risk factors across the life course that are associated with health literacy later in life, identifying possible intervention targets to reduce risk of poor health as people age. Our results suggest that a range of life course factors, beginning in early life, predict health literacy. Further research studying health literacy over the life course is warranted.
authors.affiliation: Program in Public Health, Department of Preventive Medicine, Stony Brook University, Stony Brook, NY, USA.
authors.forename: Sean A P
authors.initials: SAP
authors.lastname: Clouston
authors.affiliation: School of Public Health, University at Albany-State, University of New York, New York, NY, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Manganello
authors.affiliation: MRC Unit for Lifelong Health and Ageing at UCL, London, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Richards
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003071:Cognition; D000066492:Cognitive Aging / Q000523:psychology*; D004522:Educational Status; D005260:Female; D057220:Health Literacy; D054624:Health Status Disparities; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D008568:Memory; D008875:Middle Aged; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D012737:Sex Factors; D013997:Time Factors; D014922:Wisconsin
keywords: cognitive epidemiology; health literacy; life course epidemiology; older people; psychology; social inequalities in health