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Literacy outcomes for students with speech impairment: long-term follow-up.

BACKGROUND: Theoretical and empirical support now exists for the finding that many children with expressive phonological impairment experience problems in acquiring phonological awareness and early literacy skills. Few studies, however, have examined the long-term academic and literacy outcomes for this population, in particular as the students leave the final stages of primary school. AIMS: The reported study forms the final stage of a longitudinal research project that tracked the phonological processing and literacy skills of a group of children with specific speech impairment from their first year at school (aged 5-6 years). The earlier data provided evidence of a relationship between speech impairment characterized by the presence of non-developmental error processes and weaker phonological awareness and literacy skills in the first 2-3 years at school. It was hypothesized that the effect of this relationship would continue to be apparent as the students completed the final stages of primary school. METHODS & PROCEDURES: Fourteen of the original set of 36 students were available for reassessment of their phonological processing, reading and spelling skills at age 12-13 years. OUTCOMES & RESULTS: Those children with an original classification of non-developmental speech errors performed significantly more poorly than those with an original classification of developmental errors on phonological awareness and reading comprehension measures. Reading accuracy and spelling scores also showing a similar trend. CONCLUSIONS: These findings provide further evidence for the long-term impact of speech impairment. The follow-up data demonstrated ongoing difficulties for students who entered school with expressive speech impairment, particularly those whose speech errors were characterized by non-developmental error processes. The impact was apparent on tasks measuring phonological awareness, reading accuracy and spelling (skills that depend on good phonological processing skills and clear underlying phonological representations). Weaknesses in reading comprehension were also found. These findings have implications for the early identification of those at risk. In addition, intervention approaches for young children with expressive speech difficulties demonstrating these patterns of error should address weak underlying phonological representations and develop phonological awareness skills.

Adolescent↗

Emergent literacy of deaf children.

This article reviews the literature on emergent literacy in young deaf children, focusing on the nature and course of both emergent reading and emergent writing. Beginning with definitions and background information concerning emergent literacy as a field of study, it examines instructional approaches that support emergent literacy learning. The review of the literature is organized into four major sections that reflect the body of work to date. The article concludes with an eye toward the future of emergent literacy in pedagogy, theory, and research.

Child↗

Pictures to print: a software scaffold to written literacy.

BACKGROUND: Successful school placements require effective written literacy skills. When a student has traumatic brain injury (TBI), written literacy instruction may need to be individualized and intense to facilitate optimal reintegration into the school program. Software products can provide a method that assists in creating the needed individualized, intense experiences. Written literacy-learning experiences span a continuum from preconventional messages expressed through pictures, to conventional printed expressions designed to convey meaning, to the literate writing needed to create stories and reports. DESIGN: This article is designed to familiarize rehabilitation and research professionals in TBI with the range of written literacy software and to stimulate clinical applications and research related to their use with students who have sustained a TBI.

Adolescent↗

Pre-literacy skills of subgroups of children with speech sound disorders.

BACKGROUND: The existing literature has conflicting findings about the literacy outcome of children with speech sound disorders (SSD), which may be due to the heterogeneity within SSD. Previous studies have documented that two important dimensions of heterogeneity are the presence of a comorbid language impairment (LI) and the persistence of SSD, but these factors have not been examined separately. METHOD: The current study used a 2 x 2 MANOVA design (with follow-up MANCOVAs) to examine how a comorbid language impairment (LI) and the persistence of SSD relate to pre-literacy skills in a sample of 5- to 6-year-old children with SSD. RESULTS: Significant main effects for persistent SSD and LI were obtained, such that each factor was associated with worse performance on pre-literacy tasks, particularly those assessing phonological awareness (even with nonverbal IQ covaried). In addition, even SSD children with normalized speech without LI were found to have deficits on phonological awareness tasks relative to control participants. CONCLUSIONS: These results suggest that a history of SSD and comorbid LI are strong correlates of pre-literacy deficits.

Child↗

Using innovative strategies to enhance health promotion critical literacy.

