Literacy and health 2014

Adult Literacy and its possible relation with some health aspects: Puerto Rico 2010 ©Dr. Orville M. Disdier

Adult Literacy and its possible relation with health related factors: Puerto Rico 2010

Dr. Orville M. Disdier Flores

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Version: 102114

Objectives

• Frame the historical context of literacy statistics in Puerto Rico

• Present a brief summary of the results obtained in the Literacy Survey of Puerto Rico: Natural Year 2010 (LEA2010)

• Examine the possible relationship between the adult literacy status and the health status during the natural year of 2010

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INTRODUCTION AND BACKGROUND

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Importance of Literacy in Society

• It is essential to…– Eradicate poverty– Reduce child mortality– Curb population grow– Achieve gender equality– Ensure sustainable development, peace and democracy

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(UNESCO, 2011)


Literacy is a technology…Walter Ong

“…technologies are never distributed evenly among the population”.

Neil Postman (1992)

Clipart form: http://www.closedstacks.com.


What is the current literacy rate in Puerto Rico?

6Clipart form: Microsoft Clipart, Power Point, 2007.


Literacy in Puerto Rico (1899‐2010)

“…the present can be understood only

with reference to its past.”

R.F. Hoxie (1906)

Clipart form: http://images.search.yahoo.com/search/images;_ylt=A0oG7mP2XB5RUkMAgAtXNyoA?p=time+travel&fr=yfp‐t‐701&fr2=piv‐web.

Historical Context of Literacy Statistics in Puerto Rico (1899‐2010)

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Illiteracy in Puerto Rico (1899‐2010)

• year 1899• 953,243 habitants• 79.6% literacy rate• 1903 University of

Puerto Rico, Río Piedras

79.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

1899

1910

1920

1930

1940

1950

1960

1970

1980

1990

2000*

2010



• year 1930 • 1,543,913 habitants• 41.4% literacy rate• 24,244 enrollment in

adult schools (1914‐1915)

• $30,000 legislative allocation to establish adult schools (1919‐1925)

79.0%

65.5%

55.0%

41.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

1899

1910

1920

1930

1940

1950

1960

1970

1980

1990

2000*

2010



• year 1960 • 2,349,544 habitants• 16.6% literacy rate• 22 PRERA camps in 3

lines: literacy, English teaching and special courses

• 1 Auxiliary Secretary of the Program of Education Extension in the Public Instruction Department

79.0%

65.5%

55.0%

41.4%

31.5%

24.7%

16.6%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

1899

1910

1920

1930

1940

1950

1960

1970

1980

1990

2000*

2010



• year 1990 • 3,523,037 habitants• 10.4% literacy rate• $3,515,464 assigned

budget by Legislature and Federal Government for the education of adult population

• 2000 Literacy question was not included in the 2000 Census.

79.0%

65.5%

55.0%

41.4%

31.5%

24.7%

16.6%10.8% 11.5% 10.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

1899

1910

1920

1930

1940

1950

1960

1970

1980

1990

2000*

2010


Results summary of the Literacy Survey of Puerto Rico: Natural Year 2010 (LEA2010)

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Figure 1. Literacy rate by sex (2010)

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___________________________________Weighted Percentages.n (male) = 2,436n (female) = 4,042Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

91.4 92.5 92.0

8.6 7.5 8.0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Masculino Femenino Ambos sexos

Percen

tage

SexAlfabetizado Analfabeta

Male Female

Literate

Both sexes

Illiterate


Figure 2. Literacy rate by age (2010)

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_________________________________Weighted Percentages.n (18‐34) = 1,597n (35‐44) = 2,082n (55 or more) = 2,757Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

2.78.2 13.5 8.0

97.3 91.8 86.592.0

0

10

20

30

40

50

60

70

80

90

100

18 ‐ 34 35 ‐ 54 55 o más Todas lasedades

Percen

tage (%

)

Age Group

Analfabeta Alfabetizado

All ages55 or more

Literate Illiterate


Figure 3. Literacy rate by marital status (2010)

