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Edward J Boyko

Publications and source records attributed to Edward J Boyko.

At least 37 records · Page 2Linked to original sources
PubMed2005

The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System.

OBJECTIVE: To describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States. DATA SOURCE: The 2000 Behavioral Risk Factor Surveillance System. STUDY DESIGN: Our study cohort included individuals who reported a diagnosis of diabetes (n=11,647). We performed bivariate and multivariate logistic regression analyses by age greater or less than 65 years to examine the association of health insurance coverage with diabetes-specific quality of care measures, controlling for the effects of race/ethnicity, annual income, gender, education, and insulin use. PRINCIPAL FINDINGS: Most individuals with diabetes are covered by private insurance (39 percent) or Medicare (44 percent). Among persons under the age of 65 years, 11 percent were uninsured. The uninsured were more likely to be African American or Hispanic and report low incomes. The uninsured were less likely to report annual dilated eye exams, foot examinations, or hemoglobin A1c (HbA1c) tests and less likely to perform daily blood glucose monitoring than those with private health insurance. We found few differences in quality indicators between Medicare, Medicaid, or the Department of Veterans Affairs (VA) as compared with private insurance coverage. Persons who received care through the VA were more likely to report taking a diabetes education class and HbA1c testing than those covered by private insurance. CONCLUSIONS: Uninsured adults with diabetes are predominantly minority and low income and receive fewer preventive services than individuals with health insurance. Among the insured, different types of health insurance coverage appear to provide similar levels of care, except for higher rates of diabetes education and HbA1c testing at the VA.

Adult↗
PubMed2005

A reduced-fat diet and aerobic exercise in Japanese Americans with impaired glucose tolerance decreases intra-abdominal fat and improves insulin sensitivity but not beta-cell function.

Lifestyle modification reduces the risk of developing type 2 diabetes and may have its effect through improving insulin sensitivity, beta-cell function, or both. To determine whether diet and exercise improve insulin sensitivity and/or beta-cell function and to evaluate these effects over time, we quantified insulin sensitivity and the acute insulin response to glucose (AIRg) in 62 Japanese Americans (age 56.5 +/- 1.3 years; mean +/- SE) with impaired glucose tolerance (IGT) who were randomized to the American Heart Association (AHA) Step 2 diet plus endurance exercise (n = 30) versus the AHA Step 1 diet plus stretching (n = 32) for 24 months. beta-Cell function (disposition index [DI]) was calculated as S(i) x AIRg, where S(i) is the insulin sensitivity index. The incremental area under the curve for glucose (incAUCg) was calculated from a 75-g oral glucose tolerance test. Intra-abdominal fat (IAF) and subcutaneous fat (SCF) areas were measured by computed tomography. At 24 months, the Step 2/endurance group had lower weight (63.1 +/- 2.4 vs. 71.3 +/- 2.9 kg; P = 0.004) and IAF (75.0 +/- 7.9 vs. 112.7 +/- 10.4 cm(2); P = 0.03) and SCF (196.5 +/- 18.0 vs. 227.7 +/- 19.9 cm(2); P < 0.001) areas, greater S(i) (4.7 +/- 0.5 vs. 3.3 +/- 0.3 x 10(-5) min . pmol(-1) . l(-1); P = 0.01), and a trend toward lower AIRg (294.9 +/- 50.0 vs. 305.4 +/- 30.0 pmol/l; P = 0.06) and incAUCg (8,217.3 +/- 350.7 vs. 8,902.0 +/- 367.2 mg . dl(-1) . 2 h(-1); P = 0.08) compared with the Step 1/stretching group after adjusting for baseline values. There was no difference in the DI (P = 0.7) between the groups. S(i) was associated with changes in weight (r = -0.426, P = 0.001) and IAF (r = -0.395, P = 0.003) and SCF (r = -0.341, P = 0.01) areas. Thus, the lifestyle modifications decreased weight and central adiposity and improved insulin sensitivity in Japanese Americans with IGT. However, such changes did not improve beta-cell function, suggesting that this degree of lifestyle modifications may be limited in preventing type 2 diabetes over the long term.

Abdomen↗
PubMed2005

Insulin, C-peptide, and leptin concentrations predict increased visceral adiposity at 5- and 10-year follow-ups in nondiabetic Japanese Americans.

