Dimensions of Deaf/Hard-of-Hearing and Hearing Adolescents' Health Literacy and Health Knowledge

Silent struggles to self-manage high blood pressure among deaf sign language users: a qualitative study

AIMS

Tailored self-management support of hypertension, considering language and communication, is important for minorities, specifically in the deaf community. However, little is known about the experiences of hypertension self-management in deaf individuals who use sign language. This study aimed to explore the factors and processes of self-management in deaf sign language users with hypertension.

METHODS AND RESULTS

Ten men and women who used sign language participated in this study. Data were collected using in-depth personal interviews conducted in the presence of a sign language interpreter between November 2022 and February 2023. All interviews were recorded and transcribed for conventional content analysis. Qualitative analyses identified four categories related to the self-management of hypertension among participants: personal factors (chronic hand pain, unique language and communication, and efforts to turn crisis into opportunities), family and socioeconomic factors (family support and financial burden of living), challenges (limited health literacy and alienation from health education), and desire for health education considering the deaf community.

CONCLUSION

The results of this study suggest that family support, socioeconomic status, hand pain, and health literacy should be considered for the planning and development of health education on self-management of hypertension in deaf individuals. In addition, this health education requires cooperation with qualified sign language interpreters in healthcare settings.

Developing and Evaluating a School-Based Tobacco and E-Cigarette Prevention Program for Deaf and Hard-of-Hearing Youth

School-based programs are an important tobacco prevention tool. Yet, existing programs are not suitable for Deaf and Hard-of-Hearing (DHH) youth. Moreover, little research has examined the use of the full range of tobacco products and related knowledge in this group. To address this gap and inform development of a school-based tobacco prevention program for this population, we conducted a pilot study among DHH middle school (MS) and high school (HS) students attending Schools for the Deaf and mainstream schools in California (n = 114). American Sign Language (ASL) administered surveys, before and after receipt of a draft curriculum delivered by health or physical education teachers, assessed product use and tobacco knowledge. Thirty-five percent of students reported exposure to tobacco products at home, including cigarettes (19%) and e-cigarettes (15%). Tobacco knowledge at baseline was limited; 35% of students knew e-cigarettes contain nicotine, and 56% were aware vaping is prohibited on school grounds. Current product use was reported by 16% of students, most commonly e-cigarettes (12%) and cigarettes (10%); overall, 7% of students reported dual use. Use was greater among HS versus MS students. Changes in student knowledge following program delivery included increased understanding of harmful chemicals in tobacco products, including nicotine in e-cigarettes. Post-program debriefings with teachers yielded specific recommendations for modifications to better meet the educational needs of DHH students. Findings based on student and teacher feedback will guide curriculum development and inform next steps in our program of research aimed to prevent tobacco use in this vulnerable and heretofore understudied population group.

Understanding health literacy of deaf persons with hypertension in South Korea: A cross-sectional study

BACKGROUND

Health literacy is strongly associated with health inequality among persons with deafness, and hypertension (HTN) is the most prevalent chronic disease among persons with deafness in South Korea. Despite its importance, research regarding the health literacy levels of persons with deafness with HTN in South Korea is lacking. This study aimed to comprehensively assess the health literacy levels of persons with deafness with HTN in South Korea, including linguistic, functional, and internet health literacy.

METHODS

In this descriptive cross-sectional study, 95 persons with deafness with HTN were recruited through facilities associated with the deaf community. From August 2022 to February 2023, data were collected through face-to-face surveys attended by a sign language interpreter and online surveys. The data were analyzed using descriptive statistics and Spearman's correlation.

RESULTS

Approximately 62.1% of the participants exhibited a linguistic health literacy level corresponding to less than that of middle school students, and the total percentage correct of functional health literacy was 17.9%. Each domain of internet health literacy was low. Significant correlations were found between some aspects of health literacy.

CONCLUSIONS

The study's findings highlight the low health literacy levels across various facets among persons with deafness with HTN in South Korea. Based on these findings, several strategies are suggested for developing HTN self-management interventions for persons with deafness. This study contributes to the foundational understanding of health literacy among persons with deafness with HTN in South Korea and provides valuable insights and guidance for developing HTN self-management interventions.

Exploring the health literacy status of people with hearing impairment: a systematic review

BACKGROUND

People with hearing impairment have many problems with healthcare use, which is associated with health literacy. Research on health literacy is less focused on people with hearing impairments. This research aimed to explore the levels of health literacy in people with hearing impairment, find the barriers to health literacy, and summarize methods for improving health literacy.

