Published online October 27, 2009
PEDIATRICS Vol. 124 Supplement November 2009, pp. S289-S298 (doi:10.1542/peds.2009-1162E)

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SUPPLEMENT ARTICLE

The Health Literacy of Parents in the United States: A Nationally Representative Study

H. Shonna Yin, MD, MS^a, Matthew Johnson, PhD^b, Alan L. Mendelsohn, MD^a, Mary Ann Abrams, MD, MPH^c, Lee M. Sanders, MD^d, Benard P. Dreyer, MD^a

^a Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York
^b Department of Human Development, Teacher's College, Columbia University, New York, New York
^c Clinical Performance Improvement, Iowa Health System, Des Moines, Iowa
^d Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida

OBJECTIVE: To assess the health literacy of US parents and explore the role of health literacy in mediating child health disparities.

METHODS: A cross-sectional study was performed for a nationally representative sample of US parents from the 2003 National Assessment of Adult Literacy. Parent performance on 13 child health-related tasks was assessed by simple weighted analyses. Logistic regression analyses were performed to describe factors associated with low parent health literacy and to explore the relationship between health literacy and self-reported child health insurance status, difficulty understanding over-the-counter medication labeling, and use of food labels.

RESULTS: More than 6100 parents made up the sample (representing 72600098 US parents); 28.7% of the parents had below-basic/basic health literacy, 68.4% were unable to enter names and birth dates correctly on a health insurance form, 65.9% were unable to calculate the annual cost of a health insurance policy on the basis of family size, and 46.4% were unable to perform at least 1 of 2 medication-related tasks. Parents with below-basic health literacy were more likely to have a child without health insurance in their household (adjusted odds ratio: 2.4 [95% confidence interval: 1.1–4.9]) compared with parents with proficient health literacy. Parents with below-basic health literacy had 3.4 times the odds (95% confidence interval: 1.6–7.4) of reporting difficulty understanding over-the-counter medication labels. Parent health literacy was associated with nutrition label use in unadjusted analyses but did not retain significance in multivariate analyses. Health literacy accounted for some of the effect of education, racial/ethnic, immigrant-status, linguistic, and income-related disparities.

CONCLUSIONS: A large proportion of US parents have limited health-literacy skills. Decreasing literacy demands on parents, including simplification of health insurance and other medical forms, as well as medication and food labels, is needed to decrease health care access barriers for children and allow for informed parent decision-making. Addressing low parent health literacy may ameliorate existing child health disparities.

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Key Words: health literacy • literacy • health care disparities

Abbreviations: NCES—National Center for Education Statistics • NAAL—National Assessment of Adult Literacy • OTC—over-the-counter • aOR—adjusted odds ratio • CI—confidence interval

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Accepted Jul 20, 2009.

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