We prospectively examined the relationship between leptin and markers of insulin resistance and secretion and future visceral adipose tissue accumulation. In this study, 518 nondiabetic Japanese-American men and women underwent the following measurements at baseline and at 5- and 10-year follow-ups: plasma glucose and insulin measured after an overnight fast and during a 75-g oral glucose tolerance test, insulin secretion ratio (ISR) [(30-min insulin - fasting insulin)/30-min glucose], fasting C-peptide levels, plasma leptin (baseline only), and fat areas (intra-abdominal and subcutaneous) measured by computed tomography. Predictors of future intra-abdominal fat (IAF) were determined using multiple linear regression. Fasting insulin and C-peptide levels at baseline were significantly associated with IAF area at 5 years (coefficient = 0.041, P = 0.001 and coefficient = 1.283, P < 0.001, respectively) and 10 years (coefficient = 0.031, P = 0.020 and coefficient = 0.221, P = 0.035, respectively). ISR was not significantly associated with IAF at 5 or 10 years. Leptin level at baseline was positively associated with IAF at 5 years (coefficient = 0.055, P = 0.002) and 10 years (coefficient = 0.059, P = 0.003). In conclusion, higher levels of fasting insulin, C-peptide, and circulating leptin level predicted visceral fat accumulation independent from subcutaneous fat accumulation in nondiabetic Japanese-American men and women in both short-term (5 years) and long-term (10 years) follow-up.

Abdomen↗
PubMed2005

Urinary incontinence and diabetes in postmenopausal women.

OBJECTIVE: This study evaluates diabetes characteristics and other risk factors for urinary incontinence among community-dwelling postmenopausal women. RESEARCH DESIGN AND METHODS: We performed a cross-sectional analysis of a population-based study of 1,017 postmenopausal women (218 with diabetes), aged 55-75 years, enrolled from a health maintenance organization. Outcomes included any incontinence and severe incontinence in the prior month. RESULTS: Overall, 60% of women had any incontinence in the prior month and 8% had severe incontinence. Parity and postvoid residual bladder volume were not associated with incontinence. Oral estrogen and vaginal estrogen use were positively associated with a report of any incontinence but not severe incontinence. A history of urinary tract infection (UTI) and measures of general health were associated with both outcomes. Women with diabetes reported disproportionately more severe incontinence, difficulty controlling urination, mixed (stress and urge) incontinence, use of pads, inability to completely empty the bladder, being unaware of leakage, and discomfort with urination (P < or = 0.06). Diabetes duration, treatment type, peripheral neuropathy, and retinopathy were significantly associated with severe incontinence in multiple regression models adjusted for age, education, and history of UTI (P = 0.01-0.06); however, additional adjustment for BMI diminished the strength of association (P = 0.17-0.52). CONCLUSIONS: Urinary incontinence is highly prevalent among postmenopausal women. Women with diabetes are more likely to experience severe and symptomatic urinary incontinence. UTI history is a major risk factor, postvoid residual bladder volume plays no demonstrable role, and BMI confounds the relationship between diabetes and incontinence among healthy postmenopausal women.

Aged↗
PubMed2004

Predictors of urinary tract infection after menopause: a prospective study.

PURPOSE: To describe the incidence of and risk factors for acute cystitis among nondiabetic and diabetic postmenopausal women. METHODS: We conducted a population-based, prospective cohort study of 1017 postmenopausal women, aged 55 to 75 years, who were enrolled in a health maintenance organization and followed for 2 years. A wide range of behavioral and physiologic exposures were assessed at baseline interview and follow-up clinic visits; the main outcome measure was microbiologically confirmed acute symptomatic cystitis. Follow-up was 87% at 12 months and 81% at 24 months. RESULTS: During 1773 person-years of follow-up, 138 symptomatic urinary tract infections occurred (incidence, 0.07 per person-year). Independent predictors of infection included insulin-treated diabetes (hazard ratio [HR] = 3.4; 95% confidence interval [CI]: 1.7 to 7.0) and a lifetime history of urinary tract infection (HR for six or more infections = 6.9; 95% CI: 3.5 to 13.6). Borderline associations included a history of vaginal estrogen cream use in the last month (HR = 1.8; 95% CI: 1.0 to 3.4), a history of kidney stones (HR = 1.9; 95% CI: 1.0 to 3.7), and asymptomatic bacteriuria at baseline (HR = 1.8; 95% CI: 0.9 to 3.5). Sexual activity, urinary incontinence, parity, postcoital urination, vaginal dryness, use of cranberry juice, vaginal bacterial flora, and postvoid residual bladder volume were not associated with incident acute cystitis after multivariable adjustment. CONCLUSION: Insulin-treated diabetes is a potentially modifiable risk factor for incident acute cystitis among postmenopausal women, whereas a lifetime history of urinary tract infection was the strongest predictor. Use of oral or vaginal estrogen was not protective, and a wide range of behavioral and physiologic factors was not associated with acute cystitis episodes in this generally healthy sample.