New and improved teaching strategies are required to engage students in meaningful coursework to enhance critical thinking, problem-solving, and decision-making. Advanced practice nurses are responsible for producing creative and realistic health promotion and disease prevention proposals, which have the potential for implementation as part of a course requirement. Unfortunately, these proposals often lack the sophistication and critical literacy necessary to effectively communicate the student's knowledge and understanding of their ideas. Infusing critical thinking and critical literacy into all curricula is one of the stated goals of the university-wide "Enhancing Critical Literacy Project." This learning-centered program serves as the platform for this article and the early adoption of selected student assessment techniques. Concepts presented as part of a critical literacy enhancement seminar provides the theoretical underpinning of this approach and is designed to encourage student innovation through creative writing. A detailed description of the various strategies and their implementation are discussed.

California↗

Enhancing teacher health literacy in school health promotion: a vision for the new millennium.

While the National Health Education Standards focused interest and attention on student (consumer) health literacy, equal attention should be given to teacher (provider) health literacy. Teacher health literacy may be defined as "the capacity of teachers to obtain, interpret, and understand basic health information and services, with the competence to use such information and services in ways that enhance the learning of health concepts and skills by school students." This paper reviews a traditional model for school health teacher preparation, then presents an alternative, university field-tested model for enhancing health literacy in teacher education. This new model presents an innovative instructional paradigm, the Child and Adolescent Health (CAH) Logic Framework. This training model (vision) illustrates and emphasizes the link between child and adolescent health research and theory, CAH information, and application to health education, public policy, medical care, and health advocacy.

Adolescent↗

Assessing the psychiatric patient's ability to meet the literacy demands of hospitalization.

One hundred patients admitted consecutively to a state psychiatric hospital were tested to determine their literacy skills in both ward recognition and reading comprehension. In addition, the readability of literature intended to inform patients about various aspects of their hospitalization was evaluated to determine if a significant discrepancy existed between literacy demands on patients and their literacy skills. Results showed that the majority of the patients were functionally illiterate in reading comprehension skills but literate in their ability to recognize or pronounce words. Educational background correlated with the ability to pronounce words, but was not predictive of reading comprehension skills. Hospital document demanded reading comprehension skills far in excess of the literacy skills of most patients. Procedures for minimizing this discrepancy are discussed.

Adolescent↗

Literacy of children with physical disabilities: a literature review.

The ability to read and write can influence an individual's educational, communication, and vocational opportunities. Occupational therapists can assist children with physical disabilities to achieve literacy skills. By setting priorities and goals for each child, in conjunction with their parent(s), opportunities can be provided and technologies utilized to access literacy material and enhance the child's abilities to read and write. This extensive literature review provides clinicians with information on the factors that influence the development of literacy for children with physical disabilities. The expectations and priorities of parent(s) are critical determinants of whether opportunities will be provided for the child to learn to read and write. This article concludes with recommendations and strategies for the use of technology to help develop literacy skills, and future research questions for considerations.

Child↗

Mental health literacy. Public knowledge and beliefs about mental disorders.

BACKGROUND: Although the benefits of public knowledge of physical diseases are widely accepted, knowledge about mental disorders (mental health literacy) has been comparatively neglected. AIMS: To introduce the concept of mental health literacy to a wider audience, to bring together diverse research relevant to the topic and to identify gaps in the area. METHOD: A narrative review within a conceptual framework. RESULTS: Many members of the public cannot recognise specific disorders or different types of psychological distress. They differ from mental health experts in their beliefs about the causes of mental disorders and the most effective treatments. Attitudes which hinder recognition and appropriate help-seeking are common. Much of the mental health information most readily available to the public is misleading. However, there is some evidence that mental health literacy can be improved. CONCLUSIONS: If the public's mental health literacy is not improved, this may hinder public acceptance of evidence-based mental health care. Also, many people with common mental disorders may be denied effective self-help and may not receive appropriate support from others in the community.

Health Knowledge, Attitudes, Practice↗

Evaluation of an American Legacy Foundation/Washington State Department Of Health Media Literacy Pilot Study.

