(DH, CH, NO); and the Behavior Change Research Group, Population Sciences and Cancer Control Program (DH, JC) at the University of New Mexico, Albuquerque, New Mexico. Submitted August 14, 2007; accepted February 26, 2008. Address correspondence to Deborah Helitzer, ScD, Family and Community Medicine, University of New Mexico, MSC 09-5040, Albuquerque, NM 87131. E-mail: helitzer@salud.unm pitalization have been documented. [1][2][3] Evidence demonstrates that patients with lower health literacy incur higher health care costs, 1,4 and health literacy has been linked to lower use of preventive services such as Pap tests, mammograms, and dental care. 5,6 The Institute of Medicine and Healthy People 2010 define health literacy as the "degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." 7 Functional health literacy requires complex, multidimensional skills, including reading, writing, listening, numeric literacy, oral and visual communication, and decision-making abilities. It also calls for an understanding of health topics (such as cervical cancer) and the ability to navigate health systems. 8,9 Written health education materials and forms, which the health system IntroductionResearch continues to reveal the association between literacy and health. Literacy is defined as "using printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential." 1 Relationships between literacy levels and heart disease, physical health, and rates of hos- most often relies on to convey information and treatment procedures, place certain "demands" on their users or readers. These demands compel health consumers to use their functional health literacy skills to read (at different levels), interpret, comprehend, analyze, and apply the information they gain from these written materials. These demands may be substantial if materials are written at a high reading level, if text and format are too dense, or if concepts are ambiguous and nonmotivating.Thus, health literacy is not a one-sided issue, limited to the capacity or capabilities of the patient/client. Indeed, the health system itself places complex demands on health consumers. These demands include requiring people to self-manage their health care, read difficult texts, and understand their health rights, as well as obliging them to find their way (navigate) in confusing clinic/hospital settings with technical medical signs or without conveniently placed or easy to read maps. 10 National Literacy AssessmentsIn 2003, the National Assessment of Adult Literacy (NAAL) was conducted in the United States with more than 19,000 adults. The NAAL included a separate literacy component intended to measure adults' ability to use literacy skills to read and understand health-related information. The results indicated that most (53%) adults had intermediate health literacy, and 12% scored in the proficient range. The...

Cervical cancer is a preventable disease resulting from infection with high-risk types of sexually transmitted human papillomaviruses (HPVs). Public knowledge of HPVs and their link to cervical cancer is limited. Participation in cervical cancer prevention programs, including Pap and HPV screening and HPV vaccine acceptance, is crucial for limiting the incidence of cervical cancer. Hispanic women suffer the highest cervical cancer incidence rates in the United States. In this study, we conducted community-based focus groups with Hispanic women to explore knowledge and attitudes relating to cervical cancer, HPV, HPV testing, and HPV vaccination. Study findings suggest a need to increase public health literacy in relation to HPV, the link between HPV and cervical cancer, and HPV primary and secondary prevention options. Health care providers should be prepared to share information with patients that supports and promotes informed decision making about HPV testing and vaccines and their complementary roles in cervical cancer screening and prevention.

Objective To determine the efficacy and effectiveness of training to improve primary care providers’ patient-centered communication skills and proficiency in discussing their patients’ health risks. Methods Twenty-eight primary care providers participated in a baseline simulated-patient interaction and were subsequently randomized into intervention and control groups. Intervention providers participated in training focused on patient-centered communication about behavioral risk factors. Immediate efficacy of training was evaluated by comparing the two groups. Over the next three years, all providers participated in two more sets of interactions with patients. Longer term effectiveness was assessed using the interaction data collected at 6 and 18 months post training. Results The intervention providers significantly improved in patient-centered communication and communication proficiencies immediately post-training and at both follow-up time points. Conclusions This study suggests that the brief training produced significant and large differences in the intervention group providers which persisted two years after the training. Practice Implications The results of this study suggest that primary care providers can be trained to achieve and maintain gains in patient-centered communication, communication skills and discussion of adverse childhood events as root causes of chronic disease.

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Although national colorectal cancer (CRC) incidence rates have steadily decreased, the rate for New Mexico Hispanics has been increasing and screening rates are low. We conducted an exploratory qualitative study to determine barriers to CRC screening for New Mexico Hispanics. We found that machismo served as a dynamic influence on men’s health seeking behaviors; however, it was conceptualized differently by two distinct Hispanic subpopulations and therefore appeared to play a different role in shaping their screening attitudes and behaviors. Machismo emerged as more of an influence for Mexican men, who expressed concern over colonoscopies being potentially transformative and/or stigmatizing, but was not as salient for Hispanos, who viewed the colonoscopy as “strictly medical” and were more concerned with discomfort and pain. This study highlights the importance of identifying varying characteristics among subpopulations to better understand screening barriers and provide optimal CRC screening counseling in primary care settings.