METHODS

A systematic review was conducted using three databases (PubMed, Cochrane, and Embase) to search the relevant articles and analyze them. The studies were selected using pre-defined inclusion/exclusion criteria in two steps: first, selection by examining the title and abstract; and second, after reading the study in full. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was used to assess the quality of the articles.

RESULTS

Twenty-nine studies were synthesized qualitatively. Individuals with hearing impairment were found to have lower health literacy, when compared to those without impairment, which can lead to a higher medical cost. Most of the people with hearing impairment faced barriers to obtaining health-related information and found it difficult to communicate with healthcare providers. To improve their health literacy, it is essential to explore new ways of accessing health information and improving the relationship between patients and healthcare providers.

CONCLUSIONS

Our findings show that people with hearing impairment have lower health literacy than those without. This suggests that developing new technology and policies for people with hearing impairment is necessary not to mention promoting provision of information via sign language.

TRIAL REGISTRATION

OSF: https://doi.org/10.17605/OSF.IO/V6UGW .

PROSPERO ID

CRD42023395556.

Deaf and hard-of-hearing patients are unsatisfied with and avoid German health care: Results from an online survey in German Sign Language

BACKGROUND

Approximately 235,000 deaf and hard of hearing (DHH) people live in Germany. Due to communication barriers, medical care for this group is difficult in many respects. Especially in the case of acute illnesses, the possibilities of communication, e.g., through sign language interpreters, are limited. This study investigates the satisfaction of DHH patients with medical care in Germany in unplanned medical consultations. The aim of this study is to provide insights into DHH patient's perception of medical care, to identify barriers and avoidance behaviours that stem from fears, miscommunication, and prior experiences.

METHODS

We obtained data from adult DHH participants between February and April 2022 throughout Germany via an online survey in German Sign Language. The responses of N = 383 participants (65% female, M = 44 years, SD = 12.70 years) were included in statistical analyses. Outcomes were convictions of receiving help, satisfaction with healthcare provision, and avoiding healthcare visits; further variables were concerns during healthcare visits, incidences of miscommunication, and a communication score. We calculated t-tests, ANOVAs, correlations, and linear and logistic regression analyses.

RESULTS

Our main findings show that (1) DHH patients were unsatisfied with provided healthcare (M = 3.88; SD = 2.34; range 0-10); (2) DHH patients reported many concerns primarily about communication and treatment aspects when visiting a doctor; and (3) 57% of participants deliberately avoided doctor visits even though they experienced symptoms. Factors such as concerns during doctor's visits (B = -0.18; 95%CI: -0.34--0.02; p = .027) or miscommunication with medical staff (B = -0.19; 95%CI: -0.33-0.06; p = .006) were associated with satisfaction with medical care, while we found almost no associations with gender and location, and only few with age and education.

CONCLUSIONS

Overall, our findings suggest that DHH patients are unsatisfied with provided healthcare, they deliberately avoid doctor visits, and they face various communication barriers. This study revealed several communication-related determinants of satisfaction with healthcare in DHH patients, such as incidences of miscommunication and the communication score. Communication-related barriers have high potential to be addressed in collaboration with the DHH community. To improve the medical care and the satisfaction with healthcare in DHH patients, training healthcare professionals, digital technologies, and other communication-enhancing interventions should be explored in future intervention studies.

Associations of childhood hearing loss and adverse childhood experiences in deaf adults

Childhood trauma and adverse childhood experiences have a strong relationship with health disparities across the lifespan. Despite experiencing approximately doubled rates of trauma, Adverse Childhood Experiences (ACEs) are poorly characterized in deaf populations. We sought to characterize deaf-specific demographic factors and their association with multiple experiences of ACEs before the age of 18 years old. An analytical cross-sectional approach was used to ascertain associations of deaf-specific demographic factors and experiences with ACEs. The complete dataset included 520 participants for a total response rate of 56%. After adjusting for confounding effects, less severe hearing loss of 16-55 dB (2+ OR: 5.2, 4+ OR: 4.7), having a cochlear implant (2+ OR: 2.1, 4+ OR: 2.6), and not attending at least one school with signing access (2+ OR: 2.4, 4+ OR: 3.7) were significantly and independently associated with reported experiences of multiple ACEs. We conclude that factors associated with childhood hearing loss and language experiences increase risk of experiencing ACEs. Given the strong relationship between ACEs and poor social outcomes, early intervention clinical practice and health policies should consider interventions to support healthy home environments for deaf children.