A pretest-posttest quasi-experiment was used to evaluate a pilot test of a media literacy curriculum implemented during summer 2001 in Washington state. As expected, media literacy training reduced youths' beliefs that most peers use tobacco, increased their understanding of advertising techniques, and increased their levels of efficacy regarding the extent to which they would participate in advocacy and prevention activities. Mixed results were found for skepticism, which appeared to suffer from a ceiling effect, and surprising results were found for desirability, also seemingly an artifact of the measures used. The results indicate that media literacy training combining skill development with a motivational component represents a promising avenue for tobacco use prevention efforts. The study also helps establish some reliable outcome measures for media literacy evaluations, but additional testing should continue to pursue the development of a complete battery of reliable and valid indicators.

Adolescent↗

Health literacy and patient knowledge in a Southern US HIV clinic.

Pharmaceutical management of HIV infection is complex, and proper adherence to antiretroviral regimens is contingent on active patient involvement in treatment. We examined the relationship between patient understanding of HIV and its treatment and health literacy. Structured interviews were conducted with 157 HIV-infected individuals receiving care at a community-based clinic in Shreveport, Louisiana, USA. In all, 48% of patients were reading below a 9th grade level. One-third of patients could not name their HIV medications and this was significantly related to low literacy (P < 0.01). Two-thirds of those reading below the 9th grade level did not know how to take their medications correctly (P < 0.05), and 75% did not know the meaning of a CD4 count or viral load (P < 0.001). Patients with low literacy skills were more likely to state that their physician was their sole source of HIV information (P < 0.005). Physicians may require training to appropriately convey health information to patients of low literacy.

Adult↗

Inadequate literacy is a barrier to asthma knowledge and self-care.

STUDY OBJECTIVES: To determine the relationship of literacy to asthma knowledge and ability to use a metered-dose inhaler (MDI) among patients with asthma. DESIGN: Cross-sectional survey. SETTING: Emergency department and asthma clinic at an urban public hospital. PATIENTS: Convenience sample of 273 patients presenting to the emergency department for an asthma exacerbation and 210 patients presenting to a specialized asthma clinic for routine care. INTERVENTIONS: Measurement of literacy with the Rapid Estimate of Adult Literacy in Medicine, asthma knowledge (20 question oral test), and demonstration of MDI technique (six-item assessment). MEASUREMENTS AND RESULTS: Only 27% of patients read at the high-school level, although two thirds reported being high-school graduates; 33% read at the seventh- to eighth-grade level, 27% at the fourth- to sixth-grade level, and 13% at or below the third-grade level. Mean asthma knowledge scores (+/-SD) were directly related to reading levels: 15.1+/-2.5, 13.9+/-2.5, 13.4+/-2.8, 11.9+/-2.5, respectively (p < 0.01). Patient reading level was the strongest predictor of asthma knowledge score in multivariate analysis. Poor MDI technique (< or =3 correct steps) was found in 89% of patients reading at less than the third-grade level compared with 48% of patients reading at the high-school level. In multivariate regression analyses, reading level was the strongest predictor of MDI technique. CONCLUSIONS: Inadequate literacy was common and strongly correlated with poorer knowledge of asthma and improper MDI use.

Adult↗

Mental health literacy of those with major depression and suicidal ideation: an impediment to help seeking.

Mental health literacy is the knowledge and beliefs about mental disorders that aid their recognition, management, or prevention, and is an important determinant of help seeking. This has relevance in suicide prevention, particularly for those with major depression, the clinical condition most frequently associated with suicidal behavior. In this study of a random and representative community sample, a vignette depicting classical features of major depression was presented to subjects along with questions related to mental health literacy. The responses of those with major depression, as delineated by the Primary Care Evaluation of Mental Disorders instrument, both with and without suicidal ideation, were compared to those of a third group of respondents. The results demonstrated that despite increased professional contact by those with major depression and suicidal ideation, there were few differences among the three groups on either open-ended or direct questions related to mental health literacy. This indicates that increased professional contact in itself was not related to increased mental health literacy, and suggests that more specific psychoeducational programs are required.

Adult↗

Parental literacy level and understanding of medical information.

