eHealth literacy among undergraduate nursing students

BACKGROUND

The Internet has become a major source of health related information. Nursing students, as future healthcare providers, should be skilled in locating, using and evaluating online health information.

AIM

The main purpose of this study was to assess eHealth literacy among nursing students in Jordan, as well as to explore factors associated with eHealth literacy.

METHODS

A descriptive cross sectional survey was conducted in two universities in Jordan, one public and one private. A total of 541 students completed the eHealth literacy scale (eHEALS). Some additional personal and demographical variables were collected to explore their relation to eHealth literacy.

RESULTS

Students have a moderate self-perceived level of eHealth literacy (M=3.62, SD=0.58). They are aware of the available online health resources and know how to search, locate, and use these resources. Yet, they lack skills to evaluate them and cannot differentiate between high and low quality resources. Factors that are related to eHealth literacy include type of university, type of student admission, academic level, students' internet skills, and their perception of the usefulness and importance of the internet. On the other hand, age, gender, grade point average (GPA), and frequency of internet use were found not to significantly affect eHealth literacy.

CONCLUSION

This study represents a baseline reference for eHealth literacy in Jordan. Students have some of the necessary skills, while others still need to be improved. Nursing educators and administrators should incorporate eHealth literacy skills into the curriculum.

Classroom quality as a predictor of first graders' time in non-instructional activities and literacy achievement

This study investigated how quality of the classroom learning environment influenced first grade students' (n=533) time spent in two non-instructional classroom activities (off-task and in transition) and their subsequent literacy outcomes. Hierarchical linear modeling revealed that higher classroom quality was related to higher student performance in reading comprehension and expressive vocabulary. Further, classroom quality predicted the amount of time students spent off-task and in transitions in the classroom, with slopes of change across the year particularly impacted. Mediation effects were detected in the case of expressive vocabulary such that the influence of classroom quality on students' achievement operated through students' time spent in these non-instructional activities. Results highlight the importance of overall classroom quality to how students navigate the classroom environment during learning opportunities, with subsequent literacy achievement impacted. Implications for policy and educational practices are discussed.

The Role of Phonological versus Morphological Skills in the Development of Arabic Spelling: An Intervention Study

The current study investigated the contribution of two linguistic intervention programs, phonological and morphological to the development of word spelling among skilled and poor native Arabic readers, in three grades: second, fourth and sixth. The participants were assigned to three experimental groups: morphological intervention, phonological intervention and a non-intervention control group. Phonological awareness, morphological awareness, and spelling abilities were tested before and after the intervention. Participants from both linguistic intervention programs and in all grades made significant progress in linguistic awareness and spelling after the intervention. The results showed that both intervention programs were successful in promoting children's spelling skills in both groups. Also, older poor readers showed a stronger response to the morphological intervention than the older skilled readers. A transfer effect was found with the phonological training contributing to the morphological skills and vice versa. The results of the current study were discussed in the light of developmental and psycholinguistic views of spelling acquisition as well as the characteristics of Arabic language and orthography.

Evaluation of an Australian health literacy training program for socially disadvantaged adults attending basic education classes: study protocol for a cluster randomised controlled trial

BACKGROUND

People with low literacy and low health literacy have poorer health outcomes. Literacy and health literacy are distinct but overlapping constructs that impact wellbeing. Interventions that target both could improve health outcomes.

METHODS/DESIGN

This is a cluster randomised controlled trial with a qualitative component. Participants are 300 adults enrolled in basic language, literacy and numeracy programs at adult education colleges across New South Wales, Australia. Each adult education institute (regional administrative centre) contributes (at least) two classes matched for student demographics, which may be at the same or different campuses. Classes (clusters) are randomly allocated to receive either the health literacy intervention (an 18-week program with health knowledge and skills embedded in language, literacy, and numeracy training (LLN)), or the standard Language Literacy and Numeracy (LLN) program (usual LLN classes, specifically excluding health content). The primary outcome is functional health literacy skills - knowing how to use a thermometer, and read and interpret food and medicine labels. The secondary outcomes are self-reported confidence, more advanced health literacy skills; shared decision making skills, patient activation, health knowledge and self-reported health behaviour. Data is collected at baseline, and immediately and 6 months post intervention. A sample of participating teachers, students, and community health workers will be interviewed in-depth about their experiences with the program to better understand implementation issues and to strengthen the potential for scaling up the program.

DISCUSSION

Outcomes will provide evidence regarding real-world implementation of a health literacy training program with health worker involvement in an Australian adult education setting. The evaluation trial will provide insight into translating and scaling up health literacy education for vulnerable populations with low literacy.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12616000213448 .

Preservice teacher knowledge of basic language constructs in Canada, England, New Zealand, and the USA

The present study examined preservice teachers' (PSTs) knowledge of basic language constructs across four different English-speaking teacher preparations programs. A standardized survey was administered to participants from Canada (n = 80), England (n = 55), New Zealand (n = 26), and the USA (n = 118). All participants were enrolled in undergraduate university programs that led to teacher certification for general education in the primary grades. Our data reveal that preservice teachers from all four countries show patterns of relative strength in areas that were targeted to be crucial within their national initiatives. Nevertheless, in general, PSTs demonstrated a lack of knowledge of certain constructs needed to teach early reading skills. The results are discussed in relation to research reports and initiatives regarding beginning reading instruction from each of the four countries.

Language and reading instruction in early years' classrooms: the knowledge and self-rated ability of Australian teachers

This study sought to investigate the level of knowledge of language constructs in a cohort of Australian teachers and to examine their self-rated ability and confidence in that knowledge. Seventy-eight teachers from schools across the Australian state of Victoria completed a questionnaire which included items from existing measures, as well as newly developed items. Consistent with a number of earlier Australian and international studies, teachers' explicit and implicit knowledge of basic linguistic constructs was limited and highly variable. A statistically significant correlation was found between (1) total self-rated ability and (2) years since qualification and experience teaching the early years of primary school; however, no relationship was found between self-rated ability and overall performance on knowledge items. Self-rated ability to teach phonemic awareness and phonics had no relationship with demonstrated knowledge in these areas. Teachers were most likely to rate their ability to teach skills including spelling, phonics, comprehension or vocabulary as either moderate or very good. This was despite most respondents demonstrating limited knowledge and stating that they did not feel confident answering questions about their knowledge in these areas. The findings from this study confirm that in the field of language and literacy instruction, there is a gap between the knowledge that is theoretically requisite, and therefore expected, and the actual knowledge of many teachers. This finding challenges current pre-service teacher education and in-service professional learning.

Relevance of graph literacy in the development of patient-centered communication tools

OBJECTIVE

To determine the literacy skill sets of patients in the context of graphical interpretation of interactive dashboards.