Equitable Access to Telehealth and Other Services for Deaf People During the COVID-19 Pandemic

Introduction

Deaf people who use American Sign Language (ASL) with low self-perceived ability to understand spoken information face inequitable access to health care due to systemic barriers.

Methods

We conducted interviews with 266 deaf ASL users at baseline (May-Aug 2020) and 244 deaf ASL users at follow-up (3 months). Questions addressed (1) access to interpretation during in-person visits; (2) whether they visited clinics (3) or emergency departments (EDs); and (4) telehealth use. Analyses involved univariate and multivariable logistic regressions across levels of perceived ability to understand spoken language.

Results

Less than a third were aged >65 (22.8%); Black, Indigenous, People of Color (28.6%), or LGBTQ+ (31.1%); and had no college degree (30.6%). More respondents reported outpatient visits at follow-up (63.9%) than at baseline (42.3%). Ten more respondents reported going to urgent care or an ED at follow-up than at baseline. At follow-up interviews, 57% of deaf ASL respondents with high perceived ability to understand spoken language reported receiving interpretation at clinic visits compared to 32% of ASL respondents with low perceived ability to understand spoken language (p<0.01). Telehealth and ED visits showed no between-group differences for low versus high perceived ability to understand spoken language.

Discussion

Our study is the first to explore deaf ASL users' access to telehealth and outpatient encounters over time during the pandemic. The U.S. health care system is designed for people who have high perceived ability to understand spoken information. Systemic access to health care, including telehealth and clinics, must be made consistently equitable for deaf people who require accessible communication.

Turkish Sign Language Adaptation of the Turkish Health Literacy Scale-32

Sign language speakers are at a disadvantage in terms of health literacy due to the lack of health education materials in sign languages. Deaf and hard of hearing (DHH) individuals are excluded from health literacy research due to the lack of measurement tools in their language of excellent fluency. This study aims to provide the literature with a tool that allows the measurement of health literacy among DHH individuals. The Turkish Health Literacy Scale (THLS)-32 was translated into Turkish Sign Language (TSL). After the THLS-32 was translated into TSL in video format, it was tested for validity and reliability. The translated version of the scale was administered to participants from a DHH association in Turkey who are fluent in TSL. Subsequently, a study was conducted with 207 DHH individuals. The study group was assessed in terms of their mean index scores and evaluated to have "limited health literacy" according to the THLS-32 classification. We conclude that the THLS-32 in TSL is suitable to measure health literacy in DHH individuals and to assess the impact of the health education system.

Factors contributing to successful employment outcomes for individuals who are hard-of-hearing

BACKGROUND: The State-Federal Vocational Rehabilitation (VR) Program provides rehabilitation services to people with disabilities with the intention of assisting them in securing competitive employment. The VR services offer substantial resources to help individuals who are hard-of-hearing to enhance their quality of life and employment opportunities. OBJECTIVE: The current study investigated the impact of demographic variables and the use of VR services on employment outcomes among hard-of-hearing consumers. Specific VR services that lead to successful employment among hard-of-hearing consumers were thoroughly examined. METHODS: Binary logistic regression, Chi-square, and Chi-square Automatic Interaction Detector analyses were used to analyze the data extracted from the 2014 fiscal year US. Department of Education Rehabilitation Service Administration Case Service Report (RSA-911). RESULTS: Logistic regression reveals that VR services such as diagnosis and treatment of impairments (p-value 0.000), counseling, and guidance (p-value 0.000), and rehabilitation technology (p-value 0.000) were influential factors in determining the successful employment outcome among the consumers. The relative importance of the factors based on the mean decrease in accuracy in CHAID identifies rehabilitation technology (0.264), diagnosis and treatment of impairments (0.090), job placement assistance (0.016), transportation (0.016), and secondary disability (0.010) to be among the most contributing factors. CONCLUSION: Overall, rehabilitation technology services were especially beneficial, particularly for minority consumers, in achieving a successful employment outcome.

