English proficiency and health literacy in an Immigrant population: Findings from the Health Information National Trend Survey

The immigrant population has steadily grown in the United States. Language may be a barrier in accessing non-prescription (a.k.a., over-the-counter [OTC]) drug information for the population. In this study, we examined the impact of English language proficiency on foreign-born adults’ ability to understand food and OTC drug information using national surveillance data, Health Information National Trend Survey (HINTS 4-I, N= 3,804). We incorporated the jackknife replicate weights to estimate population characteristics including standard errors.

We compared three subgroups in terms of their ability to find and understand information on foods and OTC drugs: US-born adults (85.6%); English proficient foreign-born adults (9.8%); and foreign-born adults with limited English proficiency (4.6%). We found that smaller proportions of foreign-born adults with limited English proficiency (40.1% to 48.0%) were able to comprehend information about risks and benefits of OTC drugs and foods than English proficient foreign-born adults (53.3% to 67.4%) and US-born adults (55.4% to 68.1%). We also found that smaller portions of foreign-born adults with limited proficiency (39.6% to 52.0%) could easily find information on OTC drugs and foods than proficient foreign-born adults (57.9% to 67.9%) and US-born adults (59.9% to 68.5%).

The subgroup analyses with small number of responses yielded relatively unstable estimates and they contributed to non-significant results. Several observed differences (US-born vs. foreign born with limited proficiency; English proficient foreign-born vs. foreign-born with limited proficiency), did not reach significance because of relatively small cell sizes but may still have important implications.  The results suggest the importance of addressing health literacy in immigrant populations.