METHODS

We assessed literacy characteristics of prostate cancer patients and assessed comprehension of quality of life dashboards. Health literacy, numeracy and graph literacy were assessed with validated tools. We divided patients into low vs. high numeracy and graph literacy. We report descriptive statistics on literacy, dashboard comprehension, and relationships between groups. We used correlation and multiple linear regressions to examine factors associated with dashboard comprehension.

RESULTS

Despite high health literacy in educated patients (78% college educated), there was variation in numeracy and graph literacy. Numeracy and graph literacy scores were correlated (r=0.37). In those with low literacy, graph literacy scores most strongly correlated with dashboard comprehension (r=0.59-0.90). On multivariate analysis, graph literacy was independently associated with dashboard comprehension, adjusting for age, education, and numeracy level.

CONCLUSIONS

Even among higher educated patients; variation in the ability to comprehend graphs exists.

PRACTICE IMPLICATIONS

Clinicians must be aware of these differential proficiencies when counseling patients. Tools for patient-centered communication that employ visual displays need to account for literacy capabilities to ensure that patients can effectively engage these resources.

Premarital childbearing in sub-Saharan Africa: Can investing in women's education offset disadvantages for children?

Premarital childbearing is common in many parts of sub-Saharan Africa, and may become increasingly so with the rise in women’s age at first marriage. These trends are concerning given the severe childhood health consequences associated with being born premaritally. However, women’s could condition the experience of having a premarital birth in a way that lessens its consequences for children. Extending the large literature on the child health benefits of mothers’ education—including her educational attainment and acquisition of key educational skills – I analyze whether the consequences of being born premaritally are lessened among children whose mothers are more highly-educated. The study focuses on Malawi, a southeast African country where child mortality rates remain high. I use Demographic and Health Survey data to estimate discrete-time logistic regression models (N=30,411 children younger than age five) of the relationships between premarital childbearing, mothers’ educational background, and child mortality. The findings confirm that though being born premaritally is associated with higher child mortality, this is only true for children whose mothers have never been to school or discontinued at the primary level and/or never learned how to read. There is no evidence that being born premaritally is associated with elevated mortality among children whose mothers have been to secondary school and/or know how to read. The results demonstrate that analyzing how premarital childbearing intersects with other sources of health inequality enhances our understanding of the circumstances under which it poses the greatest risk to child well-being in sub-Saharan Africa.

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Premarital childbearing is common in sub-Saharan Africa.

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Being born premaritally is known to increase children’s risk of mortality.

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In Malawi, the consequences of being born premaritally differs by mothers’ education.

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Mothers’ educational attainment and literacy offsets the elevated mortality risk associated with being born premaritally.

Implications of Physical Literacy for Research and Practice: A Commentary

Physical literacy is a term that has increasingly gained popularity in recent years. A variety of individuals and organizations have promoted the use of the term internationally, and a variety of claims have been made for the benefits of using the term. A historical overview allows the reader to consider physical literacy as one of many terms that have gained popularity in the field and describes divergent views as well as areas of agreement concerning the term physical literacy. Three North American institutional approaches to physical literacy are discussed. Other issues are also discussed, including assessment and other literacy types (e.g., health, sports). The article is designed to provoke thought among professionals and representatives of institutions concerning physical literacy.

Risk and protective factors in gifted children with dyslexia

This study investigated risk and protective factors associated with dyslexia and literacy development, both at the group and individual level, to gain more insight in underlying cognitive profiles and possibilities for compensation in high-IQ children. A sample of 73 Dutch primary school children included a dyslexic group, a gifted-dyslexic group, and a borderline-dyslexic group (i.e., gifted children with relative literacy problems). Children were assessed on literacy, phonology, language, and working memory. Competing hypotheses were formulated, comparing the core-deficit view to the twice-exceptionality view on compensation with giftedness-related strengths. The results showed no indication of compensation of dyslexia-related deficits by giftedness-related strengths in gifted children with dyslexia. The higher literacy levels of borderline children compared to gifted children with dyslexia seemed the result of both fewer combinations of risk factors and less severe phonological deficits in this group. There was no evidence for compensation by specific strengths more relevant to literacy development in the borderline group. Accordingly, the findings largely supported the core-deficit view, whereas no evidence for the twice-exceptionality view was found. Besides practical implications, the findings also add to knowledge about the different manifestations of dyslexia and associated underlying cognitive factors at the higher end of the intelligence spectrum.

A qualitative study on personal information management (PIM) in clinical and basic sciences faculty members of a medical university in Iran

BACKGROUND

Personal Information Management (PIM) refers to the tools and activities to save and retrieve personal information for future uses. This study examined the PIM activities of faculty members of Iran University of Medical Sciences (IUMS) regarding their preferred PIM tools and four aspects of acquiring, organizing, storing and retrieving personal information.

METHODS

The qualitative design was based on phenomenology approach and we carried out 37 interviews with clinical and basic sciences faculty members of IUMS in 2014. The participants were selected using a random sampling method. All interviews were recorded by a digital voice recorder, and then transcribed, codified and finally analyzed using NVivo 8 software.

RESULTS

The use of PIM electronic tools (e-tools) was below expectation among the studied sample and just 37% had reasonable knowledge of PIM e-tools such as, external hard drivers, flash memories etc. However, all participants used both paper and electronic devices to store and access information. Internal mass memories (in Laptops) and flash memories were the most used e-tools to save information. Most participants used "subject" (41.00%) and "file name" (33.7 %) to save, organize and retrieve their stored information. Most users preferred paper-based rather than electronic tools to keep their personal information.

CONCLUSION

Faculty members had little knowledge about PIM techniques and tools. Those who organized personal information could easier retrieve the stored information for future uses. Enhancing familiarity with PIM tools and training courses of PIM tools and techniques are suggested.

Impact of Age and Comorbidity on Cervical and Breast Cancer Literacy of African Americans, Latina, and Arab Women

This study examines the relationship between age, comorbidity, and breast and cervical cancer literacy in a sample of African American, Latina, and Arab women (N = 371) from Detroit, Michigan. The Age-adjusted Charlson Comorbidity Index (ACC) was used characterize the impact of age and comorbidity on breast and cervical cancer literacy. The relationship between ACC and breast and cervical cancer screening, and group differences, were assessed. There was a statistically significant difference between breast cancer literacy scores. ACC had a greater impact on breast cancer literacy for African Americans.

Early prediction of language and literacy problems: is 18 months too early?