A Nationwide Study Examining Deafness Among Hospitalized Adults

Background It is unknown whether hospital outcomes differ among nonspeaking deaf patients compared to those without this disability. Objective This article aims to compare clinical outcomes and utilization data among patients with and without deafness. Design This study used a retrospective cohort study. Setting and Participants The participants included Nationwide Inpatient Sample, year 2017, hospitalized adults with and without diagnostic codes related to deafness and inability to speak. Method Multiple logistic and linear regression were used to compare in-hospital outcomes. Results Thirty million four hundred one thousand one hundred seventeen adults were hospitalized, and 7,180 had deafness and inability to speak related coding. Patients with deafness were older (mean age ± SEM: 59.2 ± 0.51 vs. 57.9 ± 0.09 years, p = .01), and less likely female (47.0% vs. 57.7%, p < .01) compared to controls. Those with deafness had more comorbidities compared to the controls (Charlson comorbidity score ≥ 3: 31.2% vs. 27.8%, p < .01). Mortality was higher among deaf versus controls (3.6% vs. 2.2%; p < .01); this translated into higher adjusted odds of mortality (adjusted odds ratio = 1.7. [confidence interval (CI) 1.3-2.4]; p = .01). Deaf patients had lower odds of being discharged home compared to controls {aOR} = 0.6, (CI) 0.55-0.73]; p < .01. Length of stay was longer (adjusted mean difference = 1.5 days CI [0.7-2.3]; p < .01) and hospital charges were higher, but not significantly so (adjusted mean difference = $4,193 CI [-$1,935-$10,322]; p = .18) in patients with deafness. Conclusions Hospitalized nonspeaking deaf patients had higher mortality and longer hospital stays compared to those without this condition. These results suggest that specialized attention may be warranted when deaf patients are admitted to our hospitals in hopes of reducing disparities in outcomes. Supplemental Material https://doi.org/10.23641/asha.14336663.

Using an OSCE to assess the potential for assistive technology to enhance communication between student pharmacists and simulated patients who are deaf/hard of hearing

OBJECTIVES

To evaluate the usefulness of assistive technology in health care interactions between student pharmacists and simulated patients who are deaf/hard of hearing and to assess changes in confidence and comfort levels (among both groups) when using assistive technology.

METHODS

Forty-nine second-year student pharmacists were enrolled in a pharmacy communication laboratory course and 8 undergraduate students were recruited during Fall 2019. The first communication laboratory interaction consisted of student pharmacists using their normal mode of communication with role-played patients who are deaf/hard of hearing to establish baseline measures; a pretest survey was administered to each participant at the conclusion of this 10-minute laboratory interaction. In the second laboratory interaction, student pharmacists used the app to assist in communicating with the simulated patients who are deaf/hard of hearing. Posttests were administered at the conclusion of this laboratory interaction.

RESULTS

Most student pharmacists and simulated patients who are deaf/hard of hearing reported feeling able to effectively communicate their needs to the other individual in their dyad (pharmacist or patient) during their health care interactions. Using an iPad (Apple Inc) app to communicate significantly increased student pharmacist and simulated patient comfort with health care communication from preintervention to postintervention.

CONCLUSION

The use of assistive technology in simulated communication laboratory interactions can enhance student pharmacist comfort in health care interactions with patients who are deaf/hard of hearing.

The epidemiology of injury among adolescents with hearing loss, health beliefs regarding injury and associated factors

BACKGROUND

Adolescents with hearing loss are more at risk of injury. Their injuries commonly occur at school, in traffic, and other sporting areas and can adversely affect their health.

OBJECTIVE

The study aims were to understand the epidemiology of the injuries that occurred among adolescents with hearing loss and to explore their health beliefs regarding injury and their associated factors.

METHODS

A cross-sectional study was conducted over the period 2018-2019 with 218 adolescents with hearing loss. A sociodemographic questionnaire, an accident and knowledge questionnaire, the Health Belief Model (HBM)-based Injury Scale and a school accident form were provided by interviewers who were fluent in sign language. Descriptive statistics, the Mann-Whitney U, Kruskal-Wallis tests and regression analysis were used to analyze the responses given to the above instruments.

RESULTS

Forty-six percent of the adolescents with hearing loss experienced accidents, with pedestrian (42.9%) and passenger (42.9%) types being the most common traffic-related injuries and bleeding (29.4%) and fracture (23.5%) for school related injuries. Factors that are protective against injuries are higher parental education level (father education: OR 1.08, 95% CI = 0.81-1.44; mother education: OR 0.77, 95% CI = 0.59-1.01), and higher knowledge of traffic signs (right: OR 1.23, 95% CI = 0.62-2.42; green: OR 0.59, 95% CI = 0.28-1.23). Factors that were associated with elevated risk of injuries included worse hearing loss categories (OR 3.39, 95% CI = 1.07-8.99).

