Tobacco education in low-literacy individuals.

Approximately 20% of the adult population in the United States have low-literacy skills. The subpopulations with the highest incidence of low literacy are nearly identical to those with the highest prevalence of tobacco use. Low-literacy smokers are more likely to underestimate the risks related to tobacco use, have less social pressure and support to quit smoking, may experience more life stress and consequently rely more heavily on nicotine use for stress reduction and require more assistance in developing a sense of self-efficacy. This indicates a need to modify smoking cessation methods of counselling, content and selection of educational materials for the marginally literate. Currently available low-literacy materials are listed, and suggestions for adjusting or developing materials are made.