OBJECTIVE: To ascertain the impact of literacy level on parents' understanding of medical information and ability to follow therapy prescribed for their children. DESIGN/METHODS: A prospective cohort of parents accompanying their children for acute care. Parents were interviewed about demographic status, their child's health, and use of pediatric preventive services. The Rapid Estimate of Adult Literacy in Medicine (REALM) test was used to assess parental literacy. The same parent was interviewed 48 to 96 hours later and asked to recall the child's diagnosis, any medication prescribed, and instructions. RESULTS: A total of 633 patients were enrolled. Follow-up was obtained in 543 patients (85.8%). Mean parental age was 32.43 years (SD = 9.07). Mean REALM score was 57.6 (SD = 10.9), corresponding to a 7th- to 8th-grade reading level, with a mean parental educational level of 13.43 years (SD = 2.09). Low REALM score was significantly correlated with young parental age and parental education. African-American race was associated with lower REALM scores. After controlling for these variables, REALM score significantly correlated with parental perception of how sick the child was, but not with use of preventive services, comprehension of diagnosis, medication name and instructions, or ability to obtain and administer prescribed medications. CONCLUSIONS: Parental literacy level did not correlate with use of preventive services or parental understanding of or ability to follow medical instructions for their children.

Adolescent↗

Child centered literacy orientation: a form of social capital?

OBJECTIVE: To describe the home literacy environment and to identify financial, human, and social capital variables associated with the presence or lack of Child Centered Literacy Orientation (CCLO) in families with young children who regularly attend pediatric primary care clinics. DESIGN: Cross-sectional case-control analysis of structured parent interviews conducted in two hospital-based and four community-based pediatric clinics in New England. SUBJECTS: Parents of 199 healthy 1- to 5-year-old children whose mean age was 30 +/- 15 (SD) months were interviewed. Parents were primarily mothers (94%) with a mean age of 28 +/- 7 (SD) years 60% of whom were single. Educational levels of study parents varied: 43% had not graduated from high school, 29% had a high school equivalency, and 28% had at least a year of college or vocational training. This was a multiethnic parent group. Sixty-five percent were bilingual or non-English speaking. Fifty-eight percent were born outside of the continental United States. Parents were primarily of low-income status with 85% receiving Women, Infant, and Children (WIC) food supplements, Aid to Families With Dependent Children, and/or Medicaid. RESULTS: Half of the parents interviewed reported that they rarely read books. Sixty percent of children had fewer than 10 books at home and two-thirds of these households contained fewer than 50 books total. When asked open-ended questions, 28% of parents said that sharing books with their child was one of their three favorite activities together, 14% said that looking at books was one of their child's three favorite things to do, and 19% reported sharing books at bedtime at least six times each week. Thirty-nine percent of families had at least one of these three literacy-related responses present and so were said to have a CCLO. A backwards stepwise multiple logistic regression on CCLO was performed with family financial, human, and social capital variables. Parents married or living together (odds ratio [OR] 2.56, 95% confidence interval [CI] = 1.21-5.42), higher adult-to-child ratios in the home (OR 1.92, 95% CI = 1.20-3.05), households speaking only English (OR 2.67, 95% CI = 1.24-5.76), parents reading books themselves at least a few times a week (OR 2.86, 95% CI = 1.38-5.91), and homes with more than 10 children's books (OR 3.3, 95% CI = 1.6-6.83), were all independently and significantly associated with the presence of CCLO. Older child age and higher parent education remain in the model but were not significant at the P <.05 level. Ethnicity and income status were dropped for lack of additional significance from this model, which described 24% of the variance in CCLO. CONCLUSION: Although two-parent families and higher adult-to-child ratios in the home appear to be social capital variables with protective effects, low-income, single-parent, and minority or immigrant families are at significant risk for lacking both children's books and a CCLO. We suggest that CCLO may itself be another form of social capital reflecting parental goals and expectations for their children. We speculate that interventions which provide children's books and information about reading with children to impoverished families with young children may facilitate more parent-child book sharing. Pediatricians and other primary care providers serving underserved populations may have a unique opportunity to encourage activities focusing on young children and promoting literacy.

Analysis of Variance↗

The impact of a clinic-based literacy intervention on language development in inner-city preschool children.