CONCLUSIONS

Adolescents with hearing loss are commonly injured. Schools should consider education on how adolescents with hearing loss can protect themselves through potential tailored HBM-based injury prevention interventions.

Health Literacy and Health Outcomes Among Children With Developmental Disabilities: A Systematic Review

Developmental disabilities (DDs) are prevalent and associated with health disparities among children. Family health literacy of parents and/or children is one modifiable factor associated with child health; however, little is known about family health literacy for children with DDs. This systematic review was conducted to determine evidence on associations of health literacy with health outcomes among children with DDs. Medline, CINAHL, Embase, ERIC, PsycInfo, and Web of Science were searched through August 2018. Of 2,768 unique records, 53 full text articles were reviewed and four articles were included. Associations of family health literacy with health outcomes among children with DDs were mixed. Future research should include more diverse samples, greater breadth in health outcomes assessed, and increased methodological rigor.

An Informatics Framework to Assess Consumer Health Language Complexity Differences: Proof-of-Concept Study

Background

The language gap between health consumers and health professionals has been long recognized as the main hindrance to effective health information comprehension. Although providing health information access in consumer health language (CHL) is widely accepted as the solution to the problem, health consumers are found to have varying health language preferences and proficiencies. To simplify health documents for heterogeneous consumer groups, it is important to quantify how CHLs are different in terms of complexity among various consumer groups.

Objective

This study aimed to propose an informatics framework (consumer health language complexity [CHELC]) to assess the complexity differences of CHL using syntax-level, text-level, term-level, and semantic-level complexity metrics. Specifically, we identified 8 language complexity metrics validated in previous literature and combined them into a 4-faceted framework. Through a rank-based algorithm, we developed unifying scores (CHELC scores [CHELCS]) to quantify syntax-level, text-level, term-level, semantic-level, and overall CHL complexity. We applied CHELCS to compare posts of each individual on online health forums designed for (1) the general public, (2) deaf and hearing-impaired people, and (3) people with autism spectrum disorder (ASD).

Methods

We examined posts with more than 4 sentences of each user from 3 health forums to understand CHL complexity differences among these groups: 12,560 posts from 3756 users in Yahoo! Answers, 25,545 posts from 1623 users in AllDeaf, and 26,484 posts from 2751 users in Wrong Planet. We calculated CHELCS for each user and compared the scores of 3 user groups (ie, deaf and hearing-impaired people, people with ASD, and the public) through 2-sample Kolmogorov-Smirnov tests and analysis of covariance tests.

Results

The results suggest that users in the public forum used more complex CHL, particularly more diverse semantics and more complex health terms compared with users in the ASD and deaf and hearing-impaired user forums. However, between the latter 2 groups, people with ASD used more complex words, and deaf and hearing-impaired users used more complex syntax.

Conclusions

Our results show that the users in 3 online forums had significantly different CHL complexities in different facets. The proposed framework and detailed measurements help to quantify these CHL complexity differences comprehensively. The results emphasize the importance of tailoring health-related content for different consumer groups with varying CHL complexities.

A qualitative study on the design and development of an mHealth app to facilitate communication with the Deaf community: perspective of community pharmacists

PURPOSE

This study prepares the groundwork on the potential design and development of a mobile health (mHealth) app that will be able to bridge the communication gap between pharmacists and patients who are Deaf and Hard of Hearing (DHoH).

PATIENTS AND METHODS

A focus group discussion was conducted with 12 community pharmacists. Participants were recruited using snowball sampling. Audio-recordings were transcribed verbatim, and analyzed using a thematic approach.

RESULTS

Three themes were apparent: 1) suggestions for app design and content, 2) perceived benefits of the app, and 3) potential challenges related to the app. Participants believed the app would be able to facilitate and improve communication, and hence relationship, between pharmacists and the DHoH. Potential challenges of the app were highlighted, such as the need for manpower to manage the app, and its cost to this group of economically disadvantaged people. There were also concerns about privacy and security.

CONCLUSIONS

This study allowed community pharmacists, one of the end-users of the app, to provide feedback on the contents and design of the app, which would allow them to provide pharmaceutical care services to patients who are DHoH, and better serve them. Potential benefits and challenges of the app were also identified. Undoubtedly, through the mHealth app, community pharmacists will be better equipped to serve and communicate with the DHoH, and this will hopefully translate to improved health outcomes in these patients.