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______________________________Weighted percentages. n (married or unmarried living as a married couple) = 3,385n (divorced, widowed or separated) = 1,953n (never married) = 1,120Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

65.0 61.0

15.1 25.619.9 13.4

0%10%20%30%40%50%60%70%80%90%100%

Literate Iliterate

Percen

tage

Literacy statusNever married

Divorced, widowed or separated

Married or unmarried living as married couple


Figure 4. Literacy rate by employment status (2010)

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40.317.4

59.782.6

0%10%20%30%40%50%60%70%80%90%100%

Literate Illiterate

Percen

tage

Literacy status

Employed Unemployed

______________________________Weighted percentages. n (employed) = 2,541n (unemployed) = 3,916Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.


Is there any possible relationship between Adult Literacy and Health Status?

18Clipart form: Microsoft Clipart, Power Point, 2007.


According to some authors and researchers…

• Literacy goes further than the ability to read, write and make mathematical operations; it includes other dimensions such as the capacity to maintain an adequate health status (Bennett and colleagues , 2002).

• Literate people have a highest probability of experimenting a better health status (Berkman and

colleagues, 2004).– Lower prevalence of diabetes and hypertension

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Other researchers have also found…

• Limited literacy contributes to reported poor health status (Hoffman‐Goetz, Meissner & Thompson, 2009)

• Illiterate people are more likely to suffer mental health conditions in comparison to literate people (TenHave, Van Horn & Kumanyika, 1997).

• Literacy is critically important in the successful treatment of several conditions, such as asthma. – The reading level was an important predictor of knowledge of asthma condition and its treatment.(Williams et al, 1998).

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Is there any relationship between adult literacy status in adults who live in Puerto Rico and some

health factors?

21Clipart form: http://www.marketingsociale.net/aree/24.htm.


METHODOLOGY

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Methodology

• Literacy questions were realized as a supplement for the PR‐BRFSS.

• 6,574 people who were 18 years old or more and lived in Puerto Rico during 2010.

• Probabilities obtained through Prevalence Odds Ratio (POR)– Logistic regression models were used to calculate the adjusted POR.

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RESULTS

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Figure 5. Prevalence of general health* perception by literacy status, Puerto Rico 2010

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64.7

32.3

35.3

67.7

0%10%20%30%40%50%60%70%80%90%100%

Alfabetizado Analfabeta

Percen

tage

Literacy status

Excelente/Muy buena/Buena Pobre/Muy pobreExcellent/Very good/Good Health______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio*Would you say that in general your health is—Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

p<0.001POR = 3.8

Poor/ Very poor Health

IlliterateLiterate


Figure 6. Prevalence of diabetes* by literacy status, Puerto Rico 2010

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______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio*Have you ever been told by a doctor that you have diabetes? Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

p<0.001POR = 0.42

[58%]

86.773.0

13.327.0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Alfabetizado Analfabeta

Porcen

taje

Literacy status

No Sí Yes

Literate Illiterate

Diabetes, YesDiabetes, No


Figure 7. Prevalence of physical activity* by literacy status, Puerto Rico 2010

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______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio*During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

p<0.001POR = 2.245.3

64.9

54.735.1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Literate Illiterate

Percen

tage

Literacy status

No YesPhysical activity, No Physical activity, Yes


Figure 8. Prevalence of heart attack* by literacy status, Puerto Rico 2010

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______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio* Has a doctor, nurse, or other health professional EVER told you that you had any of the following? (Ever told) you had a heart attack, also called a myocardial infarction?Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

88.171.7

11.928.3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Literate Illiterate

Percen

tage

Literacy status

No Yes

Weightedp<0.001

Unweightedp<0.001

Heart attack, No Heart attack, Yes


Figure 9 . Prevalence of current asthma* by literacy status, Puerto Rico 2010

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______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio* Adults who have been told they currently have asthma? This is a calculated variable using the responses from the following questions: a) Have you ever been told by a doctor, nurse, or other health professional that you had asthma?; and b) Do you still have asthma?Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

