Associations between health literacy and smoking

For over 90 million adults in the United States, difficulty with health literacy (HL) interferes with the capacity to obtain, process, and understand health information. Moreover, these individuals have an increased risk of disease. Because tobacco smoking is the leading behavioral risk factor contributing to social disparities in the incidence and mortality of disease, there is a critical need to better understand how HL and smoking may be related. This study assessed associations between HL, demographics, nicotine dependence, and other smoking-related variables within a sample of 402 smokers enrolled in a study evaluating smoking health risk messages. Participants were predominantly male (66%) and African American (70%) with an average age of 43.2 (SD=10.8) years. Most (73%) completed high school or GED and 70% reported a total annual income of <$0,000. HL was assessed using the REALM and dichotomized at the 9th grade reading level (low=43%; high=57%). Lower HL was associated with being male, household income <$0,000, and having < a high school diploma or GED. Compared to individuals with higher HL, those with lower HL were more nicotine dependent, had more positive and fewer negative smoking outcome expectancies, were less knowledgeable about smoking-related health risks, and perceived themselves as less vulnerable to smoking health consequences (all ps<.05). These findings might be useful in informing cessation programs, as they suggest that even within a sample of low-SES, racially/ethnically diverse smokers, those with lower HL may have particular difficulty quitting. Research is needed to explore the potential mechanisms underlying these relationships.