Considering parental hearing status as a social determinant of deaf population health: Insights from experiences of the "dinner table syndrome"

The influence of early language and communication experiences on lifelong health outcomes is receiving increased public health attention. Most deaf children have non-signing hearing parents, and are at risk for not experiencing fully accessible language environments, a possible factor underlying known deaf population health disparities. Childhood indirect family communication–such as spontaneous conversations and listening in the routine family environment (e.g. family meals, recreation, car rides)–is an important source of health-related contextual learning opportunities. The goal of this study was to assess the influence of parental hearing status on deaf people’s recalled access to childhood indirect family communication. We analyzed data from the Rochester Deaf Health Survey–2013 (n = 211 deaf adults) for associations between sociodemographic factors including parental hearing status, and recalled access to childhood indirect family communication. Parental hearing status predicted deaf adults’ recalled access to childhood indirect family communication (χ² = 31.939, p < .001). The likelihood of deaf adults reporting “sometimes to never” for recalled comprehension of childhood family indirect communication increased by 17.6 times for those with hearing parents. No other sociodemographic or deaf-specific factors in this study predicted deaf adults’ access to childhood indirect family communication. This study finds that deaf people who have hearing parents were more likely to report limited access to contextual learning opportunities during childhood. Parental hearing status and early childhood language experiences, therefore, require further investigation as possible social determinants of health to develop interventions that improve lifelong health and social outcomes of the underserved deaf population.

Quality of health literacy instruments used in children and adolescents: a systematic review

OBJECTIVE

Improving health literacy at an early age is crucial to personal health and development. Although health literacy in children and adolescents has gained momentum in the past decade, it remains an under-researched area, particularly health literacy measurement. This study aimed to examine the quality of health literacy instruments used in children and adolescents and to identify the best instrument for field use.

DESIGN

Systematic review.

SETTING

A wide range of settings including schools, clinics and communities.

PARTICIPANTS

Children and/or adolescents aged 6-24 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Measurement properties (reliability, validity and responsiveness) and other important characteristics (eg, health topics, components or scoring systems) of health literacy instruments.

RESULTS

There were 29 health literacy instruments identified from the screening process. When measuring health literacy in children and adolescents, researchers mainly focus on the functional domain (basic skills in reading and writing) and consider participant characteristics of developmental change (of cognitive ability), dependency (on parents) and demographic patterns (eg, racial/ethnic backgrounds), less on differential epidemiology (of health and illness). The methodological quality of included studies as assessed via measurement properties varied from poor to excellent. More than half (62.9%) of measurement properties were unknown, due to either poor methodological quality of included studies or a lack of reporting or assessment. The 8-item Health Literacy Assessment Tool (HLAT-8) showed best evidence on construct validity, and the Health Literacy Measure for Adolescents showed best evidence on reliability.

CONCLUSIONS

More rigorous and high-quality studies are needed to fill the knowledge gap in measurement properties of health literacy instruments. Although it is challenging to draw a robust conclusion about which instrument is the most reliable and the most valid, this review provides important evidence that supports the use of the HLAT-8 to measure childhood and adolescent health literacy in future school-based research.

Communication barrier in family linked to increased risks for food insecurity among deaf people who use American Sign Language

OBJECTIVE

Food security is defined as being able to access enough food that will help maintain an active, healthy lifestyle for those living in a household. While there are no studies on food security issues among deaf people, research shows that communication barriers early in life are linked to poor physical and mental health outcomes. Childhood communication barriers may also risk later food insecurity. Design/Setting/Subjects A single food security screener question found to have 82 % sensitivity in classifying families who are at risk for food insecurity was taken from the six-item US Household Food Security Survey Module. Questions related to food insecurity screener, depression diagnosis and retrospective communication experience were translated to American Sign Language and then included in an online survey. Over 600 deaf adult signers (18-95 years old) were recruited across the USA.

RESULTS

After adjusting for covariates, deaf adults who reported being able to understand little to none of what their caregiver said during their formative years were about five times more likely to often experience difficulty with making food last or finding money to buy more food, and were about three times more likely to sometimes experience this difficulty, compared with deaf adults who reported to being able to understand some to all of what their caregiver said.

CONCLUSIONS

Our results have highlighted a marked risk for food insecurity and related outcomes among deaf people. This should raise serious concern among individuals who have the potential to effect change in deaf children's access to communication.