91.387.8

8.712.2

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

100%

Literate Illiterate

Percen

tage

Literacy status

No YesAsthma, No

Weightedp<0.001

Unweightedp=0.08

Asthma, Yes


Figure 10. Prevalence of overweight/obesity* by literacy status, Puerto Rico 2010

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31.9 31.3

68.1 68.7

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Literate Illiterate

Percen

tage

Literacy status

Normal Overweight/Obese

______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio*Based on the Body Mass Index.Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

Weightedp<0.001

UnweightedP=0.120


Figure 11. Prevalence of cigarette smoking* by literacy status, Puerto Rico 2010

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______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio*Have you smoked at least 100 cigarettes in your entire life? Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

Weightedp<0.001

Unweightedp=0.98084.9 84.0

15.1 16.0

75%

80%

85%

90%

95%

100%

Literate Illiterate

Percen

tage

Literacy status

No YesSmoking, YesSmoking, No


Figure 12 . Prevalence of health plan coverage status* by literacy status, Puerto Rico 2010

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______________________________Weighted percentages. The sample includes home phone and mobile phone number.POR=Crude Prevalence Odd Ratio*Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare? Note: It was classified as literate anyone who met the following: answered “never”, “almost never” or “sometimes” to the required questions about difficulties in the understanding of reading and difficulty to write. Not all the respondents completed the required questions.

Weightedp<0.001

Unweightedp=0.630

9.8 9.9

90.2 90.1

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Literate Illiterate

Percen

tage

Literacy status

No YesHealth plan, YesHealth plan, No


Table 1. Literacy versus health factors and protectors: crude and adjusted Prevalence Odds Ratios (POR) by age and sex (Adults, Puerto Rico 2010)

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______________________________All models evaluated the probability of literates versus illiterates of having the factor, condition or illness.

POR = Prevalence Odds Ratio.

Factor PORCrude

PORAdjusted

General Health Perception(Good, very good, excellent)

3.8(p<0.001)

3.0(p<0.001)

Living with diabetes (Yes)58.3%

less probability(p<0.001)

39.2%less probability

(p<0.001)

Have performed exercises or physical activity, not related to work, in the last 30 days (Yes)

2.2(p<0.001)

2.1(p<0.001)


CONCLUSIONS

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Conclusions• Based on the presented results it is possible to suggest that literate adults that reside in Puerto Rico have:1. Better general health2. Lower diabetes prevalence3. Lower overweight/obesity prevalence?4. Lower asthma prevalence5. Lower heart attack prevalence6. Lower cigarette smoking prevalence7. And also perform more physical activity

…in comparison with the illiterate adults.

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• Literacy seems to be positively associated with human health.


PUBLIC HEALTH LEADERSHIP?

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38Source: Rowitz, L. (2009). Public Health Leadership: Putting Principles into Practice (2nd Ed). Jones & Bartlett Publishers, Sudbury: Mass.


39Source: Rowitz, L. (2009). Public Health Leadership: Putting Principles into Practice (2nd Ed). Jones & Bartlett Publishers, Sudbury: Mass.


Adult Education Program Puerto Rico Department of Education

• Principal aim:– To promote, facilitate and expand educative opportunities and employability of this population

• Oriented to:– Reduce illiteracy– Develop academic skills required at work places– Improve educational attainment of young people and adults outside the school

– Develop skills in English, from 1st to 8th grade and 9thto 12th grade

– Integrate technology in teaching‐learning process

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Adult Education Program Puerto Rico Department of Education

• Available in public schools and non‐profit installations all around the island that had been approved by the Puerto Rico Department of Education.

• Academic offer:– To adults (16 or more years old) who are outside school and want to continue or start with their studies

– Course schedules are: diurnal, evening, nocturnal and Saturday

– Basic Education– Secondary Education– Conversational English


National Leadership Activities U.S. Department of Education

• The Office of Vocational and Adult Education, Division of Adult Education and Literacy (DAEL), oversees national leadership activities, funded through Section 243 of the Adult Education and Family Literacy Act (AEFLA).