There is a lack of stability in language difficulties across early childhood: most late talkers (LTs) resolve their difficulties by pre-school; and a significant number of children who were not LTs subsequently manifest language difficulties. Greater reliability in predicting individual outcomes is needed, which might be achieved by waiting until later in development when language is more stable. At 18 months, productive vocabulary scores on the Oxford Communicative Developmental Inventory were used to classify children as LTs or average talkers (ATs). Thirty matched-pairs of LTs and ATs were followed up at school-age (average age 7 years), when language and literacy outcomes were assessed. For 18 children, intermediate testing at age 4 had classified them as showing typical development (TD) or specific language impairment (SLI). After correcting for multiple comparisons, there were no significant differences between the LTs and ATs on any outcome measure, and the LTs were performing in the average range. However, there were large-sized effects on all outcomes when comparing the TD and SLI groups. LT status on its own is not determinative of language and literacy difficulties. It would therefore not be appropriate to use expressive vocabulary measures alone to screen for language difficulties at 18 months. However, children with language impairment at age 4 are at risk of enduring difficulties.

Quality of education predicts performance on the Wide Range Achievement Test-4th Edition Word Reading subtest

The current study examined whether self-rated education quality predicts Wide Range Achievement Test-4th Edition (WRAT-4) Word Reading subtest and neurocognitive performance, and aimed to establish this subtest's construct validity as an educational quality measure. In a community-based adult sample (N = 106), we tested whether education quality both increased the prediction of Word Reading scores beyond demographic variables and predicted global neurocognitive functioning after adjusting for WRAT-4. As expected, race/ethnicity and education predicted WRAT-4 reading performance. Hierarchical regression revealed that when including education quality, the amount of WRAT-4's explained variance increased significantly, with race/ethnicity and both education quality and years as significant predictors. Finally, WRAT-4 scores, but not education quality, predicted neurocognitive performance. Results support WRAT-4 Word Reading as a valid proxy measure for education quality and a key predictor of neurocognitive performance. Future research should examine these findings in larger, more diverse samples to determine their robust nature.

From emergent literacy to reading: how learning to read changes a child's brain

The ability to comprehend language is uniquely human. Behavioural and neuroimaging data reinforce the importance of intact oral language as foundational for the establishment of proficient reading. However, proficient reading is achieved not only via intact biological systems, but also a stimulating Home Literacy Environment.

CONCLUSION

Behavioural and neuroimaging correlates for linguistic ability and literacy exposure support the engagement of neural circuits related to reading acquisition.

Normative Study of the Literacy Independent Cognitive Assessment in Illiterate and Literate Elderly Koreans

OBJECTIVE

The aim of this study was to provide normative data on the Literacy Independent Cognitive Assessment (LICA) and to explore the effects of age, education/literacy, and gender on the performance of this test.

METHODS

Eight hundred and eighty-eight healthy elderly subjects, including 164 healthy illiterate subjects, participated in this study. None of the participants had serious medical, psychiatric, or neurological disorders including dementia. Bivariate linear regression analyses were performed to examine the effects of age, education/literacy, and sex on the score in each of the LICA cognitive tests. The normative scores for each age and education/literacy groups are presented.

RESULTS

Bivariate linear regression analyses revealed that total score and all cognitive tests of the LICA were significantly influenced by both age and education/literacy. Younger and more-educated subjects outperformed older and illiterate or less-educated subjects, respectively, in all of the tests. The normative scores of LICA total score and subset score were presented according to age (60-64, 65-69, 70-74, 75-80, and ≥80 years) and educational levels (illiterate, and 0-3, 4-6, and ≥7 years of education).

CONCLUSION

These results on demographic variables suggest that age and education should be taken into account when attempting to accurately interpret the results of the LICA cognitive subtests. These normative data will be useful for clinical interpretations of the LICA neuropsychological battery in illiterate and literate elderly Koreans. Similar normative studies and validations of the LICA involving different ethnic groups will help to enhance the dementia diagnosis of illiterate people of different ethnicities.

Computer-tailored smoking cessation advice matched to reading ability: Perceptions of participants from the ESCAPE trial

OBJECTIVE

To explore perceptions of computer-tailored advice reports for smoking cessation matched to the recipient's reading level.

METHODS

Current cigarette smokers in the UK aged 18-65 who completed a Smoking Behavior Questionnaire (n=6911) were randomized to receive standard generic materials or standard materials plus computer-tailored reports adapted to the recipient's reading level. Smoking status and perception of the reports was assessed at a 6-month follow-up. 4677 participants were included in the analysis.

RESULTS

53.3% were categorized into the easy reading group (ERG). The relative benefit of the intervention for prolonged 3-month abstinence was more marked in the ERG (2.6%/1.9%, OR=1.50) than in the standard reading group (SRG) (4.0%/3.8%, OR=1.05), although the interaction was not statistically significant. Participants in the Intervention group perceived the standard materials more positively than did those in the Control group, and participants in the ERG perceived both the generic material and the tailored report more positively.

CONCLUSIONS

The easy reading version of this brief self-help intervention was better perceived than the standard version, and appeared to have a small, but promising effect in smokers with a lower literacy level.

PRACTICE IMPLICATIONS

An association between reading level and deprivation emphasizes the need to adapt smoking cessation materials to address the needs of smokers with lower literacy.

Predictors of reading comprehension ability in primary school-aged children who have pragmatic language impairment

PURPOSE

Children who have pragmatic language impairment (CwPLI) have difficulties with the use of language in social contexts and show impairments in above-sentence level language tasks. Previous studies have found that typically developing children's reading comprehension (RC) is predicted by reading accuracy and spoken sentence level comprehension (SLC). This study explores the predictive ability of these factors and above-sentence level comprehension (ASLC) on RC skills in a group of CwPLI.

METHOD

Sixty nine primary school-aged CwPLI completed a measure of RC along with measures of reading accuracy, spoken SLC and both visual (pictorially presented) and spoken ASLC tasks.

RESULTS

Regression analyses showed that reading accuracy was the strongest predictor of RC. Visual ASLC did not explain unique variance in RC on top of spoken SLC. In contrast, a measure of spoken ASLC explained unique variance in RC, independent from that explained by spoken SLC. A regression model with nonverbal intelligence, reading accuracy, spoken SLC and spoken ASLC as predictors explained 74.2% of the variance in RC.

CONCLUSIONS

Findings suggest that spoken ASLC may measure additional factors that are important for RC success in CwPLI and should be included in routine assessments for language and literacy learning in this group.

Knowledge, transfer, and innovation in physical literacy curricula

Literate individuals possess knowledge and skill and can apply these to perform tasks in novel settings. Knowledge is at the heart of physical literacy and provides the foundation for knowing what to do and how and when to perform. In this paper I argue that physical literacy includes not only knowledge for performance but also the ability to apply knowledge and use knowledge for innovation. Scholars since the 1930s have addressed the role of knowledge in physical literacy designing curricula centered on transmitting knowledge through a range of interdisciplinary approaches to physical education. This emphasis on physical literacy curricula continues today in the Science, PE, & Me! and The Science of Healthful Living interdisciplinary curricula.

