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Background: Medicaid enrollment and retention among eligible populations remains a challenge. Purpose: We assessed health literacy-related features and content of Internet-based state Medicaid enrollment materials and resources. Methods: In February 2021, using established tools, we evaluated paper Medicaid enrollment applications and scope of enrollment resources (on-line enrollment option, toll-free telephone assistance, live chat function, instructional and/or informational audiovisuals). Results: Forty (78.4%) English- and 28 (54.9%) Spanish-language paper Medicaid enrollment applications were available. Overall, document complexity was high as a large volume of information is required to apply for Medicaid coverage. An on-line Medicaid enrollment option was nearly universal. Medicaid government platforms were more likely to provide toll-free telephone assistance (n = 34; 66.7%) than a live chat function (n = 10; 19.6%). Eleven (n = 11; 21.6%) government platforms provided an instructional and/or informational Medicaid enrollment audiovisual resource. Discussion: Our work suggests the need for states to leverage technology in creation of resources to match language and cultural needs of the diverse US population. Translation to Health Education Practice: Access to continuous health insurance coverage, comprehensive clinical care services, and evidence-based health education programming combined are essential in promoting both individual and community health.

Background: As children are at high dehydration risk, caregivers must have access to understandable and actionable educational resources. Purpose: This study assessed usability, accessibility, complexity and readability of diverse pediatric dehydration educational materials. Methods: Over-the-counter (OTC) electrolyte replacement solution labeling, internet-based OTC electrolyte replacement solution content features and YouTube™ dehydration management videos were reviewed and evaluated for adherence to health literacy guidelines. Results: Reading demands ([approximately equal to] 8th-9th grade) and text point sizes of OTC usage and instruction labels did not meet health literacy formatting guidelines. Just one electrolyte replacement solution included both English- and Spanish-language information labeling. All (n = 5) brand name electrolyte replacement solutions provided supplemental internet-based product-related resources. Unique YouTube™ dehydration management videos (n = 9), uploaded between February 16, 2015 and June 30, 2020, had view ranges from 3413 to 202 945. Discussion: The scope of pediatric childhood dehydration educational materials should be expanded upon to include multilingual options adhering to evidence-based health literacy formatting guidelines. Translation to Health Education Practice: There is need for health educators to be cognizant of communication components -- literacy levels, language, culture -- when designing health education materials and familiarize themselves with validated evidence-based tools to assess suitability of communication aids and materials.

The purposes of this study were to (1) longitudinally examine US college and university COVID-19 dashboard content and (2) explore county-level population health and COVID-19 community indicators where colleges with large undergraduate enrollments were located. We identified 10 colleges with the largest undergraduate enrollments. Next, we located all public and private two- and four-year nonprofit colleges (n = 58) in each respective county. We assessed active COVID-19 dashboards using established criteria from We Rate COVID Dashboards in March 2021 and February 2022. In 2021 and 2022, two-thirds (n = 38/58) of colleges had an active COVID-19 dashboard. While most COVID-19 dashboards were easy to read, they were less likely to include updated daily infection rates and testing frequency details. Overall quality, content, and features of COVID-19 dashboards varied greatly across colleges. Future COVID-19 dashboard designs should focus on providing evidence-based information with the goal of promoting and supporting informed decision making. [ABSTRACT FROM AUTHOR]

Author(s): Lorraine S. Wallace[sup.1] , Patricia Fine Rosenstein[sup.2] , Noga Gal[sup.1] Author Affiliations: (1) AHEC Clear Health Communication Program, The Ohio State University College of Medicine, 43210, Columbus, OH, USA [...], Objectives This study aimed to assess readability characteristics and layout features, including reading grade level, text point size, dimensions (length and width), diagrams, key directions (warnings, proper hygiene, preparation and use, and storage), and compliance to International Code provisions of English-language instructions affixed to a representative sample of brand-name and generic powdered, infant formula containers currently available for purchase in the US. Methods During June 2014, comprehensive Internet searches were conducted to identify brand-name powdered infant formulas currently available for purchase in the US (n = 10). The English-language instruction section affixed to each formula container was evaluated for readability characteristics and layout features, including reading grade level, text point size, dimensions (length and width), diagrams, key directions (warnings, proper hygiene, preparation and use, and storage), and compliance to International Code. Results Overall, containers were similar in circumference (50.8 ± 7.3 cm) and height (14.0 ± 0.0 cm) and held an average of 656.0 ± 12.3 g (range 629-663 g) of powdered infant formula. Both Directions for Preparation and Use and Storage Instructions sections had average reading difficulty scores at the college level. Step-by-Step Preparation Directions and Warnings and Safe Handling sections had reading difficulty between the 8th and 9th grade level. All container labels contained three diagrams depicting step-by-step preparation instructions and a feeding chart. Overall, infant formula containers reviewed in our study adhered to compliance to International Code provisions. Conclusions As negative health outcomes are associated with inappropriately prepared infant formula feedings, healthcare providers should routinely query infant caregivers regarding their formula preparation and administration practices.

