Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 1, pp 182–188 | Cite as

A Preliminary Study of Health Literacy in an Ethnically Diverse University Sample

  • Gunes AvciEmail author
  • Victoria M. Kordovski
  • Steven P. Woods


There is a considerable body of research on health literacy in adult healthcare settings, mostly among at-risk clinical populations. However, much less is known about health literacy among youth transitioning to adulthood, including college students. Despite the protective effects of higher levels of education, some college students might have other risk factors for low health literacy (i.e., minority status). Hence, the purpose of the present study was to explore health literacy in an ethnically diverse public urban university. Although a majority of the students performed within the adequate range, we observed a subset of Hispanic and foreign students with lower health literacy, particularly in the domain of numeracy. Our preliminary results suggest that, contrary to common belief, there exists a vulnerable subpopulation of college students that have difficulty understanding and using health-related information. Health professionals should be alert to possible low health literacy among college students that may interfere with communication of vital health-related information and decision-making.


Health literacy Health disparities Minorities Ethnicity Newest Vital Sign Rapid Estimate of Adult Literacy 



The authors thank the students who participated in the study.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Institutional Review Board at the University of Houston (Protocol ID: 15289-02 - 6020).


  1. 1.
    U.S. Department of Health and Human Services. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In: Selden CR, Zorn M, Ratzan SC, Parker RM, editors. NLM Pub. No. CBM 2000–1 National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services; 2000.Google Scholar
  2. 2.
    Baker DW. The meaning and the measure of health literacy. J Gen Intern Med. 2006;21:878–83.CrossRefGoogle Scholar
  3. 3.
    Nielsen-Bohlman L, Panzer AM, Kindig DA. Health literacy: a prescription to end confusion. Washington, DC: National Academy Press; 2004.Google Scholar
  4. 4.
    Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.CrossRefGoogle Scholar
  5. 5.
    Wolf MS. Misunderstanding of prescription drug warning labels among patients with low literacy. Am J Health Syst Pharm. 2006;63(11):1048–55.CrossRefGoogle Scholar
  6. 6.
    Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2):175–84.CrossRefGoogle Scholar
  7. 7.
    Weiss BD, Blanchard JS, McGee DL, Hart G, Warren B, Burgoon M, et al. Illiteracy among Medicaid recipients and its relationship to health care costs. J Health Care Poor Underserved. 1994;5(2):99–111.CrossRefGoogle Scholar
  8. 8.
    Manganello JA. Health literacy and adolescents: a framework and agenda for future research. Health Educ Res. 2008;23(5):840–7.CrossRefGoogle Scholar
  9. 9.
    Wyatt TJ, Oswalt SB, Ochoa Y. Mental health and academic success of first-year college students. International Journal of Higher Education. 2017;6(3):178.CrossRefGoogle Scholar
  10. 10.
    Ickes MJ, Cottrell R. Health literacy in college students. J Am Coll Heal. 2010;58(5):491–8.CrossRefGoogle Scholar
  11. 11.
    Kutner M, Greenberg E, Jin Y, Paulson C. The health literacy of America’s adults: results from the 2003 National Assessment of adult literacy. US Department of education. Washington, DC: National Center for Education Statistics; 2006.Google Scholar
  12. 12.
    Shigaki CL, Kruse RL, Mehr DR, Ge B. The REALM vs. NVS: a comparison of health literacy measures in patients with diabetes. Ann Behav Sci Med Educ. 2012;18(1):9–13.CrossRefGoogle Scholar
  13. 13.
    Parikh NS, Parker RM, Nurss JR, Baker DW, Williams MV. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996;27(1):33–9.CrossRefGoogle Scholar
  14. 14.
    Shaw SJ, Huebner C, Armin J, Orzech K, Vivian J. The role of culture in health literacy and chronic disease screening and management. J Immigr Minor Health. 2009;11(6):460–7.CrossRefGoogle Scholar
  15. 15.
    Kawamura M, Honkala E, Widström E, Komabayashi T. Cross-cultural differences of self-reported oral health behaviour in Japanese and Finnish dental students. Int Dent J. 2000;50(1):46–50.CrossRefGoogle Scholar
  16. 16.
    Institute of Medicine. Health literacy: a prescription to end confusion. Washington, DC: The National Academies Press; 2004.Google Scholar
  17. 17.
    Andrulis DP, Brach C. Integrating literacy, culture, and language to improve health care quality for diverse populations. Am J Health Behav. 2007;31(Suppl 1):S122–33.CrossRefGoogle Scholar
  18. 18.
    Bennett IM, Chen J, Soroui JS, White S. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009;7(3):204–11.CrossRefGoogle Scholar
  19. 19.