The Structure of Oral Language and Reading and Their Relation to Comprehension in Kindergarten through Grade 2

This study examined the structure of oral language and reading and their relation to comprehension from a latent variable modeling perspective in Kindergarten, Grade 1, and Grade 2. Participants were students in Kindergarten (n = 218), Grade 1 (n = 372), and Grade 2 (n = 273), attending Title 1 schools. Students were administered phonological awareness, syntax, vocabulary, listening comprehension, and decoding fluency measures in mid-year. Outcome measures included a listening comprehension measure in Kindergarten and a reading comprehension test in Grades1 and 2. In Kindergarten, oral language (consisting of listening comprehension, syntax, and vocabulary) shared variance with phonological awareness in predicting a listening comprehension outcome. However, in Grades 1 and 2, phonological awareness was no longer predictive of reading comprehension when decoding fluency and oral language were included in the model. In Grades 1 and 2, oral language and decoding fluency were significant predictors of reading comprehension.

Effects of Parent and Child Pre-Intervention Characteristics on Child Skill Acquisition during a School Readiness Intervention

200 preschool children in Head Start (55% girls; 20% Hispanic, 25% African-American, 55% European American; M age = 4.80 years old) participated in a randomized-controlled trial of a home visiting intervention designed to promote their emergent literacy skills (the Research-based Developmentally Informed parent [REDI-P] program). This study explored concurrent changes in levels of parent support and child literacy skills that occurred over the course of the intervention, and examined the impact of pre-intervention parent support and child literacy skills as potential moderators of parent and child outcomes. Cross-lagged structural equation models and follow-up analyses indicated that intervention had the strongest impact on child literacy skills when parents were high on support at the pre-intervention assessment. Conversely, the REDI-Parent program promoted the greatest gains in parent support when parents entered the program with low levels. These findings suggest that families may benefit from home visit school readiness interventions in different ways: child skill acquisition may be greatest when parents are initially high in support, whereas parenting may improve most when parents are initially low in support.

The health competence measurement tool (HCMT): developing a new scale to measure self-rated "health competence"

OBJECTIVES

To develop and test a tool for measuring health competence.

METHODS

In order to measure this attribute, we used a sequential exploratory mixed methods design in rural and urban communities in Cameroon. In the qualitative phase, 67 clients constituted 10 focus groups to elicit themes related to health competence. In the quantitative phase, self-rated items were tested on 300 participants and on a random selection of 25 participants 2 weeks later.

RESULTS

The internal consistency for the subscales derived varied from 0.61-0.81. Older (F[45, 339.1]=1.2; p=0.031) and more educated (F[3, 22.6]=2.1; p=0.004) people were more likely to score higher on the scale. Interviewers also contributed to the variance (F[5, 37.6]=3.6; p<0.001). Test-retest reliability was 0.66. The final scale with 15 items is made up of three subscales: knowledge of disease, how to stay in good health and health information.

CONCLUSION

We present a new self-rated scale for health competence with good psychometric properties. It circumvents the need to be literate, but requires well trained interviewers. We recommend that it be tested in other settings.

PRACTICE IMPLICATIONS

This tool should be used to appraise individual and community health education needs with minor context specific modifications.

Associations between patient-provider communication and socio-cultural factors in prostate cancer patients: a cross-sectional evaluation of racial differences

OBJECTIVE

To examine the association between socio-cultural factors and patient-provider communication and related racial differences.

METHODS

Data analysis included 1854 men with prostate cancer from a population-based study. Participants completed an assessment of communication variables, physician trust, perceived racism, religious beliefs, traditional health beliefs, and health literacy. A multi-group structural equation modeling approach was used to address the research aims.

RESULTS

Compared with African Americans, Caucasian Americans had significantly greater mean scores of interpersonal treatment (p<0.01), prostate cancer communication (p<0.001), and physician trust (p<0.001), but lower mean scores of religious beliefs, traditional health beliefs, and perceived racism (all p values <0.001). For both African and Caucasian Americans, better patient-provider communication was associated with more physician trust, less perceived racism, greater religious beliefs (all p-values <0.01), and at least high school education (p<0.05).

CONCLUSION

Socio-cultural factors are associated with patient-provider communication among men with cancer. No evidence supported associations differed by race.

PRACTICE IMPLICATION

To facilitate patient-provider communication during prostate cancer care, providers need to be aware of patient education levels, engage in behaviors that enhance trust, treat patients equally, respect religious beliefs, and reduce the difficulty level of the information.

Predictors of help-seeking for suicidal ideation in the community: risks and opportunities for public suicide prevention campaigns

Help-seeking behaviour for suicidality is low and the reasons for this have not systematically been examined. The aim of the current study was to examine the relationship between suicide stigma, suicide literacy and help-seeking attitudes and intentions. One thousand two hundred seventy-four Australian adults recruited via Facebook completed an online survey assessing a range of mental health outcomes. High suicide literacy and low suicide stigma were significantly associated with more positive help-seeking attitudes and, among a subsample of 534, greater intentions to seek help. Attribution of suicide to isolation was associated with more positive attitudes toward help-seeking and greater intentions to seek help, while respondents experiencing suicidal ideation had more negative attitudes toward help-seeking and lower intentions to seek help. Lower depressive symptoms, older age and female gender were associated with more positive help-seeking attitudes and higher help-seeking intentions. However, there were differential associations of specific suicide knowledge items and specific stigmatising attitudes with help-seeking outcomes; suggesting a nuanced approach may be required to promote help seeking for suicidality. Suicide knowledge and attitudes play an important role in the help-seeking process for suicide and should be carefully considered in the development of public awareness campaigns.

Effectiveness of a child's fable on the cognition of preschools when used to address childhood obesity

The study investigated the effectiveness of a child's fable on the cognition of preschoolers when used to address childhood obesity. A single group, pretest/posttest design was used with 57 preschool children. Analysis of variance compared pre-existing differences between the four classes with respect to pre-test scores. A repeated measures t-test analyzed changes in scores as a result of the intervention. Following the fable intervention, students showed a significant difference (0.5) between their pre- and post-test scores, indicating this method to an effective learning strategy in this setting and age population.

Low literacy is associated with uncontrolled blood pressure in primary care patients with hypertension and heart disease

OBJECTIVES

To evaluate the association between low literacy and uncontrolled blood pressure (BP) and their associations with medication adherence.

