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OBJECTIVES: This study examined the relationship of functional health literacy to self-reported health and use of health services. METHODS: Patients presenting to two large, urban public hospitals in Atlanta, Ga, and Torrance, Calif, were administered a health literacy test about their overall health and use of health care services during the 3 months preceding their visit. RESULTS: Patients with inadequate functional health literacy were more likely than patients with adequate literacy to report their health as poor. Number of years of school completed was less strongly associated with self-reported health. Literacy was not related to regular source of care or physician visits, but patients in Atlanta with inadequate literacy were more likely than patients with adequate literacy to report a hospitalization in the previous year. CONCLUSIONS: Low literacy is strongly associated with self-reported poor health and is more closely associated with self-reported health than number of years of school completed.

Inadequate functional health literacy is common, but its impact on patients with chronic diseases is not well described.To examine among patients with hypertension or diabetes the relationship between their functional health literacy level and their knowledge of their chronic disease and treatment.We conducted a cross-sectional survey of patients with hypertension and diabetes presenting to the general medicine clinics at 2 urban public hospitals. Literacy was measured by the Test of Functional Health Literacy in Adults. Knowledge of their illness was assessed in patients with diabetes or hypertension using 21 hypertension and 10 diabetes questions based on key elements in educational materials used in our clinics.A total of 402 patients with hypertension and 114 patients with diabetes were enrolled. Mean (+/- SD) knowledge scores for patients with hypertension with inadequate (n = 189), marginal (n = 49), or adequate (n = 155) literacy were 13.2 +/- 3.1, 15.3 +/- 2.2, and 16.5 +/- 2.3, respectively (range, 4-20; P.001). A total of 92% of patients with hypertension and adequate literacy levels knew that a blood pressure reading of 160/100 mm Hg was high compared with 55% of those in the lowest reading level (P.001). Mean (+/- SD) knowledge scores for patients with diabetes with inadequate (n = 50), marginal (n = 13), or adequate (n = 51) literacy were 5.8 +/- 2.1, 6.8 +/- 1.9, and 8.1 +/- 1.6, respectively (range, 1-10; P.001). A total of 94% of patients with diabetes and adequate functional health literacy knew the symptoms of hypoglycemia compared with 50% of those with inadequate literacy (P.001).Inadequate functional health literacy poses a major barrier to educating patients with chronic diseases, and current efforts to overcome this appear unsuccessful.

Five language-eliciting situations were presented to 48 kindergarten and primary-grade children to identify developmental trends and task effects in the complexity of language structures, vocabulary, functions, and story conventions used. Limited developmental differences (between kindergarten and primary children but not within primary groups) were found. Significant task effects were found. Telling an original story with no picture stimulus produced the most mature language structures and functions; the wordless picture book task elicited more mature narrative structures; and the single picture tasks elicited more varied vocabulary. Classroom instructional implications are suggested.

guage deficiencies into account. If a child cannot use school language to express ideas clearly and with ease, he is not likely to meet the expectations schools place on him. If one intervenes early enough in the lives of lower-status children, changes in language can be effected. To this end, eight classes of innercity, lower-status, threeto fouryear-old pre-kindergarten children in Atlanta, Georgia, were given ten months' instruction to increase their

INVESTIGATES WHAT EACH of the tests in a battery of 53 perceptual, cognitive, linguistic, and achievement measures was assessing in two socio-economic level (SEL) groups: upper-middle and low. Subjects were 211 second-grade boys and girls from the Atlanta Public Schools, approximately one third black and two thirds white from each SEL. Separate intercorrelation matrices and factor analyses were computed for the two SEL groups. Several well-defined factors common to both groups were found: immediate memory span, academic achievement, vocabulary, and four visual-perceptual factors. A separate auditory processing factor was found for the low SEL group and a verbal mediation factor for the upper-middle SEL group. The greatest similarity between the two SEL groups seemed to be in the visual factors and the greatest difference in the language factors. Implications were made about use of some of the tests and about teaching reading to Southern upper-middle and low SEL children.