OBJECTIVE: To determine the effect of a clinic-based literacy intervention on the language development of preschool children. METHODS: A convenience sample of families presenting to 2 urban pediatric clinics for well-child care met the following criteria: the family was Latino or black and English- or Spanish-speaking; the child was 2 to 5.9 years old, with no neurodevelopmental disability, at a gestational age of 34 weeks or more, and not attending kindergarten. Participants at the first clinic (intervention group) were exposed to a literacy support program, based on Reach Out and Read (ROR), during the previous 3 years. At the second clinic (comparison group), a similar program started 3 months before the study. Parent-child reading activities were measured using the READ Subscale of the StimQ. Language development was measured using the One-Word Expressive and Receptive Picture Vocabulary Tests, and was performed in the child's primary language. RESULTS: A total of 122 study participants (49 interventions and 73 comparisons) met inclusion criteria and completed all measures. Intervention and comparison families were similar for most sociodemographic variables. Intervention families reported reading together with their children approximately 1 more day per week. Intensity of exposure to ROR (measured by total number of contacts with the program) was associated with increased parent-child reading activities, as measured by the StimQ-Read Subscale (r = 0.20). Intervention children had higher receptive language (mean: 94.5 vs 84.8) and expressive language (mean: 84.3 vs 81.6). After adjusting for potential confounders in a multiple regression analysis, intervention status was associated with an 8.6-point increase (95% confidence interval [CI]: 3.3, 14.0) in receptive language (semipartial correlation [SR]coefficient = 0.27), and a 4.3-point increase (95% CI: 0.04, 8.6) in expressive language (SR = 0.17). In a similar multiple regression, each contact with ROR was associated with an adjusted mean 0.4-point increase (95% CI: 0.1, 0.6) in receptive score, and an adjusted mean 0.21-point increase (95% CI: 0. 02, 0.4) in expressive score. CONCLUSIONS: ROR is an important intervention, promoting parental literacy support and enhancing language development in impoverished preschool children. Integration of literacy promoting interventions such as these into routine pediatric health care for underserved populations can be recommended.

Chi-Square Distribution↗

Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): a tool to screen adolescents for below-grade reading in health care settings.

OBJECTIVE: The magnitude and consequences of low literacy in adolescent health and health care are unknown. The purpose of this study was to validate the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen), a word-recognition test in English that can be used as a brief literacy-screening tool in health care settings. PATIENTS AND METHODS: A total of 1533 adolescents aged 10 to 19 years attending 1 of 5 middle schools, 3 high schools, 1 pediatric clinic, or 2 summer programs in Louisiana and North Carolina participated in face-to-face interviews. Demographic information was solicited, and participants were administered a battery of reading tests, including the REALM-Teen, Wide Range Achievement Test-Revised (WRAT-3), and Slosson Oral Reading Test-Revised (SORT-R). Internal consistency for the REALM-Teen was determined using Cronbach's alpha, and criterion validity was established through correlations with both the WRAT-R and SORT-R. Using reading below grade level (according to SORT-R scores) as an outcome, instrument accuracy and corresponding cutoff scores were calculated by plotting receiver operating characteristic curves and stratum-specific likelihood ratios. RESULTS: Participants were 50% black and 53% female; 34% were enrolled in middle school and 66% in high school. The average time required to administer the REALM-Teen was 3 minutes. Internal consistency was excellent, as was test-retest reliability. The REALM-Teen is strongly correlated with both the WRAT-R and SORT-R. Five reading level categories were identified: 3rd grade and below, 4th to 5th grade, 6th to 7th grade, 8th to 9th grade, and 10th grade and above. Forty-six percent of participants were reading below grade level according to the SORT-R and 28% had repeated at least 1 grade. CONCLUSION: The REALM-Teen is a brief, reliable instrument for assessing adolescent literacy skills and reading below grade level.

Adolescent↗

Health literacy: a review.

Illiteracy has become an increasingly important problem, especially as it relates to health care. A national survey found that almost half of the adult population has deficiencies in reading or computation skills. Literacy is defined as the basic ability to read and speak English, whereas functional health literacy is the ability to read, understand, and act on health information. Up to 48% of English-speaking patients do not have adequate functional health literacy. The consequences of inadequate health literacy include poorer health status, lack of knowledge about medical care and medical conditions, decreased comprehension of medical information, lack of understanding and use of preventive services, poorer self-reported health, poorer compliance rates, increased hospitalizations, and increased health care costs. The medical community must acknowledge this issue and develop strategies to ensure that patients receive assistance in overcoming the barriers that limit their ability to function adequately in the health care environment.

Educational Status↗