METHODS

Cross-sectional study of 423 urban, primary care patients with hypertension and coronary disease. The relationship between low literacy (Rapid Estimate of Adult Literacy in Medicine ≤ 44) and uncontrolled BP (≥140/90 mmHg, ≥130/80 mmHg for patients with diabetes) was evaluated by crude and adjusted logistic regression. Relationships with self-reported adherence and refill adherence were explored using adjusted linear and logistic regression.

RESULTS

Overall, 192 (45%) subjects had low literacy and 227 (52.9%) had uncontrolled BP. Adjusting for age, gender, race, employment, education, mental status, and self-reported adherence, low literacy was associated with uncontrolled BP (OR 1.75, 95% CI 1.06-2.87). Lower self-reported adherence was associated with uncontrolled BP; the relationship between refill adherence and uncontrolled BP was not statistically significant.

CONCLUSION

Low literacy is independently associated with uncontrolled BP.

PRACTICE IMPLICATIONS

Awareness of the relationships among patient literacy, BP control, and medication adherence may guide healthcare providers as they communicate with patients.

Are literacy skills associated with young adults' health in Africa? Evidence from Malawi

This study investigates whether literacy skills are a distinct dimension of education that influences young adults' health in the southeast African context of Malawi. It uses new data from Tsogolo la Thanzi, a study of young adults in southern Malawi, to achieve three aims. The first is descriptive: to demonstrate a direct assessment for measuring literacy in a population-based survey, and show that it captures variability in skills among young adults, including those with comparable levels of educational attainment. The second aim is to identify whether literacy influences young adults' health - net of their educational attainment and other confounding factors. Multivariate analyses reveal that literacy is associated with two measures of physical health: self-rated health and prolonged sickness. Because literacy is a key determinant of health, the third aim is to provide insight into how to measure it: can commonly used indirect approaches to estimating literacy (e.g., based on educational attainment or self-reports), accurately capture its prevalence and relationship with health? In a second set of analyses, bivariate results show whether, and the extent to which, indirect measures of literacy overestimate literacy's prevalence, and multivariate models assess whether indirect estimates of literacy capture its relationship with health. The findings support future efforts to incorporate literacy assessments into population surveys to accurately estimate literacy's prevalence and health benefits, particularly in contexts like Malawi where access to high-quality schools remains limited.

Uncovering health literacy: Developing a remotely administered questionnaire for determining health literacy levels in health disparate populations

INTRODUCTION

Low health literacy contributes to health disparities. We sought to develop and evaluate a remotely administered tool to measure health literacy in health disparate populations. The basic research design involved asking the remotely administered questions in conjunction with an existing and valid measure of health literacy, the S-TOFHLA, to a non-representative convenience sample of individuals drawn from lower income communities. The measures of the remotely administered questions were then correlated with the results of the S-TOFHLA to determine if there was a connection between the two measures. We found a statistically significant correlation between a single question in the remotely administered survey and the validated S-TOFHLA measure. This research supports previous work that points to the importance of just a single remotely administered question in terms of correspondence with the S-TOFHLA.

OBJECTIVE

Develop a questionnaire that can be remotely administered to check for Health Literacy.

METHODS

Correlation analysis is conducted between various questions and S-TOFHLA scores to determine criterion validity.

RESULTS

A single question, "How confident are you in filling out medical forms by yourself?" outperforms other measures in correlating with the S-TOFHLA scores.

CONCLUSIONS

Further assessment of the confidence question both in isolation and in conjunction with other literacy identifiers should be conducted. Also, this question should be tested against other measures of health literacy beyond the S-TOFHLA.

Word reading skill predicts anticipation of upcoming spoken language input: a study of children developing proficiency in reading

Despite the efficiency with which language users typically process spoken language, a growing body of research finds substantial individual differences in both the speed and accuracy of spoken language processing potentially attributable to participants' literacy skills. Against this background, the current study took a look at the role of word reading skill in listeners' anticipation of upcoming spoken language input in children at the cusp of learning to read; if reading skills affect predictive language processing, then children at this stage of literacy acquisition should be most susceptible to the effects of reading skills on spoken language processing. We tested 8-year-olds on their prediction of upcoming spoken language input in an eye-tracking task. Although children, like in previous studies to date, were successfully able to anticipate upcoming spoken language input, there was a strong positive correlation between children's word reading skills (but not their pseudo-word reading and meta-phonological awareness or their spoken word recognition skills) and their prediction skills. We suggest that these findings are most compatible with the notion that the process of learning orthographic representations during reading acquisition sharpens pre-existing lexical representations, which in turn also supports anticipation of upcoming spoken words.

Comprehension Tools for Teachers: Reading for Understanding from Prekindergarten through Fourth Grade

This paper describes the theoretical framework, as well as the development and testing of the intervention, Comprehension Tools for Teachers (CTT), which is composed of eight component interventions targeting malleable language and reading comprehension skills that emerging research indicates contribute to proficient reading for understanding for prekindergarteners through fourth graders. Component interventions target processes considered largely automatic as well as more reflective processes, with interacting and reciprocal effects. Specifically, we present component interventions targeting cognitive, linguistic, and text-specific processes, including morphological awareness, syntax, mental-state verbs, comprehension monitoring, narrative and expository text structure, enacted comprehension, academic knowledge, and reading to learn from informational text. Our aim was to develop a tool set composed of intensive meaningful individualized small group interventions. We improved feasibility in regular classrooms through the use of design-based iterative research methods including careful lesson planning, targeted scripting, pre- and postintervention proximal assessments, and technology. In addition to the overall framework, we discuss seven of the component interventions and general results of design and efficacy studies.

Self-rated literacy level does not explain educational differences in health and disease

BACKGROUND

Although literacy is increasingly considered to play a role in socioeconomic inequalities in health, its contribution to the explanation of educational differences in health has remained unexplored. The aim of this study was to investigate the contribution of self-rated literacy to educational differences in health.

METHODS

Data was collected from the Healthy Foundation and Lifestyle Segmentation Dataset (n = 4257). Self-rated literacy was estimated by individuals' self-reported confidence in reading written English. We used logistic regression analyses to assess the association between educational level and health (long term conditions and self-rated health). Self-rated literacy and other potential explanatory variables were separately added to each model. For each added variable we calculated the percentage change in odds ratio to assess the contribution to the explanation of educational differences in health.

RESULTS

People with lower educational attainment level were more likely to report a long term condition (OR 2.04, CI 1.80-2.32). These educational differences could mostly be explained by age (OR decreased by 27%) and could only minimally be explained by self-rated literacy, as measured by self-rated reading skills (OR decreased by 1%). Literacy could not explain differences in cardiovascular condition or diabetes, and only minimally contributed to mental health problems and depression (OR decreased by 5%). The odds of rating ones own health more negatively was higher for people with a low educational level compared to those with a higher educational level (OR 1.83, CI 1.59-2.010), self-rated literacy decreased the OR by 7%.

