A-256 Literacy Level May Mediate the Relationship Between an Individual’s Ethnicity and Letter Fluency Ability

Abstract

Objective: Previous research suggests that literacy level may be a better predictor of cognitive performance than years of education in minoritized groups. Although literacy tests remain a mainstay in the context of neuropsychological evaluations due to their role in the estimation of premorbid intellectual functioning, there is relatively little research examining the role of literacy in the relationship between ethnicity and cognitive performance. This study examined whether literacy level influences the relationship between ethnicity and letter fluency ability. Method: This cross-sectional study included 64 adult patients consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. The sample was 54.7% male, 43.8% White, 56.3% Black, with Mage of 57.8 years (SD=11.7) and Meducation of 12.6 years (SD=2.5). A mediation analysis was performed using Hayes’ PROCESS macro within SPSS to evaluate whether literacy, as measured by the Test of Premorbid Functioning (TOPF), mediated the association between ethnicity (dichotomized as Black/White) and letter fluency via raw scores from the F/A/S trials. Results: The main model of the mediation analysis was significant, F (4, 51) = 13.89, p <.001, R2 = .521. After accounting for age and years of education, there was a significant mediation effect of literacy on the relationship between ethnicity and letter fluency (B = .740, SE = .143, t = 5.19, p <.001). Conclusion(s): In sum, this study provided evidence that literacy level helps explain the letter fluency performance differences observed between Black and White patients.

Adverse childhood experiences, cognitive functioning, depression, and anxiety in adulthood.

“…Findings from this dataset are currently under consideration for publication (Khan et al, 2023; Shields et al, 2023). Khan et al (2023) evaluated whether literacy mediated race-associated differences in executive functioning between non-Hispanic White and Black individuals. Although the current study also examined executive functioning, the scope of the present investigation differs from that of Khan et al (2023) in its focus on adverse childhood experience (ACE) exposure and cognitive performance across domains.…”

“…The data reported in this article were collected as part of a larger, ongoing Institutional Review Board-approved study at a large academic medical center in the Midwest. Findings from this dataset are currently under consideration for publication (Khan et al, 2023; Shields et al, 2023). Khan et al (2023) evaluated whether literacy mediated race-associated differences in executive functioning between non-Hispanic White and Black individuals.…”

“…Khan et al (2023) evaluated whether literacy mediated race-associated differences in executive functioning between non-Hispanic White and Black individuals. Although the current study also examined executive functioning, the scope of the present investigation differs from that of Khan et al (2023) in its focus on adverse childhood experience (ACE) exposure and cognitive performance across domains. Shields et al (2023) examined the extent to which dichotomous and dimensional scores on two social determinants of health measures, health literacy, and ACEs, accounted for variance in multiple cognitive and psychiatric outcomes.…”