Objective: To examine whether theories and/or models are used in interventions geared towards improving health-related outcomes for individuals with limited literacy skills. Methods: Intervention studies (n = 52) published between 1980 and 2009 that met inclusion criteria were reviewed to assess the topic addressed, type of theory and/or model used, and the extent of theory use. Results: Twenty-one (40.4%) interventions were based on a theory or model. Most of those 21 interventions were either "informed by" (n = 15, 71.4%) or "applied" (n = 4, 19.1%) theory whereas 2 (9.5%) "tested" theory. Conclusions: Most low-literacy intervention research is not based on any educational, behavioral, or social science theory or model.

Author(s): Jennifer E. DeVoe[sup.1] , Carrie J. Tillotson[sup.2] , Heather Angier[sup.1] , Lorraine S. Wallace[sup.3] Author Affiliations: (1) Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam [...], To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children's Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child's coverage gap in both 1998 and 2009. Compared to children with at least one parent continuously covered, children whose parents did not have continuous coverage had a significantly higher relative risk (RR) of a coverage gap [RR 17.96, 95 % confidence interval (CI) 14.48-22.29 in 1998; RR 12.88, 95 % CI 10.41-15.93 in 2009]. In adjusted models, parental continuous coverage was the only significant predictor of discontinuous coverage for children (with one exception in 2009). The magnitude of the pattern was higher for privately-insured children [adjusted relative risk (aRR) 29.17, 95 % CI 20.99-40.53 in 1998; aRR 25.54, 95 % CI 19.41-33.61 in 2009] than publicly-insured children (aRR 5.72, 95 % CI 4.06-8.06 in 1998; aRR 4.53, 95 % CI 3.40-6.04 in 2009). Parental coverage continuity has a major influence on children's coverage continuity; this association remained even after public health insurance expansions for children. The Affordable Care Act will increase coverage for many adults; however, 'churning' on and off programs due to income fluctuations could result in coverage discontinuities for parents. If parental coverage instability persists, these discontinuities may continue to have a negative impact on children's coverage stability as well.

Introduction In recent years, significant changes in children's health insurance coverage policies have occurred in the United States (US). The Children's Health Insurance Program (CHIP), established in 1997, increased federal [...], In the past decade, political and economic changes in the United States (US) have affected health insurance coverage for children and their parents. Most likely these policies have differentially affected coverage patterns for children (versus parents) and for low-income (versus high-income) families. We aimed to examine--qualitatively and quantitatively--the impact of changing health insurance coverage on US families. Primary data from interviews with Oregon families (2008-2010) were analyzed using an iterative process. Qualitative findings guided quantitative analyses of secondary data from the nationally-representative Medical Expenditure Panel Survey (MEPS) (1998-2009); we used Joinpoint Regression to assess average annual percent changes (AAPC) in health insurance trends, examining child and parent status and type of coverage stratified by income. Interviewees reported that although children gained coverage, parents lost coverage. MEPS analyses confirmed this trend; the percentage of children uninsured all year decreased from 9.6% in 1998 to 6.1% in 2009; AAPC = -3.1% (95% confidence interval [CI] from -5.1 to -1.0), while the percentage of parents uninsured all year rose from 13.6% in 1998 to 17.1% in 2009, AAPC = 2.7% (95% CI 1.8-3.7). Low-income families experienced the most significant changes in coverage. Between 1998 and 2009, as US children gained health insurance, their parents lost coverage. Children's health is adversely affected when parents are uninsured. Investigation beyond children's coverage rates is needed to understand how health insurance policies and changing health insurance coverage trends are impacting children's health. Keywords Health insurance * Access to care * Health services research * Health policy * Health care disparities * Children's health care

A study was conducted to determine the predictors of uninsurance among US children and adolescents with insured parents. Results indicate that predictors of uninsurance included those having low and middle income.

The purpose of this study was to evaluate changes in behaviors and behavioral intentions that occurred among 342 middle-age women (M age 49.5 yr.) after participating in an Osteoporosis Prevention Program. The valid and reliable Osteoporosis Preventing Behaviors Survey (developed by Doheny and Sedlak) and a survey developed for this work were measures. Significant changes in behaviors were reported, especially increases in weight-bearing physical activity, dairy product intake, and decreases in consumption of caffeine-containing beverages. Many subjects reported intentions to increase physical activity and calcium intake. An Osteoporosis Prevention Program may help promote osteoporosis prevention behaviors, but intents must be followed up to check actual change.