CONCLUSION

Measuring self-rated reading skills does not contribute significantly to the explanation of educational differences in health and disease. Further research should aim for the development of objective generic and specific instruments to measure health literacy skills in the context of health care, disease prevention and health promotion. Such instruments are not only important in the explanation of educational differences in health and disease, but can also be used to identify a group at risk of poorer health through low basic skills, enabling health services and health information to be targeted at those with greater need.

Clinicoinvestigational and demographic profile of children with thalassemia major

There are an estimated 200 million carriers of the β-thalassemia gene worldwide, 20 million being in India. The mean prevalence in India is 3.3 %. Objective To evaluate the clinico-investigational profile and the demographic characteristics of patients with thalassemia major (TM). Methods This was a retrospective analysis of the clinico-demographic profile at presentation of patients of TM diagnosed in the Paediatric Hematology Clinic of our hospital. Results The clinical profile of 964 patients of TM was analyzed. The mean age at presentation of untransfused children was 13.2 ± 9.7 months. Nearly 2/3(rd) children presented before 1 year of age. Almost 40 % had symptoms for 3 months prior to presentation. The manifestations at presentation included pallor and failure to thrive. About 40 % presented with severe anemia, with a hemoglobin of <5.0 gm/dl. A large number received blood transfusions prior to establishment of the diagnosis. Half of the families had ancestors who hailed originally from Pakistan. Approximately 50 % belonged to the Khatri/Arora castes. The parental literacy rate was about 90 %. Conclusions Thalassemia needs greater public awareness and prevention strategies in our country. Some communities are at high risk as compared to others. Education programs and compulsory antenatal screening appear to be the order of the day.

Integration of literacy into speech-language therapy: a descriptive analysis of treatment practices

PURPOSE

The purpose of the present study was: (a) to examine the extent to which speech-language therapy provided to children with language disorders in the schools targets code-based literacy skills (e.g., alphabet knowledge and phonological awareness) during business-as-usual treatment sessions, and (b) to determine whether literacy-focused therapy time was associated with factors specific to children and/or speech-language pathologists (SLPs).

METHOD

Participants were 151 kindergarten and first-grade children and 40 SLPs. Video-recorded therapy sessions were coded to determine the amount of time that addressed literacy. Assessments of children's literacy skills were administered as well as questionnaires regarding characteristics of SLPs (e.g., service delivery, professional development).

RESULTS

Results showed that time spent addressing code-related literacy across therapy sessions was variable. Significant predictors included SLP years of experience, therapy location, and therapy session duration, such that children receiving services from SLPs with more years of experience, and/or who utilized the classroom for therapy, received more literacy-focused time. Additionally, children in longer therapy sessions received more therapy time on literacy skills.

CONCLUSIONS

There is considerable variability in the extent to which children received literacy-focused time in therapy; however, SLP-level factors predict time spent in literacy more than child-level factors. Further research is needed to understand the nature of literacy-focused therapy in the public schools.

LEARNING OUTCOMES

Readers will be able to: (a) define code-based literacy skills, (b) discuss the role that speech-language pathologists have in fostering children's literacy development, and (c) identify key factors that may currently influence the inclusion of literacy targets in school-based speech-language therapy.

Dimensionality and Reliability of Letter Writing in 3- to 5-Year-Old Preschool Children

The primary purpose of this study was to examine the dimensionality and reliability of letter writing skills in preschool children with the aim of determining whether a sequence existed in how children learn to write the letters of the alphabet. Additionally, we examined gender differences in the development of letter writing skills. 471 children aged 3 to 5 years old completed a letter writing task. Results from factor analyses indicated that letter writing represented a unidimensional skill. Similar to research findings that the development of letter-names and letter-sound knowledge varies in acquisition, our findings indicate that the ability to write some letters is acquired earlier than the ability to write other letters. Although there appears to be an approximate sequence for the easiest and most difficult letters, there appears to be a less clear sequence for letters in the middle stages of development. Overall, girls had higher letter writing scores compared to boys. Gender differences regarding difficulty writing specific letters was less conclusive; however, results indicated that when controlling for ability level, girls had a higher probability of writing a letter correctly than boys. Implications of these findings for the assessment and instruction of letter writing are discussed.

Defining Success in Adult Basic Education Settings: Multiple Stakeholders, Multiple Perspectives

This study employed quantitative and qualitative research approaches to investigate what constitutes "success" in Adult Basic Education (ABE) programs from the perspectives of multiple educational stakeholders: the state funding agency, the teachers, and the students. Success was defined in multiple ways. In the quantitative section of the study, we computed classroom value-added scores (used as a metric of the state's definition of success) to identify more and less effective ABE classrooms in two Florida counties. In the qualitative section of the study, we observed and conducted interviews with teachers and students in the selected classrooms to investigate how these stakeholders defined success in ABE. Iterative consideration of the qualitative data revealed three principal markers of success: (a) instructional strategies and teacher-student interactions; (b) views on standardized testing; and (c) student motivational factors. In general, classrooms with higher value-added scores were characterized by multiple instructional approaches, positive and collaborative teacher-student interactions, and students engaging in goal setting and citing motivational factors such as family and personal fulfillment. The implications for ABE programs are discussed.

Comorbid motor deficits in a clinical sample of children with specific language impairment

The aim of the present study was to compare the motor function of a clinical sample of children with specific language impairment (SLI) to a language-matched comparison group that had not been referred for SLI assessment. A typical language comparison group with similar nonverbal IQ was also included. There were approximately 35 children in each group, aged 9- to 10-years-old, and the children completed a range of standardised language, motor and literacy measures. The results showed that the SLI group scored significantly lower than the language-matched and typical language comparison groups on all of the motor and literacy measures. We conclude that language factors alone are insufficient to explain the extensive comorbid motor and literacy deficits shown by the children with SLI in this study. We suggest that the clinical diagnosis of SLI may be influenced by the presence of additional developmental difficulties, which should be made explicit in assessment procedures, and that intervention strategies, which address the broad range of difficulties experienced by children with a clinical diagnosis of SLI, should be prioritised.

The effect of school status and academic skills on the reporting of premarital sexual behavior: evidence from a longitudinal study in rural Malawi

PURPOSE

Reliable data on sexual behavior are needed to identify adolescents at risk of acquiring human immunodeficiency virus or other sexually transmitted diseases, as well as unintended pregnancies. This study aimed to investigate whether schooling status and literacy and numeracy skills affect adolescents' reports of premarital sex, collected using audio computer-assisted self-interviews.