Acute Disease↗
PubMed2004

Racial and ethnic differences in microalbuminuria prevalence in a diabetes population: the pathways study.

The objective of this study was to determine whether racial or ethnic differences in prevalence of diabetic microalbuminuria were observed in a large primary care population in which comparable access to health care exists. A cross-sectional analysis of survey and automated laboratory data 2969 primary care diabetic patients of a large regional health maintenance organization was conducted. Study data were analyzed for racial/ethnic differences in microalbuminuria (30 to 300 mg albumin/g creatinine) and macroalbuminuria (>300 mg albumin/g creatinine) prevalence among diabetes registry-identified patients who completed a survey that assessed demographics, diabetes care, and depression. Computerized pharmacy, hospital, and laboratory data were linked to survey data for analysis. Racial/ethnic differences in the odds of microalbuminuria and macroalbuminuria were assessed by unconditional logistic regression, stratified by the presence of hypertension. Among those tested, the unadjusted prevalence of micro- or macroalbuminuria was 30.9%, which was similar among the various racial/ethnic groups. Among those without hypertension, microalbuminuria was twofold greater (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.14 to 3.53) and macroalbuminuria was threefold greater (OR 3.17; 95% CI 1.09 to 9.26) for Asians as compared with whites. Among those with hypertension, adjusted odds of microalbuminuria were greater for Hispanics (OR 3.82; 95% CI 1.16 to 12.57) than whites, whereas adjusted odds of macroalbuminuria were threefold greater for blacks (OR 3.32; 95% CI 1.26 to 8.76) than for whites. For most racial/ethnic minorities, hypertriglyceridemia was significantly associated with greater odds of micro- and macroalbuminuria. Among a large primary care population, racial/ethnic differences exist in the adjusted prevalence of microalbuminuria and macroalbuminuria depending on hypertension status. In this setting, racial/ethnic differences in early diabetic nephropathy were observed despite comparable access to diabetes care.

Aged↗
PubMed2004

Visceral adiposity is an independent predictor of incident hypertension in Japanese Americans.

BACKGROUND: Visceral adiposity is generally considered to play a key role in the metabolic syndrome. OBJECTIVE: To examine the relationship between directly measured visceral adiposity and the risk for incident hypertension, independent of other adipose depots and fasting plasma insulin levels. DESIGN: Community-based prospective cohort study with 10- to 11-year follow-up. SETTING: King County, Washington. PARTICIPANTS: 300 Japanese Americans with a systolic blood pressure less than 140 mm Hg and a diastolic blood pressure less than 90 mm Hg who were not taking antihypertensive medications, oral hypoglycemic medications, or insulin at study entry. MEASUREMENTS: Abdominal, thoracic, and thigh fat areas were measured by using computed tomography. Total subcutaneous fat area was calculated as the sum of these fat areas excluding the intra-abdominal fat area. Hypertension during follow-up was defined as having a systolic blood pressure of 140 mm Hg or greater, having a diastolic blood pressure of 90 mm Hg or greater, or taking antihypertensive medications. RESULTS: There were 92 incident cases of hypertension during the follow-up period. The intra-abdominal fat area was associated with an increased risk for hypertension. Multiple-adjusted odds ratios of hypertension for quartiles of intra-abdominal fat area (1 = lowest; 4 = highest) were 5.07 (95% CI, 1.75 to 14.73) for quartile 3 and 3.48 (CI, 1.01 to 11.99) for quartile 4 compared with quartile 1 after adjustment for age, sex, fasting plasma insulin level, 2-hour plasma glucose level, body mass index, systolic blood pressure, alcohol consumption, smoking status, and energy expenditure through exercise (P = 0.003 for quadratic trend). The intra-abdominal fat area remained a significant risk factor for hypertension, even after adjustment for total subcutaneous fat area, abdominal subcutaneous fat area, or waist circumference; however, no measure of these fat areas was associated with risk for hypertension in models that contained the intra-abdominal fat area. LIMITATIONS: It is not known whether these results pertain to other ethnic groups. CONCLUSIONS: Greater visceral adiposity increases the risk for hypertension in Japanese Americans.

