inundation with information has increased as the Internet has become an increasingly important source of health information. Socioeconomic status, education level, and primary language all affect whether consumers will seek out health information, where they will look for the information, what type of information they prefer, and how they will interpret that information. Limited health literacy decreases the likelihood that health-related information will be accessible to all (Houston and Allison, 2002).

Finding 4-1 Culture gives meaning to health communication. Health literacy must be understood and addressed in the context of culture and language.

Finding 4-2 More than 300 studies indicate that health-related materials far exceed the average reading ability of U.S. adults.

Finding 4-3 Competing sources of health information (including the national media, the Internet, product marketing, health education, and consumer protection) intensify the need for improved health literacy.

Finding 4-4 Health literacy efforts have not yet fully benefited from research findings in social and commercial marketing.

The Educational System

Adult education is an important resource for individuals with limited literacy or limited English proficiency. A major source of support for American adult education programs in literacy is the U.S. adult basic education and literacy (ABEL) system. ABEL programs provide classes in topics that support health literacy including basic literacy and math skills, English language, and high school equivalence, and predominantly serve students with literacy and math skills in NALS Levels 1, 2, or the low end of NALS Level 3. Sadly, these programs serve far fewer than the millions of Americans who could benefit.

Both childhood literacy education and childhood health education can provide a basis for health literacy in adulthood. Although most elementary, middle, and high schools require students to take health education, the sequence of coursework is not coordinated. The percentage of schools that require health education increases from 33 percent in kindergarten to 44 percent in grade 5, but then falls to 10 percent in grade 9, and 2 percent in grade 12. The absence of a coordinated health education program across grade levels may impede student learning of needed health literacy skills. Furthermore, only 9.6 percent of health education classes have a teacher



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