METHODS

We analyzed data on 2,320 participants in the first three rounds of the Malawi Schooling and Adolescent Study to estimate the level of inconsistency in reporting premarital sex among rural Malawian adolescents. We used multivariate logistic regressions to examine the relationships between school status and academic skills and premarital sexual behavior reports.

RESULTS

Males were more likely than females to report premarital sex at baseline, whereas females were more likely than males to report sex inconsistently within and across rounds. School-going females and males were more likely to report never having had sex at baseline and to retract reports of ever having sex across rounds than were their peers who had recently left school. School-going females were also more likely to report sex inconsistently at baseline. Literate and numerate respondents were less likely to report sex inconsistently at baseline; however, they were more likely to retract sex reports across rounds.

CONCLUSIONS

The level of inconsistency both within a survey round and across rounds reflects the difficulties in collecting reliable sexual behavior data from young people in settings such as rural Malawi, where education levels are low and sex among school-going females is not socially accepted.

The influence of reading ability on subsequent changes in verbal IQ in the teenage years

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Reading ability predicts subsequent changes in verbal IQ (VIQ) in teenagers.

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The effect of reading was observed on all VIQ subtests, except arithmetic.

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VIQ changes were larger when there was a discrepancy between VIQ and reading.

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The effect of reading on VIQ changes was validated by structural brain changes.

Intelligence Quotient (IQ) is regularly used in both education and employment as a measure of cognitive ability. Although an individual's IQ is generally assumed to stay constant across the lifespan, a few studies have suggested that there may be substantial variation at the individual level. Motivated by previous reports that reading quality/quantity has a positive influence on vocabulary acquisition, we hypothesised that reading ability in the early teenage years might contribute to changes in verbal IQ (VIQ) over the next few years. We found that good readers were more likely to experience relative improvements in VIQ over time, with the reverse true for poor readers. These effects were largest when there was a discrepancy between Time 1 reading ability and Time 1 VIQ. In other words, VIQ increases tended to be greatest when reading ability was high relative to VIQ. Additional analyses supported these findings by showing that variance in VIQ change associated with Time 1 behaviour was also associated with independent measurements of brain structure. Our finding that reading in the early teenage years can predict a significant proportion of the variance in subsequent VIQ change has implications for targeted education in both home and school environments.

Impact of literacy on the prevalence, awareness, treatment and control of hypertension in adults in Golestan Province (northern Iran)

Background : Hypertension is considered as a major health problem in our society. The association between educational level with hypertension and its control in the Golestan Province (northern Iran) were the main objectives of this study.

METHODS

This was a population-based cross-sectional study that enrolled 3497 subjects aged 15-65 years using stratified and cluster sampling. The interviewers recorded the data using a multidimensional questionnaire, including blood pressure level. Blood pressure was measured three times with 5 minutes interval and defined based on Join National Committee (JNC-7).

RESULTS

Totally, 741 (21.2 %) cases suffered from hypertension and illiterate people were significantly more aware of their disease (p=0.011). In the aware group, 435 (89.6%) cases used one method to control their disease and it was not statistically significant as far as educational levels was concerned. The control of hypertension was significantly greater in college educated group than the illiterate one (32.4% vs 68.8%) (p=0.001). Logistic regression analysis revealed that illiteracy is a risk factor for hypertension (p<0.001).

CONCLUSION

In spite of awareness in the illiterate people was high, the rate of hypertension control was low in this group. Prevention, detection, treatment, and control of hypertension especially the illiterate people should be given high priority.

Impact of Literacy on the Prevalence, Awareness, Treatment andControl of Hypertension in Iran

INTRODUCTION

Hypertension is an important global health concern claiming 7.1 million lives annually. Literacy, as an essential element of the health education, and its relationship with health has previously been studied. However, few studies have been conducted on the association between literacy and health outcomes. To assess the association between educational level and hypertension, awareness and hypertension control in the north of Iran were the main objectives of this study.

METHODS

The present study was a population-based cross-sectional study carried out on 3497 subjects aged 15-65 years using stratified and cluster sampling. Interviewers recorded the data using a multidimensional questionnaire, including blood pressure level. Blood pressure was measured three times with 5-minute intervals and defined based on JNC-7.

RESULTS

Totally, 21.2 %(741 cases) of our patients suffered from hypertension and illiterate people were significantly more aware of their disease (P=0.011). Among the aware group, at least 89.6% (435 cases) used one method to control their disease; this however was not statistically significant among the educational levels. Control of hypertension was significantly greater in college educated group than in illiterate group (32.4% vs. 68.8%; P=0.001). Logistic regression analysis revealed that illiteracy is a risk factor for hypertension (P<0.001).

CONCLUSION

In spite of the fact that awareness in illiterate people was high, the rate of hypertension control was low in this group. Prevention, detection, treatment, and control of hypertension especially in illiterate people should receive high priority.

Patient input into the development and enhancement of ED discharge instructions: a focus group study

OBJECTIVES

Previous research indicates that patients have difficulty understanding ED discharge instructions; these findings have important implications for adherence and outcomes. The objective of this study was to obtain direct patient input to inform specific revisions to discharge documents created through a literacy-guided approach and to identify common themes within patient feedback that can serve as a framework for the creation of discharge documents in the future.

METHODS

Based on extensive literature review and input from ED providers, subspecialists, and health literacy and communication experts, discharge instructions were created for 5 common ED diagnoses. Participants were recruited from a federally qualified health center to participate in a series of 5 focus group sessions. Demographic information was obtained and a Rapid Estimate of Adult Literacy in Medicine (REALM) assessment was performed. During each of the 1-hour focus group sessions, participants reviewed discharge instructions for 1 of 5 diagnoses. Participants were asked to provide input into the content, organization, and presentation of the documents. Using qualitative techniques, latent and manifest content analysis was performed to code for emergent themes across all 5 diagnoses.

RESULTS

Fifty-seven percent of participants were female and the average age was 32 years. The average REALM score was 57.3. Through qualitative analysis, 8 emergent themes were identified from the focus groups.

CONCLUSIONS

Patient input provides meaningful guidance in the development of diagnosis-specific discharge instructions. Several themes and patterns were identified, with broad significance for the design of ED discharge instructions.

Global Inequalities in Cervical Cancer Incidence and Mortality are Linked to Deprivation, Low Socioeconomic Status, and Human Development

OBJECTIVES

This study examined global inequalities in cervical cancer incidence and mortality rates as a function of cross-national variations in the Human Development Index (HDI), socioeconomic factors, Gender Inequality Index (GII), and healthcare expenditure.

METHODS

Age-adjusted incidence and mortality rates were calculated for women in 184 countries using the 2008 GLOBOCAN database, and incidence and mortality trends were analyzed using the WHO cancer mortality database. Log-linear regression was used to model annual trends, while OLS and Poisson regression models were used to estimate the impact of socioeconomic and human development factors on incidence and mortality rates.