Abdomen↗
PubMed2004

Risk factors for urinary tract infections in postmenopausal women.

BACKGROUND: Urinary tract infections (UTI) occur frequently in postmenopausal women and account for substantial morbidity and economic costs. Although extensively studied in younger women and older, debilitated women, the risk factors for UTI among healthy community-dwelling postmenopausal women have not been well described. METHODS: We conducted a population-based, case-control study of women aged between 55 and 75 years enrolled in a large, staff-model health maintenance organization. Cases were identified using computerized laboratory and outpatient records. Controls were randomly selected from the plan's enrollment files. We interviewed subjects regarding their habits, general health, and potential risk factors for UTI. RESULTS: We interviewed 899 study subjects and 911 controls. Sociodemographic characteristics were similar in subjects and controls. Most women were insured and white. Like younger women, postmenopausal women with current UTI were more likely to be sexually active (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.07-1.87) and have a history of UTI (OR, 4.20; 95% CI, 3.25-5.42). Like older debilitated women, study subjects were more likely to have diabetes mellitus (OR, 2.78; 95% CI, 1.78-4.35) and to be incontinent (OR, 1.36; 95% CI, 1.03-1.78). Oral estrogen replacement did not reduce UTI risk. CONCLUSIONS: In this population, the risk factors of healthy community-dwelling postmenopausal women reflect the health status of women as they transition toward old age. Sexual activity, history of UTI, treated diabetes, and incontinence were all associated with a higher risk of UTI. The therapeutic role of oral estrogen remains uncertain. Prospective studies in different patient populations are needed to better understand the risk factors of UTI.

Aged↗
PubMed2004

Risk of congestive heart failure in an elderly population treated with peripheral alpha-1 antagonists.

OBJECTIVES: To compare the risk of congestive heart failure (CHF) in elderly individuals treated with any peripheral alpha-1 antagonist for hypertension with any thiazide, test whether the risk persists in subjects without cardiovascular disease (CVD) at baseline, and examine CHF risk in normotensive men with prostatism treated with alpha antagonists. DESIGN: Prospective cohort study. SETTING: Four U.S. sites: Washington County, Maryland; Allegheny County, Pennsylvania; Sacramento County, California; and Forsyth County, North Carolina. PARTICIPANTS: A total of 5,888 community-dwelling subjects aged 65 and older. MEASUREMENTS: Adjudicated incident CHF. RESULTS: The 3,105 participants with treated hypertension were at risk for CHF; 22% of men and 8% of women took alpha antagonists during follow-up. The age-adjusted risk of CHF in those receiving monotherapy treated with alpha antagonists was 1.90 (95% confidence interval=1.03-3.50) compared with thiazides. In subjects without CVD at baseline receiving monotherapy, women taking an alpha antagonist had a 3.6 times greater age-adjusted risk of CHF, whereas men had no difference in risk. Adjustment for systolic blood pressure attenuated statistical differences in risk. There were 930 men without hypertension at risk for CHF; 5% used alpha antagonists during follow-up, with no observed increase in CHF risk. CONCLUSION: Subjects receiving alpha antagonist monotherapy for hypertension had a two to three times greater risk of incident CHF, also seen in lower-risk subjects, but differences in blood pressure control partly explained this.

Adrenergic alpha-Antagonists↗
PubMed2004

Type 2 diabetes prevalence in Asian Americans: results of a national health survey.

