Stewart Diana W, Cano Miguel Angel, Correa-Fernández Virmarie, Spears Claire Adams, Li Yisheng, Waters Andrew J, Wetter David W, Vidrine Jennifer Irvin
The Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
BMC Public Health. 2014 Jul 14;14:716. doi: 10.1186/1471-2458-14-716.
Nearly half of U.S. adults have difficulties with health literacy (HL), which is defined as the ability to adequately obtain, process, and understand basic health information. Lower HL is associated with negative health behaviors and poor health outcomes. Racial/ethnic minorities and those with low socioeconomic status (SES) are disproportionately affected by poor HL. They also have higher smoking prevalence and more difficulty quitting smoking. Thus, lower HL may be uniquely associated with poorer cessation outcomes in this population.
This study investigated the association between HL and smoking cessation outcomes among 200, low-SES, racially/ethnically diverse smokers enrolled in smoking cessation treatment. Logistic regression analyses adjusted for demographics (i.e., age, gender, race/ethnicity, relationship status), SES-related characteristics (i.e., education, income), and nicotine dependence were conducted to investigate associations between HL and smoking relapse at the end of treatment (3 weeks post quit day).
Results indicated that smokers with lower HL (score of < 64.5 on the Rapid Estimate of Adult Literacy in Medicine [REALM]) were significantly more likely than those with higher HL (score of ≥ 64.5 on the REALM) to relapse by the end of treatment, even after controlling for established predictors of cessation including demographics, SES, and nicotine dependence (OR = 3.26; 95% CI = 1.14, 9.26).
Findings suggest that lower HL may serve as an independent risk factor for smoking relapse among low-SES, racially/ethnically diverse smokers enrolled in treatment. Future research is needed to investigate longitudinal relations between HL and cessation outcomes and potential mechanisms of this relationship.
近一半的美国成年人存在健康素养（HL）方面的困难，健康素养被定义为充分获取、处理和理解基本健康信息的能力。较低的健康素养与负面健康行为及不良健康结果相关。种族/族裔少数群体以及社会经济地位（SES）较低的人群受不良健康素养的影响尤为严重。他们的吸烟率也更高，且戒烟难度更大。因此，较低的健康素养可能与该人群较差的戒烟结果存在独特关联。
本研究调查了200名参加戒烟治疗的低SES、种族/族裔多样化吸烟者的健康素养与戒烟结果之间的关联。进行了逻辑回归分析，对人口统计学因素（即年龄、性别、种族/族裔、恋爱状况）、SES相关特征（即教育程度、收入）和尼古丁依赖进行了调整，以研究治疗结束时（戒烟日3周后）健康素养与吸烟复发之间的关联。
结果表明，健康素养较低的吸烟者（医学成人识字率快速评估[REALM]得分<64.5）在治疗结束时比健康素养较高的吸烟者（REALM得分≥64.5）更有可能复发，即使在控制了包括人口统计学、SES和尼古丁依赖等既定的戒烟预测因素之后（OR = 3.26；95% CI = 1.14，9.26）。
研究结果表明，较低的健康素养可能是参加治疗的低SES、种族/族裔多样化吸烟者吸烟复发的独立危险因素。未来需要开展研究，以调查健康素养与戒烟结果之间的纵向关系以及这种关系的潜在机制。