RESULTS

Cervical cancer incidence and mortality rates varied widely, with many African countries such as Guinea, Zambia, Comoros, Tanzania, and Malawi having at least 10-to-20-fold higher rates than several West Asian, Middle East, and European countries, including Iran, Saudi Arabia, Syria, Egypt, and Switzerland. HDI, GII, poverty rate, health expenditure per capita, urbanization, and literacy rate were all significantly related to cervical cancer incidence and mortality, with HDI and poverty rate each explaining >52% of the global variance in mortality. Both incidence and mortality rates increased in relation to lower human development and higher gender inequality levels. A 0.2 unit increase in HDI was associated with a 20% decrease in cervical cancer risk and a 33% decrease in cervical cancer mortality risk. The risk of a cervical cancer diagnosis increased by 24% and of cervical cancer death by 42% for a 0.2 unit increase in GII. Higher health expenditure levels were independently associated with decreased incidence and mortality risks.

CONCLUSIONS AND PUBLIC HEALTH IMPLICATIONS

Global inequalities in cervical cancer are clearly linked to disparities in human development, social inequality, and living standards. Reductions in cervical cancer rates are achievable by reducing inequalities in socioeconomic conditions, availability of preventive health services, and women's social status.

The readability of paediatric patient information materials: Are families satisfied with our handouts and brochures?

OBJECTIVES

To determine the grade reading level of eight easily available patient handouts for parents of children with otitis media, to calculate the internal reliability and consistency of seven readability tests, and to explore the relationship between the grade reading level of a handout and parent satisfaction.

METHODS

Eight patient handouts developed for the parents of children with otitis media were collected, stripped of all formatting and analyzed using seven different readability formulas. Cronbach's alpha and intraclass correlation coefficients (ICC) were calculated to determine the internal reliability and consistency of the seven formulas. Parents were surveyed on their satisfaction with three of the handouts, and their responses were compared with the handouts' reading grade levels using ANOVA.

RESULTS

Only four of the eight handouts had a mean grade 8 or less reading level. None of the handouts had a grade 5 or less reading level. Cronbach's alpha was calculated to be 0.990, single measures ICC 0.931 and average class ICC 0.990, indicating extremely high internal reliability/consistency among the different readability tests. One-way ANOVA showed no evidence of a significant difference in parental satisfaction with the three handouts tested, despite their different grade reading levels (grades 7, 10 and 14) (P=0.24).

CONCLUSIONS

While many readability formulas are available, the high internal reliability/consistency among them indicates that only one formula needs to be used to assess readability (eg, the Flesch-Kincaid Grade Level formula). Because there was no difference in parental satisfaction among three patient handouts that had widely different grade reading levels, studies should explore whether writing patient information materials explicitly to achieve low grade reading level scores is a worthwhile strategy.

Attitudes and practice of Children's Hospital of Eastern Ontario (Ottawa, Ontario) paediatricians and residents toward literacy promotion in Canada

BACKGROUND

Literacy is a critical health issue in Canada. Paediatricians play an important role in improving literacy skills; however, formal training in literacy education and promotion is not currently part of most Canadian paediatric residency programs.

OBJECTIVE

To examine the attitudes and practice of paediatricians and residents at the Children's Hospital of Eastern Ontario (CHEO [Ottawa, Ontario]) toward literacy promotion.

METHODS

A descriptive, cross-sectional survey of CHEO-affiliated paediatricians, residents and fellows was performed. Survey items addressed demographics, attitudes toward literacy, current practice and previous education/training in literacy education through self-reporting.

RESULTS

One hundred ninety-seven surveys were distributed, with a response rate of 82%. Ninety-one per cent of respondents reported never having formal training in literacy development and promotion. Seventy-four per cent of respondents believed that low literacy is a significant health issue in Canada; however, only 16% of respondents reported regularly discussing literacy with patients and their families. Thirty-nine per cent of general paediatricians reported discussing literacy with patients and families regularly, compared with 10% of paediatric subspecialists (P<0.01). Seventy-one per cent of respondents believed that literacy education should be a standard part of residency education.

CONCLUSIONS

While most respondents identified literacy as an important paediatric issue, most paediatricians did not regularly discuss the importance of literacy with their patients. General paediatricians are most likely to discuss literacy. There is a lack of formal education among paediatricians in literacy development and promotion, and the majority of respondents believe that this should be a standard part of paediatric residency training.

Geographically indirect immigration to Canada: description and analysis

"This article is concerned with geographically indirect immigration to Canada over the period 1968-1988. A geographically indirect immigrant is an individual legally admitted to Canada whose country of last permanent residence differs from country of birth. Records maintained by Employment and Immigration Canada on every immigrant legally admitted over the period were used in the study. Relative to geographically direct immigrants, geographically indirect immigrants tend to be older, more educated, and more highly skilled. Moreover, if they were not born in an English or French speaking country, indirect immigrants are more likely to speak English and/or French capably than direct migrants born in such countries. The study also contains bivariate logit estimates of a model of geographically indirect Canadian immigration. This model suggests that indirect migrants tend to be influenced by personal characteristics (age, sex, marital status, occupation, language ability), as well as by various characteristics of the country of birth (distance from Canada, income level, political conditions)."

An optimized model for substitution of expatriate workforce in a Gulf-Council country: the Kuwaiti case

"This article is based on data from a research project carried out during 1992-1994 to achieve a replacement mechanism and a model for the substitution of expatriate labour by Kuwaiti nationals. Since Kuwait can readily enforce its Kuwaitization policy in the public sector, the presented model aims at reducing the share of non-Kuwaitis in that sector over five years. Published data on distribution of the workforce in the public sector by nationality indicate that the non-Kuwaiti share of the total workforce is 38 per cent. The majority of [migrant] workers are unskilled or semi-skilled and engaged in production, commerce and services. Sex ratios are unbalanced and workers exhibit a high rate of literacy...." (SUMMARY IN FRE AND SPA)

Literacy transition and female nuptiality: implications for fertility in Pakistan

"This paper is an attempt to examine trends and differentials in education and age at marriage of males and females [in Pakistan] and then relate the two variables to one important aspect of demographic behaviour, namely fertility, and evaluate the implication of these relationships on reduction of fertility in Pakistan." The data are from the 1981 census and the 1979-1980 Population, Labour Force and Migration (PLM) Survey. "Given the limitations of the survey data which pertain to a sample of ever-married women between the ages of 15 and 49 years, the main conclusions of the study are that a rise in female age at marriage and education at secondary and higher levels are important in affecting fertility levels." Policy implications of the findings are discussed. Comments by Akhtar Hasan Khan are included (pp. 601-3).