OBJECTIVE: Asians are thought to be at high risk for diabetes, yet there is little population-based information about diabetes in Asian Americans. The purpose of this study was to directly compare the prevalence of type 2 diabetes in Asian Americans with other racial and ethnic groups in the U.S. using data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). RESEARCH DESIGN AND METHODS: The BRFSS is a population-based telephone survey of the health status and health behaviors of Americans in all 50 states, Guam, Puerto Rico, and the U.S. Virgin Islands. Subjects included 3,071 Asians, 12,561 blacks, 12,153 Hispanics, 2,299 Native Americans, 626 Pacific Islanders, and 129,116 non-Hispanic whites aged >/=30 years. Subjects who reported a physician-diagnosis of diabetes were considered to have type 2 diabetes unless they were diagnosed before age 30. RESULTS: Compared with whites, odds ratios (95% CIs) for diabetes, adjusted for age and sex, were 1.0 (0.7-1.4) for Asians, 2.3 (2.1-2.6) for blacks, 2.0 (1.8-2.3) for Hispanics, 2.2 (1.6-2.9) for Native Americans, and 3.1 (1.4-6.8) for Pacific Islanders. Results adjusted for BMI, age, and sex were 1.6 (1.2-2.3) for Asians, 1.9 (1.7-2.2) for blacks, 1.9 (1.6-2.1) for Hispanics, 1.8 (1.3-2.5) for Native Americans, and 3.0 (1.4-6.7) for Pacific Islanders. CONCLUSIONS: Similar proportions of Asian and non-Hispanic white Americans report having diabetes, but after accounting for the lower BMI of Asians, the adjusted prevalence of diabetes is 60% higher in Asian Americans.

Asian↗
PubMed2004

Association of bioavailable, free, and total testosterone with insulin resistance: influence of sex hormone-binding globulin and body fat.

OBJECTIVE: Previous reports of an association between low testosterone levels and diabetes risk were often confounded by covariation of sex hormone-binding globulin (SHBG) and testosterone measurements. Measurements of bioavailable and free testosterone, more reliable indexes of biologically active testosterone, were examined for their associations with markers of insulin resistance and body fat measures in 221 middle-aged nondiabetic men. RESEARCH DESIGN AND METHODS: Bioavailable and free testosterone were calculated from the concentrations of total testosterone, SHBG, and albumin, and they were not significantly correlated with SHBG (r = 0.07-0.1). In contrast, total testosterone correlated significantly with SHBG (r = 0.63). We evaluated the relationship between these measures of circulating testosterone and markers for insulin resistance (i.e., fasting insulin, C-peptide, and homeostasis model assessment for insulin resistance [HOMA-IR]) as well as total body fat (assessed by dual-energy X-ray absorptiometry [DEXA]) and abdominal fat distribution (assessed by single-slice computed tomography [CT]). RESULTS: Bioavailable, free, and total testosterone and SHBG all correlated significantly with fasting insulin (age-adjusted r = -0.15 [P = 0.03], -0.14 [P = 0.03], -0.32 [P < 0.0001], and -0.38 [P < 0.0001], respectively), fasting C-peptide (r = -0.18 [P = 0.009] to -0.41 [P < 0.0001]), HOMA-IR (r = -0.15 [P = 0.03] to - 0.39 [P < 0.0001]), and body fat measures (r = -0.17 [P = 0.008] to -0.44 [P < 0.0001]). Only SHBG and total testosterone were significantly associated with fasting glucose (r = -0.20 [P = 0.003] to -0.21 [P = 0.002]). In multivariate analysis, bioavailable or free testosterone was significantly and inversely associated with insulin, C-peptide, and HOMA-IR, but this was not independent of total body or abdominal fat. SHBG was a significant determinant of insulin, C-peptide, and HOMA-IR, independent of body fat. The associations between total testosterone and insulin resistance were confounded by SHBG. CONCLUSIONS: The inverse association between testosterone and insulin resistance, independent of SHBG, was mediated through body fat.

Adipose Tissue↗
PubMed2004

Effectiveness of diabetic therapeutic footwear in preventing reulceration.

OBJECTIVE: To review the evidence for the effectiveness of therapeutic footwear in preventing foot reulceration in individuals with diabetes and foot risk factors. RESEARCH DESIGN AND METHODS: We conducted a structured literature review based on a Medline search for studies of therapeutic footwear that examined prevention of reulceration. Nine published articles were identified. Characteristics of the study population, components of the intervention, and level of adherence were evaluated. U.S. Preventive Services Task Force criteria for evaluating research were applied to rate each study on study design and internal validity. RESULTS: Risk ratios in all studies assessing the association between therapeutic footwear and reulceration were below 1.0, suggesting some protective footwear benefit. However, in the most rigorous experimental study, no statistically significant benefit was observed between control patients wearing their own footwear and intervention patients wearing study footwear. Annual reulceration in these studies' control groups ranged from 8.4 to 59.3%. In patients with severe foot deformity or prior toe or ray amputation, observational studies suggested a significant protective benefit from therapeutic footwear. CONCLUSIONS: Therapeutic footwear has been used for decades as one of many strategies to prevent reulceration in patients with diabetes and foot risk factors. The findings of several studies reporting statistically significant protective effects from therapeutic footwear may have been influenced by several design issues. When considering the appropriateness of therapeutic footwear recommendations for moderate-risk patients, clinicians and patients should jointly explore individual strategies to decrease events that lead to foot ulcers.