• These activities strive to ensure that all youth and adult students:– Are ready for, have access to, and complete college and career

pathways– Have effective teachers and leaders– Have equitable access to high quality learning opportunities on

demand– Benefit from an expanding research and evidence base


ADDITIONAL INTERVENTIONS?

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“Studies of interventions to improve the health of persons with low literacy have increased in number over the past 10 years but remain relatively uncommon”.

“Fewer studies have examined interventions designed to mitigate the effects of low literacy on intermediate markers, measures of disease incidence or prevalence, or use of health services”.

“No research to date has examined how interventions affect the general health status of persons with low literacy or whether interventions can affect health care costs or health disparities based on race, ethnicity, culture, or age”.


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QU E S T I O N S ?

46Clipart form: http://www.garylellis.org/if‐you‐could‐ask‐jesus‐one‐question‐by‐gary‐ellis/.


ReferencesAsociación de Ejecutivos de Ventas y Mercadeo de Puerto Rico (2011) Puerto Rico Internet Pulse 2010.Departamento de Educación. Proyecto de alfabetización. Historia de la alfabetización en Puerto Rico. Estado Libre

Asociado de Puerto Rico. Retirado de http://www.dde.pr/dePortal/Comunidad/Adultos/AlfabetHistory.htm el 25 de agosto de 2011.

Departamento de la Guerra (1900). Informe sobre el Censo de Puerto Rico. Washington: Imprenta del Gobierno. Retirado de http://www.estadisticas.gobierno.pr/iepr/LinkClick.aspx?fileticket=02D_v0VNgmM%3d&tabid=186el 25 de agosto de 2011.

Hoxie, R. F. (Nov., 1906). Historical Method vs. Historical Narrative. Journal of Political Economy. 14(9), pp. 568‐572.International Telecommunication Union (2012) Global ICT developments, 2001‐2011. http://www.itu.int/ict/statisticsNegociado del Censo (1992). Censo de Población y Vivienda de 1990. Resumen de características sociales, económicas y

de la vivienda.Washington: U.S. Government Printing Office. Retirado de http://www.estadisticas.gobierno.pr/iepr/LinkClick.aspx?fileticket=CxAuqnr2Rgg%3d&tabid=186 el 25 de agosto de 2011.

Universidad de Puerto Rico‐UPR (2011) La UPR‐Historia. Retirado de http://www.upr.edu/?type=page&id=la_upr_historia&ancla=historia&r_type=items&r_id=0 el 25 de agosto de 2011.

Bennett J, Boyle PA, James BD, Bennett DA. (2012). Correlates of health and financial literacy in older adults without dementia. BMC Geriatrics. Obtenido el 4 de diciembre de 2012, en http://www.biomedcentral.com/1471‐2318/12/30.

Berkman ND, DeWalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and Health Outcomes. (2004, January). Evidence Report/Technology Assessment No. 87 (Prepared by RTI International–University of North Carolina Evidence‐based Practice Center under Contract No. 290‐02‐0016). AHRQ Publication No. 04‐E007‐2. Rockville, MD: Agency for Healthcare Research and Quality.

Hoffman‐Goetz L, Meissner HI, Thomson MD. (2009). Literacy and Cancer Anxiety as Predictors of Health Status: An Exploratory Study. Journal of Cancer Education. 24:218‐224. DOI:10.1080/08858190902910871

TenHave TR, Van Horn B, Kumanyika S, et al. (1997). Literacy assessment in a cardiovascular nutrition education setting. Patient Educat Counsel; 31(2):139‐50.

Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. (1998). Inadequate Literacy Is a Barrier to Asthma Knowledge and Self‐Care. CHEST. 114:1008‐1015. Accessed March 6, 2014 from: <http://publictaions.chestnet.org/>

Thanks!

“Al educarse la razón también se educa la conciencia; al educarse la conciencia, se induce al bien.”

Eugenio María de Hostos