    Smith PC, Brice JH, Lee J. The relationship between functional health literacy and adherence to emergency department discharge instructions among Spanish-speaking patients. J Natl Med Assoc. 2012;104(11–12):521–7.CrossRefGoogle Scholar
  20. 20.
    Lee HY, Rhee TG, Kim NK, Ahluwalia JS. Health literacy as a social determinant of health in Asian American immigrants: findings from a population-based survey in California. J Gen Intern Med. 2015;30(8):1118–24.CrossRefGoogle Scholar
  21. 21.
    Chaudhry SI, Herrin J, Phillips C, Butler J, Mukerjhee S, Murillo J, et al. Racial disparities in health literacy and access to care among patients with heart failure. J Card Fail. 2011;17(2):122–7.CrossRefGoogle Scholar
  22. 22.
    Colby SL, Ortman JM. Projections of the size and composition of the U.S. population: 2014 to 2060. Current Population Reports; 25-1143, U.S. Washington, DC: Census Bureau; 2014.Google Scholar
  23. 23.
    Department of Education, National Center for Education Statistics: Higher Education General Information Survey (HEGIS), “Fall Enrollment in Colleges and Universities” surveys, 1976 and 1980; Integrated Postsecondary Education Data System (IPEDS), “Fall Enrollment Survey” (IPEDS-EF:90); and IPEDS Spring 2001 through Spring 2016, Fall Enrollment component. 2016; ?current=yes. Accessed 12 June, 2018.
  24. 24.
    Mas FS, Jacobson HE, Dong Y. Health literacy level of Hispanic college students. South Med J. 2014;107(2):61–5.CrossRefGoogle Scholar
  25. 25.
    Marin G, Gamba RJ. A new measurement of acculturation for Hispanics: the bidimensional acculturation scale for Hispanics (BAS). Hisp J Behav Sci. 1996;18(3):297–316.CrossRefGoogle Scholar
  26. 26.
    Ciampa PJ, White RO, Perrin EM, Yin HS, Sanders LM, Gayle EA, et al. The association of acculturation and health literacy, numeracy and health-related skills in Spanish-speaking caregivers of young children. J Immigr Minor Health. 2013;15:492–8.CrossRefGoogle Scholar
  27. 27.
    National Institute of Health. Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes. 2015; Accessed 13 Apr. 2018.
  28. 28.
    Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3(6):514–22.CrossRefGoogle Scholar
  29. 29.
    Shealy KM, Threatt TB. Utilization of the newest vital sign (NVS) in practice in the United States. Health Commun. 2016;31(6):679–87.CrossRefGoogle Scholar
  30. 30.
    Kordovski VM, Woods SP, Avci G, Verduzco M, Morgan EE. Is the newest vital sign a useful measure of health literacy in HIV disease? J Int Assoc Provid AIDS Care. 2017;16(6):595–602.CrossRefGoogle Scholar
  31. 31.
    Murphy P, Davis T, Long S, Jackson R, Decker B. Rapid estimate of adult literacy in medicine (REALM): a quick reading test for patients. J Read. 1993;37(2):124–30.Google Scholar
  32. 32.
    Dumenci L, Matsuyama RK, Kuhn L, Perera RA, Siminoff LA. On the validity of the shortened rapid estimate of adult literacy in medicine (REALM) scale as a measure of health literacy. Commun Methods Meas. 2013;7(2):134–43.CrossRefGoogle Scholar
  33. 33.
    Berryman B, Bobée D, Cluis D, Haemmerli J. Nonparametric tests for trend detection in water quality time series. J Am Water Resour Assoc. 1988;24:545–56.CrossRefGoogle Scholar
  34. 34.
    Garcia-Retamero R, Andrade A, Sharit J, Ruiz JG. Is patients’ numeracy related to physical and mental health? Med Decis Mak. 2015;35(4):501–11.CrossRefGoogle Scholar
  35. 35.
    Escarce JJ, Kapur K. Access to and quality of health care. In: National Research Council (US) Panel on Hispanics in the United States. In: Tienda M, Mitchell F, editors. Hispanics and the Future of America. Washington (DC): National Academies Press (US); 2006.Google Scholar
  36. 36.
    Morales LS, Lara M, Kington RS, Valdez RO, Escarce JJ. Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. J Health Care Poor Underserved. 2002;13(4):477–503.CrossRefGoogle Scholar
  37. 37.
    Else-Quest NM1, Hyde JS, Linn MC. Cross-national patterns of gender differences in mathematics: a meta-analysis. Psychol Bull. 2010;136(1):103–27.CrossRefGoogle Scholar
  38. 38.
    Wu AD, Begoray DL, MacDonald M, Wharf Higgins J, Frankish J, Kwan B, et al. Developing and evaluating a relevant and feasible instrument for measuring health literacy of Canadian high school students. Health Promot Int. 2010;25(4):444–52.CrossRefGoogle Scholar
  39. 39.
    Torres R, Nichols J. Health literacy knowledge and experiences of associate degree nursing students: a pedagogical study. Teach Learn Nurs. 2014;9(2):84–92.CrossRefGoogle Scholar
  40. 40.
    Osborn CY, Weiss BD, Davis TC, Skripkauskas S, Rodrigue C, Bass PF, et al. Measuring adult literacy in health care: performance of the newest vital sign. Am J Health Behav. 2007;31(Suppl 1):S36–46.CrossRefGoogle Scholar
  41. 41.
    Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults. J Gen Intern Med. 1995;10:537–41.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of HoustonHoustonUSA

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