Diabetic Foot↗
PubMed2004

Diabetes in nonveterans, veterans, and veterans receiving Department of Veterans Affairs health care.

OBJECTIVE: To compare behavioral risk factors and health and disease characteristics among three groups of adults with diabetes: nonveterans, veterans not receiving Department of Veterans Affairs (VA) health care, and veterans using VA services. RESEARCH DESIGN AND METHODS: Two data sources were used to describe the veteran population. First, the 2000 Behavioral Risk Factor Surveillance System (BRFSS) characterized the U.S. adult population by preventive health practices and risk behaviors linked to chronic and preventable diseases. New to the 2000 survey were questions on veteran status, which were administered in all states. Second, VA administrative and veterans benefits data were analyzed to describe comorbidity, education services, and veterans benefits. RESULTS: The estimated prevalence of diabetes in male veterans receiving VA care was 16%. Male veterans with diabetes using VA care were more likely to be nonwhite, not employed, have lower income, lower health status, and more activity limitations than male veterans not using these services. Computerized records indicate VA users with diabetes also had high concurrent comorbidity. Frequency of VA diabetes and preventive care services, as measured by selected quality indicators, was equivalent to or higher than the levels reported by veterans not receiving VA care and nonveterans. In addition to health care, nearly one-fourth of veterans with diabetes also received monthly awards for compensation and pension. CONCLUSIONS: Males receiving VA care with self-reported diabetes indicated receiving preventive care services at equivalent or higher levels than their counterparts receiving care outside the VA and nonveterans.

Diabetes Mellitus↗
PubMed2004

Diabetes research in the Department of Veterans Affairs.

OBJECTIVE: To provide an overview of the Department of Veterans Affairs (VA) research activities, highlighting diabetes-related research. RESEARCH DESIGN AND METHODS: Diabetes is an important component of the VA research portfolio. All four VA research services support aspects of diabetes research. VA diabetes research projects and funding were examined from 1998 to 2003. RESULTS: VA scientists are conducting research on diabetes genetics, etiology, diagnosis, therapy, epidemiology, health services, and rehabilitation. VA research funding is available to answer important veteran-relevant questions through peer review, Center of Excellence activities, and multisite trial mechanisms. Many VA scientists also receive research support from nonfederal sources, including private corporations and nonprofit foundations. The VA Office of Research and Development actively supports training the next generation of researchers through their career development awards and the VA health profession training programs. CONCLUSIONS: The VA's diabetes research portfolio is extensive and includes many investigators, trainees, and fellows. There is substantial leveraging of VA diabetes research with support from other federal and nonfederal funding agencies, foundations, and private corporations. VA diabetes research findings benefit the global diabetes care community.

Diabetes Mellitus↗
PubMed2004

Brief questions to identify patients with inadequate health literacy.

BACKGROUND AND OBJECTIVES: No practical method for identifying patients with low heath literacy exists. We sought to develop screening questions for identifying patients with inadequate or marginal health literacy. METHODS: Patients (n=332) at a VA preoperative clinic completed in-person interviews that included 16 health literacy screening questions on a 5-point Likert scale, followed by a validated health literacy measure, the Short Test of Functional Health Literacy in Adults (STOHFLA). Based on the STOFHLA, patients were classified as having either inadequate, marginal, or adequate health literacy. Each of the 16 screening questions was evaluated and compared to two comparison standards: (1) inadequate health literacy and (2) inadequate or marginal health literacy on the STOHFLA. RESULTS: Fifteen participants (4.5%) had inadequate health literacy and 25 (7.5%) had marginal health literacy on the STOHFLA. Three of the screening questions, "How often do you have someone help you read hospital materials?" "How confident are you filling out medical forms by yourself?" and "How often do you have problems learning about your medical condition because of difficulty understanding written information?" were effective in detecting inadequate health literacy (area under the receiver operating characteristic curve of 0.87, 0.80, and 0.76, respectively). These questions were weaker for identifying patients with marginal health literacy. CONCLUSIONS: Three questions were each effective screening tests for inadequate health literacy in this population.

Adult↗